PURPOSE: A low mutation rate seems to be a general feature of pediatric cancers, in particular in oncofusion gene-driven tumors. Genetically, Ewing sarcoma is defined by balanced chromosomal EWS/ETS translocations, which give rise to oncogenic chimeric proteins (EWS-ETS). Other contributing somatic mutations involved in disease development have only been observed at low frequency. EXPER-IMENTAL DESIGN: Tumor samples of 116 Ewing sarcoma patients were analyzed here. Whole-genome sequencing was performed on two patients with normal, primary, and relapsed tissue. Whole-exome sequencing was performed on 50 Ewing sarcoma and 22 matched normal tissues. A discovery dataset of 14 of these tumor/normal pairs identified 232 somatic mutations. Recurrent nonsynonymous mutations were validated in the 36 remaining exomes. Transcriptome analysis was performed in a subset of 14 of 50 Ewing sarcomas and DNA copy number gain and expression of FGFR1 in 63 of 116 Ewing sarcomas. RESULTS: Relapsed tumors consistently showed a 2-to 3-fold increased number of mutations. We identified several recurrently mutated genes at low frequency (ANKRD30A, CCDC19, KIAA0319, KIAA1522, LAMB4, SLFN11, STAG2, TP53, UNC80, ZNF98). An oncogenic fibroblast growth factor receptor 1 (FGFR1) mutation (N546K) was detected, and the FGFR1 locus frequently showed copy number gain (31.7%) in primary tumors. Furthermore, high-level FGFR1 expression was noted as a characteristic feature of Ewing sarcoma. RNA interference of FGFR1 expression in Ewing sarcoma lines blocked proliferation and completely suppressed xenograft tumor growth. FGFR1 tyrosine kinase inhibitor (TKI) therapy in a patient with Ewing sarcoma relapse significantly reduced 18-FDG-PET activity. CONCLUSIONS: FGFR1 may constitute a promising target for novel therapeutic approaches in Ewing sarcoma.

The delicate anatomy of the ear require surgeons to use great care when operating on its internal structures. One example for such an intervention is the stapedectomy, where a small crook shaped piston is placed in the oval window of the cochlea and connected to the incus through crimping thus bypassing the diseased stapes. Performing the crimp process with the correct force is necessary since loose crimps poorly transmit sound whereas tight crimps will eventually result in necrosis of the incus. Clinically, demand is high to reproducibly conduct the crimp process through a precise force measurement. For this reason, we have developed a fiber Bragg grating (FBG) integrated microforceps for use in such interventions. This device was calibrated, and tested in cadaver preparations. With this instrument we were able to measure for the first time forces involved in crimping a stapes prosthesis to the incus. We also discuss a method of attaching and actuating such forceps in conjunction with a robot currently under development in our group. Each component of this system can be used separately or combined to improve surgical accuracy, confidence and outcome.

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<p>Supplementary Figures S1-6. Supplementary Fig S1: Combined patient characteristics and subjected methods Supplementary Fig. S2 A: ROC curves were constructed by using the somatic scores from the sequenced genotypes. Supplementary Fig. S3: Circos plots of representative Ewing sarcomas. Supplementary Fig. S4: Sanger sequencing results confirmed (A) somatic inactivating mutations of the STAG2 gene (positions according to RefSeq NG 033796.2) and (B) the activating N546 mutation of FGFR1. Supplementary Fig. S5: FGFR-1 expression in Ewing Sarcomas by means of real time RT PCR (A, normalized to FGFR-1 expression in VH-64). (B) Array-based analysis of FGFR1 expression in ES compared to normal tissue (NBA; SI Materials and Methods). (C) Knock-down by means of lentiviral transduced FGFR1.shRNA effectively reduced FGFR1 mRNA expression by 70 % or more in Ewing sarcoma cell lines as compared to scrambled shRNA. (D) Knockdown was confirmed on the protein level by means of western blotting. Supplementary Fig. S6: Amplification of the FGFR-1 gene (A) as well as gene expression (B) are associated with a trend towards inferior survival in patients with ES. (C) Treatment with Ponatinib inhibited growth of ES cell lines significantly. (D) FGFR1 tyrosine kinase inhibitor therapy in a patient with relapsed Ewing sarcoma.</p>

<p>Supplementary Tables S1-6. Table S1: Validation of somatic mutations by Sanger sequencing for construction of ROC Table S2: Characteristics of the discovery data set for exome sequencing Table S3: Somatic mutations in the discovery data set (filtered with MutSigCV1.6) Table S4: Recurrent non-synonymous mutations (filtered with MutSigCV1.6) Table S5: Characteristics of the expression data set. Table S6 : Shared mutations in consecutive sarcomas</p>

