The INFORM personalized medicine study for high-risk pediatric cancer patients.

Author:

Worst Barbara Christine1,Pfaff Elke1,Van Tilburg Cornelis M.2,Balasubramanian Gnana Prakash1,Fiesel Petra1,Pajtler Kristian W.1,Freitag Angelika3,Witt Ruth3,Kulozik Andreas E.2,von Deimling Andreas4,Eggert Angelika5,Dirksen Uta6,Lichter Peter1,Capper David1,Pfister Stefan M.7,Jones David T. W.8,Witt Olaf2

Affiliation:

1. German Cancer Research Center (DKFZ), Heidelberg, Germany;

2. Heidelberg University Hospital, Heidelberg, Germany;

3. NCT Trial Center, Heidelberg, Germany;

4. Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany;

5. Charité Universitätsmedizin Berlin, Berlin, Germany;

6. University Hospital of Muenster, Muenster, Germany;

7. Hopp Children’s Cancer Center at NCT Heidelberg (KiTZ), Heidelberg, Germany;

8. Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, and German Cancer Consortium (DKTK), Heidelberg, Germany;

Abstract

10509 Background: Relapses from high-risk tumors pose a major clinical challenge in pediatric oncology. The German INFORM registry (INdividualized therapy FOr Relapsed Malignancies in children) addresses this problem using integrated next-generation sequencing to rapidly identify patient-specific therapeutic targets. Methods: Whole-exome, low-coverage whole-genome and RNA sequencing is complemented with microarray-based DNA methylation profiling. Identified alterations are discussed and prioritized according to biological significance and potential druggability in a weekly molecular tumor board. Results: To date, 214 tumor samples of high-risk pediatric cancer patients have been profiled from 47 German centers, with 39% being sarcomas, 30% brain tumors, 13% neuroblastoma and 18% hematological or other malignancies. Turnaround time from tissue arrival to molecular results was 21 calendar days on average. In 14/214 patients (7%) we identified an underlying germline predisposition syndrome. In several cases there were discrepancies between the original histological diagnosis and our molecular findings, especially in brain tumors. We detected one or more potentially druggable alterations in 147/214 (69%) cases. Tyrosine kinases, the PI3K/mTOR pathway, MAPK pathway, and cell-cycle as well as transcriptional regulators were commonly affected. Based on these findings, targeted therapeutics were incorporated into the therapy regime in one-third of patients, with anecdotal reports of marked responses, including a patient with a pleomorphic sarcoma, where we detected a previously undescribed RAF-fusion, showing a partial remission upon RAF-inhibition. Conclusions: In summary, real-time comprehensive profiling of pediatric tumors provides valuable diagnostic information and identifies potential therapeutic targets. In parallel, the implementation of a systematic program for reverse-translational evaluation is ongoing. Recently, this nationwide effort has expanded to include patients from other countries. We will also recruit patients to the complementary eSMART and INFORM2 biomarker-driven, phase I/II combination trial series, to provide unprecedented access to targeted therapies in Europe.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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