von Loga, K.
Woolston, A.
Punta, M.
Barber, L.
Griffiths, B.
Semiannikova, M.
Spain, G.
Challoner, B.
Fenwick, K.
Simon, R.
Marx, A.
Sauter, G.
Lise, S.
Matthews, N.
Gerlinger, M.
(2020). Extreme intratumour heterogeneity and driver evolution in mismatch repair deficient gastro-oesophageal cancer. Nature communications,
Vol.11
(1),
pp. 139-139.
show abstract
Mismatch repair deficient (dMMR) gastro-oesophageal adenocarcinomas (GOAs) show better outcomes than their MMR-proficient counterparts and high immunotherapy sensitivity. The hypermutator-phenotype of dMMR tumours theoretically enables high evolvability but their evolution has not been investigated. Here we apply multi-region exome sequencing (MSeq) to four treatment-naive dMMR GOAs. This reveals extreme intratumour heterogeneity (ITH), exceeding ITH in other cancer types >20-fold, but also long phylogenetic trunks which may explain the exquisite immunotherapy sensitivity of dMMR tumours. Subclonal driver mutations are common and parallel evolution occurs in RAS, PIK3CA, SWI/SNF-complex genes and in immune evasion regulators. MSeq data and evolution analysis of single region-data from 64 MSI GOAs show that chromosome 8 gains are early genetic events and that the hypermutator-phenotype remains active during progression. MSeq may be necessary for biomarker development in these heterogeneous cancers. Comparison with other MSeq-analysed tumour types reveals mutation rates and their timing to determine phylogenetic tree morphologies..
Challoner, B.R.
von Loga, K.
Woolston, A.
Griffiths, B.
Sivamanoharan, N.
Semiannikova, M.
Newey, A.
Barber, L.J.
Mansfield, D.
Hewitt, L.C.
Saito, Y.
Davarzani, N.
Starling, N.
Melcher, A.
Grabsch, H.I.
Gerlinger, M.
(2020). Computational image analysis of T-cell infiltrates in resectable gastric cancer: association with survival and molecular subtypes. J natl cancer inst,
.
show abstract
BACKGROUND: Gastric and gastro-oesophageal junction cancers (GCs) frequently recur after resection but markers to predict recurrence risk are missing. T-cell infiltrates have been validated as prognostic markers in other cancer types, but not in GC due to methodological limitations of past studies. We aimed to define and validate the prognostic role of major T-cell subtypes in GC by objective computational quantification. METHODS: Surgically resected chemotherapy-naïve GCs were split into discovery (n = 327) and validation (n = 147) cohorts. CD8 (cytotoxic), CD45RO (memory) and FOXP3 (regulatory) T-cell densities were measured through multicolour immunofluorescence and computational image analysis. Cancer specific survival (CSS) was assessed. All statistical tests were two-sided. RESULTS: CD45RO-cell and FOXP3-cell densities statistically significantly predicted CSS in both cohorts. Stage, CD45RO-cell and FOXP3-cell densities were independent predictors of CSS in multivariable analysis; mismatch repair (MMR) and Epstein-Barr Virus (EBV) status were not statistically significant. Combining CD45RO-cell and FOXP3-cell densities into the Stomach Cancer Immune Score showed highly statistically significant (all p ≤ 0.002) CSS differences (0.9y median CSS to not reached). T-cell infiltrates were highest in EBV-positive GCs and similar in MMR-deficient and MMR-proficient GCs. CONCLUSION: The validation of CD45RO-cell and FOXP3-cell densities as prognostic markers in GC may guide personalized follow-up or (neo)adjuvant treatment strategies. Only those 20% of GCs with the highest T-cell infiltrates showed particularly good CSS, suggesting that a small subgroup of GCs is highly immunogenic. The potential for T-cell densities to predict immunotherapy responses should be assessed. The association of high FOXP3-cell densities with longer CSS warrants studies into the biology of regulatory T-cells in GC..
