Genetic determinants of cisplatin resistance in patients with advanced germ cell tumors

Aditya Bagrodia, Byron H. Lee, William Lee, Eugene K. Cha, John P. Sfakianos, Gopa Iyer, Eugene J. Pietzak, Sizhi Paul Gao, Emily C. Zabor, Irina Ostrovnaya, Samuel D. Kaffenberger, Aijazuddin Syed, Maria E. Arcila, Raju S. Chaganti, Ritika Kundra, Jana Eng, Joseph Hreiki, Vladimir Vacic, Kanika Arora, Dayna M. OschwaldMichael F. Berger, Dean F. Bajorin, Manjit S. Bains, Nikolaus Schultz, Victor E. Reuter, Joel Sheinfeld, George J. Bosl, Hikmat A. Al-Ahmadie, David B. Solit, Darren R. Feldman

Research output: Contribution to journalArticlepeer-review

116 Scopus citations


Purpose: Owing to its exquisite chemotherapy sensitivity, most patients with metastatic germ cell tumors (GCTs) are cured with cisplatin-based chemotherapy. However, up to 30% of patients with advanced GCT exhibit cisplatin resistance, which requires intensive salvage treatment, and have a 50% risk of cancer-related death. To identify a genetic basis for cisplatin resistance, we performed whole-exome and targeted sequencing of cisplatin-sensitive and cisplatin-resistant GCTs. Methods: Men with GCT who received a cisplatin-containing chemotherapy regimen and had available tumor tissue were eligible to participate in this study. Whole-exome sequencing or targeted exon-capture-based sequencing was performed on 180 tumors. Patients were categorized as cisplatin sensitive or cisplatin resistant by using a combination of postchemotherapy parameters, including serum tumor marker levels, radiology, and pathology at surgical resection of residual disease. Results: TP53 alterations were present exclusively in cisplatin-resistant tumors and were particularly prevalent among primary mediastinal nonseminomas (72%). TP53 pathway alterations including MDM2 amplifications were more common among patients with adverse clinical features, categorized as poor risk according to the International Germ Cell Cancer Collaborative Group (IGCCCG) model. Despite this association, TP53 and MDM2 alterations predicted adverse prognosis independent of the IGCCCG model. Actionable alterations, including novel RAC1 mutations, were detected in 55% of cisplatin-resistant GCTs. Conclusion: In GCT, TP53 and MDM2 alterations were associated with cisplatin resistance and inferior outcomes, independent of the IGCCCG model. The finding of frequent TP53 alterations among mediastinal primary nonseminomas may explain the more frequent chemoresistance observed with this tumor subtype. A substantial portion of cisplatin-resistant GCTs harbor actionable alterations, which might respond to targeted therapies. Genomic profiling of patients with advanced GCT could improve current risk stratification and identify novel therapeutic approaches for patients with cisplatin-resistant disease.

Original languageEnglish (US)
Pages (from-to)4000-4007
Number of pages8
JournalJournal of Clinical Oncology
Issue number33
StatePublished - Nov 20 2016

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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