Journal
JOURNAL OF CLINICAL ONCOLOGY
Volume 36, Issue 35, Pages 3485-+Publisher
AMER SOC CLINICAL ONCOLOGY
DOI: 10.1200/JCO.2018.79.0352
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Funding
- Department of Defense [CA150220]
- National Cancer Institute (NCI) [R01 CA198138]
- University of Hawaii Foundation
- Honeywell International
- Riviera United 4-a Cure grant
- Early Detection Research Network NCI [5U01CA111295-08]
- KAKENHI [26460689, 25460710, 24590715, 15K08658]
- Hyogo College of Medicine, 2017
- Melohn family endowment
- Grants-in-Aid for Scientific Research [26460689, 25460710, 24590715, 15K08658] Funding Source: KAKEN
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Purpose We hypothesized that four criteria could help identify malignant mesotheliomas (MMs) most likely linked to germline mutations of BAP1 or of other genes: family history of MM, BAP1-associated cancers, or multiple malignancies; or age younger than 50 years. Patients and Methods Over the course of 7 years, 79 patients with MM met the four criteria; 22 of the 79 (28%) reported possible asbestos exposure. They were screened for germline BAP1 mutations by Sanger sequencing and by targeted next-generation sequencing (tNGS) for germline mutations in 55 additional cancer-linked genes. Deleterious mutations detected by tNGS were validated by Sanger sequencing. Results Of the 79 patients, 43 (16 probands and 27 relatives) had deleterious germline BAP1 mutations. The median age at diagnosis was 54 years and median survival was 5 years. Among the remaining 36 patients with no BAP1 mutation, median age at diagnosis was 45 years, median survival was 9 years, and 12 had deleterious mutations of additional genes linked to cancer. When compared with patients with MMs in the SEER cohort, median age at diagnosis (72 years), median survival for all MM stages (8 months), and stage I (11 months) were significantly different from the 79 patients with MM in the current study (P < .0001). Conclusion We provide criteria that help identify a subset of patients with MM who had significantly improved survival. Most of these patients were not aware of asbestos exposure and carried either pathogenic germline mutations of BAP1 or of additional genes linked to cancer, some of which may have targeted-therapy options. These patients and their relatives are susceptible to development of additional cancers; therefore, genetic counseling and cancer screening should be considered. (c) 2018 by American Society of Clinical Oncology
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