Woolston, A.
Khan, K.
Spain, G.
Barber, L.J.
Griffiths, B.
Gonzalez-Exposito, R.
Hornsteiner, L.
Punta, M.
Patil, Y.
Newey, A.
Mansukhani, S.
Davies, M.N.
Furness, A.
Sclafani, F.
Peckitt, C.
Jiménez, M.
Kouvelakis, K.
Ranftl, R.
Begum, R.
Rana, I.
Thomas, J.
Bryant, A.
Quezada, S.
Wotherspoon, A.
Khan, N.
Fotiadis, N.
Marafioti, T.
Powles, T.
Lise, S.
Calvo, F.
Guettler, S.
von Loga, K.
Rao, S.
Watkins, D.
Starling, N.
Chau, I.
Sadanandam, A.
Cunningham, D.
Gerlinger, M.
(2019). Genomic and Transcriptomic Determinants of Therapy Resistance and Immune Landscape Evolution during Anti-EGFR Treatment in Colorectal Cancer. Cancer cell,
Vol.36
(1),
pp. 35-50.e9.
show abstract
Despite biomarker stratification, the anti-EGFR antibody cetuximab is only effective against a subgroup of colorectal cancers (CRCs). This genomic and transcriptomic analysis of the cetuximab resistance landscape in 35 RAS wild-type CRCs identified associations of NF1 and non-canonical RAS/RAF aberrations with primary resistance and validated transcriptomic CRC subtypes as non-genetic predictors of benefit. Sixty-four percent of biopsies with acquired resistance harbored no genetic resistance drivers. Most of these had switched from a cetuximab-sensitive transcriptomic subtype at baseline to a fibroblast- and growth factor-rich subtype at progression. Fibroblast-supernatant conferred cetuximab resistance in vitro, confirming a major role for non-genetic resistance through stromal remodeling. Cetuximab treatment increased cytotoxic immune infiltrates and PD-L1 and LAG3 immune checkpoint expression, potentially providing opportunities to treat cetuximab-resistant CRCs with immunotherapy..
Lipinski, K.A.
Barber, L.J.
Davies, M.N.
Ashenden, M.
Sottoriva, A.
Gerlinger, M.
(2016). Cancer Evolution and the Limits of Predictability in Precision Cancer Medicine. Trends cancer,
Vol.2
(1),
pp. 49-63.
show abstract
The ability to predict the future behavior of an individual cancer is crucial for precision cancer medicine. The discovery of extensive intratumor heterogeneity and ongoing clonal adaptation in human tumors substantiated the notion of cancer as an evolutionary process. Random events are inherent in evolution and tumor spatial structures hinder the efficacy of selection, which is the only deterministic evolutionary force. This review outlines how the interaction of these stochastic and deterministic processes, which have been extensively studied in evolutionary biology, limits cancer predictability and develops evolutionary strategies to improve predictions. Understanding and advancing the cancer predictability horizon is crucial to improve precision medicine outcomes..
Gerlinger, M.
Horswell, S.
Larkin, J.
Rowan, A.J.
Salm, M.P.
Varela, I.
Fisher, R.
McGranahan, N.
Matthews, N.
Santos, C.R.
Martinez, P.
Phillimore, B.
Begum, S.
Rabinowitz, A.
Spencer-Dene, B.
Gulati, S.
Bates, P.A.
Stamp, G.
Pickering, L.
Gore, M.
Nicol, D.L.
Hazell, S.
Futreal, P.A.
Stewart, A.
Swanton, C.
