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Whole-Genome Sequencing Identifies Actionable Mutations in HCC

Published Online: Jan 16,2014
A research team at Cold Spring Harbor Laboratory in New York has succeeded in identifying the most common genetically altered genes and the major oncogenic drivers in hepatitis B virus-associated hepatocellular carcinoma (HCC). Their work has located and verified several “actionable” mutations, including, for the first time, novel and activating mutations in Janus kinase 1 (JAK1).

By means of a whole-genome sequencing study of 88 matched HCC tumor and normal pairs, 81 of which were HPV-positive, the scientists identified beta catenin as the most frequently mutated oncogene (15.9% of cases) and TP53 as the most frequently mutated gene suppressor (35.2% of cases). The Wnt/beta catenin (62.5% of cases) and JAK/STAT pathways (45.5% of cases) are likely to be two major oncogenic drivers in HCC, Kan et al reported in a June publication of Genome Research.

Several inhibitors of enzymes or key components of cancer pathways that are commonly altered in HCC are currently in clinical development for other indications (Table), and based upon their established role in HCC, warrant testing in preclinical models and in patients with HCC, the investigators maintained. In particular, the authors pointed to the potential value of assessing existing JAK inhibitors for the treatment of HCC. One JAKtargeted agent, ruxolitinib, which was recently approved by the FDA for the treatment of myelofibrosis, should be considered for testing in patients with HCC with activating JAK1 mutations, the authors recommended.

In addition, PARP inhibitors may play a therapeutic role in HCC. Olaparib has been shown to have efficacy in studies with BRCA-related ovarian and breast cancer. The DNA repair pathway is “extensively altered” in HCC, according to Kan and colleagues, who said that although these alterations remain to be tested, there is empirical evidence for including HCC in PARP-inhibitor trials.

Table. Potentially Actionable Mutations in HCC and Matched Clinical-Stage Inhibitors

Gene Mutation Amplification Deletion Combined Frequency Inhibitor
JAK1 JAK1 (9.1%) - - 9.1% JAK1 (ruxolitinib)
FAK JAK1 (9.1%) FAK (26.1%) - 26.1% FAKi (PF-04554878, PF-562271
- CCND1 (4.5%) CDKN2A (10.2%) 14.7% CDK4/6i(PD-0332991, LY835219, LEE011)
FGF19 - FGF19 (4.5%) - 4.5% FGFRi (brivanib, BG1398, LY874455)
BRCA1/2, PARP1 - BRCA1 (1.1%)
BRCA2 (5.7%)
- 25.0% PARPi (AG-14699, olaparib)

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Whole-Genome Sequencing Identifies Actionable Mutations in HCC
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