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• Defining T cell States Associated with Response to Checkpoint Immunotherapy in Melanoma

  Checkpoint blockade therapy using antibodies targeting CTLA4, PD1 or PDL1 have changed the way cancer patients with advanced disease are being treated, as evident by their FDA approval in a wide variety of malignancies, and their ability to induce high response rates when compared to conventional therapies (e.g. chemotherapy). However, even in melanoma, despite the high response rate, most patients are refractory to therapy or acquire resistance in 10-12 months. To identify key immunological elements coupled with response or resistance to checkpoint immunotherapy, we performed an unbiased analysis on 16,291 CD45+ immune cells from 32 patients (48 samples) treated with checkpoint therapy (anti-PD1=37; anti-PD1/CTLA4=11), using single cell transcriptomics. Initial unsupervised clustering of all CD45+ cells identified 11 clusters. When examining the association of these clusters with clinical outcome, we found that two clusters (B-cells, p=0.005; memory T-cells, p=0.03) were significantly enriched in responder lesions while 4 clusters (monocytes/macrophages, p=0.003; dendritic cells, p=0.015; exhausted CD8+ T-cells, p=0.005; and exhausted/cell-cycle lymphocytes, 1.3x10-5) are enriched in non-responder lesions. Next, by leveraging our unbiased single cell approach, we identified not only clusters but also specific markers associated with either responder lesions (PLAC8, LTB, LY9, SELL, TCF7, IGKC and CCR7) or non-responder ones (CCL3, CD38, HAVCR2, ENTPD1 and WARS), many of which were not previously reported to be associated with clinical outcome to checkpoint therapy. Due to the importance of CD8+ T-cells in controlling tumors, the significant association of T-cell states with clinical outcome, and their high abundance in melanoma tumors, we next focused our analysis on CD8+ T-cells and identified 2 main clusters CD8_G (with increased expression of genes linked to memory) and CD8_B (enriched for genes linked to cell dysfunction), that were significantly enriched in responder (CD8_G, p=1.4x10-6) and non-responder (CD8_B, p=0.005) lesions, respectively. Since cells with both states coexist in each of the responder and non-responder lesions, we decided to calculate the ratio between the number of cells in these 2 clusters and observed a significant separation between responders (CD8_G/CD8_B>1) and non-responders (CD8_G/CD8_B<1) when looking at all samples, baseline or post samples separately. Similar results were detected when looking at the expression of a single transcription factor, TCF7, in CD8 T-cells in an independent cohort (n=43) using a simple immunofluorescence assay. Additionally, we validated the identity and function of some of the newly identified cell states as well as their epigenetic landscape, and found that cells expressing the inhibitory molecules CD39 and TIM3, on top of being enriched in non-responder lesions, are likely to play a crucial role in T-cell exhaustion in melanoma. Collectively, our study provides extensive unbiased data in human tumors for discovery of predictors and therapeutic targets to checkpoint immunotherapy.

  Study phs001680

• Blood Somatic Mutations in TCGA Donors Suffering from Solid Tumors

  Blood somatic mutations identified across 8,530 solid tumor patients in TCGA cohort. We reasoned that low-coverage whole-genome sequencing of blood samples routinely carried out in cancer genomics projects may be repurposed to detect clonal hematopoiesis (CH). Thus, inspired by a previous approach to identify early mutations in the development of the hematopoietic system, we implemented a pipeline to systematically carry out this "reverse" somatic mutation calling on the paired blood/tumor samples. Blood somatic mutations were called using a 'reverse' approach, in which the tumor sample taken from each patient was used as control of their germline genome. Blood somatic mutations are thus detected as variants in the blood (with respect to the human reference genome) that are absent in the tumor sample. The variant calling was carried out in our in house cluster on downloaded blood/tumor BAM files. The matched blood and tumoral BAM files -- masked and deduplicated using GATK -- of 8,530 whole-exome patients were obtained as described above. The variant calling was carried out using Strelka2 (employing default parameters) with the blood sample as the tumoral input and the tumor sample as control (reverse calling). All variants with two or more supporting reads matching the caller PASS filter and with VAF<0.5 were kept. Mutations in lowly mappable regions as defined by the DUST algorithm (k=30) and UMAP68 (36-kmers) were excluded. Contiguous variants were merged into double-base substitutions. Variants with greater frequency across the cohorts than the DNMT3A R882H or JAK2 V617F hotspot in a cohort-specific Panel of Normals and in gnomAD v2.1 were removed. This was equivalent to discarding variants present in these datasets with an allele frequency greater than 0.008 in PoN TCGA and 0.0003 in gnomAD v2.1. Additionally, common SNPs as defined by the dbSNP 151 Common UCSC track and dbSNP were excluded. Mutations within segmental duplications, simple repeats and masked regions as defined in UCSC tracks were also removed. Finally, samples with the mutation count above the 97.5 percentile of the mutation burden across the cohort were deemed unreliable and excluded for further analyses. We call the set of variants obtained after the application of these filters the full set. A more conservative subset of somatic mutations was generated from the full set of blood somatic mutations. To this end, we applied MosaicForecast, a software designed to phase mutations to polymorphisms with the aim of identifying somatic mutations in a small number of cells and also predict mosaicism for the unphased ones with a random forest classifier. As a result, we obtained a subset of mosaic-phased mutations, and a subset of mutations likely to be somatic (mosaic set).In order to obtain access to this study, please first obtain access to TCGA study (phs000178).

