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Urothelial cancer harbours EGFR and HER2 amplifications and exon 20 insertions
Author(s) -
Madison Russell W.,
Gupta Sumati V.,
Elamin Yasir Y.,
Lin Douglas I.,
Pal Sumanta K.,
Necchi Andrea,
Miller Vincent A.,
Ross Jeffrey S.,
Chung Jon H.,
Alexander Brian M.,
Schrock Alexa B.,
Heymach John V.,
Reddy Prasanth,
Ali Siraj M.
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.15006
Subject(s) - exon , urothelial cancer , urothelial carcinoma , gene duplication , cancer , biology , epidermal growth factor receptor , cancer research , gene , medicine , oncology , genetics , bladder cancer
Objective To review the genomic landscape of advanced urothelial carcinoma (UC) to assess the frequencies of EGFR and ERBB2 ( HER2 ) alterations. Materials and Methods Tumour specimens from 3753 patients with advanced UC were assayed with hybrid capture‐based comprehensive genomic profiling of 180–395 genes. Tumour mutational burden (TMB) was assessed on 0.8 or 1.1 Mb of DNA, and is reported as mutations per megabase. Results In 3753 cases of UC, EGFR alterations were detected in 4.1% (154) and were most commonly amplifications (64%; 99/154), while exon 20 insertions ( EGFR exon20ins ) were the second most common alteration (18%; 27/154). Alterations in ERBB2 were observed in 15% (552/3753) of cases and, similarly, ERBB2 amplification was the most commonly observed alteration (278/552; 50%); ERBB2 exon20ins occurred in 3.6% (20/552) of cases. EGFR exon20ins and ERBB2 exon20ins occurred in younger patients (median age 62 vs 69 years, P = 2.6E‐2 and 60 vs 68 years, P = 7.8E‐4), and these cases had significantly lower TMB (median 3.6 vs 7.2, P = 2.7E‐4 and 2.5 vs 10, P = 1.2E‐7) and less frequent TP53 alterations (3.7% vs 83%, P = 4.3E‐14 and 20% vs 68%, P = 9.8E‐4) compared to cases with other EGFR or ERBB2 alterations. Conclusion EGFR and ERBB2 alterations occur in 4% and 15% of UC, respectively. EGFR exon20ins and ERBB2 exon20ins were present in 0.7% and 0.5% of UC overall and collectively define a small, but distinct, subset of UC with infrequent co‐occurrence of other drivers and low TMB. Given recent promising clinical studies of inhibitors with activity against exon 20 insertions in non‐small cell lung cancer, consideration should be given to developing a trial inclusive of patients with UC harbouring these alterations.