Osteosarcoma is the most common bone malignancy in children and adolescents with poorly understood aetiology. Recently, disease susceptibility and aetiology in several cancers have been associated with genomic copy-number (CN) change. We therefore studied the contribution of CN change in osteosarcoma. We report that individuals with osteosarcoma have increased germline structural variation compared to controls. These CN variants (CNVs) preferentially localize to genes implicated in control of osteoblast differentiation, bone mineralization and ossification. We propose that germline CNVs contribute to osteosarcoma susceptibility through deregulation of developmental processes controlled by genes contained within CNVs. Further supporting the notion that germline CNVs in individuals with osteosarcoma are pathogenic, we demonstrate that CNVs are associated with poor patient survival. Finally, we characterize two germline CNVs, at chromosome 1q43 and 2p11.2, which are overrepresented in osteosarcoma patients and propose that they contribute to osteosarcoma susceptibility through effect on neighbouring genes, which could be involved in control of microtubule dynamics and tumour suppression. We further characterize two regions in the tumour genome of osteosarcoma patients that harbour recurrent CN alterations (CNAs). These include deletions at chromosome 3q13.31 and vi ii amplifications at chromosome 7p14.1, which are the most altered regions in osteosarcoma and contest the view that CNAs in osteosarcoma are non-recurrent. Both chromosome 3q13.31 and 7p14.1 CNAs involve genes implicated in carcinogenesis, including LASMP at 3q13.31 and TARP at 7p14.1, while 3q13.31 CNAs also involve two non-coding RNAs. We further show that expression of 3q13.31 genes correlates with the presence of 3q13.31 CNAs. We report that chromosome 3q13.31 and 7p14.1 CNAs are also common in other cancers, identifying these loci as candidates with a global role in carcinogenesis. Supporting the notion that 3q13.31 deletions play a role in osteosarcomagenesis, we find that depletion of 3q13.31 genes promotes proliferation of osteoblasts by regulation of apoptotic and cell-cycle transcripts and also VEGF receptor 1 and that genetic deletions of 3q13.31 are associated with poor survival of osteosarcoma patients. In summary, our study implicates germline and somatic CN changes in osteosarcoma and represents a model approach for elucidation of elements contributing to disease susceptibility and aetiology in human cancer.

Osteosarcoma is the most common bone malignancy in children and adolescents with poorly understood aetiology. Recently, disease susceptibility and aetiology in several cancers have been associated with genomic copy-number (CN) change. We therefore studied the contribution of CN change in osteosarcoma. We report that individuals with osteosarcoma have increased germline structural variation compared to controls. These CN variants (CNVs) preferentially localize to genes implicated in control of osteoblast differentiation, bone mineralization and ossification. We propose that germline CNVs contribute to osteosarcoma susceptibility through deregulation of developmental processes controlled by genes contained within CNVs. Further supporting the notion that germline CNVs in individuals with osteosarcoma are pathogenic, we demonstrate that CNVs are associated with poor patient survival. Finally, we characterize two germline CNVs, at chromosome 1q43 and 2p11.2, which are overrepresented in osteosarcoma patients and propose that they contribute to osteosarcoma susceptibility through effect on neighbouring genes, which could be involved in control of microtubule dynamics and tumour suppression. We further characterize two regions in the tumour genome of osteosarcoma patients that harbour recurrent CN alterations (CNAs). These include deletions at chromosome 3q13.31 and vi ii amplifications at chromosome 7p14.1, which are the most altered regions in osteosarcoma and contest the view that CNAs in osteosarcoma are non-recurrent. Both chromosome 3q13.31 and 7p14.1 CNAs involve genes implicated in carcinogenesis, including LASMP at 3q13.31 and TARP at 7p14.1, while 3q13.31 CNAs also involve two non-coding RNAs. We further show that expression of 3q13.31 genes correlates with the presence of 3q13.31 CNAs. We report that chromosome 3q13.31 and 7p14.1 CNAs are also common in other cancers, identifying these loci as candidates with a global role in carcinogenesis. Supporting the notion that 3q13.31 deletions play a role in osteosarcomagenesis, we find that depletion of 3q13.31 genes promotes proliferation of osteoblasts by regulation of apoptotic and cell-cycle transcripts and also VEGF receptor 1 and that genetic deletions of 3q13.31 are associated with poor survival of osteosarcoma patients. In summary, our study implicates germline and somatic CN changes in osteosarcoma and represents a model approach for elucidation of elements contributing to disease susceptibility and aetiology in human cancer.