  Study phs002867

• Phenotypic characterization and prognostic impact of CD103+ tissue-resident memory T cells in diffuse large B cell lymphoma

  Tissue-resident memory T (TRM) cells are a population of memory T cells that stably occupy tissues and play a key role in immunosurveillance, having been linked to favorable survival outcomes in various solid tumors. While TRM cells have been identified in lymph nodes, their phenotype and prognostic significance in B-cell non-Hodgkin lymphoma (B-NHL), including diffuse large B-cell lymphoma (DLBCL), remains poorly characterized. The frequency of CD103 expressing T cells in patient samples with DLCBL was quantified by immunofluorescence (IF) staining of tissue biopsies (n=306) and flow cytometry (n=252) of cell disaggregates, and linked with clinical outcome. The phenotype of TRM cells was characterized by spectral flow cytometry (n=10 DLBCL and 2 reactive lymph node (rLN) samples) and single-cell RNA sequencing (scRNAseq) (n=12 aggressive B cell lymphomas and 4 rLN samples). An additional 51 samples from an external dataset were included to verify the single cell transcriptome findings. The flow cytometry and scRNAseq findings in DLBCL were extrapolated to additional B-NHL entities. Through analysis of these datasets we were able to characterize CD103+ TRM-like cells in DLBCL and other B-NHL entities and identified them to represent a prognostically favorable population with an activated/cytotoxic T cell phenotype.

  Study EGAS50000000943

• Liquid biopsy for molecular characterization of diffuse large B-cell lymphoma and early assessment of minimal residual disease

  Circulating tumor DNA (ctDNA) allows genotyping and minimal residual disease (MRD) detection in lymphomas. Using a NGS approach (Euroclonality-NDC), we evaluated clinical and prognostic value of ctDNA in a series of R-CHOP-treated DLBCL patients at baseline (n=68) and after 2-cycles (n=59), monitored by metabolic imaging (PET/CT). A molecular marker was identified in 61/68 (90%) ctDNA samples at diagnosis. Pre-treatment high ctDNA levels significantly correlated with elevated LDH, advanced stage, high risk IPI and a trend to shorter 2-year PFS. Valuable NGS data after 2-cycles of treatment were obtained in 44 cases, and 38 achieved major molecular response (MMR; 2.5-log drop in ctDNA). PFS curves displayed statistically significant differences among those achieving MMR vs. those not achieving MMR (2yr PFS of 76% vs. 0%, p<0.001). Similarly, more than 66% reduction in SUVmax by PET/CT identified two subgroups with different prognosis (2yr PFS of 83% vs. 38%; p<0.001). Combining both approaches MMR and SUVmax reduction, a better stratification was observed (2yr PFS of 84% vs. 17% vs. 0%, p<0.001). Euroclonality-NDC panel allows the detection of a molecular marker in the ctDNA in 90% of DLBCL. ctDNA reduction at 2 cycles and its combination with interim PET results improves patient prognosis stratification.

  Study EGAS50000000215

• Personalized peptide vaccination among 173 patients with IDH wildtype glioblastoma: a retrospective analysis

  Tumors from 173 GBM patients were analysed for somatic mutations to generate a personalized peptide vaccine targeting tumor-specific neoantigens. Exome libraries for 173 glioblastoma tumors and matched normal DNA were sequenced on Illumina platform, alongside whole transcriptomes from the tumor samples. Paper Abstract: Current treatment outcome of patients with glioblastoma (GBM) remains poor. Following standard therapy, recurrence is universal with limited survival. GBM tumors from 173 patients were analysed for somatic mutations to generate a personalized peptide vaccine targeting tumor-specific neoantigens. Among all patients, including 70 treated prior to progression (primary) and 103 treated after progression (recurrent), the median overall survival from first diagnosis was 31.9 months (95% CI: 25.0-36.5). Side effects were infrequent and were predominantly grade 1 or 2. A vaccine-induced immune response to at least one of the vaccinated peptides was detected in blood samples of 87 of 99 (88%) monitored patients. T-cell responses to vaccinated neoepitope peptides were durable in most patients. Significantly prolonged survival was observed for patients with multiple vaccine-induced immune responses (53 months) compared to those with no/low induced responses (27 months; P=0.03). Altogether, our results highlight that the application of personalized neoantigen-targeting peptide vaccine is feasible and represents a promising potential treatment option for GBM patients.

