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Published on: July 3, 2013
Molecular characteristics of advanced colorectal cancer and multi-hit PIK3CA mutations
Faiza Yasin1,2, Ethan Sokol3, Neil Vasan4
1Department of Medicine (Medical Oncology), Yale University, New Haven, CT 06510, United States.
Introduction:
Approximately 20% of patients living with colorectal cancer (CRC) have activating mutations in their tumors in the PIK3CA oncogene. Two or more activating mutations (multi-hit) for the PIK3CA allele increase PI3K⍺ signaling compared to single-point mutations, resulting in exceptional response to PI3K⍺ inhibition. We aimed to identify the prevalence of PIK3CA multi-hit mutations in metastatic CRC to identify patients who may benefit from PI3K inhibitors.
Methods:
The Foundation Medicine database (Boston, MA, USA) was analyzed for patients with CRC who underwent genomic profiling on tumor DNA isolated during routine clinical care from 2013 to 2021. Molecular and clinical variables were abstracted for patients with PIK3CA mutations.
Results:
We identified 49 051 patients with CRC who underwent Foundation Medicine testing. 710/41154 (1.7%) patients had multi-hit PIK3CA mutations, of which 53% were male (n = 448) with a median age of 60. Microsatellite status was available for 697 patients with multi-hit PIK3CA and 17.6% (123/697) were microsatellite instability-high. Clinically relevant mutations in KRAS and BRAFV600E were seen in 459/710 (64.7%) and 65/710 (9.1%), respectively. The 4 most common PIK3CA variants were H1047R (9.8%), E545K (9.2%), E542K (9.0%), and R88Q (7.1%). The most common variant pair was E542K-E545K (4.7%).
Conclusions:
Multi-hit mutations in PIK3CA are seen in 1.7% of advanced CRC, a meaningful prevalence given the high burden of CRC worldwide, and may represent a subset of patients that have enhanced sensitivity to PI3K inhibition. Future investigation regarding the clinical utility of PI3K inhibitors is warranted in multi-hit PIK3CA CRC.
Insights
Multi-hit PIK3CA mutations occur in 1.7% of advanced colorectal cancer (CRC) patients. This finding identifies a potential patient subset with enhanced sensitivity to PI3K inhibitors for future clinical trials.
Area of Science:
- Oncology
- Genomics
- Molecular Biology
Background:
- Activating mutations in the PIK3CA oncogene are present in approximately 20% of colorectal cancer (CRC) patients.
- Multi-hit PIK3CA mutations amplify PI3K⍺ signaling more than single-point mutations, suggesting heightened sensitivity to PI3K⍺ inhibitors.
Purpose of the Study:
- To determine the prevalence of PIK3CA multi-hit mutations in metastatic CRC.
- To identify patients who could potentially benefit from PI3K inhibitors based on PIK3CA mutation status.
Main Methods:
- Analysis of the Foundation Medicine database for CRC patients who underwent genomic profiling between 2013 and 2021.
- Abstraction of molecular and clinical variables for patients with PIK3CA mutations.
Main Results:
- 1.7% (710/41154) of CRC patients had multi-hit PIK3CA mutations.
- Microsatellite instability-high status was observed in 17.6% of these patients.
- Common PIK3CA variants included H1047R, E545K, and E542K, with E542K-E545K being the most frequent pair.
Conclusions:
- Multi-hit PIK3CA mutations represent a significant subset (1.7%) of advanced CRC.
- These patients may exhibit increased sensitivity to PI3K inhibitors.
- Further research is warranted to explore the clinical utility of PI3K inhibitors in this specific CRC population.
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