Cited by 1,737Cancer Genomics and DiagnosticsGlioma Diagnosis and TreatmentAcute Myeloid Leukemia Research

Intratumor heterogeneity in human glioblastoma reflects cancer evolutionary dynamics

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Sottoriva, Andrea, Spiteri, Inmaculada, Piccirillo, Sara G. M., Touloumis, Anestis, Collins, V. Peter, Marioni, John C., Curtis, Christina, Watts, Colin +1 more·2013·Proceedings of the National Academy of Sciences

Abstract

Glioblastoma (GB) is the most common and aggressive primary brain malignancy, with poor prognosis and a lack of effective therapeutic options. Accumulating evidence suggests that intratumor heterogeneity likely is the key to understanding treatment failure. However, the extent of intratumor heterogeneity as a result of tumor evolution is still poorly understood. To address this, we developed a unique surgical multisampling scheme to collect spatially distinct tumor fragments from 11 GB patients. We present an integrated genomic analysis that uncovers extensive intratumor heterogeneity, with most patients displaying different GB subtypes within the same tumor. Moreover, we reconstructed the phylogeny of the fragments for each patient, identifying copy number alterations in EGFR and CDKN2A/B/p14ARF as early events, and aberrations in PDGFRA and PTEN as later events during cancer progression. We also characterized the clonal organization of each tumor fragment at the single-molecule level, detecting multiple coexisting cell lineages. Our results reveal the genome-wide architecture of intratumor variability in GB across multiple spatial scales and patient-specific patterns of cancer evolution, with consequences for treatment design.

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  • Glioblastoma is the most common malignant primary brain tumor, but it is classified as a rare disease because its incidence rate of 3 per 100,000 people is below the rare disease definition rate of less than 10 per 100,000 people.

    “While glioblastoma is the most common malignant primary brain tumor26–28, it is still classified as a “rare” disease, as its incidence rate (i.e., 3/100,000 people) is substantially lower than the rare disease definition rate (i.e., <10/100,000 people)24.”
  • GBM is challenged by molecular heterogeneity and genetic instability, even within the same patient.

    “A significant challenge in the development of efficacious treatments for GBM is the molecular heterogeneity and genetic instability of these tumors, even within the same patient.38”
  • Most clinically relevant solid tumors are highly heterogeneous at the phenotypic, physiologic, and genomic levels and continue to evolve over time.

    “It is now appreciated that most clinically relevant solid tumors are highly heterogeneous at the phenotypic, physiologic, and genomic levels (13–15) and that they continue to evolve over time.”

    From Radiomics: Images Are More than Pictures, They Are Data (2016) · cites this paper as [15]

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Authors
Sottoriva, A., Spiteri, I., Piccirillo, S. G. M., Touloumis, A., Collins, V. P., Marioni, J. C., Curtis, C., Watts, C., & Tavaré, S.
Affiliations
  • University of Southern California (US)
  • Cancer Research UK (GB)
  • University of Cambridge (GB)
  • European Bioinformatics Institute (GB)
Venue
Proceedings of the National Academy of Sciences
Published
2013-02-14
Volume
110
Issue
10
Pages
4009-4014
ISSN
  • 0027-8424 (ISSN-L)
  • 1091-6490
OpenAlex
W2040458067
Cited by
1,737
References
43
Citations by year
2026: 68 · 2025: 82 · 2024: 107 · 2023: 140 · 2022: 134 · 2021: 171 · 2020: 170 · 2019: 154 · 2018: 153 · 2017: 153 · 2016: 137 · 2015: 126 · 2014: 107 · 2013: 32 · 2012: 1
FWCI
47.09
Type
journal article
Language
en
Open access
Locations
  • Proceedings of the National Academy of Sciences (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • University of Brighton Repository (University of Brighton) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
  • Cancer Research UK (19556, C14303/A10825)
  • Brain Tumour Charity (10/136)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer Genomics and Diagnostics
  • Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
  • Health Sciences › Medicine › Hematology › Acute Myeloid Leukemia Research
Keywords
glioblastoma, intratumoral heterogeneity, tumor evolution, phylogenetic inference, copy number alterations, EGFR, PDGFRA, PTEN, clonal architecture, single-molecule sequencing, tumor subtypes, tumor progression
MeSH terms
Base Sequence, Brain Neoplasms, Chromosome Aberrations, DNA, Neoplasm, Glioblastoma, Humans, Phylogeny, Disease Progression, Genes, erbB-1, Evolution, Molecular, Genes, p16, DNA Copy Number Variations, Transcriptome

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