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Identification of novel molecular subgroups in esophageal adenocarcinoma to predict response to neo-adjuvant therapies

ABSTRACT: Esophageal adenocarcinoma (EAC) is a highly aggressive cancer and its response to chemo-, and radiotherapy is unpredictable. EAC are highly heterogeneous at the molecular level. The aim of this study was to perform gene expression analysis of EAC to identify distinct molecular subgroups and to investigate expression signatures in relation to treatment response.

ORGANISM(S): Homo sapiens

PROVIDER: GSE207526 | GEO | 2023/01/08

REPOSITORIES: GEO

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Project description:Background:We performed whole-exome sequencing of pretreatment biopsies and examined whether genome-wide metrics of overall mutational load, clonal heterogeneity or alterations at variant, gene, and pathway levels are associated with treatment response and survival. Patients and Methods:Two hundred and three biopsies from the NeoALTTO trial were analyzed. Mutations were called with MuTect, and Strelka, using pooled normal DNA. Associations between DNA alterations and outcome were evaluated by logistic and Cox-proportional hazards regression. Results:There were no recurrent single gene mutations significantly associated with pathologic complete response (pCR), except PIK3CA [odds ratio (OR)?=?0.42, P?=?0.0185]. Mutations in 33 of 714 pathways were significantly associated with response, but different genes were affected in different individuals. PIK3CA was present in 23 of these pathways defining a ‘trastuzumab resistance-network’ of 459 genes. Cases with mutations in this network had low pCR rates to trastuzumab (2/50, 4%) compared with cases with no mutations (9/16, 56%), OR?=?0.035; P?<?0.001. Mutations in the ‘Regulation of RhoA activity’ pathway were associated with higher pCR rate to lapatinib (OR?=?14.8, adjusted P?=?0.001), lapatinib?+?trastuzumab (OR?=?3.0, adjusted P?=?0.09), and all arms combined (OR?=?3.77, adjusted P?=?0.02). Patients (n?=?124) with mutations in the trastuzumab resistance network but intact RhoA pathway had 2% (1/41) pCR rate with trastuzumab alone (OR?=?0.026, P = 0.001) but adding lapatinib increased pCR rate to 45% (17/38, OR?=?1.68, P?=?0.3). Patients (n?=?46) who had no mutations in either gene set had 6% pCR rate (1/15) with lapatinib, but had the highest pCR rate, 52% (8/15) with trastuzumab alone. Conclusions:Mutations in the RhoA pathway are associated with pCR to lapatinib and mutations in a PIK3CA-related network are associated with resistance to trastuzumab. The combined mutation status of these two pathways could define patients with very low response rate to trastuzumab alone that can be augmented by adding lapatinib or substituting trastuzumab with lapatinib.

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Identification of novel molecular subgroups in esophageal adenocarcinoma to predict response to neo-adjuvant therapies

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