Comprehensive Sarcoma Genomic Profiling, in record time. Accurate. Clinically Proven. Fast.

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1 Comprehensive Sarcoma Genomic Profiling, in record time Accurate. Clinically Proven. Fast.

2 Morphologic diagnosis based on microscopic examination of histologic sections remains the gold standard for sarcoma diagnosis. However, several ancillary techniques are useful in support of morphologic diagnosis, including immunohistochemistry, classical cytogenetics, electron microscopy, and molecular genetic testing. Molecular genetic testing has emerged as a particularly powerful ancillary testing approach since many sarcoma types harbor characteristic genetic aberrations, including single base pair substitutions, deletions and amplifications, and translocations. Recurrent genetic aberrations in sarcoma are listed below: Tumor Abbreviation Gene(s) Involved Malignant Round Cell Tumors Alveolar RMS t(2;13)(q35;q14) PAX3-FOX01 t(1;13)(p36;p14 PAX7-FOX01 t(x;2)(q13;q35) PAX3-AFX Desmoplastic small round cell tumor t(11;22)(p13;q12) EWSR1-WT1 Embryonal RMS Complex alterations Multiple, MYOD1 mutation Ewing sarcoma/peripheral t(11;22)(q24;q12) EWSR1-FLI1 neuroectodermal tumor t(21;22(q22;q12) EWSR1-ERG t(2;22)(q33;q12) EWSR1-FEV t(7;22)(p22;q12) EWSR1-ETV1 t(17;22)(q12;q12) EWSR1-E1AF inv(22)(q12;q12) EWSR1-ZSG t(16;21)(p11;q22) FUS-ERG Lipomatous Tumors Atypical lipomatous tumor/well- Supernumerary ring Amplification of region 12q14-15, differentiated liposarcoma (ALT/WDLS) chromosomes; giant marker including MDM,2, CDK4, HMGA2 chromosomes SAS,GL1 Dedifferentiated liposarcoma Same as for ALT/WDLS Same as for ALT/WDLS Myxoid/round cell liposarcoma t(12;16)(q13;p11) FUS-DD1T3 t(12;22)(q13;p12) EWSR1-DD1T3 Pleomorphic liposarcoma Complex alterations Unknown Other Sarcomas Alveolar soft part sarcoma der(17)t(x;17)(p11;q25) ASPL-TFE3 Angiomatoid fibrous histiocytoma t(12;22)(q13;q12) EWSR1-ATF1 t(2;22)(q33;q12) EWSR1-CREB1 t(12;16)(q13;p11) FUS-ATF1 Clear cell sarcoma t(12;22)(q13;q12) EWSR1-ATF1 t(2;22)(q33;q12) EWSR1-CREB1 Congenital/infantile fibrosarcoma t(12;15)(p13;q25) ETV6-NTRK3 P 1. V

3 Tumor Abbreviation Gene(s) Involved Other Sarcomas (continued) Dermatofibrosarcoma protuberans t(17;22)(q21;q13 and COLIA1-PDGFB derivative ring chromosomes Desmoid fibromatosis Trisomy 8 or 20; loss of 5q21 CTNNB1 or APC mutations Epithelioid hemangioendothelioma t(1;13)(p36;q25) WWTR1-CAMTA1 t(x;11)(q22;p11.23) YAP1-TFE3 Epithelioid sarcoma Inactivation, deletion, or INI1 (SMARCB-1) mutation of INI1 (SMARCB-1) Extrarenal rhabdoid tumor Inactivation of INI1 (SMARCB1) INI1 (SMARCB-1) Extraskeletal myxoid chondrosarcoma t(9;22)(q22;q12) EWSR1-NR4A3 t(9;17)(q22;q11) TAF2N-NR4A3 t(9;15)(q22;q21) TCF12-NR4A3 t(3;9)(q11;q22) TFG-NR4A3 Sporadic and familial GIST Activating kinase mutations KIT or PDGFRA Carney-Stratakis syndrome Krebs cycle mutations germline SDH subunit mutations (gastric GIST and paraganglioma) Inflammatory myofibroblastic tumor (IMT) t(1;2)(q22;p23) t(2;19)(p23;p13) t(2;17)(p23;q23) t(2;2)(p23;q13) t(2;11)(p23;q35) Inv(2)(p23;q35) TPM3- TPM4- CLTC- RANBP2- CARS- ATIC- Leiomyosarcoma Complex alterations Unknown Low-grade fibromyxoid sarcoma t(7;16)(q33;p11) FUS-CREB3L2 t(11;16)(p11;p11) FUS-CREB3L1 Malignant peripheral nerve sheath tumor Mesenchymal chondrosarcoma Solitary fibrous tumor NF1, CDKN2A and EED or SUZ12 HEY1-NCOA2 NAB2-STAT6 Synovial sarcoma t(x;18)(p11;q11) SS18-SSX1 t(x;18)(p11;q11) SS18-SSX2 t(x;18)(p11;q11) SS18-SSX4 Tenosynovial giant cell tumor/ t(1;2)(p13;q35) CSF1 pigmented villonodular synovitis (TGCT/PVNS) P 2. V

