Structurally Oriented Classification of FOXA1 Alterations Identifies Prostate Cancers with Opposing Clinical Outcomes and Distinct Molecular and Immunologic Subtypes Article Swipe
YOU?
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· 2025
· Open Access
·
· DOI: https://doi.org/10.1158/1078-0432.ccr-24-3471
Purpose: Around 10% to 15% of prostate cancers harbor recurrent aberrations in the Forkhead Box A1 gene, FOXA1, whereby the alteration type and the effect on the forkhead (FKH) domain affect protein function. We developed a FOXA1 classification system to inform clinical management. Experimental Design: A total of 5,014 prostate cancer samples were examined using whole-exome and -transcriptome sequencing from the Caris Life Sciences database. We denoted class 1 FOXA1 alterations as missense and in-frame insertions/deletions with subclasses oriented with respect to the FKH domain. These were in the first part of the FKH domain [class 1A: amino acids (AA) 168–246], within the Wing2 region of FKH (class 1B: AA 247–269), or outside FKH (class 1C: AA 1–167, 270+). Two hotspot missense mutations at R219 were denoted class 2. Class 3 included predicted truncating mutations with subclasses partitioned based on the FKH domain (class 3A: AA 1–269 and class 3B: AA 270+). Class 4 represented FOXA1 amplifications. Real-world overall survival and therapy outcomes were determined from insurance claims. Results: FOXA1 alterations did not influence survival when considered in aggregate but had distinct prognostic effects when stratified by class. In primary prostate samples, class 1A alterations were associated with overall improved survival (HR, 0.57; P = 0.03); a similar trend was seen in metastatic biopsies with class 1B (HR, 0.84; P = 0.09). Conversely, in primary specimens, class 1C exhibited worse survival upon second-generation androgen receptor signaling inhibitor treatment (HR, 1.93; P < 0.001). Class 2 mutations (R219C/S) were enriched in neuroendocrine prostate cancers and were associated with overall poor survival (HR, 2.05; P < 0.001) and worse outcomes to first-line androgen-deprivation therapies (HR, 2.5; P < 0.001). Class 3A alterations indicated improved survival (HR, 0.70; P = 0.01), whereas class 3B alterations portended poor outcomes (HR, 1.50; P < 0.001). Amplifications (class 4) indicated poor outcomes in metastatic samples (HR, 1.48; P = 0.02). Molecularly, different FOXA1 alteration classes harbored distinct mutational and immunologic features as well as unique transcriptional programs. Finally, relative to European Americans, African Americans had increased class 1C alterations, whereas Asian/Pacific Islander patients had increased class 1B alterations. Conclusions: FOXA1 alterations should not be interpreted in aggregate, as different classes are associated with divergent molecular features and clinical outcomes. Our revised classification schema facilitates clinical decision-making for patients with prostate cancer and uncovers important racial differences.
Related Topics
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1158/1078-0432.ccr-24-3471
- https://aacrjournals.org/clincancerres/article-pdf/doi/10.1158/1078-0432.CCR-24-3471/3529795/ccr-24-3471.pdf
- OA Status
- hybrid
- Cited By
- 8
- References
- 49
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4405990508
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4405990508Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1158/1078-0432.ccr-24-3471Digital Object Identifier
- Title
-
Structurally Oriented Classification of FOXA1 Alterations Identifies Prostate Cancers with Opposing Clinical Outcomes and Distinct Molecular and Immunologic SubtypesWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-01-02Full publication date if available
- Authors
-
Justin H. Hwang, Pornlada Likasitwatanakul, Sachin Kumar Deshmukh, Sharon Wu, Jason J. Kwon, Eamon Toye, David Moline, Mark G. Evans, Andrew Elliott, Rachel Passow, Christine Luo, Emily John, Nishant Gandhi, Rana R. McKay, Elisabeth I. Heath, Chadi Nabhan, Natalie Reizine, Jacob J. Orme, Josep Domingo‐Domenech, Oliver Sartor, Sylvan C. Baca, Scott M. Dehm, Emmanuel S. AntonarakisList of authors in order
- Landing page
-
https://doi.org/10.1158/1078-0432.ccr-24-3471Publisher landing page
- PDF URL
-
https://aacrjournals.org/clincancerres/article-pdf/doi/10.1158/1078-0432.CCR-24-3471/3529795/ccr-24-3471.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
-
https://aacrjournals.org/clincancerres/article-pdf/doi/10.1158/1078-0432.CCR-24-3471/3529795/ccr-24-3471.pdfDirect OA link when available
- Concepts
-
FOXA1, Prostate cancer, Missense mutation, Biology, Germline, Internal medicine, Genetics, Medicine, Cancer, Mutation, Gene, Transcription factorTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
8Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 8Per-year citation counts (last 5 years)
- References (count)
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49Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| title | Structurally Oriented Classification of FOXA1 Alterations Identifies Prostate Cancers with Opposing Clinical Outcomes and Distinct Molecular and Immunologic Subtypes |
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