(2014). Genomic architecture and evolution of clear cell renal cell carcinomas defined by multiregion sequencing. Nat genet,
Vol.46
(3),
pp. 225-233.
show abstract
Clear cell renal carcinomas (ccRCCs) can display intratumor heterogeneity (ITH). We applied multiregion exome sequencing (M-seq) to resolve the genetic architecture and evolutionary histories of ten ccRCCs. Ultra-deep sequencing identified ITH in all cases. We found that 73-75% of identified ccRCC driver aberrations were subclonal, confounding estimates of driver mutation prevalence. ITH increased with the number of biopsies analyzed, without evidence of saturation in most tumors. Chromosome 3p loss and VHL aberrations were the only ubiquitous events. The proportion of C>T transitions at CpG sites increased during tumor progression. M-seq permits the temporal resolution of ccRCC evolution and refines mutational signatures occurring during tumor development. .
Gerlinger, M.
Rowan, A.J.
Horswell, S.
Larkin, J.
Endesfelder, D.
Gronroos, E.
Martinez, P.
Matthews, N.
Stewart, A.
Tarpey, P.
Varela, I.
Phillimore, B.
Begum, S.
McDonald, N.Q.
Butler, A.
Jones, D.
Raine, K.
Latimer, C.
Santos, C.R.
Nohadani, M.
Eklund, A.C.
Spencer-Dene, B.
Clark, G.
Pickering, L.
Stamp, G.
Gore, M.
Szallasi, Z.
Downward, J.
Futreal, P.A.
Swanton, C.
(2012). Intratumor Heterogeneity and Branched Evolution Revealed by Multiregion Sequencing. New england journal of medicine,
Vol.366
(10),
pp. 883-892.
Gonzalez-Exposito, R.
Semiannikova, M.
Griffiths, B.
Khan, K.
Barber, L.
Woolston, A.
Spain, G.
von Loga, K.
Challoner, B.
Patel, R.
Ranes, M.
Swain, A.
Thomas, J.
Bryant, A.
Saffery, C.
Fotiadis, N.
Guettler, S.
Mansfield, D.
Melcher, A.
Powles, T.
Rao, S.
Watkins, D.
Chau, I.
Matthews, N.
Wallberg, F.
Starling, N.
Cunningham, D.
Gerlinger, M.
CEA Expression Heterogeneity and Plasticity Confer Resistance to the CEA-Targeting Bispecific Immunotherapy Antibody Cibisatamab (CEA-TCB) in Patient-Derived Colorectal Cancer Organoids. Journal for immunotherapy of cancer,
.
show abstract
Background: The T cell bispecific antibody cibisatamab (CEA-TCB) binds Carcino-Embryonic Antigen (CEA) on cancer cells and CD3 on T cells, which triggers T cell killing of cancer cell lines expressing moderate to high levels of CEA at the cell surface. Patient derived colorectal cancer organoids (PDOs) may more accurately represent patient tumors than established cell lines which potentially enables more detailed insights into mechanisms of cibisatamab resistance and sensitivity.
Methods: We established PDOs from multidrug-resistant metastatic CRCs. CEA expression of PDOs was determined by FACS and sensitivity to cibisatamab immunotherapy was assessed by co-culture of PDOs and allogeneic CD8 T cells.
Results: PDOs could be categorized into 3 groups based on CEA cell-surface expression: CEAhi (n=3), CEAlo (n=1) and CEAmixed PDOs (n=4), that stably maintained populations of CEAhi and CEAlo cells, which has not previously been described in CRC cell lines. CEAhi PDOs were sensitive whereas CEAlo PDOs showed resistance to cibisatamab. PDOs with mixed expression showed low sensitivity to cibisatamab, suggesting that CEAlo cells maintain cancer cell growth. Culture of FACS-sorted CEAhi and CEAlo cells from PDOs with mixed CEA expression demonstrated high plasticity of CEA expression, contributing to resistance acquisition through CEA antigen loss. RNA-sequencing revealed increased WNT/β-catenin pathway activity in CEAlo cells. Cell surface CEA expression was up-regulated by inhibitors of the WNT/β-catenin pathway.
