Tumor Mutational Burden as a Biomarker for Advanced Biliary Tract Cancer

Abstract

<b>Background</b>: High tumor mutational burden (TMB-H) has been reported as a predictive marker to immunotherapy or prognostic marker in various tumor types. However, there has been little study of the role of TMB-H in advanced biliary tract cancer (BTC). <b>Methods</b>: We analyzed 119 advanced BTC patients who received Gemcitabine/Cisplatin (GP) as a first-line treatment between November 2019 and April 2021. Next-generation sequencing (NGS), including TMB analysis, as a routine clinical practice was performed in 119 patients. The TruSight^TM Oncology 500 assay from Illumina was used as a cancer panel. <b>Results</b>: Among 119 patients, 18 (18.5%) had a tumor with high TMB (≥ 10 Muts/Mb). There were no significant differences between the status of TMB and clinical outcomes with GP, including objective response rate (ORR) (<i>P</i> = .126), disease control rate (DCR) (<i>p</i> = .454), and median progression-free survival (PFS) (<i>p</i> = .599). The median overall survival (OS) was not different between patients with TMB-H and no TMB-H (<i>p</i> = .430). In subgroup analysis of 32 patients receiving immune checkpoint inhibitor (ICIs), there were significant differences in ORR (<i>p</i> = .034) and median PFS (<i>p</i> <i>=</i> .025) with ICIs between patients with and without TMB-H. <b>Conclusions</b>: This study revealed that TMB-H in advanced BTCs did not have a prognostic or role in the standard first-line treatment. However, TMB-H might be a predictive biomarker for response to ICIs in advanced BTC.