4 This table is not exhaustive for either sarcomas with characteristic genetic changes or the genes involved. For example, additional genetic aberrations found in alveolar RMS including PAX3-NCOA1, PAX3- NCOA2, and PAX3-INO80D. CIC-DUX4 fusion is present in primitive round or short spindle cell sarcomas, resulting from translocation of t(4;19) (q35;q13) or t(10;19)(q26;q13). It is not clear if this is an entirely new subtype of sarcoma or a new subtype of Ewing sarcoma. BCOR-CCNB3 fusion is considered Ewing-like sarcoma. NCOA2 gene rearrangements and MyoD mutation have been identified in spindle cell RMS. MIR143-NOTCH fusion has recently been identified in glomus tumor. Receptor tyrosine kinase/ras/pik3ca aberrations are found in 93% of RMS cases. Loss of TSC1 (9q34) or TSC2 (16p13.3) (mtor pathway) or gene fusions of the TFE3 gene (microphthalmia-associated transcription factor family) have been identified in PEComa. MPNST is associated with loss of SUZ12/EED and alteration of NF1 and CDKN2A. Consultation with a physician who has expertise in sarcoma diagnosis and molecular diagnostic techniques should be obtained. SYSTEMIC THERAPY AGENTS AND REGIMENS WITH ACTIVITY IN SOFT TISSUE SARCOMA SUBTYPES (NON-SPECIFIC) Soft Tissue Subtypes with Non-Specific Histologies GIST k Desmoid Tumors (Aggressive fibromatosis) Combination regimens Single agents Imatinib Sulindac or other non-steroidal anti inflammatory AD (Doxorubicin, dacarbazine) Doxorubicin Sunitinib drugs (NSAIDs), including celecoxib AIM (doxorubicin, ifosfamide, Ifosfamide Regorafenib Tamoxifen+sulindac mesna) Epirubicin Disease progression Toremifene MAID (Mesna, Doxorubicin, Gemcitabine after imatinib, Methotrexate and vinblastine ifosfamide, dacarbazine) Dacarbazine sunitinib and Low-dose interferon ifosfamide, epirubicin, mesna Liposomal doxorubicin regorafenib Doxorubicin-based regimens Gemcitabine and doxetaxel Temozolomide Sorafenib Imatinib Gemcitabine and vinorelbine Vinorelbine Nilotinib Sorafenib Gemcitabine and dacarbazine Trabectedin Dasatinib (for Methotrexate and vinorelbine Doxorubicin and olaratumab Pazopanib patients with Liposomal doxorubicin D842V mutation) Pazopanib Everolimus + TKI Non-Pleomorphic Rhabdomyosarcoma Combination regimens Single Agents Vincristine, dactinomycin, cyclophosphamide Ifosfamide and etoposide Doxorubicin Vincristine, doxorubicin, cyclophosphamide Irinotecan and vincristine Irinotecan Vincristine, doxorubicin, and cyclophosphamide Vincristine and dactinomycin Topotecan alternating with ifosfamide and etoposide Carboplatin and etoposide Vinorelbine Vincristine, doxorubicin, ifosfamide Vinorelbine and low-dose High-dose methotrexate Cyclophosphamide and topotecan cyclophosphamide Trabectedin Ifosfamide and doxorubicin Vincristine, irinotecan, temozolomide Pigmented Villonodular Synovitis/Tenosynovial Giant Cell Tumor (PVNS/TGCT) Imatinib Angiosarcoma Paclitaxel Docetaxel Vinorelbine Sorafenib Sunitinib Bevacizumab Solitary Fibrous Tumor/Hemangiopericytoma Bevacizumab and temozolomide Sunitinib Sorafenib P 3. V

