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Comprehensive Genomic Profiling of Advanced Penile Carcinoma Suggests a High Frequency of Clinically Relevant Genomic Alterations.
Oncologist. 2016 Jan; 21(1):33-9.O

Abstract

BACKGROUND

Advanced penile squamous cell carcinoma (PSCC) is associated with poor survival due to the aggressiveness of the disease and lack of effective systemic therapies. Comprehensive genomic profiling (CGP) was performed to identify clinically relevant genomic alterations (CRGAs).

MATERIALS AND METHODS

DNA was extracted from 40 μm of formalin-fixed, paraffin-embedded sections in patients with advanced PSCC. CGP was performed on hybridization-captured, adaptor ligation-based libraries to a mean coverage depth of 692× for 3,769 exons of 236 cancer-related genes plus 47 introns from 19 genes frequently rearranged in cancer. CRGAs were defined as genomic alterations (GAs) linked to targeted therapies on the market or under evaluation in mechanism-driven clinical trials.

RESULTS

Twenty male patients with a median age of 60 years (range, 46-87 years) were assessed. Seventeen (85%) cases were stage IV and three cases (15%) were stage III. CGP revealed 109 GAs (5.45 per tumor), 44 of which were CRGAs (2.2 per tumor). At least one CRGA was detected in 19 (95%) cases, and the most common CRGAs were CDKN2A point mutations and homozygous deletion (40%), NOTCH1 point mutations and rearrangements (25%), PIK3CA point mutations and amplification (25%), EGFR amplification (20%), CCND1 amplification (20%), BRCA2 insertions/deletions (10%), RICTOR amplifications (10%), and FBXW7 point mutations (10%).

CONCLUSION

CGP identified CRGAs in patients with advanced PSCC, including EGFR amplification and PIK3CA alterations, which can lead to the rational administration of targeted therapy and subsequent benefit for these patients.

IMPLICATIONS FOR PRACTICE

Few treatment options exist for patients with advanced penile squamous cell carcinoma (PSCC). Outcomes are dismal with platinum-based chemotherapy, with median survival estimated at 1 year or less across multiple series. Biological studies of patients with PSCC to date have principally focused on human papillomavirus status, but few studies have elucidated molecular drivers of the disease. To this end, comprehensive genomic profiling was performed in a cohort of 20 patients with advanced PSCC. Findings of frequent mutations in CDKN2A, NOTCH1, PIK3CA, and EGFR (all in excess of 20%) point to potential therapeutic avenues. Trials of targeted therapies directed toward these mutations should be explored.

Authors+Show Affiliations

Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA Siraj@Foundationmedicine.com.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.Foundation Medicine, Inc., Cambridge, Massachusetts, USA; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26670666

