• Heejung Chae, Deokhoon Kim, Changhoon Yoo, Kyu-Pyo Kim, Jae Ho Jeong, Heung-Moon Chang, Sang Soo Lee, ParkDo HyunDHDepartment of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Tae Jun Song, Shin Hwang, Ki-Hun Kim, Gi-Won Song, Chul Soo Ahn, Jae Hoon Lee, Dae Wook Hwang, Song Cheol Kim, Se Jin Jang, Seung-Mo Hong, Tae Won Kim, and Baek-Yeol Ryoo.
• Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
• Eur. J. Cancer. 2019 Oct 1; 120: 31-39.

PurposeIn biliary tract cancer (BTC), standard chemotherapy has limited benefit and no molecular targeted agents have been approved. This study investigated the genetic profile of BTC to identify potential new therapeutic targets and predictive biomarkers.MethodsTargeted exome sequencing was performed for 124 patients with BTC [gallbladder cancer (GBC), 25; intrahepatic cholangiocarcinoma (ICC), 55; extrahepatic cholangiocarcinoma (ECC), 44]. Survival analysis was performed in 112 patients who received palliative chemotherapy for locally unresectable or metastatic disease.ResultsGenetic alterations were observed in 104 patients (83.8%); the most commonly mutated genes were TP53 (44.4%), KRAS (29.0%), ARID1A (12.1%) and IDH1 (9.7%). IDH1/2 mutations appeared more frequently in ICC (23.6%, P = 0.0002) than in GBC (4.0%) or ECC (2.3%), while ERBB2/3 mutations were found only in GBC (20.0%) and ECC (11.4%). Patients harbouring TP53 mutations had shorter overall survival (OS; median 15.2 vs. 37.8 months, P = 0.018), while IDH1 mutations showed a tendency for longer progression-free survival (PFS; 10.6 vs. 6.1 months, P = 0.124). Potentially actionable genetic alterations were found in 54.8%, and 7.1% received appropriate molecular targeted therapy in the clinical trial setting. Germline or somatic mutations in DNA damage repair (DDR) genes were found in 63.5% of patients and were significantly associated with longer PFS (6.9 vs. 5.7 months, P = 0.013) and OS (21.0 vs. 13.3 months, P = 0.009) in patients who received first-line platinum-containing chemotherapies (n = 88).ConclusionsA subgroup of patients with BTC may benefit from targeted therapy by the aid of genetic information. In particular, DDR alterations may be a predictive biomarker for response to platinum-containing chemotherapy in patients with BTC.Copyright © 2019 Elsevier Ltd. All rights reserved.

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