Research Papers:

Molecular driver alterations and their clinical relevance in cancer of unknown primary site

Harald Löffler, Nicole Pfarr, Mark Kriegsmann, Volker Endris, Thomas Hielscher, Philipp Lohneis, Gunnar Folprecht, Albrecht Stenzinger, Manfred Dietel, Wilko Weichert and Alwin Krämer _

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Oncotarget. 2016; 7:44322-44329. https://doi.org/10.18632/oncotarget.10035

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Harald Löffler1,*, Nicole Pfarr2,3,*, Mark Kriegsmann2,*, Volker Endris2, Thomas Hielscher4, Philipp Lohneis5, Gunnar Folprecht6, Albrecht Stenzinger2,7, Manfred Dietel5, Wilko Weichert2,3,8,9,#, Alwin Krämer1,9,#

1Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Medicine V, University of Heidelberg, Heidelberg, Germany

2Institute of Pathology, University of Heidelberg, Heidelberg, Germany

3Institute of Pathology, Technische Universität München, Munich, Germany

4Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany

5Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany

6Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany

7Department of Pathology, Center for Integrated Diagnostics (CID), Massachusetts General Hospital/Harvard Medical School, Boston, USA

8National Center of Tumor Diseases (NCT), Heidelberg, Germany

9Member of The German Cancer Consortium (DKTK), Heidelberg, Germany

*These authors contributed equally to this work shared first authorship

#These authors contributed equally to this work shared last authorship

Correspondence to:

Alwin Krämer, email: [email protected]

Wilko Weichert, email: [email protected]

Keywords: CUP, carcinoma of unknown primary, massive parallel sequencing, driver mutations, p53

Received: April 19, 2016     Accepted: May 29, 2016     Published: June 14, 2016


Cancer of unknown primary (CUP) is defined as metastatic solid malignancy where no primary tumor is detected despite appropriate staging. About 90% of CUP represent adenocarcinoma or undifferentiated carcinoma. Since therapy regimens are only modestly effective, identification of the molecular landscape of these neoplasms might be a promising approach to direct CUP therapy and aid in tumor classification. We screened a cohort of 128 patients with adenocarcinoma or undifferentiated carcinoma meeting the definition of CUP. Massive parallel multigene sequencing of 50 genes, which had been selected due to their relevance as oncogenic drivers or druggable molecular targets could ultimately be performed on samples from 55 patients for whom complete clinical datasets were also available. Overall, 60 tumor-specific mutations and 29 amplifications/deletions, as revealed by coverage analysis, were detected in 46 cases (84%). The most frequently mutated genes were TP53 (30 cases, 55%), KRAS (9 cases, 16%), CDKN2A (5 cases, 9%), and SMAD4 (5 cases, 9%). The most frequently deleted gene was CDKN2A (8 cases, 15%). KRAS and CDKN2A mutations significantly correlated with poor progression-free survival (PFS) and, in case of KRAS, overall survival (OS). WIldtype TP53 and female sex defined a relatively favorable category, with favorable PFS and OS. 8 cases (15%) harbored mutations that may be targetable by currently approved drugs. Taken together, Mutations of relevant driver genes are present in the vast majority of CUP tumors. Some of them impact on prognosis and a subset is putatively druggable.

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