Tumor mutational burden assessment and standardized bioinformatics approach using custom NGS panels in clinical routine

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Dupain, Célia | Gutman, Tom | Girard, Elodie | Kamoun, Choumouss | Marret, Grégoire | Castel-Ajgal, Zahra | Sablin, Marie-Paule | Neuzillet, Cindy | Borcoman, Edith | Hescot, Ségolène | Callens, Céline | Trabelsi-Grati, Olfa | Melaabi, Samia | Vibert, Roseline | Antonio, Samantha | Franck, Coralie | Galut, Michèle | Guillou, Isabelle | Halladjian, Maral | Allory, Yves | Cyrta, Joanna | Romejon, Julien | Frouin, Eleonore | Stoppa-Lyonnet, Dominique | Wong, Jennifer | Le Tourneau, Christophe | Bièche, Ivan | Servant, Nicolas | Kamal, Maud | Masliah-Planchon, Julien

Edité par CCSD ; BioMed Central -

International audience. Background: High tumor mutational burden (TMB) was reported to predict the efficacy of immune checkpoint inhibitors (ICIs). Pembrolizumab, an anti-PD-1, received FDA-approval for the treatment of unresectable/metastatic tumors with high TMB as determined by the FoundationOne®CDx test. It remains to be determined how TMB can also be calculated using other tests.
Results: FFPE/frozen tumor samples from various origins were sequenced in the frame of the Institut Curie (IC) Molecular Tumor Board using an in-house next-generation sequencing (NGS) panel. A TMB calculation method was developed at IC (IC algorithm) and compared to the FoundationOne® (FO) algorithm. Using IC algorithm, an optimal 10% variant allele frequency (VAF) cut-off was established for TMB evaluation on FFPE samples, compared to 5% on frozen samples. The median TMB score for MSS/POLE WT tumors was 8.8 mut/Mb versus 45 mut/Mb for MSI/POLE-mutated tumors. When focusing on MSS/POLE WT tumor samples, the highest median TMB scores were observed in lymphoma, lung, endometrial, and cervical cancers. After biological manual curation of these cases, 21% of them could be reclassified as MSI/POLE tumors and considered as “true TMB high.” Higher TMB values were obtained using FO algorithm on FFPE samples compared to IC algorithm (40 mut/Mb [10–3927] versus 8.2 mut/Mb [2.5–897], p < 0.001).
Conclusions: We herein propose a TMB calculation method and a bioinformatics tool that is customizable to different NGS panels and sample types. We were not able to retrieve TMB values from FO algorithm using our own algorithm and NGS panel.

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