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Targeted massively parallel sequencing of angiosarcomas reveals frequent activation of the mitogen activated protein kinase pathway

Identifieur interne : 001777 ( Main/Exploration ); précédent : 001776; suivant : 001778

Targeted massively parallel sequencing of angiosarcomas reveals frequent activation of the mitogen activated protein kinase pathway

Auteurs : Rajmohan Murali [États-Unis] ; Raghu Chandramohan [États-Unis] ; Inga Möller [Allemagne] ; Simone L. Scholz [Allemagne] ; Michael Berger [États-Unis] ; Kety Huberman [États-Unis] ; Agnes Viale [États-Unis] ; Mono Pirun [États-Unis] ; Nicholas D. Socci [États-Unis] ; Nancy Bouvier [États-Unis] ; Sebastian Bauer [Allemagne] ; Monika Artl [Autriche] ; Bastian Schilling [Allemagne] ; Tobias Schimming [Allemagne] ; Antje Sucker [Allemagne] ; Benjamin Schwindenhammer [Allemagne] ; Florian Grabellus [Allemagne] ; Michael R. Speicher [Autriche] ; Jörg Schaller [Allemagne] ; Uwe Hillen [Allemagne] ; Dirk Schadendorf [Allemagne] ; Thomas Mentzel [Allemagne] ; Donavan T. Cheng [États-Unis] ; Thomas Wiesner [États-Unis, Autriche] ; Klaus G. Griewank [Allemagne]

Source :

RBID : PMC:4742160

Abstract

Angiosarcomas are rare malignant mesenchymal tumors of endothelial differentiation. The clinical behavior is usually aggressive and the prognosis for patients with advanced disease is poor with no effective therapies. The genetic bases of these tumors have been partially revealed in recent studies reporting genetic alterations such as amplifications of MYC (primarily in radiation-associated angiosarcomas), inactivating mutations in PTPRB and R707Q hotspot mutations of PLCG1. Here, we performed a comprehensive genomic analysis of 34 angiosarcomas using a clinically-approved, hybridization-based targeted next-generation sequencing assay for 341 well-established oncogenes and tumor suppressor genes. Over half of the angiosarcomas (n = 18, 53%) harbored genetic alterations affecting the MAPK pathway, involving mutations in KRAS, HRAS, NRAS, BRAF, MAPK1 and NF1, or amplifications in MAPK1/CRKL, CRAF or BRAF. The most frequently detected genetic aberrations were mutations in TP53 in 12 tumors (35%) and losses of CDKN2A in 9 tumors (26%). MYC amplifications were generally mutually exclusive of TP53 alterations and CDKN2A loss and were identified in 8 tumors (24%), most of which (n = 7, 88%) arose post-irradiation. Previously reported mutations in PTPRB (n = 10, 29%) and one (3%) PLCG1 R707Q mutation were also identified. Our results demonstrate that angiosarcomas are a genetically heterogeneous group of tumors, harboring a wide range of genetic alterations. The high frequency of genetic events affecting the MAPK pathway suggests that targeted therapies inhibiting MAPK signaling may be promising therapeutic avenues in patients with advanced angiosarcomas.


Url:
PubMed: 26440310
PubMed Central: 4742160


Affiliations:


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Le document en format XML

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<title xml:lang="en" level="a" type="main">Targeted massively parallel sequencing of angiosarcomas reveals frequent activation of the mitogen activated protein kinase pathway</title>
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<name sortKey="Chandramohan, Raghu" sort="Chandramohan, Raghu" uniqKey="Chandramohan R" first="Raghu" last="Chandramohan">Raghu Chandramohan</name>
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<nlm:aff id="A2"> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
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</author>
<author>
<name sortKey="Moller, Inga" sort="Moller, Inga" uniqKey="Moller I" first="Inga" last="Möller">Inga Möller</name>
<affiliation wicri:level="3">
<nlm:aff id="A4"> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Scholz, Simone L" sort="Scholz, Simone L" uniqKey="Scholz S" first="Simone L." last="Scholz">Simone L. Scholz</name>
<affiliation wicri:level="3">
<nlm:aff id="A5"> Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Berger, Michael" sort="Berger, Michael" uniqKey="Berger M" first="Michael" last="Berger">Michael Berger</name>
<affiliation wicri:level="1">
<nlm:aff id="A1"> Department of Pathology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Department of Pathology, Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="A2"> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Huberman, Kety" sort="Huberman, Kety" uniqKey="Huberman K" first="Kety" last="Huberman">Kety Huberman</name>
<affiliation wicri:level="1">
<nlm:aff id="A2"> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Viale, Agnes" sort="Viale, Agnes" uniqKey="Viale A" first="Agnes" last="Viale">Agnes Viale</name>
<affiliation wicri:level="1">
<nlm:aff id="A2"> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Pirun, Mono" sort="Pirun, Mono" uniqKey="Pirun M" first="Mono" last="Pirun">Mono Pirun</name>
<affiliation wicri:level="1">
<nlm:aff id="A2"> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Socci, Nicholas D" sort="Socci, Nicholas D" uniqKey="Socci N" first="Nicholas D." last="Socci">Nicholas D. Socci</name>
<affiliation wicri:level="1">
<nlm:aff id="A2"> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Bouvier, Nancy" sort="Bouvier, Nancy" uniqKey="Bouvier N" first="Nancy" last="Bouvier">Nancy Bouvier</name>
<affiliation wicri:level="1">
<nlm:aff id="A2"> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Bauer, Sebastian" sort="Bauer, Sebastian" uniqKey="Bauer S" first="Sebastian" last="Bauer">Sebastian Bauer</name>
<affiliation wicri:level="3">
<nlm:aff id="A6"> Department of Medical Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Medical Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Artl, Monika" sort="Artl, Monika" uniqKey="Artl M" first="Monika" last="Artl">Monika Artl</name>
<affiliation wicri:level="1">
<nlm:aff id="A8"> Institute of Human Genetics, Medical University of Graz, Graz, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea> Institute of Human Genetics, Medical University of Graz, Graz</wicri:regionArea>
<wicri:noRegion>Graz</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Schilling, Bastian" sort="Schilling, Bastian" uniqKey="Schilling B" first="Bastian" last="Schilling">Bastian Schilling</name>
<affiliation wicri:level="3">
<nlm:aff id="A4"> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Schimming, Tobias" sort="Schimming, Tobias" uniqKey="Schimming T" first="Tobias" last="Schimming">Tobias Schimming</name>
<affiliation wicri:level="3">
<nlm:aff id="A4"> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Sucker, Antje" sort="Sucker, Antje" uniqKey="Sucker A" first="Antje" last="Sucker">Antje Sucker</name>
<affiliation wicri:level="3">
<nlm:aff id="A4"> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Schwindenhammer, Benjamin" sort="Schwindenhammer, Benjamin" uniqKey="Schwindenhammer B" first="Benjamin" last="Schwindenhammer">Benjamin Schwindenhammer</name>
<affiliation wicri:level="1">
<nlm:aff id="A7"> Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen</wicri:regionArea>
<wicri:noRegion>Essen</wicri:noRegion>
<wicri:noRegion>Essen</wicri:noRegion>
<wicri:noRegion>Essen</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Grabellus, Florian" sort="Grabellus, Florian" uniqKey="Grabellus F" first="Florian" last="Grabellus">Florian Grabellus</name>
<affiliation wicri:level="1">
<nlm:aff id="A7"> Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen</wicri:regionArea>
<wicri:noRegion>Essen</wicri:noRegion>
<wicri:noRegion>Essen</wicri:noRegion>
<wicri:noRegion>Essen</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Speicher, Michael R" sort="Speicher, Michael R" uniqKey="Speicher M" first="Michael R." last="Speicher">Michael R. Speicher</name>
<affiliation wicri:level="1">
<nlm:aff id="A8"> Institute of Human Genetics, Medical University of Graz, Graz, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea> Institute of Human Genetics, Medical University of Graz, Graz</wicri:regionArea>
<wicri:noRegion>Graz</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Schaller, Jorg" sort="Schaller, Jorg" uniqKey="Schaller J" first="Jörg" last="Schaller">Jörg Schaller</name>
