Clinical Targeted Exome-Based Sequencing in Combination with Genome-Wide Copy Number Profiling: Precision Medicine Analysis of 203 Pediatric Brain Tumors
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Neuro-Oncology 1 XX(XX), 1–11, 2017 | doi:10.1093/neuonc/now294 Clinical targeted exome-based sequencing in combination with genome-wide copy number profiling: precision medicine analysis of 203 pediatric brain tumors Shakti H. Ramkissoon,* Pratiti Bandopadhayay,* Jaeho Hwang,* Lori A. Ramkissoon,* Noah F. Greenwald, Steven E. Schumacher, Ryan O’Rourke, Nathan Pinches, Patricia Ho, Hayley Malkin, Claire Sinai, Mariella Filbin, Ashley Plant, Wenya Linda Bi, Michael S. Chang, Edward Yang, Karen D. Wright, Peter E. Manley, Matthew Ducar, Sanda Alexandrescu, Hart Lidov, Ivana Delalle, Liliana C. Goumnerova, Alanna J. Church, Katherine A. Janeway, Marian H. Harris, Laura E. MacConaill, Rebecca D. Folkerth, Neal I. Lindeman, Charles D. Stiles, Mark W. Kieran, Azra H. Ligon, Sandro Santagata, Adrian M. Dubuc, Susan N. Chi,§ Rameen Beroukhim,§ and Keith L. Ligon§ Dana-Farber/Boston Children’s Cancer and Blood Disorders Center (P.B., M.F., A.P., M.S.C., K.D.W., P.E.M., L.C.G., K.A.J., M.W.K., S.N.C.), Department of Pathology (S.A., H.L., A.J.C., M.H.H., R.D.F., S.S., K.L.L.), Department of Radiology (E.Y.), Department of Neurosurgery (L.C.G.), Boston Children’s Hospital, Boston, Massachusetts; Department of Medical Oncology (R.B.), Oncologic Pathology (S.H.R., L.A.R., K.L.L.), Department of Pediatric Oncology (P.B., N.P., H.M., C.S., M.F., A.P., M.S.C., K.D.W., P.E.M., L.C.G., K.A.J., M.H.H., M.W.K., S.N.C.), Department of Cancer Biology (N.F.G., R.O., P.H., W.L.B., C.D.S., S.S., R.B.), Center for Cancer Genome Discovery (L.E.M., M.D.), Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Pathology (S.H.R., H.L., I.D., L.E.M., R.D.F., N.I.L., A.H.L., S.S., A.M.D., K.L.L.), Department of Neurosurgery (W.L.B., N.F.G.), Department of Medicine (R.B.), Brigham and Women’s Hospital, Boston, Massachusetts; Pratiti Bandopadhayay, Broad Institute of MIT and Harvard, Boston, Massachusetts (S.E.S., R.B., K.L.L.); Harvard Medical School, Boston, Massachusetts (S.H.R., P.B., J.H., M.F., A.P., W.L.B., E.Y., K.D.W., P.E.M., S.A., H.L., L.C.G., A.J.C., K.A.J., M.H.H., L.E.M., R.D.F., N.I.L., C.D.S., M.W.K., A.H.L., S.S., A.M.D., S.N.C., R.B., K.L.L.) §Co-corresponding and co-senior authors. Correspondence should be addressed to: Susan N. Chi, ([email protected]); Rameen Beroukhim, ([email protected]); Keith L. Ligon, ([email protected]). *These authors contributed equally to this manuscript. Abstract Background. Clinical genomics platforms are needed to identify targetable alterations, but implementation of these technologies and best practices in routine clinical pediatric oncology practice are not yet well established. Methods. Profile is an institution-wide prospective clinical research initiative that uses targeted sequencing to iden- tify targetable alterations in tumors. OncoPanel, a multiplexed targeted exome-sequencing platform that includes 300 cancer-causing genes, was used to assess single nucleotide variants and rearrangements/indels. Alterations were annotated (Tiers 1–4) based on clinical significance, with Tier 1 alterations having well-established clinical utility. OncoCopy, a clinical genome-wide array comparative genomic hybridization (aCGH) assay, was also per- formed to evaluate copy number alterations and better define rearrangement breakpoints. Results. Cancer genomes of 203 pediatric brain tumors were profiled across histological subtypes, including 117 samples analyzed by OncoPanel, 146 by OncoCopy, and 60 tumors subjected to both methodologies. OncoPanel revealed clinically relevant alterations in 56% of patients (44 cancer mutations and 20 rearrangements), including BRAF alterations that directed the use of targeted inhibitors. Rearrangements in MYB-QKI, MYBL1, BRAF, and FGFR1 were also detected. Furthermore, while copy number profiles differed across histologies, the combined use of OncoPanel and OncoCopy identified subgroup-specific alterations in 89% (17/19) of medulloblastomas. Conclusion. The combination of OncoPanel and OncoCopy multiplex genomic assays can identify critical diag- nostic, prognostic, and treatment-relevant alterations and represents an effective precision medicine approach for clinical evaluation of pediatric brain tumors. