30 Apr Biomarker Mutations Offer Prognostic Value in Uveal Melanoma
MedicalResearch.com Interview with:
University of Miami Miller School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Harbour: Uveal melanoma (UM) is the most common primary cancer of the eye which has the fatal tendency to metastasis to the liver. The molecular landscape of UMs have been well characterized and can be categorized by gene expression profiling (GEP) into two molecular classes associated with metastatic risk: Class 1 (low risk) and Class 2 (high risk). The Class 2 profile is strongly associated with mutations in the tumor suppressor BAP1. This GEP-based test is the only prognostic test for UM to undergo a prospective multicenter validation, an it is available commercially as DecisionDX-UM (Castle Biosciences, Inc). It is routinely used in many North American centers.
The identification of driver mutations in cancer has become a focus of precision medicine for prognostic and therapeutic decision making in oncology. In UM, thus far, only 5 genes have been reported to be commonly mutated: BAP1, GNA11, GNAQ, EIF1AX, and SF3B1. In this study, we analyzed the associations between these 5 mutations, and with GEP classification, clinicopathologic features, and patient outcomes. The study showed that GNAQ and GNA11 are mutually exclusive, probably occur early in tumor formation, and are not associated with prognosis. In contrast, BAP1, SF3B1, and EIF1AX, which are also nearly mutually exclusive, likely occur later in tumor formation and do have prognostic value in UM.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Harbour: These findings suggest that BAP1, SF3B1, and EIF1AX mutations may have clinical value as prognostic markers in Uveal melanoma. Since the GEP remains the most prognostic biomarker in UM, the mutational landscape could supplement the GEP for prognostication. Several of these markers are also potential therapeutic targets that could guide the selection of a specific treatment on an individual patient basis.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Harbour: We will be conducting a prospective, 28 center study to evaluate the prognostic value of these mutations as well as another biomarker that we recently reported called PRAME. This could have clinical implications for precision medicine and may aid in the stratification of Uveal melanoma patients for clinical trials.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Harbour: Mutations in GNAQ and GNA11 occur early in uveal melanoma development and are not prognostically significant. In contrast, mutations in BAP1, SF3B1 and EIF1AX occur later in tumor progression in a nearly mutually exclusive manner, and they are associated with high, intermediate and low metastatic risk, respectively.
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Decatur CL, Ong E, Garg N, et al. Driver Mutations in Uveal Melanoma: Associations With Gene Expression Profile and Patient Outcomes. JAMA Ophthalmol. Published online April 28, 2016. doi:10.1001/jamaophthalmol.2016.0903.
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