Cell-free DNA epigenomic profiling enables noninvasive detection and monitoring of translocation renal cell carcinoma.

TFE3 translocation renal cell carcinoma (tRCC), an aggressive kidney cancer driven by TFE3 gene fusions, is frequently misdiagnosed owing to morphologic overlap with other kidney cancer subtypes. Conventional liquid biopsy assays that detect tumor DNA via somatic mutations or copy number alterations are unsuitable for tRCC since it often lacks recurrent genetic alterations and because fusion breakpoints are highly variable between patients. We reasoned that epigenomic profiling could more effectively detect tRCC because the driver fusion constitutes an oncogenic transcription factor that alters gene regulation. By defining a TFE3-driven epigenomic signature in tRCC cell lines and detecting it in patient plasma using ChIP-seq, we distinguished tRCC from clear-cell RCC (AUC = 0.86) and samples of individuals without evidence of cancer (AUC = 0.92) at low tumor fractions (<1%). This work establishes a framework for noninvasive epigenomic detection, diagnosis, and monitoring of tRCC, with implications for other mutationally quiet, fusion-driven cancers.
Cancer
Care/Management
Policy

Authors

Garinet Garinet, Semaan Semaan, Li Li, Zhang Zhang, Konda Konda, Sadagopan Sadagopan, Canniff Canniff, Phillips Phillips, Klega Klega, Pandey Pandey, Savignano Savignano, Davidsohn Davidsohn, Lyons Lyons, Medda Medda, Khanna Khanna, Achom Achom, Fortunato Fortunato, Nawfal Nawfal, El Hajj Chehade El Hajj Chehade, O'Toole O'Toole, Horst Horst, Freeman Freeman, Trowbridge Trowbridge, Chau Chau, Figg Figg, Berchuck Berchuck, Crompton Crompton, Seo Seo, Choueiri Choueiri, Freedman Freedman, Baca Baca, Viswanathan Viswanathan
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