Le domaine de l'oncologie progresse de manière rapide, surtout depuis l'avènement des thérapies ciblées. Parmi elles, les inhibiteurs de tyrosine kinase multicible (ITK) antiangiogéniques ont fait la preuve de leur efficacité dans plusieurs types de cancers métastatiques. Le sorafenib, le sunitinib, le pazopanib, l'axtinib, et le regorafenib sont aujourd'hui utilisés en pratique courante. Ces premières thérapeutiques ont ouvert la voie au développement de nombreuses autres molécules ciblant d'autres récepteurs TK (crizotinib, céritinib). Les ITK ciblant les récepteurs de l'angiogénèse inhibent des récepteurs membranaires tels que les VEGFR, les PDGFR, les FGFR etc. Ces molécules améliorent généralement survie et/ou survie sans progression dans les essais cliniques pivots mais il existe une grande variabilité interindividuelle en termes de bénéfice clinique. Nous avons cherché à mettre en évidence des biomarqueurs moléculaires prédictifs de la réponse, afin de mieux sélectionner les patients susceptibles de bénéficier de ces ITKs. L'objectif final de ce travail est ainsi de mieux sélectionner les patients candidats à ce traitement, mais il est également médico économique. La part la plus importante de ce travail est axée sur le regorafenib, qui a fait preuve de son efficacité dans les cancers colorectaux métastatiques prétraités et les tumeurs stromales gastro-intestinalesen échec d'imatinib et de sunitinib. Cependant, aucun paramètre clinique ou histologique n'a été identifié pour sélectionner les patients potentiels pouvant bénéficier de ce traitement, ou, à l'inverse pour éviter de traiter les patients chez lesquels la balance bénéfice/risque est défavorable. Ce travail a été réalisé dans le cadre de programme ProfiLER (NCT01774409) en partenariat avec les plateformes de génomique tumorale (Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard). Cette étude avait pour objectif de tester l'hypothèse que l'ensemble des altérations des gènes codant pour les kinases cibles d'un ITK donné pourrait être associé au bénéfice clinique de ce traitement. Dans notre étude, nous avons observé que les cancers des patients présentant un bénéfice clinique accumulent des gains chromosomiques sur les gènes cibles, et à l'inverse, les cancers des patients nonrépondeurs possèdent plutôt un profil inverse. L'index génomique, un paramètre évaluant l'instabilité chromosomique ne permet pas de différencier les patients répondeurs, mais nous avons mis en évidence que l'accumulation de certains gains sur les gènes cibles est associée à une meilleure survie. Nous avons ainsi proposé un nouveau concept : celui de TTC (Tumor Target Charge), la somme des gains sur les gènes cibles ; et à l'inverse, celui de TTL (Tumor Target Loss), la somme des pertes sur les gènes cibles. En nous appuyant sur ces définitions de TTC et TTL, nous avons généré un algorithme nommé SUMSCAN traduisant donc la somme des gains et des pertes sur les gènes cibles. Le score SUMSCAN a été appliqué à une première cohorte composée essentiellement de patients ayant un cancer colorectal métastatique et traités par regorafenib, ainsi qu'à une 2ème cohorte de validation composée des patients ayant différentes pathologies néoplasiques. Chez les patients ayant un cancer colorectal « moléculairement sélectionné», la médiane de survie sans progression était de 9 mois contre 3 mois dans la cohorte de patients non sélectionnés (X. JIANG et al, Oncotarget, 2015). Nous avons pu montrer que le principe de ce score pronostique pouvait s'appliquer aux autres antiangiogéniques multi-ITKs.. Nous sommes ainsi en cours de validation de ce score pour la prédiction de la survie sur de larges populations de patients présentant divers types tumoraux : sarcome des tissus mous, carcinomes ovariens de haut grade, carcinome rénal carcinome de la thyroïde, etc.) / Small molecule antiangiogenic tyrosine kinase inhibitors (TKI), such as regorafenib, sorafenib, sunitinib, pazopanib, axitinib, and cabozantinib, are active in a variety of advanced cancers, including renal cell carcinoma (RCC), gastrointestinal stromal tumors (GIST), hepatocellular carcinoma (HCC), colorectal cancer (CRC) and thyroid cancers. Predictive criteria for response to these multiple kinase inhibitors (MTKI) are not as well determined as for tumors harboring key driver alterations, such as BCR-ABL translocations in chronic myeloid leukemia (CML), KIT-mutant GIST, BRAF-mutant melanoma, and ALK-positive non-small cell lung cancer among others. Regorafenib, for instance, has been shown to yield a progression-free survival (PFS) improvement in pretreated metastatic colorectal cancer (mCRC) and in imatinib and sunitinib refractory gastrointestinal stromal tumors (GIST). We report that the antitumor activity of MTKIs in tumors lacking a well-defined oncogenic driver is strongly correlated with copy number alterations of genes encoding the protein kinases targeted by these drugs. A concept of tumor target charge (TTC), defined as the total gains of the genes encoding for targets of MTKIs as well as tumor target loss (TTL) was developed, and correlated to response to regorafenib in 2 cohorts of patients composed of mCRC and STS patients. A predictive model, called SUMSCAN, was conceived as a binary classifier to identify patients as either good or poor candidates for use of MTKIs. Moreover, the PFS and OS of patients with a favorable SUMSCAN score were significantly improved. Importantly, SUMSCAN predicted exclusively response to regorafenib, but not the response to conventional chemotherapy in mCRC