Citation

Ali, Siraj M., et al. "Comprehensive Genomic Profiling of Advanced Penile Carcinoma Suggests a High Frequency of Clinically Relevant Genomic Alterations." The Oncologist, vol. 21, no. 1, 2016, pp. 33-9.
Ali SM, Pal SK, Wang K, et al. Comprehensive Genomic Profiling of Advanced Penile Carcinoma Suggests a High Frequency of Clinically Relevant Genomic Alterations. Oncologist. 2016;21(1):33-9.
Ali, S. M., Pal, S. K., Wang, K., Palma, N. A., Sanford, E., Bailey, M., He, J., Elvin, J. A., Chmielecki, J., Squillace, R., Dow, E., Morosini, D., Buell, J., Yelensky, R., Lipson, D., Frampton, G. M., Howley, P., Ross, J. S., Stephens, P. J., & Miller, V. A. (2016). Comprehensive Genomic Profiling of Advanced Penile Carcinoma Suggests a High Frequency of Clinically Relevant Genomic Alterations. The Oncologist, 21(1), 33-9. https://doi.org/10.1634/theoncologist.2015-0241
Ali SM, et al. Comprehensive Genomic Profiling of Advanced Penile Carcinoma Suggests a High Frequency of Clinically Relevant Genomic Alterations. Oncologist. 2016;21(1):33-9. PubMed PMID: 26670666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comprehensive Genomic Profiling of Advanced Penile Carcinoma Suggests a High Frequency of Clinically Relevant Genomic Alterations. AU - Ali,Siraj M, AU - Pal,Sumanta K, AU - Wang,Kai, AU - Palma,Norma A, AU - Sanford,Eric, AU - Bailey,Mark, AU - He,Jie, AU - Elvin,Julia A, AU - Chmielecki,Juliann, AU - Squillace,Rachel, AU - Dow,Edward, AU - Morosini,Deborah, AU - Buell,Jamie, AU - Yelensky,Roman, AU - Lipson,Doron, AU - Frampton,Garrett M, AU - Howley,Peter, AU - Ross,Jeffrey S, AU - Stephens,Philip J, AU - Miller,Vincent A, Y1 - 2015/12/15/ PY - 2015/06/15/received PY - 2015/07/31/accepted PY - 2015/12/17/entrez PY - 2015/12/17/pubmed PY - 2016/10/8/medline KW - Genomic profiling KW - Human papillomavirus KW - Mutation KW - Penile cancer KW - Sequencing KW - Targeted therapy SP - 33 EP - 9 JF - The oncologist JO - Oncologist VL - 21 IS - 1 N2 - BACKGROUND: Advanced penile squamous cell carcinoma (PSCC) is associated with poor survival due to the aggressiveness of the disease and lack of effective systemic therapies. Comprehensive genomic profiling (CGP) was performed to identify clinically relevant genomic alterations (CRGAs). MATERIALS AND METHODS: DNA was extracted from 40 μm of formalin-fixed, paraffin-embedded sections in patients with advanced PSCC. CGP was performed on hybridization-captured, adaptor ligation-based libraries to a mean coverage depth of 692× for 3,769 exons of 236 cancer-related genes plus 47 introns from 19 genes frequently rearranged in cancer. CRGAs were defined as genomic alterations (GAs) linked to targeted therapies on the market or under evaluation in mechanism-driven clinical trials. RESULTS: Twenty male patients with a median age of 60 years (range, 46-87 years) were assessed. Seventeen (85%) cases were stage IV and three cases (15%) were stage III. CGP revealed 109 GAs (5.45 per tumor), 44 of which were CRGAs (2.2 per tumor). At least one CRGA was detected in 19 (95%) cases, and the most common CRGAs were CDKN2A point mutations and homozygous deletion (40%), NOTCH1 point mutations and rearrangements (25%), PIK3CA point mutations and amplification (25%), EGFR amplification (20%), CCND1 amplification (20%), BRCA2 insertions/deletions (10%), RICTOR amplifications (10%), and FBXW7 point mutations (10%). CONCLUSION: CGP identified CRGAs in patients with advanced PSCC, including EGFR amplification and PIK3CA alterations, which can lead to the rational administration of targeted therapy and subsequent benefit for these patients. IMPLICATIONS FOR PRACTICE: Few treatment options exist for patients with advanced penile squamous cell carcinoma (PSCC). Outcomes are dismal with platinum-based chemotherapy, with median survival estimated at 1 year or less across multiple series. Biological studies of patients with PSCC to date have principally focused on human papillomavirus status, but few studies have elucidated molecular drivers of the disease. To this end, comprehensive genomic profiling was performed in a cohort of 20 patients with advanced PSCC. Findings of frequent mutations in CDKN2A, NOTCH1, PIK3CA, and EGFR (all in excess of 20%) point to potential therapeutic avenues. Trials of targeted therapies directed toward these mutations should be explored. SN - 1549-490X UR - https://www.unboundmedicine.com/medline/citation/26670666/Comprehensive_Genomic_Profiling_of_Advanced_Penile_Carcinoma_Suggests_a_High_Frequency_of_Clinically_Relevant_Genomic_Alterations_ L2 - https://doi.org/10.1634/theoncologist.2015-0241 DB - PRIME DP - Unbound Medicine ER -