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We studied genomic alterations in 19 inflammatory breast cancer (IBC) patients with advanced disease using samples of tissue and paired blood serum or plasma (cell-free DNA, cfDNA) by targeted next generation sequencing (NGS). At diagnosis, the disease was triple negative (TN) in eleven patients (57.8%), ER+ Her2- IBC in six patients (31.6%), ER+ Her2+ IBC in one patient (5.3%), and ER- Her2+ IBC in one other patient (5.3%). Pathogenic or likely pathogenic variants were frequently detected in <i>TP53</i> (47.3%), <i>PMS2</i> (26.3%), <i>MRE11</i> (26.3%), <i>RB1</i> (10.5%), <i>BRCA1</i> (10.5%), <i>PTEN</i> (10.5%) and <i>AR</i> (10.5%); other affected genes included <i>PMS1</i>, <i>KMT2C</i>, <i>BRCA2</i>, <i>PALB2</i>, <i>MUTYH</i>, <i>MEN1</i>, <i>MSH2</i>, <i>CHEK2</i>, <i>NCOR1</i>, <i>PIK3CA</i>, <i>ESR1</i> and <i>MAP2K4.</i> In 15 of the 19 patients in which tissue and paired blood were collected at the same time point, 80% of the variants detected in tissue were also detected in the paired cfDNA. Higher concordance between tissue and cfDNA was found for variants with higher allele fraction in tissue (AF_tissue &#8805; 5%). Furthermore, 86% of the variants detected in cfDNA were also detected in paired tissue. Our study suggests that the genetic profile measured in blood cfDNA is complementary to that of tumor tissue in IBC patients.