Clin Cancer Res. 2018 May 30. pii: clincanres.0078.2018. doi: 10.1158/1078-0432.CCR-18-0078. [Epub ahead of print]
Comprehensive molecular profiling of intra- and extrahepatic cholangiocarcinomas: potential targets for intervention.
Lowery MA1, Ptashkin RN2, Jordan EJ3, Berger MF4, Zehir A5, Capanu M6, Kemeny NE7, O'Reilly EM8, El Dika I9, Jarnagin WR10, Harding JJ11, D'Angelica MI10, Cercek A8, Hechtman JF5, Solit DB12, Schultz N6, Hyman DM13, Klimstra DS2, Saltz L8, Abou-Alfa GK14.
Various genetic driver aberrations have been identified among distinct anatomic and clinical subtypes of intrahepatic and extrahepatic cholangiocarcinoma, and these molecular alterations may be prognostic biomarkers and/or predictive of drug response.
Tumor samples from patients with cholangiocarcinoma who consented prospectively were analyzed using the MSK-IMPACT platform, a targeted next generation sequencing assay that analyzes all exons and selected introns of 410 cancer-associated genes. Fisher's exact tests were performed to identify associations between clinical characteristics and genetic alterations.
195 patients were studied: 78% intrahepatic and 22% extrahepatic cholangiocarcinoma. The most commonly altered genes in intrahepatic cholangiocarcinoma (IHC) were IDH1(30%), ARID1A(23%) BAP1(20%), TP53(20%) and FGFR2gene fusions (14%). A tendency towards mutual exclusivity was seen between multiple genes in IHC including TP53:IDH1, IDH1:KRAS, TP53:BAP1, IDH1:FGFR2 Alterations in CDKN2A/B and ERBB2 were associated with reduced survival and time to progression on chemotherapy in patients with locally advanced or metastatic disease. Genetic alterations with potential therapeutic implications were identified in 47% of patients, leading to biomarker directed therapy or clinical trial enrollment in 16% of patients.
Cholangiocarcinoma is a genetically diverse cancer. Alterations in CDKN2A/Band ERBB2are associated with negative prognostic implications in patients with advanced disease. Somatic alterations with therapeutic implications were identified in almost half of patients. These prospective data provide a contemporary benchmark for guiding the development of targeted therapies in molecularly profiled cholangiocarcinoma, and support to the use of molecular profiling to guide therapy selection in patients with advanced biliary cancers.
Copyright ©2018, American Association for Cancer Research.