Diagnostic yield and clinical impact of germline sequencing in children with CNS and extracranial solid tumors—a nationwide, prospective Swedish study
Bianca Tesi, Kristina Lagerstedt‐Robinson, Frida Abel, Teresita Díaz de Ståhl, Sara Orrsjö, Anna Poluha, Maria Hellberg, Sandra Wessman, Sofie Samuelsson, Tony Frisk, Hartmut Vogt, Karin Henning, Magnus Sabel, Torben Ek, Niklas Pal, Per Olof Nyman, G Giraud, Joakim Wille, Cornelis Jan Pronk, Ulrika Norén‐Nyström, Magnus Borssén, Maria Filì, Gustav Stålhammar, Nikolas Herold, Giorgio Tettamanti, Carolina Maya‐González, Linda Arvidsson, Anna Rosén, Katja Ekholm, Ekaterina Kuchinskaya, Anna‐Lotta Hallbeck, Margareta Nordling, Pia Palmebäck, Per Kogner, Gunilla Kanter Smoler, Päivi M. Lähteenmäki, Susanne Fransson, Tommy Martinsson, Alia Shamik, Fredrik Mertens, Richard Rosenquist, Valtteri Wirta, Emma Tham, Pernilla Grillner, Johanna Sandgren, Gustaf Ljungman, David Gisselsson, Fulya Taylan, Ann Nordgren
Abstract
Background Childhood cancer predisposition (ChiCaP) syndromes are increasingly recognized as contributing factors to childhood cancer development. Yet, due to variable availability of germline testing, many children with ChiCaP might go undetected today. We report results from the nationwide and prospective ChiCaP study that investigated diagnostic yield and clinical impact of integrating germline whole-genome sequencing (gWGS) with tumor sequencing and systematic phenotyping in children with solid tumors. Methods gWGS was performed in 309 children at diagnosis of CNS (n = 123, 40%) or extracranial (n = 186, 60%) solid tumors and analyzed for disease-causing variants in 189 known cancer predisposing genes. Tumor sequencing data were available for 74% (227/309) of patients. In addition, a standardized clinical assessment for underlying predisposition was performed in 95% (293/309) of patients. Findings The prevalence of ChiCaP diagnoses was 11% (35/309), of which 69% (24/35) were unknown at inclusion (diagnostic yield 8%, 24/298). A second-hit and/or relevant mutational signature was observed in 19/21 (90%) tumors with informative data. ChiCaP diagnoses were more prevalent among patients with retinoblastomas (50%, 6/12) and high-grade astrocytomas (37%, 6/16), and in those with non-cancer related features (23%, 20/88), and ≥2 positive ChiCaP criteria (28%, 22/79). ChiCaP diagnoses were autosomal dominant in 80% (28/35) of patients, yet confirmed de novo in 64% (18/28). The 35 ChiCaP findings resulted in tailored surveillance (86%, 30/35) and treatment recommendations (31%, 11/35). Interpretation Overall, our results demonstrate that systematic phenotyping, combined with genomics-based diagnostics of ChiCaP in children with solid tumors is feasible in large-scale clinical practice and critically guides personalized care in a sizable proportion of patients. Funding The study was supported by the Swedish Childhood Cancer Fund and the Ministry of Health and Social Affairs.