Tumour lineage shapes BRCA-mediated phenotypes

P Jonsson, C Bandlamudi, ML Cheng, P Srinivasan… - Nature, 2019 - nature.com
P Jonsson, C Bandlamudi, ML Cheng, P Srinivasan, SS Chavan, ND Friedman, EY Rosen…
Nature, 2019nature.com
Mutations in BRCA1 and BRCA2 predispose individuals to certain cancers,–, and disease-
specific screening and preventative strategies have reduced cancer mortality in affected
patients,. These classical tumour-suppressor genes have tumorigenic effects associated
with somatic biallelic inactivation, although haploinsufficiency may also promote the
formation and progression of tumours,. Moreover, BRCA1/2-mutant tumours are often
deficient in the repair of double-stranded DNA breaks by homologous recombination …
Abstract
Mutations in BRCA1 and BRCA2 predispose individuals to certain cancers, –, and disease-specific screening and preventative strategies have reduced cancer mortality in affected patients,. These classical tumour-suppressor genes have tumorigenic effects associated with somatic biallelic inactivation, although haploinsufficiency may also promote the formation and progression of tumours,. Moreover, BRCA1/2-mutant tumours are often deficient in the repair of double-stranded DNA breaks by homologous recombination, , , , –, and consequently exhibit increased therapeutic sensitivity to platinum-containing therapy and inhibitors of poly-(ADP-ribose)-polymerase (PARP),. However, the phenotypic and therapeutic relevance of mutations in BRCA1 or BRCA2 remains poorly defined in most cancer types. Here we show that in the 2.7% and 1.8% of patients with advanced-stage cancer and germline pathogenic or somatic loss-of-function alterations in BRCA1/2, respectively, selective pressure for biallelic inactivation, zygosity-dependent phenotype penetrance, and sensitivity to PARP inhibition were observed only in tumour types associated with increased heritable cancer risk in BRCA1/2 carriers (BRCA-associated cancer types). Conversely, among patients with non-BRCA-associated cancer types, most carriers of these BRCA1/2 mutation types had evidence for tumour pathogenesis that was independent of mutant BRCA1/2. Overall, mutant BRCA is an indispensable founding event for some tumours, but in a considerable proportion of other cancers, it appears to be biologically neutral—a difference predominantly conditioned by tumour lineage—with implications for disease pathogenesis, screening, design of clinical trials and therapeutic decision-making.
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