<affiliation wicri:level="1">
<nlm:aff id="A10"> Dermatopathology Duisburg, Duisburg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Dermatopathology Duisburg, Duisburg</wicri:regionArea>
<wicri:noRegion>Duisburg</wicri:noRegion>
<wicri:noRegion>Duisburg</wicri:noRegion>
<wicri:noRegion>Duisburg</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Hillen, Uwe" sort="Hillen, Uwe" uniqKey="Hillen U" first="Uwe" last="Hillen">Uwe Hillen</name>
<affiliation wicri:level="3">
<nlm:aff id="A4"> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Schadendorf, Dirk" sort="Schadendorf, Dirk" uniqKey="Schadendorf D" first="Dirk" last="Schadendorf">Dirk Schadendorf</name>
<affiliation wicri:level="3">
<nlm:aff id="A4"> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Mentzel, Thomas" sort="Mentzel, Thomas" uniqKey="Mentzel T" first="Thomas" last="Mentzel">Thomas Mentzel</name>
<affiliation wicri:level="1">
<nlm:aff id="A11"> Dermatopathology Friedrichshafen, Friedrichshafen, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Dermatopathology Friedrichshafen, Friedrichshafen</wicri:regionArea>
<wicri:noRegion>Friedrichshafen</wicri:noRegion>
<wicri:noRegion>Friedrichshafen</wicri:noRegion>
<wicri:noRegion>Friedrichshafen</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Cheng, Donavan T" sort="Cheng, Donavan T" uniqKey="Cheng D" first="Donavan T." last="Cheng">Donavan T. Cheng</name>
<affiliation wicri:level="1">
<nlm:aff id="A2"> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Wiesner, Thomas" sort="Wiesner, Thomas" uniqKey="Wiesner T" first="Thomas" last="Wiesner">Thomas Wiesner</name>
<affiliation wicri:level="1">
<nlm:aff id="A3"> Human Oncology and Pathogenesis Program Memorial Sloan Kettering Cancer Center, New York NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea> Human Oncology and Pathogenesis Program Memorial Sloan Kettering Cancer Center, New York NY</wicri:regionArea>
<wicri:noRegion>New York NY</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="A9"> Department of Dermatology, Medical University of Graz, Graz, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea> Department of Dermatology, Medical University of Graz, Graz</wicri:regionArea>
<wicri:noRegion>Graz</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Griewank, Klaus G" sort="Griewank, Klaus G" uniqKey="Griewank K" first="Klaus G." last="Griewank">Klaus G. Griewank</name>
<affiliation wicri:level="3">
<nlm:aff id="A4"> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea> Department of Dermatology, UUniversity Hospital Essen, University of Duisburg-Essen, Essen, Germany and German Cancer Consortium (DKTK), Heidelberg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Heidelberg</settlement>
</placeName>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Oncotarget</title>
<idno type="eISSN">1949-2553</idno>
<imprint>
<date when="2015">2015</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass></textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>Angiosarcomas are rare malignant mesenchymal tumors of endothelial differentiation. The clinical behavior is usually aggressive and the prognosis for patients with advanced disease is poor with no effective therapies. The genetic bases of these tumors have been partially revealed in recent studies reporting genetic alterations such as amplifications of
<italic>MYC</italic>
(primarily in radiation-associated angiosarcomas), inactivating mutations in
<italic>PTPRB</italic>
and R707Q hotspot mutations of
<italic>PLCG1</italic>
. Here, we performed a comprehensive genomic analysis of 34 angiosarcomas using a clinically-approved, hybridization-based targeted next-generation sequencing assay for 341 well-established oncogenes and tumor suppressor genes. Over half of the angiosarcomas (
<italic>n</italic>
= 18, 53%) harbored genetic alterations affecting the MAPK pathway, involving mutations in
<italic>KRAS</italic>
,
<italic>HRAS</italic>
,
<italic>NRAS</italic>
,
<italic>BRAF</italic>
,
<italic>MAPK1</italic>
and
<italic>NF1</italic>
, or amplifications in
<italic>MAPK1</italic>
/
<italic>CRKL</italic>
,
<italic>CRAF</italic>
or
<italic>BRAF</italic>
. The most frequently detected genetic aberrations were mutations in
<italic>TP53</italic>
in 12 tumors (35%) and losses of
<italic>CDKN2A</italic>
in 9 tumors (26%).
<italic>MYC</italic>
amplifications were generally mutually exclusive of
<italic>TP53</italic>
alterations and
<italic>CDKN2A</italic>
loss and were identified in 8 tumors (24%), most of which (
<italic>n</italic>
= 7, 88%) arose post-irradiation. Previously reported mutations in
<italic>PTPRB</italic>
(
<italic>n</italic>
= 10, 29%) and one (3%)
<italic>PLCG1</italic>
R707Q mutation were also identified. Our results demonstrate that angiosarcomas are a genetically heterogeneous group of tumors, harboring a wide range of genetic alterations. The high frequency of genetic events affecting the MAPK pathway suggests that targeted therapies inhibiting MAPK signaling may be promising therapeutic avenues in patients with advanced angiosarcomas.</p>
</div>
</front>
<back>
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