Theranostic profiling for actionable aberrations in advanced high risk osteosarcoma with aggressive biology reveals high molecular diversity: the human fingerprint hypothesis

Daniela Egas-Bejar1, Pete M. Anderson1,2, Rishi Agarwal3, Fernando Corrales-Medina1, Eswaran Devarajan4, Winston W. Huh1, Robert E Brown5,Vivek Subbiah3

1 Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX

2 Pediatric Hematology/ Oncology/ BMT, Levine Children’s Hospital/ Levine Cancer Institute, Charlotte, NC

3 Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX

4 Department of Orthopedic Oncology- Research, The University of Texas MD Anderson Cancer Center, Houston, TX

5 Department of Pathology, UT Health-Department of Pathology and Laboratory medicine, Houston, TX


Vivek Subbiah, email:

Keywords: Osteosarcoma, Targeted therapy, Sarcoma, Bone tumors, Next generation sequencing, CLIA, biomarker.

Received: January 6, 2014 Accepted: March 10, 2014 Published: March 12, 2014


The survival of patients with advanced osteosarcoma is poor with limited therapeutic options. There is an urgent need for new targeted therapies based on biomarkers. Recently, theranostic molecular profiling services for cancer patients by CLIA-certified commercial companies as well as in-house profiling in academic medical centers have expanded exponentially. We evaluated molecular profiles of patients with advanced osteosarcoma whose tumor tissue had been analyzed by one of the following methods: 1. 182-gene next-generation exome sequencing (Foundation Medicine, Boston, MA), 2. Immunohistochemistry (IHC)/PCR-based panel (CARIS Target Now, Irving, Tx), 3.Comparative genome hybridization (Oncopath, San Antonio, TX). 4. Single-gene PCR assays, PTEN IHC (MDACC CLIA), 5. UT Houston morphoproteomics (Houston, TX). The most common actionable aberrations occur in the PI3K/PTEN/mTOR pathway. No patterns in genomic alterations beyond the above are readily identifiable, and suggest both high molecular diversity in osteosarcoma and the need for more analyses to define distinct subgroups of osteosarcoma defined by genomic alterations. Based on our preliminary observations we hypothesize that the biology of aggressive and the metastatic phenotype osteosarcoma at the molecular level is similar to human fingerprints, in that no two tumors are identical. Further large scale analyses of osteosarcoma samples are warranted to test this hypothesis.

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