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Actionable gene-based classification toward precision medicine in gastric cancer.

Abstract：

BACKGROUND:Intertumoral heterogeneity represents a significant hurdle to identifying optimized targeted therapies in gastric cancer (GC). To realize precision medicine for GC patients, an actionable gene alteration-based molecular classification that directly associates GCs with targeted therapies is needed. METHODS:A total of 207 Japanese patients with GC were included in this study. Formalin-fixed, paraffin-embedded (FFPE) tumor tissues were obtained from surgical or biopsy specimens and were subjected to DNA extraction. We generated comprehensive genomic profiling data using a 435-gene panel including 69 actionable genes paired with US Food and Drug Administration-approved targeted therapies, and the evaluation of Epstein-Barr virus (EBV) infection and microsatellite instability (MSI) status. RESULTS:Comprehensive genomic sequencing detected at least one alteration of 435 cancer-related genes in 194 GCs (93.7%) and of 69 actionable genes in 141 GCs (68.1%). We classified the 207 GCs into four The Cancer Genome Atlas (TCGA) subtypes using the genomic profiling data; EBV (N = 9), MSI (N = 17), chromosomal instability (N = 119), and genomically stable subtype (N = 62). Actionable gene alterations were not specific and were widely observed throughout all TCGA subtypes. To discover a novel classification which more precisely selects candidates for targeted therapies, 207 GCs were classified using hypermutated phenotype and the mutation profile of 69 actionable genes. We identified a hypermutated group (N = 32), while the others (N = 175) were sub-divided into six clusters including five with actionable gene alterations: ERBB2 (N = 25), CDKN2A, and CDKN2B (N = 10), KRAS (N = 10), BRCA2 (N = 9), and ATM cluster (N = 12). The clinical utility of this classification was demonstrated by a case of unresectable GC with a remarkable response to anti-HER2 therapy in the ERBB2 cluster. CONCLUSIONS:This actionable gene-based classification creates a framework for further studies for realizing precision medicine in GC.

journal_name

Genome Med

journal_title

Genome medicine

authors

Ichikawa H,Nagahashi M,Shimada Y,Hanyu T,Ishikawa T,Kameyama H,Kobayashi T,Sakata J,Yabusaki H,Nakagawa S,Sato N,Hirata Y,Kitagawa Y,Tanahashi T,Yoshida K,Nakanishi R,Oki E,Vuzman D,Lyle S,Takabe K,Ling Y,Okuda

doi

10.1186/s13073-017-0484-3

subject

Has Abstract

pub_date

2017-10-31 00:00:00

pages

93

issue

1

issn

1756-994X

pii

10.1186/s13073-017-0484-3

journal_volume

9

pub_type

杂志文章

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