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Giornale Italiano di Dermatologia e Venereologia 2019 Dec 04

DOI: 10.23736/S0392-0488.19.06516-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Personalized and targeted mutational analysis of multiple second primary melanomas under kinase inhibitors

Michele DONATI 1, Giovanni ZELANO 2, Rosa COPPOLA 3 , Eleonora CINELLI 4, Martina VERRI 1, Paolo PERSICHETTI 3, Eleonora PERRELLA 1, Valeria DEVIRGILIIS 3, Stefano CALVIERI 5, Anna CRESCENZI 1, Vincenzo PANASITI 3

1 Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy; 2 Institute of Human Anatomy and Cell Biology, Sacro Cuore Catholic University, Rome, Italy; 3 Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy; 4 Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 5 Unit of Dermatology, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy


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BACKGROUND: Ssecond primary melanomas (SPMs) are new developed primary melanomas occurring in a subset of patients affected by BRAF-mutated metastatic melanoma during treatment with BRAF-inhibitors. A drug-induced paradoxical activation of mitogen-activated protein kinase (MAPK) signaling pathway in BRAF-wild type/RAS-mutated cells have been proposed as a possible molecular mechanism but data on the mutational status of SPMs are lacking. In order to better understand genetic alterations affecting the biological mechanism of SPMs, we performed a personalized and targeted next-generation sequencing analysis of a patient affected by metastatic melanoma who developed multiple SPMs during treatment with encorafenib (LGX818).
METHODS: Using a cancer panel of 50 genes for solid tumors enriched with a custom panel of 10 genes specifically involved in melanoma pathogenesis, we analyzed the primary melanoma, two SPMs, one benign compound nevus and the normal DNA extracted from blood lymphocytes of the patient.
RESULTS: We identified HRAS Q61 somatic mutation in one SPM developed in a pre-existing nevus. In the primary melanoma, besides the BRAF mutation, we identified the clinically actionable IDH1 R132C somatic mutation. Both SPMs were BRAF wild type. The patient harbors the recently recognized pathogenetic germline variant KDR Q472. We observed that mutations detected in tumor samples involving genes related to melanoma pathogenesis (TP53, PIK3CA, FGFR3, ATF1, KIT, HRAS and MAP2K2) were present in heterozygosis in the germline status of the patient.
CONCLUSIONS: Our results support the paradoxical mechanism of MAPK pathway for SPMs under BRAF inhibitors. Moreover, they suggest that targeted mutational assessment based on matching somatic and germline analysis represent a promising approach to detect the neoplastic landscape of the tumor and to identify most accurate treatment in metastatic melanoma patient.


KEY WORDS: Targeted mutational analysis; Multiple second primary melanomas; Kinase inhibitors

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