Conclusions: Based on these preclinical findings, heterogeneity and plasticity of CEA expression appear to confer low cibisatamab sensitivity in PDOs, supporting further clinical evaluation of their predictive effect in CRC. Pharmacological inhibition of the WNT/β-catenin pathway may be a rational combination to sensitize CRCs to cibisatamab. Our novel PDO and T cell co-culture immunotherapy models enable pre-clinical discovery of candidate biomarkers and combination therapies that may inform and accelerate the development of immuno-oncology agents in the clinic..
Davidson, M.
Barber, L.J.
Woolston, A.
Cafferkey, C.
Mansukhani, S.
Griffiths, B.
Moorcraft, S.-.
Rana, I.
Begum, R.
Assiotis, I.
Matthews, N.
Rao, S.
Watkins, D.
Chau, I.
Cunningham, D.
Starling, N.
Gerlinger, M.
Detecting and Tracking Circulating Tumour DNA Copy Number Profiles during First Line Chemotherapy in Oesophagogastric Adenocarcinoma. Cancers,
Vol.11
(5),
pp. 736-736.
show abstract
DNA somatic copy number aberrations (SCNAs) are key drivers in oesophagogastric adenocarcinoma (OGA). Whether minimally invasive SCNA analysis of circulating tumour (ct)DNA can predict treatment outcomes and reveal how SCNAs evolve during chemotherapy is unknown. We investigated this by low-coverage whole genome sequencing (lcWGS) of ctDNA from 30 patients with advanced OGA prior to first-line chemotherapy and on progression. SCNA profiles were detectable pretreatment in 23/30 (76.7%) patients. The presence of liver metastases, primary tumour in situ, or of oesophageal or junctional tumour location predicted for a high ctDNA fraction. A low ctDNA concentration associated with significantly longer overall survival. Neither chromosomal instability metrics nor ploidy correlated with chemotherapy outcome. Chromosome 2q and 8p gains before treatment were associated with chemotherapy responses. lcWGS identified all amplifications found by prior targeted tumour tissue sequencing in cases with detectable ctDNA as well as finding additional changes. SCNA profiles changed during chemotherapy, indicating that cancer cell populations evolved during treatment; however, no recurrent SCNA changes were acquired at progression. Tracking the evolution of OGA cancer cell populations in ctDNA is feasible during chemotherapy. The observation of genetic evolution warrants investigation in larger series and with higher resolution techniques to reveal potential genetic predictors of response and drivers of chemotherapy resistance. The presence of liver metastasis is a potential biomarker for the selection of patients with high ctDNA content for such studies..
Newey, A.
Griffiths, B.
Michaux, J.
Pak, H.
Stevenson, B.
Woolston, A.
Semiannikova, M.
Spain, G.
Barber, L.
Matthews, N.
Rao, S.
Watkins, D.
Chau, I.
Coukos, G.
Racle, J.
Gfeller, D.
Starling, N.
Cunningham, D.
Bassani-Sternberg, M.
Gerlinger, M.
Immunopeptidomics of colorectal cancer organoids reveals a sparse HLA class I neoantigen landscape and no increase in neoantigens with interferon or MEK-inhibitor treatment. Journal for immunotherapy of cancer,
.
Barber, L.
Mansukhani, S.
Kleftogiannis, D.
Moorcraft, S.Y.
Davidson, M.
Woolston, A.
Proszek, P.
Griffiths, B.
Fenwick, K.
Matthews, N.
O'Leary, B.
Hulkki, S.
Gonzalez de Castro, D.
Wotherspoon, A.
Okachi, A.
Rana, I.
Begum, R.
Davies, M.
von Loga, K.
Hubank, M.
Turner, N.
Watkins, D.
Chau, I.
Cunningham, D.
Lise, S.
Starling, N.
Gerlinger, M.
Ultra-sensitive mutation detection and genome-wide DNA copy number reconstruction by error corrected circulating tumor DNA sequencing. Clinical chemistry,
.