Routine Plasma-Based Genotyping to Comprehensively Detect Germline, Somatic, and Reversion BRCA Mutations among Patients with Advanced Solid Tumors

Neelima Vidula*, Thereasa A. Rich, Oliver Sartor, Jennifer Yen, Aaron Hardin, Tracy Nance, Michael B. Lilly, Mohammad Amin Nezami, Sandip P. Patel, Benedito A. Carneiro, Alice C. Fan, Adam M. Brufsky, Barbara A. Parker, Benjamin B. Bridges, Neeraj Agarwal, Benjamin L. Maughan, Victoria M. Raymond, Stephen R. Fairclough, Richard B. Lanman, Aditya BardiaMassimo Cristofanilli

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Purpose: PARP inhibitors (PARPi) are efficacious in multiple cancers harboring germline (and possibly somatic) BRCA1/2 mutations. Acquired reversions can restore BRCA1/2 function, causing resistance to PARPi and/or platinum-based chemotherapy. The optimal method of identifying patients with germline, somatic, and/ or reversion mutations in BRCA1/2 has not been established. Next-generation sequencing (NGS) of cell-free DNA (cfDNA) provides a platform to identify these three types of BRCA1/2 mutations. Experimental Design: Patients with advanced breast, ovarian, prostate, or pancreatic cancer were tested using a clinically validated 73-gene cfDNA assay that evaluates single-nucleotide variants and insertion–deletion mutations (indels) in BRCA1/2, and distinguishes somatic/reversion from germline mutations with high accuracy. Results: Among 828 patients, one or more deleterious BRCA1/2 mutations were detected in 60 (7.2%) patients, including germline (n = 42) and somatic (n = 18) mutations. Common coexisting mutations included TP53 (61.6%), MYC (30%), PIK3CA (26.6%), BRAF (15%), and ESR1 (11.5%). Polyclonal reversion mutations (median, 5) were detected in 9 of 42 (21.4%) germline BRCA1/2-mutant patients, the majority (77.7%) of whom had prior PARPi exposure (median duration, 10 months). Serial cfDNA demonstrated emergence of reversion BRCA mutations under therapeutic pressure from initial PARPi exposure, which contributed to subsequent resistance to PARPi and platinum therapy. Conclusions: cfDNA NGS identified high rates of therapeutically relevant mutations without foreknowledge of germline or tissue-based testing results, including deleterious somatic BRCA1/2 mutations missed by germline testing and reversion mutations that can have important treatment implications. Further research is needed to confirm clinical utility of these findings to guide precision medicine approaches for patients with advanced malignancies.

Original languageEnglish (US)
Pages (from-to)2546-2555
Number of pages10
JournalClinical Cancer Research
Issue number11
StatePublished - Jun 1 2020

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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