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: [email protected] 2 Ramkissoon et al. An integrative genomic analysis of 203 pediatric brain tumors Key words array CGH | brain tumor | clinical sequencing | pediatric neuro-oncology | precision medicine Importance of the study Clinically validated genomics platforms are required alterations in 55% of all patients, including identifica- for the implementation of precision medicine, tion of driver genomic mutations. In addition, we iden- including in pediatric neuro-oncology. In this study, tified alterations that confer diagnostic and prognostic we demonstrate the utility of a targeted exome- significance, such as those that allow subtyping of sequencing platform in combination with genome- medulloblastoma. Our results indicate that genomic wide copy number profiling using aCGH in a clinical profiling of pediatric brain tumors is feasible and clini- setting. These platforms detected clinically relevant cally useful. Over the last 30 years, childhood mortality from cancer Clinical Data and Review of Histology has declined significantly across most cancer types, with an average decrease of more than 50%. By contrast, how- Clinical data were extracted from clinical charts and de- ever, pediatric brain cancers have demonstrated only a identified. A histological diagnosis for each patient was 30% decrease in mortality, thus highlighting the pressing rendered for the study by at least one pediatric neuro- clinical necessity to improve diagnostics and disease man- pathologist for all cases (S.H.R.) and most cases were agement. Furthermore, from 2008 to 2012, brain tumors reviewed by a second neuropathologist. accounted for 25% of all pediatric cancer deaths.1 Although mortality has decreased, many patients suffer long-lasting and debilitating morbidities as a result of aggressive surgi- Clinical Array Comparative Genomic cal resection and high doses of radiation therapy and cyto- Hybridization toxic chemotherapy.2 High resolution array comparative genomic hybridization Across a variety of cancer types, the identification of sub- (aCGH) (Agilent Sure Print G3 Human 1 × 1M feature array) type-specific mutations has often represented a critical ini- was performed on clinical biopsy samples from formalin- tiating step in the path toward targeted therapies.3,4 Recent fixed paraffin embedded material in a CLIA-certified labora- work in pediatric brain tumors has demonstrated key dif- tory as part of clinical care using a methodology previously ferences between these tumors compared with adult coun- described.13,14 Two micrograms of patient and reference terparts. Tumors from both these cohorts show not only DNA (Promega) were fragmented and hybridized to each different incidence rates across their respective popula- microarray. The average resolution of the aCGH platform tions, but substantial variation in identified driver events.5–8 across Reference Sequence genes is 1.8 kb, and across the In order to translate these advances into clinical practice, genome 2.1 kb. physicians require a means by which to obtain accurate Analysis was performed as previously described14 and clinically relevant genomic data for these tumors. Patients clinical reports were generated by teams of board-certified require that this type of testing be affordable and widely clinical cytogeneticists, neuropathologists, and molecular accessible. Implementation of such platforms has been pathologists. well described in the adult neuro-oncology population.9–12 Herein, we report our experience of performing genomic profiling of pediatric neuro-oncology patients using a tar- Targeted Next-Generation geted exome approach in conjunction with genome-wide Sequencing—OncoPanel copy number analysis in a setting certified by the Clinical Laboratory Improvement Amendments (CLIA). For patients enrolled on the Profile clinical trial, detec- tion of mutations and gene rearrangements in tumors was achieved using targeted next-generation sequencing Methods (OncoPanel).15,16 This assay (Agilent SureSelect for target capture and Illumina HiSeq sequencing) surveys exonic Ethics Statement DNA sequences of 300 cancer genes, including 91 introns across 30 genes (Supplementary Table 1) for mutation and Ethics approval was granted by the human institutional rearrangement detection in tumor-derived DNA (minimum review board committees of the Dana-Farber/Harvard 50 ng, formalin-fixed paraffin embedded–derived tissue). Cancer Center. Informed consent was obtained from all Neuropathologists review each tumor specimen and esti- patients and/or their guardians. Targeted exome sequenc- mate the number of neoplastic cells in the submitted sam- ing was performed on tumors from patients enrolled on ple (tumor purity). OncoPanel results were interpreted and the Profile clinical study. reported by molecular pathologists, and alterations were Ramkissoon et al. An integrative genomic analysis of 203 pediatric brain tumors 3 Oncology Neuro- classified into 4 tiers (Tier 1 to Tier 4) to provide therapeu- molecular aberrations (including both single nucleotide tic and prognostic significance16 (Supplementary Table 1), variants and copy number aberrations) identified through