5 SYSTEMIC THERAPY AGENTS AND REGIMENS WITH ACTIVITY IN SOFT TISSUE SARCOMA SUBTYPES (NON-SPECIFIC) (CONTINUED) Alveolar Soft Part Sarcoma (ASPS) Sunitinib (category 2B) PEComa, Recurrent Angiomyolipoma, Lymphangioleiomyomatosis Sirolimus Everolimus Temsirolimus Inflammatory Myofibroblastic Tumor (IMT) with Anaplastic Lymphoma Kinase () Translocation Crizotinib Ceritinib Well-differentiated/Dedifferentiated Liposarcoma (WD-DDLS) for Retroperitoneal Sarcomas Palbociclib PARADIGM PCDx GENE LIST DNA MUTATION COPY NUMBER VARIATION mrna EXPRESSION PROTEIN EXPRESSION BY IHC FUSION PANEL SARCOMA FUSION PANEL ABCB1 AKT1 BRAF BRCA1 BRCA2 CHEK1 CREBBP CSF1R DDR2 EGFR EP300 EPHA5 ERBB2 ERBB4 ERCC2 ERRFI1 ESR1 EZH2 FGD4 FGFR2 FGFR3 FLT3 GATA3 GNAQ GNAS HRAS IGF1R IDH1 IDH2 KIT KRAS MAP2K1 MAP2K2 MAP3K1 MDM2 MSH6 MSI MTOR NRAS PDGFRA PIK3CA PTCH1 RET SMO STAT3 TGFBR2 TP53 TSC1 TSC2 19Q 1P AURKA C11ORF30 CCND1 CCND2 CCND3 CCNE1 CDK4 CDK6 CDKN2A EGFR ERBB2 FGF3 FGF4 FGFR1 FGFR2 FGFR3 MYC MYCN NTRK1 SMAD4 TOP2A VEGFA AR AREG ARID1A BAD BAX BCL2 BIRC5 BRCA1 CA9 CDA CDH1 CES2 CHUK DCK DHFR DPYD EPHA2 ERBB2 ERBB3 ERCC1 EREG ESR1 EZH2 FGFR1 IGF1R KDR KIT LRP6 MGMT MITF MTOR NFKB1 PARP1 PDGFRB PGR PTEN PTGS2 PTPN6 RELA RPS6KB1 RRM1 SLC29A1 SSTR2 TNFSF13 TOP2A TUBB3 TYMP TYMS VEGFA AR CAIX ER HENT1 HER2 IDO MGMT PD1 PDL1 PR PTEN RET TOPO1 TP TRKPAN TS TUBB3 MLH1 MSH2 MSH6 PMS2 AXL BRAF CCND1 FGFR1 FGFR2 FGFR3 NRG1 NTRK1 NTRK2 NTRK3 PPARG RAF1 RET THADA ISOFORMS: EGFR VIII EXON 14 SKIPPING CAMTA1 CCNB3 CIC EPC1 EWSR1 FOXO1 FUS GLI1 HMGA2 JAZF1 MEAF6 MKL2 NCOA2 NTRK3 PDGFB PLAG1 SS18 STAT6 TAF15 TCF12 TFE3 TFG USP6 YWHAE P 4. V

6 Accurate. 5000x average depth of coverage Low sample rejection (QNS) rates (6% vs. 18%) 6 Clinically Proven. Analyzes Tumor DNA, RNA & Protein Prospective data published showing improvement in Progression Free Survival (PFS) 7 Provides associations to >80 single agent and combination therapies Full PCDx results possible from >5% tumor; including FNAs Fast. Results delivered in 4 to 5 business days Reduces time to next therapy Ensures continuity of clinical care PCDx can help identify the best cancer treatment options for you today. Start getting better results, faster. For more information, please contact Client Services at or visit paradigmdx.com