While most testicular germ cell tumours (TGCTs) exhibit exquisite sensitivity to platinum chemotherapy, ~10% are platinum resistant. To gain insight into the underlying mechanisms, we undertake whole ...exome sequencing and copy number analysis in 40 tumours from 26 cases with platinum-resistant TGCT, and combine this with published genomic data on an additional 624 TGCTs. We integrate analyses for driver mutations, mutational burden, global, arm-level and focal copy number (CN) events, and SNV and CN signatures. Albeit preliminary and observational in nature, these analyses provide support for a possible mechanistic link between early driver mutations in RAS and KIT and the widespread copy number events by which TGCT is characterised.
Frameshift insertion/deletions (fs-indels) are an infrequent but highly immunogenic mutation subtype. Although fs-indels are degraded through the nonsense-mediated decay (NMD) pathway, we hypothesise ...that some fs-indels escape degradation and elicit anti-tumor immune responses. Using allele-specific expression analysis, expressed fs-indels are enriched in genomic positions predicted to escape NMD, and associated with higher protein expression, consistent with degradation escape (NMD-escape). Across four independent melanoma cohorts, NMD-escape mutations are significantly associated with clinical-benefit to checkpoint inhibitor (CPI) therapy (P
= 0.0039). NMD-escape mutations are additionally found to associate with clinical-benefit in the low-TMB setting. Furthermore, in an adoptive cell therapy treated melanoma cohort, NMD-escape mutation count is the most significant biomarker associated with clinical-benefit. Analysis of functional T cell reactivity screens from personalized vaccine studies shows direct evidence of fs-indel derived neoantigens eliciting immune response, particularly those with highly elongated neo open reading frames. NMD-escape fs-indels represent an attractive target for biomarker optimisation and immunotherapy design.
The focus of tumour-specific antigen analyses has been on single nucleotide variants (SNVs), with the contribution of small insertions and deletions (indels) less well characterised. We investigated ...whether the frameshift nature of indel mutations, which create novel open reading frames and a large quantity of mutagenic peptides highly distinct from self, might contribute to the immunogenic phenotype.
We analysed whole-exome sequencing data from 5777 solid tumours, spanning 19 cancer types from The Cancer Genome Atlas. We compared the proportion and number of indels across the cohort, with a subset of results replicated in two independent datasets. We assessed in-silico tumour-specific neoantigen predictions by mutation type with pan-cancer analysis, together with RNAseq profiling in renal clear cell carcinoma cases (n=392), to compare immune gene expression across patient subgroups. Associations between indel burden and treatment response were assessed across four checkpoint inhibitor datasets.
We observed renal cell carcinomas to have the highest proportion (0·12) and number of indel mutations across the pan-cancer cohort (p<2·2 × 10−16), more than double the median proportion of indel mutations in all other cancer types examined. Analysis of tumour-specific neoantigens showed that enrichment of indel mutations for high-affinity binders was three times that of non-synonymous SNV mutations. Furthermore, neoantigens derived from indel mutations were nine times enriched for mutant specific binding, as compared with non-synonymous SNV derived neoantigens. Immune gene expression analysis in the renal clear cell carcinoma cohort showed that the presence of mutant-specific neoantigens was associated with upregulation of antigen presentation genes, which correlated (r=0·78) with T-cell activation as measured by CD8-positive expression. Finally, analysis of checkpoint inhibitor response data revealed frameshift indel count to be significantly associated with checkpoint inhibitor response across three separate melanoma cohorts (p=4·7 × 10−4).
Renal cell carcinomas have the highest pan-cancer proportion and number of indel mutations. Evidence suggests indels are a highly immunogenic mutational class, which can trigger an increased abundance of neoantigens and greater mutant-binding specificity.
