Therapeutic relevance of molecular screening program in patients with metastatic sarcoma: Analysis from the ProfiLER 01 trial

Abstract

Background Advanced sarcoma is a group of heterogeneous disease with poor prognosis and poor efficacy of medical treatment. They represent a promising group of tumors to assess molecular-based therapy (MBT) strategy. Patients and methods Genomic profiles of patients with advanced sarcoma included in the ProfiLER program were established by NGS using a 69 genes panel and CGH array. A weekly molecular board reviewed genomic reports to select relevant genomic alterations and propose recommendations for MBT. Results A genomic profile was available for 158 of 164 patients. At least 1 relevant genomic alteration was reported for 106 patients (67%), with frequent multiple alterations (68%). In total, 289 relevant genomic alterations were identified in 143 different genes; 139 homozygous deletions, 86 gene amplifications and 64 somatic mutations. The most frequently impacted genes were TP53, Rb1, CDKN2A, CDK4, MDM2, and PTEN. MBT was recommended for 47 patients and initiated for 13 patients. One objective response was observed for an angiosarcoma treated with pazopanib for FLT4 amplification; 4 patients had a stable disease, including a long-lasting 33 months stabilization. Conclusion Genomic profiling for advanced sarcoma is feasible, even for bone sarcoma. A small proportion of patients are eventually treated with MBT, similar to other tumor types. We could not demonstrate this strategy to be beneficial to patients. Our data suggest that molecular profiling should not be used in routine practice but warrants further exploration in clinical trials, focusing on sarcoma with complex genomic, and adding transcriptomic analysis to the copy number and mutational analyses.

The 2020 WHO Classification of Soft Tissue Tumours: news and perspectives

“…An unavoidable consequence of using molecular genetics as the main driver for tumour classification is to generate a debate regarding the principles behind the definition of a tumour entity. Moreover, the advent of “precision oncology” has generated the (mis) concept that extensive molecular profiling of cancer is the only way to improve patients’ outcome 71 . The underlying ambition would be the generation of a new taxonomy of human cancer based on molecular genetics, aimed to replace histology-based classifications.…”

Case report: Unique FLT4 variants associated with differential response to anlotinib in angiosarcoma

“…Arnaud-Coffin et al. ( 37 ) also reported a partial response to pazopanib in an FLT4 amplified angiosarcoma patient, but with a worse PFS of 3.1 months. FLT 4 amplification was also reported to be a poor prognostic factor for ASs ( 38 ).…”

New molecular targets in canine hemangiosarcoma—Comparative review and future of the precision medicine

“…Veterinarians can get into serious troubles by trying non‐conventional attempts in their practice, but subtle changes might be easier and more acceptable for dog owners. Thus far, unfortunately, molecular profiling cannot be used in clinical practice because it warrants further studies, based on clinical trials involving sarcomas with complex genomics 298 …”