Molecular genetics of clear-cell renal cell carcinoma

J Clin Oncol. 2014 Jun 20;32(18):1968-76. doi: 10.1200/JCO.2012.45.2003. Epub 2014 May 12.

Abstract

Renal cell carcinoma of clear-cell type (ccRCC) is an enigmatic tumor type, characterized by frequent inactivation of the VHL gene (infrequently mutated in other tumor types), responsiveness to angiogenesis inhibitors, and resistance to both chemotherapy and conventional radiation therapy. ccRCC tumors exhibit substantial mutation heterogeneity. Recent studies using massively parallel sequencing technologies have implicated several novel driver genes. In VHL wild-type tumors, mutations were discovered in TCEB1, which encodes Elongin C, a protein that binds to VHL and is required for its function. Several additional tumor suppressor genes have been identified near the VHL gene, within a region that is frequently deleted in ccRCC on chromosome 3p: SETD2, BAP1, and PBRM1. Mutations in BAP1 and PBRM1 are largely mutually exclusive and are associated with different tumor biology and patient outcomes. In addition, the mTORC1 pathway is deregulated by mutations in MTOR, TSC1, PIK3CA, and PTEN in approximately 20% of ccRCCs. Mutations in TSC1, and possibly other genes, may predict for sensitivity to mTORC1 inhibitors. These discoveries provide insight into ccRCC development and set the foundation for the first molecular genetic classification of the disease, paving the way for subtype-specific therapies.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Antineoplastic Agents / pharmacology
  • Carcinoma, Renal Cell / genetics*
  • Carcinoma, Renal Cell / metabolism
  • Carcinoma, Renal Cell / pathology
  • DNA-Binding Proteins
  • Gene Expression Regulation, Neoplastic
  • Gene Silencing
  • Histone-Lysine N-Methyltransferase / genetics
  • Humans
  • Kidney Neoplasms / genetics*
  • Kidney Neoplasms / metabolism
  • Kidney Neoplasms / pathology
  • Mechanistic Target of Rapamycin Complex 1
  • Molecular Targeted Therapy / methods
  • Multiprotein Complexes / genetics
  • Mutation*
  • Nuclear Proteins / genetics
  • TOR Serine-Threonine Kinases / genetics
  • Transcription Factors / genetics
  • Transcriptome*
  • Tumor Suppressor Proteins / genetics
  • Ubiquitin Thiolesterase / genetics
  • Von Hippel-Lindau Tumor Suppressor Protein / genetics

Substances

  • Antineoplastic Agents
  • BAP1 protein, human
  • DNA-Binding Proteins
  • Multiprotein Complexes
  • Nuclear Proteins
  • PBRM1 protein, human
  • Transcription Factors
  • Tumor Suppressor Proteins
  • Histone-Lysine N-Methyltransferase
  • SETD2 protein, human
  • Von Hippel-Lindau Tumor Suppressor Protein
  • TOR Serine-Threonine Kinases
  • Mechanistic Target of Rapamycin Complex 1
  • Ubiquitin Thiolesterase
  • VHL protein, human