  Study EGAS50000000449

• Raw sequencing files from WGS and RNA-Seq

  Acute leukemias are the most common malignancies in children with an onset of the disease among 0-6 years-old. The early development of theses malignancies has been proposed as an indicator of their prenatal origin, hypothesis that has been confirmed especially in the case of acute lymphoblastic leukemia. For acute myeloid leukemia (AML), comprising an heterogenous group of different cytogenetics subtypes, this prenatal origin has also been confirmed specially for MLL-rearranged and t(8;21) subgroups. AMLs carrying t(7;12) constitute up to 30% of cases under 2-years-old, frequently being associated with a trisomy of chromosome 19 and an overexpression of MNX1 gene. An in utero origin of this specific subgroup has been suggested but not clearly confirmed. Here, we present the case of a 5-months-old AML patient with t(7;12) in which we have fully characterized a novel breakpoint occurring among ETV6 and NOM1 genes. We demonstrate the presence of this specific ETV6-NOM1 fusion in CD34+ hematopoietic stem and progenitor cells isolated from the cord blood unit from the same patient and stored at birth. Moreover, trisomy +19 present at diagnosis was not detected at birth. Together, our results demonstrate the prenatal origin of the t(7;12) in infant AML, and establish trisomy +19 as a secondary event in this leukemia.

  Study EGAS50000000186

• A Cancer Cell-Line Titration Series for Evaluating Somatic Classification

  Accurate detection of somatic single nucleotide variants and small insertions and deletions from DNA sequencing experiments of tumour-normal pairs is a challenging task. Tumour samples are often contaminated with normal cells confounding the available evidence for the somatic variants. Furthermore, tumours are heterogeneous so sub-clonal variants are observed at reduced allele frequencies. We present here a cell-line titration series dataset that can be used to evaluate somatic variant calling pipelines with the goal of reliably calling true somatic mutations at low allele frequencies. Cell-line DNA was mixed with matched normal DNA at 8 different ratios to generate samples with known tumour cellularities, and exome sequenced on Illumina HiSeq to depths of >300x. The data was processed with several different variant calling pipelines and verification experiments were performed to assay >1,500 somatic variant candidates using Ion Torrent PGM as an orthogonal technology. By examining the variants called at varying cellularities and depths of coverage, we show that the best performing pipelines are able to maintain a high level of precision at any cellularity. In addition, we estimate the number of true somatic variants undetected as cellularity and coverage decrease. Our cell-line titration series dataset, along with the associated verification results, is effective for this evaluation and will serve as a valuable dataset for future somatic calling algorithm development.

  Study EGAS00001001016

• Chromothripsis in human breast cancer (HIPO K26K/H017/A017)

  Chromothripsis is a form of genome instability, by which a presumably single catastrophic event generates extensive genomic rearrangements of one or a few chromosome(s). Widely assumed to be an early event in tumor development, this phenomenon plays a prominent role in tumor onset. We analyzed chromothripsis in 252 human breast cancers from two patient cohorts (149 metastatic breast cancers, 63 untreated primary tumors, 29 local relapses, 11 longitudinal pairs) using whole-genome and whole-exome sequencing. We showed that chromothripsis affects a substantial proportion of human breast cancers, with a prevalence over 60% in a cohort of metastatic cases and 25% in a cohort comprising predominantly luminal breast cancers (cohorts from HIPO K26K and H017 and A017). In the vast majority of cases, multiple chromosomes per tumor are affected, with most chromothriptic events on chromosomes 11 and 17 including, among other significantly altered drivers, CCND1, ERBB2, CDK12 and BRCA1. Importantly, chromothripsis generates recurrent fusions that drive tumor development. Chromothripsis-related rearrangements are linked with univocal mutational signatures, with clusters of point mutations due to kataegis in close proximity to the genomic breakpoints, and with the activation of specific signaling pathways. Analysis of the temporal order of events in tumors with and without chromothripsis as well as longitudinal analysis of chromothriptic patterns in tumor pairs revealed important insights on the role of chromothriptic chromosomes in tumor evolution.

