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Profile of somatic mutations in young adults with pancreatic cancer.

e15790 Background: Most pancreatic carcinomas (PC) occur in older people, however a few cases are detected in young adults. In this age group, the carcinogenic process is less well understood. Our goal was to identify and to characterize cancer driver genes in early age onset PC. Methods: Somatic variants of individuals affected by PC aged ≤45 years were searched in the COSMIC and CBioPortal databases. The variants were annotated using Oncotator, excluding the silent and intronic variants. Implication in cancer causality was evaluated in the Cancer Gene Census (CGC) and the Candidate Cancer Gene Database (CCGD). The most frequently mutated genes were identified and investigated to determine if they configured FrequentLy mutAted GeneS (FLAGs). Results: Whole genome (4) or exome (29) sequencing was available from 33 individuals (14 females and 19 males). A median of 31 (7-102) alterations per tumor, mainly represented by C > T substitutions (median 16, 2-71), was detected. A median of 3 (0-11) truncated alterations, 4 (1-13) genes cataloged as CGC and 8 (1-22) genes cataloged as CCGD rank A or B was identified per tumor. The most frequently affected genes were those characteristic of tumor promotion in pancreatic cancer carcinogenesis, such as KRAS (79%), TP53 (64%), SMAD4 (18%), followed by RYR1 (15%) and TTN (12%) genes, the latter two classified as FLAGs and, finally, HERC2, GREB1 and DMBT1 (9%). Seventeen samples presented variants in both TP53 and KRAS (17/33), 9 and 4 presented only KRAS or TP53 variants, respectively. Three samples with mutations in neither of these genes presented mutations in genes such as BCLAF1, DCC, BRAF, CDH11 and CDKN2A, both CGCs. Three out of 9 samples carrying KRAS but not TP53 mutations presented variants in DNA homologous repair (HHR) genes. Among all the altered genes, the main biological processes were cell adhesion (139 genes involved) and anatomical structure formation involved in morphogenesis (127), while the most enriched pathways were Wnt (45) and Cadherin (30). Conclusions: TP53 and KRAS are the somatic mutations most frequently detected in PC. 10% of the samples showed no change in these genes, but showed changes in other CGCs. HERC2, GREB1 and DMBT1 are potential cancer drivers in young adult PCs.