Cancer Research UK, UK National Institute for Health Research (NIHR) at the Royal Marsden Hospital National Health Service Foundation Trust, Institute of Cancer Research and University College London Hospitals Biomedical Research Centres, the UK Medical Research Council, the Rosetrees Trust, Novo Nordisk Foundation, the Prostate Cancer Foundation, the Breast Cancer Research Foundation, the European Research Council.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Checkpoint inhibitors (CPIs) augment adaptive immunity. Systematic pan-tumor analyses may reveal the relative importance of tumor-cell-intrinsic and microenvironmental features underpinning CPI ...sensitization. Here, we collated whole-exome and transcriptomic data for >1,000 CPI-treated patients across seven tumor types, utilizing standardized bioinformatics workflows and clinical outcome criteria to validate multivariable predictors of CPI sensitization. Clonal tumor mutation burden (TMB) was the strongest predictor of CPI response, followed by total TMB and CXCL9 expression. Subclonal TMB, somatic copy alteration burden, and histocompatibility leukocyte antigen (HLA) evolutionary divergence failed to attain pan-cancer significance. Dinucleotide variants were identified as a source of immunogenic epitopes associated with radical amino acid substitutions and enhanced peptide hydrophobicity/immunogenicity. Copy-number analysis revealed two additional determinants of CPI outcome supported by prior functional evidence: 9q34 (TRAF2) loss associated with response and CCND1 amplification associated with resistance. Finally, single-cell RNA sequencing (RNA-seq) of clonal neoantigen-reactive CD8 tumor-infiltrating lymphocytes (TILs), combined with bulk RNA-seq analysis of CPI-responding tumors, identified CCR5 and CXCL13 as T-cell-intrinsic markers of CPI sensitivity.
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•Large-scale meta-analysis of >1,000 CPI-treated cases with exome/transcriptome data•Clonal TMB and CXCL9/CXCL13 expression are the strongest predictors of CPI response•A multivariable predictor of CPI response significantly outperforms TMB•9q34 loss and CCND1 amplification are additional determinants of CPI response
A whole-exome and transcriptome meta-analysis of over 1,000 patients treated with immune checkpoint blockade across seven tumor types highlights the potential of multivariable prediction models that consider both tumor- and T-cell-intrinsic mechanisms of response.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The interplay between an evolving cancer and a dynamic immune microenvironment remains unclear. Here we analyse 258 regions from 88 early-stage, untreated non-small-cell lung cancers using RNA ...sequencing and histopathology-assessed tumour-infiltrating lymphocyte estimates. Immune infiltration varied both between and within tumours, with different mechanisms of neoantigen presentation dysfunction enriched in distinct immune microenvironments. Sparsely infiltrated tumours exhibited a waning of neoantigen editing during tumour evolution, indicative of historical immune editing, or copy-number loss of previously clonal neoantigens. Immune-infiltrated tumour regions exhibited ongoing immunoediting, with either loss of heterozygosity in human leukocyte antigens or depletion of expressed neoantigens. We identified promoter hypermethylation of genes that contain neoantigenic mutations as an epigenetic mechanism of immunoediting. Our results suggest that the immune microenvironment exerts a strong selection pressure in early-stage, untreated non-small-cell lung cancers that produces multiple routes to immune evasion, which are clinically relevant and forecast poor disease-free survival.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The integration of cancer biomarkers into oncology has revolutionized cancer treatment, yielding remarkable advancements in cancer therapeutics and the prognosis of cancer patients. The development ...of personalized medicine represents a turning point and a new paradigm in cancer management, as biomarkers enable oncologists to tailor treatments based on the unique molecular profile of each patient’s tumor.
In this review, we discuss the scientific milestones of cancer biomarkers and explore future possibilities to improve the management of patients with solid tumors. This progress is primarily attributed to the biological characterization of cancers, advancements in testing methodologies, elucidation of the immune microenvironment, and the ability to profile circulating tumor fractions. Integrating these insights promises to continually advance the precision oncology field, fostering better patient outcomes.
Cancer biomarkers have transformed oncology, enabling treatments tailored to each tumor’s unique profile. This review highlights the field’s progress due to advancements in understanding cancer biology, testing methods, and understanding of the immune microenvironment to advance precision oncology for improved patient outcomes.
