Comprehensive analysis of cancers of unknown primary for the biomarkers of response to immune checkpoint blockade therapy. (May 2018)

• Record Type: Journal Article
• Authors: Gatalica, Zoran; Xiu, Joanne; Swensen, Jeff; Vranic, Semir
• Is Part Of: European journal of cancer. Volume 94(2018)
• Page Start: 179
• Page End: 186
• Publication Date: 2018-05
• Subjects: Cancer of unknown primary (CUP) -- Targeted therapy -- Immune checkpoint inhibitors; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2018.02.021
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Cancer of unknown primary (CUP) accounts for approximately 3% of all malignancies. Avoiding immune destruction is a major cancer characteristic and therapies aimed at immune checkpoint blockade are in use for several specific cancer types. A comprehensive survey of predictive biomarkers to immune checkpoint blockade in CUP were explored in this study. Methods: About 389 cases of CUP were analysed for mutations in 592 genes and 52 gene fusions using a massively parallel DNA sequencing platform (next-generation sequencing [NGS]). Total mutational load (TML) and microsatellite instability (MSI) were calculated from NGS data. PD-L1 expression was explored using immunohistochemistry (with 5% cutoff value). Results: High TML was seen in 11.8% (46/389) of tumours. MSI-high (MSI-H) was detected in 7/384 (1.8%) of tumours. Tumour PD-L1 expression was detected in 80/362 CUP (22%). A small proportion of CUP cases harboured genetic alterations of negative predictive biomarkers to immune checkpoint inhibitors (predictors to hyperprogression) including MDM2 gene amplification (2%) and loss of function JAK2 gene mutations (1%). Amplifications of CD274 (PD-L1) and PDCD1LG2 (PD-L2) genes were also rare (1.4% and 0.8%, respectively). The most frequently mutated genes were TP53 (54%), KRAS (22%), ARID1A (13%), PIK3CA (9%), CDKN2A (8%), SMARCA4 (7%) and PBRM1, STK11, APC, RB1 (5%, respectively). Conclusions: Using a multiplex testing approach, 28% of CUP carried one or more predictive biomarkers (MSI-H, PD-L1 and/or TML-H) to the immune checkpoint blockade, providing a novel option for treatment in patients with CUP. Highlights: Our study showed that PD-L1 was overexpressed in 22% of CUP samples. High tumour mutational load was detected in 12% of the cases, while MSI-H status was present in ∼2% of CUP cases. A small proportion of CUP cases harboured genetic alterations of predictors to hyperprogression including MDM2 amplification and JAK2 mutations. 28% of CUP carried one or more predictive biomarkers to the immune checkpoint blockade, providing a novel option fortreatment in patients with CUP.