Abstract 1759: Integrative longitudinal genomic analysis of therapy-resistant and metastatic pediatric cancers

Abstract Pediatric cancer patients are commonly profiled with gene-panel sequencing tests that yield few actionable results, in part due to the complex genomic alterations that define these malignancies. We hypothesized that integration of whole-genome (WGS) and RNA sequencing (RNAseq), would lead to a more comprehensive understanding of these diseases. Our study is uniquely focused on metastatic and relapsed disease, whereas previous studies focused on primary cases. We also prioritized longitudinal profiling, including with deep sequencing, to capture tumor evolution across primary and metastatic sites and to quantify the utility of resampling. We assembled a cohort of 219 high-risk pediatric oncology patients, including solid tumors, CNS tumors, leukemias/lymphomas, patients with relapsed/refractory disease (75), metastatic disease at diagnosis (7), rare diagnoses (17), prior cancer history, and estimated overall survival 50%. We characterized 286 samples with WGS (tumor ~60X; germline ~30X) and/or RNAseq (polyA selected, ≥20 million reads), including 95 samples taken from 44 patients at different time points (diagnosis, relapse, etc. ). Variants, structural rearrangements, mutational signatures, and copy-number alterations were identified using WGS. RNAseq was used to profile gene expression outliers, gene fusions, and expression of variants. Integrated results were used to prioritize potentially actionable variants. For 20 patients (44 samples), we performed targeted deep sequencing of the DNA (~500X). RNAseq identified potentially druggable outlier gene expression and fusions, including 102 novel fusions where the 3’ gene is overexpressed. WGS identified aneuploidy, loss of heterozygosity and whole genome duplication across histotypes. Mutational burden and mutational signatures analyses identified profound effects from platinum drugs on tumor evolution, but treatment effects were not universal. Multiple sampling per patient uncovered drastic spatial and temporal differences in the genomes and transcriptomes of these tumors. Custom deep sequencing confirmed these findings, captured evolution missed by WGS, and furthered our understanding of the complex impacts of treatment on clonal evolution. Histotypes differed by whether actionability was higher for WGS or RNAseq alone, but in 66% of samples modality integration increased actionability. Integration also identified a subset of tumors that may be amenable to immunotherapy, but which lack canonical markers of response. Longitudinal analysis highlighted both the opportunities and risks of targeted therapy, with targetable variants gained and lost between timepoints. Our study shows that integrated multi-modality sequencing can elucidate novel insights into the biology of pediatric cancers and identify potential therapeutic targets not detected using gene-panel testing alone. Citation Format: Henry J. Martell, Avanthi T. Shah, Alex G. Lee, Stanley G. Leung, Soo-Jin Cho, María Pons Ventura, Ana Golla, Amanda E. Marinoff, Elizabeth P. Young, Bogdan Tanasa, Inge Behroozfard, Heng-Yi Liu, Aviv Spillinger, Michelle L. Turski, Nicole Elzie-Tuttle, Carlos Espinosa-Mendez, Arun Rangaswami, Tabitha M. Cooney, Cassie Kline, Anurag Agrawal, Jennifer Michlisch, Elliot Stieglitz, Mignon Loh, Amit J. Sabnis, Kieuhoa T. Vo, Sheri Spunt, Norman Lacayo, Holly C. Beal, Florette K. Hazard, Sophie Salama, David Haussler, Olena M. Vaske, Marcus R. Breese, E. Alejandro Sweet-Cordero. Integrative longitudinal genomic analysis of therapy-resistant and metastatic pediatric cancers abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts) ; 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84 (6Suppl): Abstract nr 1759.