Abstract
Background: Cancer evolution occurs though a Darwinian process of natural selection. Selective sweeps occur in most human tumours which obscure early, unsuccessful lineages. In addition, ...analysis of bulk samples has limited phylogenies to SNVs and Indels, due to methodological difficulties in bulk clonal deconvolution of copy number aberrations (CNAs). Using single cell whole genome sequencing we construct phylogenies of CNAs for murine models of the early stages in lung adenocarcinoma evolution and define features of unsuccessful lineages not yet obscured by full selective sweeps. Methods: Non-invasive tumour tissue was homogenised from EGFRL858R and EGFRL858R/TP53 knock out (KO) mice and subject to 0.1X single cell WGS. Bowtie and AnneuFinder were used to align FASTQ files and call CNAs respectively. A strict quality control step was step applied using read depth and coverage variability, removing 15% of cells. MEDDIC was used to construct phylogenetic trees and ancestral CN states at each node. These ancestral CN states were translated into distinct CN events in the evolutionary history of each tumour. Results: We reconstructed tumour CNA phylogenies using scWGS to determine phylogenetic relationships and time CN events. CNAs in these data were far more heterogenous than in previously published human studies. We noted small populations of progenitor cells which branched off early in evolutionary time, containing far fewer copy number aberrations and which were not genome doubled. These populations allow us to more accurately time CN events such as would be obscured after a full selective sweep. Whole chromosomal events were significantly more likely to occur earlier in evolutionary history than intra-chromosomal events (Wilcoxon test, P < 1e-16, OR = 2.24) and chromosomal gains were also significantly more common at the earlier stages of tumour evolution (Wilcoxon test, P < 1e-16, OR = 1.44). Within whole chromosomal events, gains were significantly more enriched for early timing (Wilcoxon test, P < 1e-16, OR = 7.11). Progenitor cell populations also contained a small number of additional events, which were usually unique to a single cell. We reasoned these events may represent evolutionary dead ends. We found these events were highly enriched for losses in TP53 wild type tumours (Wilcoxon test, P < 1e-16, OR = 11.9) but much less so in TP53 mutant tumours (Wilcoxon test, P = 1e-6, OR = 1.14) suggesting early negative selection against loss of heterozygosity, particularly when TP53 is intact. Discussion: The observed depletion of intrachromosomal events may be caused by a more intact DNA damage response system which is therefore less permissive to chromosomal breaks. Heterozygous losses may be negatively selected due to resultant decreased dosage of a large numbers of genes, upon which the cells become less reliant as cancer progresses. These data are consistent with a recent report of spontaneous CNAs in culture of normal hTERT lines which have a strong preference for gains in a TP53 WT context but not upon TP53 KO.
Citation Format: Alexander M. Frankell, Sebastian Hobor, Maise Al-bakir, Eva Grönroos, Charles Swanton. Single cell whole genome sequencing reveals the dynamics of copy number instability at the earliest stages of cancer evolution abstract. In: Proceedings of the AACR Virtual Special Conference on Tumor Heterogeneity: From Single Cells to Clinical Impact; 2020 Sep 17-18. Philadelphia (PA): AACR; Cancer Res 2020;80(21 Suppl):Abstract nr PO-018.
Colorectal cancer (CRC) shows variable response to immune checkpoint blockade, which can only partially be explained by high tumor mutational burden (TMB). We conducted an integrated study of the ...cancer tissue and associated tumor microenvironment (TME) from patients treated with pembrolizumab (KEYNOTE 177 clinical trial) or nivolumab to dissect the cellular and molecular determinants of response to anti- programmed cell death 1 (PD1) immunotherapy.
We selected multiple regions per tumor showing variable T-cell infiltration for a total of 738 regions from 29 patients, divided into discovery and validation cohorts. We performed multiregional whole-exome and RNA sequencing of the tumor cells and integrated these with T-cell receptor sequencing, high-dimensional imaging mass cytometry, detection of programmed death-ligand 1 (PDL1) interaction in situ, multiplexed immunofluorescence, and computational spatial analysis of the TME.
In hypermutated CRCs, response to anti-PD1 immunotherapy was not associated with TMB but with high clonality of immunogenic mutations, clonally expanded T cells, low activation of Wnt signaling, deregulation of the interferon gamma pathway, and active immune escape mechanisms. Responsive hypermutated CRCs were also rich in cytotoxic and proliferating PD1+CD8 T cells interacting with PDL1+ antigen-presenting macrophages.
Our study clarified the limits of TMB as a predictor of response of CRC to anti-PD1 immunotherapy. It identified a population of antigen-presenting macrophages interacting with CD8 T cells that consistently segregate with response. We therefore concluded that anti-PD1 agents release the PD1-PDL1 interaction between CD8 T cells and macrophages to promote cytotoxic antitumor activity.
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Colorectal cancers responsive to anti-programmed cell death 1 immunotherapy show clonal immunogenic mutations, low Wnt activation, beta-2-microglobulin deregulation, and high infiltration of antigen presenting macrophages interacting with programmed cell death 1-positive cluster of differentiation 8 T cells.
