Frequent Whole-Genome Duplication Events Drive the Genomic Evolution of Triple-Negative Breast Cancer During Neoadjuvant Chemotherapy

Background

Triple-negative breast cancer (TNBC) is associated with poor survival rate and high genomic instability, generating complex tumour genomes. However, the processes that generate this complexity are poorly studied in longitudinal samples. Here, we study the temporal dynamics of TNBC somatic mutations, revealing major transitions in tumour genome evolution, from diagnostic biopsies, through treatment, to cancer remission or recurrence.

Methods

Deep whole exome sequencing and CUTseq, a reduced representation whole genome sequencing approach, were performed in parallel, to comprehensively identify short nucleotide variants (SNVs), copy number alterations (CNAs) and aneuploidies. Tumour samples (N=74) from 22 patients were profiled before and after neoadjuvant chemotherapy (NACT), and encompassed spatially diverse samples from multiple primary breast tumours, to allow tracking of the gain and loss of candidate driver variants over time.

Results

Genome-wide SNV mutational burden remained stable across disease progression and RCB classes. However, recurrent SNVs were identified in several known TNBC driver genes in response to treatment, with TP53, MICA, CYP2D6, BRCA1, and BRCA2 being frequently altered. The candidate driver variants in these genes frequently exhibited dynamic changes throughout the course of a patient’s treatment, with the original SNVs in pre-treatment samples often lost, while novel variants in the same genes emerged at subsequent time points.

In contrast to the stable genome-wide SNV burdens, dramatic changes in chromosome structure were seen in all tumours, with abundant CNAs and chromosome arm aneuploidies seen in pre-treatment samples, followed by frequent loss of these alterations post-treatment, and their re-emergence at recurrence. Whole genome duplication (WGD) events appear to drive these dynamics, with a higher frequency of pre-treatment WGD seen in patients with the best response to NACT.

Conclusions

Comprehensive longitudinal profiling of the TNBC genome demonstrates the complex interplay of SNVs and structural alterations during tumour progression, leading to diverse evolutionary trajectories impacting patient outcomes. Complex mutational patterns encompassing entire chromosomes emerge during progression, with WGD events making major contributions to intra-tumour heterogeneity, and emerging as a potential candidate biomarker of response at both tumour establishment and recurrence.