Abstract
Cancer drugs often induce dramatic responses in a small minority of patients. We used whole-genome sequencing to investigate the genetic basis of a durable remission of metastatic bladder cancer in a patient treated with everolimus, a drug that inhibits the mTOR (mammalian target of rapamycin) signaling pathway. Among the somatic mutations was a loss-of-function mutation in TSC1 (tuberous sclerosis complex 1), a regulator of mTOR pathway activation. Targeted sequencing revealed TSC1 mutations in about 8% of 109 additional bladder cancers examined, and TSC1 mutation correlated with everolimus sensitivity. These results demonstrate the feasibility of using whole-genome sequencing in the clinical setting to identify previously occult biomarkers of drug sensitivity that can aid in the identification of patients most likely to respond to targeted anticancer drugs.
Trial registration:
ClinicalTrials.gov NCT00805129.
MeSH terms
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Antineoplastic Agents / therapeutic use*
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Clinical Trials, Phase II as Topic
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Codon, Nonsense
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Disease-Free Survival
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Drug Resistance, Neoplasm / genetics*
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Everolimus
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Genome, Human
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Genome-Wide Association Study
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Humans
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Mechanistic Target of Rapamycin Complex 1
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Molecular Targeted Therapy
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Multiprotein Complexes
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Neoplasm Metastasis
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Neurofibromin 2 / genetics
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Proteins / antagonists & inhibitors
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Sequence Deletion
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Sirolimus / analogs & derivatives*
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Sirolimus / therapeutic use
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TOR Serine-Threonine Kinases
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Tuberous Sclerosis Complex 1 Protein
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Tumor Suppressor Proteins / genetics*
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Urinary Bladder Neoplasms / drug therapy*
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Urinary Bladder Neoplasms / genetics
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Urinary Bladder Neoplasms / pathology
Substances
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Antineoplastic Agents
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Codon, Nonsense
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Multiprotein Complexes
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Neurofibromin 2
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Proteins
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TSC1 protein, human
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Tuberous Sclerosis Complex 1 Protein
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Tumor Suppressor Proteins
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Everolimus
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Mechanistic Target of Rapamycin Complex 1
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TOR Serine-Threonine Kinases
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Sirolimus
Associated data
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ClinicalTrials.gov/NCT00805129