  Study EGAS00001004662

• Small_molecule_inhibitors_in_melanoma___Kenski___Kong___WES

  Small-molecule inhibitors targeting the most commonly activated pathway in melanoma, MAPK pathway (either alone or in combination) are already given to melanoma patients for few years, and initially reduce tumour burden dramatically, eventually melanomas become resistant and tumours progress while on treatment. Resistance to this treatment occurs by acquisition of additional mutations or other alterations that affect the mitogen-activated protein kinase (MAPK) pathway by either direct or indirect signalling. Many resistance mechanisms somehow lead to reactivation of extracellular signal-regulated kinase (ERK), thereby restoring signalling of the oncogenic BRAF/MEK/ERK pathway. In addition, PI3K pathway activation contributes to resistance to BRAF inhibition. Less frequent but equally important to the phenomenon of targeted drug resistance is the observation that B15–20% of BRAF mutant melanoma patients fail to respond to BRAF inhibition already early on treatment, owing to intrinsic resistance. These patients have little therapeutic options, unless immunotherapy can be given. To better understand the resistance mechanisms in MAPK inhibitor-treated melanoma patients and melanoma biology, our lab generated a big panel of MAPK inhibitor resistant melanoma cell lines by continuous drug exposure. The understanding of the genetic landscape and gene expression as well as cross resistance to other treatment regimens, and other aspects of melanoma biology such as phenotype switch, will allow us to better exploit new therapeutic strategies for melanoma patients.

  Study EGAS00001002863

• A Platform Study of Combination Immunotherapy for the Neoadjuvant and Adjuvant Treatment of Patients with Surgically Resectable Adenocarcinoma of the Pancreas

  This is a single-institutional, randomized, open label platform clinical trial testing various immunotherapy combinations. Patients with newly diagnosed and surgically resectable pancreatic ductal adenocarcinoma (PDA) and scheduled to undergo the Whipple procedure at Johns Hopkins Hospital were eligible to participate in this study. Criteria for determining resectability strictly followed National Comprehensive Cancer Network (NCCN) guidelines. The study consisted of 6 parts: parts 1-5 constituted the Prime Phase (see below), and part 6 was the Extended Treatment Phase. Part 1: Participants received one cycle of immunotherapy two weeks prior to undergoing the Whipple procedure. Part 2: Subjects underwent the Whipple procedure. Part 3: Subjects received a second cycle of immunotherapy 4-10 weeks following the Whipple procedure (2-4 weeks prior to adjuvant chemoradiation). Part 4: Subjects underwent chemoradiation. Part 5: Subjects received 4 additional 28-day cycles of immunotherapy beginning 1-2 months after completing chemoradiation for a total of six cycles (two before chemoradiation and 4 following chemoradiation). Eligible subjects were randomized to Arms A and B in a 1:1 ratio, stratified up-front by age (&#8804;65, >65). Arm A participants received Cy/GVAX. Arm B participants received the combination of Cy/GVAX and nivolumab. GVAX Vaccine consists of equal numbers (2.5 x 108 each) of Panc 6.03 pcDNA1GM-CSF and Panc 10.05 pcDNA1GM-CSF combined into a single vaccination. Each vaccination consisted of six total intradermal injections. A single intravenous (IV) dose of 200 mg/m2 Cy (CytoxanR) was given one day prior to GVAX. Anti-PD-1 Therapeutic Antibody Nivolumab 480 mg every 4 weeks was administered as an intravenous infusion. The primary objective for Arms A and B was to compare IL17 expression (Th17) in vaccine-induced lymphoid aggregates between resected PDAs from patients treated with the combination of Cy/GVAX and anti-PD-1 blockade antibody vs. the treatment of Cy/GVAX alone. Secondary objectives were to assess the safety, overall survival (OS), and disease free survival (DFS) of patients treated with each of the study drug combinations, and to assess the effects of each of the immunotherapy study drug combinations on PD-L1/PD-1 associated pathways, vaccine-induced immune regulatory signatures, and peripheral and intratumoral antigen specific T cell responses. The exploratory objective was to explore the effects of therapy on tumor and peripheral blood and tumor infiltrating immune cells, and to explore potential molecular determinants of response, progression and disease stability. To these ends, tumor infiltrating immune cells (TIICs) were obtained from surgically resected tumors following the neoadjuvant treatment of the study immunotherapy. TIICs were sorted into CD3+CD4+ T cells, CD3+CD8+ T cells, CD3-CD19+ B cells, and CD3-CD19-CD11b+ myeloid cells by flow cytometry. The sorted immune cell subtype pellets were sent to the commercial vendor (Eurofins) for RNA extraction and sequencing. SMART-seq v4 Ultra Low Input mRNA Sample Prep Kit was used for library preparation with 100bp paired end reads. FASTQ files, that were returned from the vendor, are deposited here.

  Study phs003002