Real-World Data and Clinical Implications of Next-Generation Sequencing (NGS)-Based Analysis in Metastatic Breast Cancer Patients

Abstract

Over the last two decades, the use of Next-Generation Sequencing (NGS) in medical oncology has increased the likelihood of identifying druggable mutations that may be potentially susceptible to targeted treatments. The European Society for Medical Oncology (ESMO) currently does not recommend the use of the NGS test to determine the therapeutic course of patients with metastatic breast cancer (mBC) in daily clinical practice. However, the aim of this work is to evaluate the potential contribution of the NGS test in selecting targeted therapies for patients with mBC. Data were retrospectively collected from 101 patients diagnosed with metastatic breast cancer and treated at the Modena Cancer Center between January 2015 and April 2022. A NGS test was performed on the tumor tissue of each patient at the Laboratory of Molecular Pathology of the University Hospital of Modena. This study analyzed the clinical-pathological characteristics and mutational profile of the population using NGS tests, with a focus on actionable mutations that could be targeted in advanced stages of clinical development. The indicator of this study was to quantify the actionable mutations that resulted in a change of cancer treatment. In total, 101 patients with metastatic breast cancer were analyzed, including 86 with luminal phenotype, 10 who were HER2-positive and 5 who were triple-negative. Median age was 52 years. NGS analysis was conducted on 47 samples of primary breast cancer, 52 on metastatic sites of disease and 2 on liquid biopsies. A total of 85 gene mutations were found. The most common mutations were identified in the PIK3CA (47%), FGFR (19%) and ERBB2 genes (12%), and to a lesser extent in other genes. Of the 61 patients with pathogenic mutations, 46 (75%) had at least one actionable mutation. Of these, nine received treatment with a molecular target drug: eight patients with a mutation of the PIK3CA gene were treated with alpelisib and fulvestrant; one patient with FGFR1/2 amplifications received TAS120. Median PFS for these patients was 3.8 months. The study results show that using the NGS test on cancer tissue of metastatic breast cancer could influence the therapeutic choices, considering the small sample size and limited follow-up. About 9% of the study population had their therapy modified based on the results of NGS. The growing number of detectable mutations and increased accessibility of the test may lead to a greater number of potential therapeutic implications for the NGS assay. Perspectives suggest that NGS analysis can be implemented in daily clinical practice, particularly in contexts where a Molecular Tumor Board (MTB) is active.

Keywords: actionable mutations; advanced breast cancer; next-generation sequencing (NGS); target therapy; tumor mutational burden.

Figure 5

(a) Implication of PIK3CA mutations and OS. (b) Implication of FGFR mutations and OS.

Figure 5

(a) Implication of PIK3CA mutations and OS. (b) Implication of FGFR mutations and OS.

Figure 1

(a) Main genetic alteration incidence. (b) Distribution of the main mutations related to tumor phenotypes at diagnosis. #Triple-negative tumors were not considered in this figure, because only 2 of 5 patients showed genetic mutations (CDK6 and MYC, respectively).

Figure 2

Correlation between changes in metastasis phenotype versus primary tumor and OS.

Figure 3

Correlation between OS and timing of NGS analysis.

Figure 4

(a) Impact of gene alterations on OS. (b) Correlation between number of mutations per patient and OS.

Figure 6

Impact of NGS on overall survival in patients who received CDK4/6 inhibitors.

Figure 7

Correlation between gene mutations according to ESCAT scale and OS.