Personalized comprehensive molecular profiling of high risk osteosarcoma: Implications and limitations for precision medicine

// Vivek Subbiah 1 , Michael J. Wagner 1 , Mary F. McGuire 3 , Nawid M. Sarwari 4 , Eswaran Devarajan 5 , Valerae O. Lewis 5 , Shanon Westin 2 , Shumei Kato 1 , Robert E. Brown 3 , Pete Anderson 6 1 Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 2 Division of Gynecological Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 3 Department of Pathology & Laboratory Medicine, The University of Texas-Houston Medical School, Houston, TX 77030, USA 4 Department of Internal Medicine, The University of Texas-Houston Medical School, Houston, TX 77030, USA 5 Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 6 Department of of Pediatric Hematology/Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA Correspondence to: Vivek Subbiah, e-mail: vsubbiah@mdanderson.org Keywords: personalized medicine, molecular profiling, osteosarcoma, precision medicine, targeted therapy Received: August 19, 2015 Accepted: September 25, 2015 Published: October 15, 2015 ABSTRACT Background: Despite advances in molecular medicine over recent decades, there has been little advancement in the treatment of osteosarcoma. We performed comprehensive molecular profiling in two cases of metastatic and chemotherapy-refractory osteosarcoma to guide molecularly targeted therapy. Patients and Methods: Hybridization capture of >300 cancer-related genes plus introns from 28 genes often rearranged or altered in cancer was applied to >50 ng of DNA extracted from tumor samples from two patients with recurrent, metastatic osteosarcoma. The DNA from each sample was sequenced to high, uniform coverage. Immunohistochemical probes and morphoproteomics analysis were performed, in addition to fluorescence in situ hybridization. All analyses were performed in CLIA-certified laboratories. Molecularly targeted therapy based on the resulting profiles was offered to the patients. Biomedical analytics were performed using QIAGEN's Ingenuity ® Pathway Analysis. Results: In Patient #1, comprehensive next-generation exome sequencing showed MET amplification, PIK3CA mutation, CCNE1 amplification, and PTPRD mutation. Immunohistochemistry-based morphoproteomic analysis revealed c-Met expression [(p)-c-Met (Tyr1234/1235)] and activation of mTOR/AKT pathway [IGF-1R (Tyr1165/1166), p-mTOR [Ser2448], p-Akt (Ser473)] and expression of SPARC and COX2. Targeted therapy was administered to match the P1K3CA , c-MET , and SPARC and COX2 aberrations with sirolimus+ crizotinib and abraxane+ celecoxib. In Patient #2, aberrations included NF2 loss in exons 2–16, PDGFRα amplification, and TP53 mutation. This patient was enrolled on a clinical trial combining targeted agents temsirolimus, sorafenib and bevacizumab, to match NF2 , PDGFRα and TP53 aberrations. Both the patients did not benefit from matched therapy. Conclusions: Relapsed osteosarcoma is characterized by complex signaling and drug resistance pathways. Comprehensive molecular profiling holds great promise for tailoring personalized therapies for cancer. Methods for such profiling are evolving and need to be refined to better assist clinicians in making treatment decisions based on the large amount of data that results from this type of testing. Further research in this area is warranted.