Clonal evolution of chemotherapy-resistant urothelial carcinoma

BM Faltas, D Prandi, ST Tagawa, AM Molina… - Nature …, 2016 - nature.com
BM Faltas, D Prandi, ST Tagawa, AM Molina, DM Nanus, C Sternberg, J Rosenberg
Nature genetics, 2016nature.com
Chemotherapy-resistant urothelial carcinoma has no uniformly curative therapy.
Understanding how selective pressure from chemotherapy directs the evolution of urothelial
carcinoma and shapes its clonal architecture is a central biological question with clinical
implications. To address this question, we performed whole-exome sequencing and
clonality analysis of 72 urothelial carcinoma samples, including 16 matched sets of primary
and advanced tumors prospectively collected before and after chemotherapy. Our analysis …
Abstract
Chemotherapy-resistant urothelial carcinoma has no uniformly curative therapy. Understanding how selective pressure from chemotherapy directs the evolution of urothelial carcinoma and shapes its clonal architecture is a central biological question with clinical implications. To address this question, we performed whole-exome sequencing and clonality analysis of 72 urothelial carcinoma samples, including 16 matched sets of primary and advanced tumors prospectively collected before and after chemotherapy. Our analysis provided several insights: (i) chemotherapy-treated urothelial carcinoma is characterized by intra-patient mutational heterogeneity, and the majority of mutations are not shared; (ii) both branching evolution and metastatic spread are very early events in the natural history of urothelial carcinoma; (iii) chemotherapy-treated urothelial carcinoma is enriched with clonal mutations involving L1 cell adhesion molecule (L1CAM) and integrin signaling pathways; and (iv) APOBEC-induced mutagenesis is clonally enriched in chemotherapy-treated urothelial carcinoma and continues to shape the evolution of urothelial carcinoma throughout its lifetime.
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