Aromatase inhibition remodels the clonal architecture of estrogen-receptor-positive breast cancers

Christopher A. Miller, Yevgeniy Gindin, Charles Lu, Obi L Griffith, Malachi Griffith, Dong Shen, Jeremy Hoog, Tiandao Li, David E. Larson, Mark Watson, Sherri R Davies, Kelly Hunt, Vera J. Suman, Jacqueline Snider, Thomas Walsh, Graham A. Colditz, Katherine DeSchryver, Richard K. Wilson, Elaine R. Mardis () and Matthew J. Ellis ()
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Christopher A. Miller: McDonnell Genome Institute, Washington University School of Medicine
Yevgeniy Gindin: McDonnell Genome Institute, Washington University School of Medicine
Charles Lu: McDonnell Genome Institute, Washington University School of Medicine
Obi L Griffith: McDonnell Genome Institute, Washington University School of Medicine
Malachi Griffith: McDonnell Genome Institute, Washington University School of Medicine
Dong Shen: McDonnell Genome Institute, Washington University School of Medicine
Jeremy Hoog: Washington University School of Medicine
Tiandao Li: McDonnell Genome Institute, Washington University School of Medicine
David E. Larson: McDonnell Genome Institute, Washington University School of Medicine
Mark Watson: Washington University School of Medicine
Sherri R Davies: Washington University School of Medicine
Kelly Hunt: MD Anderson Cancer Center
Vera J. Suman: Alliance Statistics and Data Center, Mayo Clinic
Jacqueline Snider: Washington University School of Medicine
Thomas Walsh: St Louis Breast Tissue Registry, Washington University School of Medicine
Graham A. Colditz: Siteman Cancer Center, Washington University School of Medicine
Katherine DeSchryver: Washington University School of Medicine
Richard K. Wilson: McDonnell Genome Institute, Washington University School of Medicine
Elaine R. Mardis: McDonnell Genome Institute, Washington University School of Medicine
Matthew J. Ellis: McDonnell Genome Institute, Washington University School of Medicine

Nature Communications, 2016, vol. 7, issue 1, 1-10

Abstract: Abstract Resistance to oestrogen-deprivation therapy is common in oestrogen-receptor-positive (ER+) breast cancer. To better understand the contributions of tumour heterogeneity and evolution to resistance, here we perform comprehensive genomic characterization of 22 primary tumours sampled before and after 4 months of neoadjuvant aromatase inhibitor (NAI) treatment. Comparing whole-genome sequencing of tumour/normal pairs from the two time points, with coincident tumour RNA sequencing, reveals widespread spatial and temporal heterogeneity, with marked remodelling of the clonal landscape in response to NAI. Two cases have genomic evidence of two independent tumours, most obviously an ER− ‘collision tumour’, which was only detected after NAI treatment of baseline ER+ disease. Many mutations are newly detected or enriched post treatment, including two ligand-binding domain mutations in ESR1. The observed clonal complexity of the ER+ breast cancer genome suggests that precision medicine approaches based on genomic analysis of a single specimen are likely insufficient to capture all clinically significant information.

Date: 2016
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DOI: 10.1038/ncomms12498

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