Whole genome sequencing for more accurate TMB and mutational signatures in common cancers.
Authors: Lee Won-Chul , Lim Joonoh , Park Seongyeol , Kim Ryul , Oh Baek-Lok , Lee Sangmoon , Lee Jeong Seok , Kwon Minsuk , Connolly-Strong Erin , Hong Suk Kyun , Lee Kwang-Woong , Suh Kyung-Suk , Kim Ji-Yeon , Ryu Ji In , Lee Jeongmin , Na Kwon Joong , Kim Young Tae , Park Yeon Hee , Ju Young Seok 
Published: June 2023

e15173 Background: Due to the dramatic decrease in cost of genome sequencing, we are entering the era of whole genome sequencing (WGS) at $100. Tumor mutational burden (TMB) and mutational signatures have been introduced as potential prognostic/predictive cancer biomarkers and mostly assessed by targeted cancer gene sequencing panels. However, they are truly whole genome-wide events and thus more accurately estimated by whole genome sequencing data. Methods: We analyzed WGS data produced by Genome Insight Inc. that encompass > 1,300 breast, lung, and hepatocellular carcinoma samples, collectively. Our genome-wide TMBs (wgsTMB) were systematically compared with the TMB estimates by targeted sequencing methods, such as conventional whole-exome sequencing (WES) and targeted panel sequencing from FoundationOne CDx (F1CDx). In parallel, we leveraged genome-wide somatic mutations for validating mutational signatures projected from the targeted sequencing methods. Results: Pembrolizumab is FDA approved for solid tumors with high TMB (≥ 10 mutations/Mb) assessed by F1CDx. This criterion classified that 546 of the tumors (41%) in our cohort as high F1CDx TMB (f1TMB), who may benefit from immunotherapy. However, the high f1TMB classification was inconsistent to the genome-wide TMB classification ( p < 2.2e-16). For example, 132 high f1TMB tumors (24.1%; 132/546) showed lower than the median wgsTMB estimate. On the flip side, 32% of the low f1TMB tumors (251/784) demonstrate higher than median wgsTMB estimate (see table). Although there is no approved criterion in WGS that defines hypermutators, our data illustrates that WGS will be helpful for redefining the criteria for selecting patients for immune checkpoint inhibitors. The wgsTMB was also an essential factor for accurate estimation of mutational signatures from targeted sequencing. For example, in high TMB tumors, mutational signature estimated from WES showed on average 0.87 cosine similarity with signatures from WGS. However, the correlation was substantially reduced in low TMB tumors, showing only ~0.64 on average. Particularly, ~12% of breast tumors with considerable levels of homologous recombination deficiency (HRD) signatures by WGS were not captured by whole-exome sequencing based approaches. Further exploration should be performed with WGS to select proper patients for targeted therapies, including PARP inhibitors. Conclusions: Despite the current guidelines depending on targeted sequencing in precision oncology, we showed that whole-genome sequencing can deliver more accurate cancer genome profiles, such as, but not limited to, TMB and mutational signatures. Given its more comprehensive capabilities and affordable cost, we believe that WGS-based precision oncology is medically necessary. [Table: see text]