Common Secondary Genomic Variants Associated With Advanced Epithelioid Hemangioendothelioma
Authors: Nathan D. Seligson, Achal Awasthi, Sherri Z. Millis, Brian K. Turpin, Christian F. Meyer, Anne Grand'Maison, David A. Liebner, John L. Hays, James L. Chen
Journal: JAMA Network Open (2019)

<h3>Importance</h3> Epithelioid hemangioendothelioma (EHE) is a rare, malignant vascular sarcoma characterized in most cases by a<i>WWTR1</i>-<i>CAMTA1</i>fusion. The clinical course of EHE exhibits a dual nature. The condition is often indolent but can rapidly grow and metastasize unpredictably. No biomarkers to date are available to predict this phenotype. The hypothesis of this study was that better defining the genomic landscape of EHE using next-generation sequencing could offer additional therapies and insight into clinical outcomes. <h3>Objective</h3> To characterize secondary EHE genomic alterations and their association with clinical outcomes. <h3>Design, Setting, and Participants</h3> Multicenter, cross-sectional, retrospective study of next-generation sequencing results collected from participants diagnosed with EHE. Data were abstracted between May 1, 2013, and May 31, 2019. This analysis was conducted from January through June 2019. Summary genomic data were provided by commercial genomic testing companies. <h3>Main Outcomes and Measures</h3> Presence or absence of secondary pathogenic genomic variants and their association with disease stage and clinical features. <h3>Results</h3> A total of 49 participants with EHE were assessed for the presence or absence of secondary genomic variants. Of these, 32 (65.3%) were female; the mean (SD) age at diagnosis was 49.9 (18.3) years (range, 11-81 years). In all, 46 participants (93.9%) had confirmed<i>WWTR1-CAMTA1</i>fusion; 26 participants (57.1%) exhibited a pathogenic genomic variant secondary to the<i>WWTR1-CAMTA1</i>fusion; and 9 participants (18.4%) exhibited potentially targetable genomic variants. Commonly altered genes included<i>CDKN2A/B</i>,<i>RB1</i>,<i>APC</i>, and<i>FANCA</i>. Participants older than 45 years at diagnosis had an increased prevalence of secondary genomic variants that was not statistically significant (65.6% vs 38.5%; difference, 27.1%; 95% CI, −3.5% to 58.0%;<i>P</i> = .16) and were more likely to have a clinically targetable variant (28.1% vs 0%; difference, 28.1%; 95% CI, 11.2%-40.2%;<i>P</i> = .03). In 14 participants with clinical data available, those with stage III/IV EHE were more likely to exhibit a secondary pathogenic genomic variant (80% vs 0%; difference, 80%; 95% CI, 55.2%-100%;<i>P</i> = .006). Participants with stage III/IV EHE were diagnosed at an older age (mean [SD] age, 54.6 [14.1] years vs 31.7 [16.0] years;<i>P</i> = .05) and had elevated<i>WWTR1-CAMTA1</i>fusion expression that was not statistically significant (mean [SD] expression, 677 [706] copies vs 231 [213] copies;<i>P</i> = .20). <h3>Conclusions and Relevance</h3> Although EHE exhibits few secondary genomic variants, presence of key secondary variants may be prognostic for aggressive EHE. Further research is needed to confirm this finding and determine whether more intensive upfront treatment is necessary for these patients.