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Comprehensive genomic and epigenomic analysis in cancer of unknown primary guides molecularly-informed therapies despite heterogeneity.


ABSTRACT: The benefit of molecularly-informed therapies in cancer of unknown primary (CUP) is unclear. Here, we use comprehensive molecular characterization by whole genome/exome, transcriptome and methylome analysis in 70 CUP patients to reveal substantial mutational heterogeneity with TP53, MUC16, KRAS, LRP1B and CSMD3 being the most frequently mutated known cancer-related genes. The most common fusion partner is FGFR2, the most common focal homozygous deletion affects CDKN2A. 56/70 (80%) patients receive genomics-based treatment recommendations which are applied in 20/56 (36%) cases. Transcriptome and methylome data provide evidence for the underlying entity in 62/70 (89%) cases. Germline analysis reveals five (likely) pathogenic mutations in five patients. Recommended off-label therapies translate into a mean PFS ratio of 3.6 with a median PFS1 of 2.9 months (17 patients) and a median PFS2 of 7.8 months (20 patients). Our data emphasize the clinical value of molecular analysis and underline the need for innovative, mechanism-based clinical trials.

SUBMITTER: Mohrmann L 

PROVIDER: S-EPMC9346116 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Comprehensive genomic and epigenomic analysis in cancer of unknown primary guides molecularly-informed therapies despite heterogeneity.

Möhrmann Lino L   Werner Maximilian M   Oleś Małgorzata M   Mock Andreas A   Uhrig Sebastian S   Jahn Arne A   Kreutzfeldt Simon S   Fröhlich Martina M   Hutter Barbara B   Paramasivam Nagarajan N   Richter Daniela D   Beck Katja K   Winter Ulrike U   Pfütze Katrin K   Heilig Christoph E CE   Teleanu Veronica V   Lipka Daniel B DB   Zapatka Marc M   Hanf Dorothea D   List Catrin C   Allgäuer Michael M   Penzel Roland R   Rüter Gina G   Jelas Ivan I   Hamacher Rainer R   Falkenhorst Johanna J   Wagner Sebastian S   Brandts Christian H CH   Boerries Melanie M   Illert Anna L AL   Metzeler Klaus H KH   Westphalen C Benedikt CB   Desuki Alexander A   Kindler Thomas T   Folprecht Gunnar G   Weichert Wilko W   Brors Benedikt B   Stenzinger Albrecht A   Schröck Evelin E   Hübschmann Daniel D   Horak Peter P   Heining Christoph C   Fröhling Stefan S   Glimm Hanno H  

Nature communications 20220802 1


The benefit of molecularly-informed therapies in cancer of unknown primary (CUP) is unclear. Here, we use comprehensive molecular characterization by whole genome/exome, transcriptome and methylome analysis in 70 CUP patients to reveal substantial mutational heterogeneity with TP53, MUC16, KRAS, LRP1B and CSMD3 being the most frequently mutated known cancer-related genes. The most common fusion partner is FGFR2, the most common focal homozygous deletion affects CDKN2A. 56/70 (80%) patients recei  ...[more]

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