Epithelial ovarian cancer (EOC) is a heterogeneous condition with poor survival outcomes. The genetics of hereditary and sporadic ovarian cancers will be covered and its implications to management ...and future research are discussed.
Key recent published literature.
Both genetic and environmental factors play a role in the development of EOC. Most EOCs develop sporadically and are divided into low-grade/genetically stable type I tumours and high-grade/genetically unstable type II tumours. The commonest hereditary syndromes are hereditary breast ovarian cancer syndrome (HBOC-BRCA mutations) and Lynch syndrome (DNA mismatch repair mutations).
The different histological types of EOC may not solely originate from the ovary but from the fallopian tube and endometriosis deposits; there is increasing evidence to support this.
Our understanding of the genetics and frequencies of mutations in ovarian cancer is expanding. The proportion of heritable EOC is larger than previously estimated and not all patients have a clear family history for this. Mutations in genes involving the downstream BRCA signalling pathway have recently been implicated in HBOC. TP53 mutations are the single most commonly identified mutations in aggressive sporadic high-grade serous carcinomas, affecting essentially 100% of such tumours. Furthermore, there is increasing recognition that the different histological sub-types need to be treated as separate entities.
Given how heterogeneous 'ovarian' cancer is, trials into new drugs should report responses for the different histo-/geno-types rather than simply using staging. Although the effect of new drugs such as poly(ADP-ribose) polymerase inhibitors are being investigated in ovarian cancer, there is still a need to develop targeted therapies-especially to tackle mutations in PI3 K pathway, RAS pathway and TP53.
Abstract
Introduction: Studies of cancer evolution have relied on archival tissue surplus to diagnostic requirements from living patients obtained in early stage disease and less commonly ...relapsed/metastatic disease. PEACE (Posthumous Evaluation of Advanced Cancer Environment) is a national research autopsy study aiming to understand the biological processes driving metastatic disease and cancer evolution.
Experimental procedures: Patients recruited into the national TRACERx (TRAcking Cancer Evolution through therapy (Rx)) lung study who subsequently developed metastatic disease were enrolled into PEACE. Here we present a cohort of 15 TRACERx/PEACE patients in whom multi-region tumor sampling was performed at diagnosis +/- relapse and at autopsy. Fresh frozen tissue was subjected to whole-exome sequencing (mean depth 390) and germline DNA from blood was used for reference. Single nucleotide variants (SNVs) were identified using VarScan2 and the subclonal composition of each tumor was inferred using PyClone and used to reconstruct phylogenetic trees.
Summary of data: Disease progression was associated with increased genomic complexity. Different patterns of progression occurred; monoclonal/monophyletic, polyclonal/monophyletic and polyclonal/polyphyletic dissemination. Both early and late divergence relative to the last clonal sweep were observed. Putative drivers were found to occur both clonally and subclonally. SNVs and copy number aberrations were used to reconstruct migration patterns.
Conclusions: Preliminary analysis in this cohort demonstrates increasing genomic complexity with disease progression and variation in patterns of metastatic dissemination. We are yet to establish the impact of the tumor and immune microenvironment on such patterns as well as clinical presentation and outcome. Ongoing PEACE analysis includes study of the somatic copy number landscape and the characterisation of subclones that seed metastases.
Patient & sample characteristicsN (%)Total patients15Median age (IQR)73 (65 - 80)Female sex (%)6 (40%)Histological subtypeAdenocarcinoma7 (47%)Squamous cell carcinoma5 (33%)Large cell carcinoma2 (13%)Adenosquamous carcinoma1 (7%)Treatment receivedRadiotherapy8 (53%)Chemotherapy6 (40%)Immunotherapy5 (33%)Targeted therapy4 (27%)Smoking statusCurrent smoker2 (13%)Ex-smoker12 (80%)Never smoker1 (7%)Total metastases sampled289Median samples per patient (range)19 (5 - 41)Number of samples per patient5-104 (27%)11-205 (33%)>206 (40%)Number of tissue types sampled17
Citation Format: Ariana Huebner, Sonya Hessey, Cristina Naceur-Lombardelli, Mita Akther, Selvaraju Veeriah, Maise Al Bakir, David Moore, Simone Zaccaria, Nicholas McGranahan, Charles Swanton, Mariam Jamal-Hanjani, TRACERx and PEACE consortium. Lung cancer evolutionary trajectories in PEACE abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 3123.
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