<div>Abstract<p><b>Purpose:</b> A low mutation rate seems to be a general feature of pediatric cancers, in particular in oncofusion gene-driven tumors. Genetically, Ewing sarcoma is defined by balanced chromosomal <i>EWS/ETS</i> translocations, which give rise to oncogenic chimeric proteins (EWS-ETS). Other contributing somatic mutations involved in disease development have only been observed at low frequency.</p><p><b>Experimental Design:</b> Tumor samples of 116 Ewing sarcoma patients were analyzed here. Whole-genome sequencing was performed on two patients with normal, primary, and relapsed tissue. Whole-exome sequencing was performed on 50 Ewing sarcoma and 22 matched normal tissues. A discovery dataset of 14 of these tumor/normal pairs identified 232 somatic mutations. Recurrent nonsynonymous mutations were validated in the 36 remaining exomes. Transcriptome analysis was performed in a subset of 14 of 50 Ewing sarcomas and DNA copy number gain and expression of FGFR1 in 63 of 116 Ewing sarcomas.</p><p><b>Results:</b> Relapsed tumors consistently showed a 2- to 3-fold increased number of mutations. We identified several recurrently mutated genes at low frequency (<i>ANKRD30A, CCDC19, KIAA0319, KIAA1522, LAMB4, SLFN11, STAG2, TP53, UNC80, ZNF98</i>). An oncogenic fibroblast growth factor receptor 1 (<i>FGFR1</i>) mutation (N546K) was detected, and the <i>FGFR1</i> locus frequently showed copy number gain (31.7%) in primary tumors. Furthermore, high-level FGFR1 expression was noted as a characteristic feature of Ewing sarcoma. RNA interference of FGFR1 expression in Ewing sarcoma lines blocked proliferation and completely suppressed xenograft tumor growth. FGFR1 tyrosine kinase inhibitor (TKI) therapy in a patient with Ewing sarcoma relapse significantly reduced 18-FDG-PET activity.</p><p><b>Conclusions:</b> FGFR1 may constitute a promising target for novel therapeutic approaches in Ewing sarcoma. <i>Clin Cancer Res; 21(21); 4935–46. ©2015 AACR</i>.</p></div>

<div>Abstract<p><b>Purpose:</b> A low mutation rate seems to be a general feature of pediatric cancers, in particular in oncofusion gene-driven tumors. Genetically, Ewing sarcoma is defined by balanced chromosomal <i>EWS/ETS</i> translocations, which give rise to oncogenic chimeric proteins (EWS-ETS). Other contributing somatic mutations involved in disease development have only been observed at low frequency.</p><p><b>Experimental Design:</b> Tumor samples of 116 Ewing sarcoma patients were analyzed here. Whole-genome sequencing was performed on two patients with normal, primary, and relapsed tissue. Whole-exome sequencing was performed on 50 Ewing sarcoma and 22 matched normal tissues. A discovery dataset of 14 of these tumor/normal pairs identified 232 somatic mutations. Recurrent nonsynonymous mutations were validated in the 36 remaining exomes. Transcriptome analysis was performed in a subset of 14 of 50 Ewing sarcomas and DNA copy number gain and expression of FGFR1 in 63 of 116 Ewing sarcomas.</p><p><b>Results:</b> Relapsed tumors consistently showed a 2- to 3-fold increased number of mutations. We identified several recurrently mutated genes at low frequency (<i>ANKRD30A, CCDC19, KIAA0319, KIAA1522, LAMB4, SLFN11, STAG2, TP53, UNC80, ZNF98</i>). An oncogenic fibroblast growth factor receptor 1 (<i>FGFR1</i>) mutation (N546K) was detected, and the <i>FGFR1</i> locus frequently showed copy number gain (31.7%) in primary tumors. Furthermore, high-level FGFR1 expression was noted as a characteristic feature of Ewing sarcoma. RNA interference of FGFR1 expression in Ewing sarcoma lines blocked proliferation and completely suppressed xenograft tumor growth. FGFR1 tyrosine kinase inhibitor (TKI) therapy in a patient with Ewing sarcoma relapse significantly reduced 18-FDG-PET activity.</p><p><b>Conclusions:</b> FGFR1 may constitute a promising target for novel therapeutic approaches in Ewing sarcoma. <i>Clin Cancer Res; 21(21); 4935–46. ©2015 AACR</i>.</p></div>