Deciphering evolutionary trajectories in hereditary renal cell carcinomas
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ICR Authors
Authors
Shepherd, S
Document Type
Thesis or Dissertation
Date
2024-01-16
Date Accepted
Abstract
Establishing the limits of predictability in cancer evolution has significant implications for
precision medicine. Clear cell renal cell carcinoma (ccRCC) follows highly deterministic
evolutionary pattern with conserved order of mutation and copy number events and mutual
exclusivity. While the repeatability of evolutionary trajectories within individuals cannot be
determined in those with sporadic cancers, individuals with a hereditary predisposition
may develop dozens of tumours over the course of their lifetime offering a unique
opportunity to infer the factors associated with progression.
I present novel insights into the evolution of ccRCC on the constrained background of
germline von Hippel-Lindau (VHL) mutation through molecular analysis of 1321 VHLrelated neoplasms from 132 patients. By integrating panel sequencing, single nucleus
RNA sequencing, and detailed clinicopathological data, I uncover novel findings related to
genotype/phenotype correlations, the interplay of evolutionary contingency and
convergence, and the constraints active in the evolution of VHL related neoplasms.
The study demonstrates that chance plays a predominant role in ccRCC evolution, within
the constraints of available evolutionary paths, as clonally independent ccRCCs with
germline VHL mutations exhibit random somatic profiles across the cohort. However,
specific examples of evolutionary convergence are also observed. Novel routes to biallelic
inactivation of VHL in transformed tumours are identified, and a subset of tumours without
VHL loss suggests alternative evolutionary paths that may represent evolutionary ‘deadends’. Moreover, the study highlights the influential role of the cell-of-origin lineage in
shaping the selection of somatic events.
I refine the understanding of genotype-phenotype correlations in VHL disease showing
that tumours retaining some regulation of hypoxia inducible factor (HIF) exhibit distinct
molecular profiles. The enrichment of chromosomal instability and high-risk chromosomal
loci in larger renal tumours reconciles the association between metastasis risk and tumor
diameter in VHL disease.
Lastly, in the context of the SARS-CoV-2 pandemic, I report the establishment of a
prospective, pan-cancer study (CAPTURE) focused on longitudinal immune profiling of
cancer patients and their response to COVID-19 vaccination.
Citation
2024
DOI
Source Title
Publisher
Institute of Cancer Research (University Of London)
ISSN
eISSN
Collections
Research Team
Melanoma & Kidney Cancer