COsegregation of VARiants in Panel of Genes
- Conditions
- Genetic PredispositionGene Mutation-Related Cancer
- Interventions
- Genetic: salivary kit
- Registration Number
- NCT01689584
- Lead Sponsor
- Institut Curie
- Brief Summary
The aim of the COVAR project is to classify reliably a maximum of VUS of the French database in order to use them for the genetic counseling. The results obtained through this study will have a major impact on clinical management of the patients and their families conducting in some cases to propose a prophylactic surgery.
- Detailed Description
Originally, the COVAR study was designed to explore Variants of unknown biological significance (VUS) in BRCA1 (BReast Cancer 1) and BRCA2 (BReast Cancer 2) genes, which are the two major genes identified in hereditary breast and/or ovarian cancers. Since then the study has evolved, in parallel with the evolution of diagnosis, first introducing the PALB2 (Partner and localizer of BRCA2) gene explored in diagnosis since 2015 and now opening the study to all the genes of the panels performed in diagnosis in families with a genetic predisposition syndrome to cancers.
The French UMD (Universal Mutation Database)-BRCA1/2, accredited by the French National Cancer Institute, collects anonymous results of genetic tests performed by authorized French laboratories since 1995, giving a real-time vision of families carrying the same VUS. In september 2011, the French UMD-BRCA1/2 database comprised 706 different variants in 1,300 BRCA1 families and 1,089 different variants in 2,101 BRCA2 families. In April 2021, this database contained 1,651 different VSU for BRCA1, 3,015 different VUS for BRCA2, 471 different VUS for PALB2, 68 for RAD51C and 66 for RAD51D.
Since 2017, new genes have been explored in the diagnostic setting as they have been reported as predisposing factors for cancers. This list is constantly evolving (Moretta et al., 2018; Dhooge et al., 2020). Data collection for these genes is ongoing and a new database (FrOG) gathering all VUS and mutations identified in the French oncogenetic network has been set up. We have set up a consortium agreement at the end of 2020. This database gathers to date 12 genes and 11,912 different variants in more than 40,000 French families.
One of the key measurable parameters for classification of VUS as causal mutations is their co-segregation with the disease. The average size of French families is relatively small, the information of variant co-segregation limited to one family would not be significant. However, the compilation of co-segregation results obtained from several families will allow to obtain more precise and complete estimations of the probability of causality of a given variant.
The objective of the COVAR study (COsegregation VARiants) is to organize co-segregation studies of the VUS of the database UMD-BRCA1/2, in order to determine the causal or non-causal nature of these variants. To organize the variants by their clinical relevance, a grid with 5 classes has been used: 1=neutral, 2=likely neutral, 3=VUS, 4=likely causal, 5=causal. The VUS of classes 3 and 4 will be candidates to co-segregation studies because they cannot be used for the genetic counseling.
In the selected families the index case will invite the family members (affected and unaffected) to provide a sample of salivary fluid to test the presence of the VUS. The probability that a VUS is causal will be calculated from the cosegregation data using a Bayesian model. The results will be integrated in the multifactorial model described by D. Goldgar, model integrating different parameters as amino acid conservation, structural impact of the variant, co-occurrence with a pathogenic mutation, family history and tumor characteristics.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 3500
Index cases:
- A person carrying a gene variant class 3 or 4, present and selected in the families of national database of genetic group and cancer (GGC Unicancer) which identifies the variations of all genes from the panel of genes of all French laboratories.
- Age ≥ 18 years.
- Signed written inform consent "index case"
Related parties:
- Any relative of an index case with cancer
- Any relative without cancer related to an index case, retained by investigators, based on family structure and degree of related compared to the index case
- Age ≥ 18 years
- Information and signature of the informed consent "selected relatives"
- Minors
- Persons deprived of liberty or under guardianship (including curators).
- Absence of signed written inform consent
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Covar salivary kit -
- Primary Outcome Measures
Name Time Method Perform the co-segregation analysis of the selected VUS in the families in order to classify the maximum of variants in terms of their probability to be pathogenic up to 15 years
- Secondary Outcome Measures
Name Time Method • Maximize the number of VUS (both pathogenic and neutral) having associated recommendations for clinical management of at-risk relatives that can be used to guide genetic counselling. up to 15 years • Propose a standardized method to classify VUS that can be integrated into the already existing classification established in the UMD-BRCA1/2 database, with the main focus on variants of class 4 (probably causal) and class 3 (unknown significance). up to 15 years Assess the penetrance of several class 3 and 4 VUS probably associated with moderate cancer risk, using collected phenotype/genotype data on extended pedigrees. up to 15 years
Trial Locations
- Locations (57)
Centre Léon Bérard
🇫🇷Lyon, France
CHU Bretonneau
🇫🇷Tours, France
CHU de Fort de France
🇲🇶Fort de France, Martinique
Institut Curie - Hopital Rene Huguenin
🇫🇷Saint-Cloud, Haut De Seine, France
Institut Curie
🇫🇷Paris, Ile De France, France
Centre Hospitalier d'Angoulème
🇫🇷Angoulême, France
CHU Amiens - Hôpital Nord
🇫🇷Amiens, France
ICO - Centre Paul Papin
🇫🇷Angers, France
CHU Besançon
🇫🇷Besancon, France
Institut Sainte-Catherine
🇫🇷Avignon, France
Groupe Hospitalier Pellegrin
🇫🇷Bordeaux, France
Institut Bergonié
🇫🇷Bordeaux, France
Centre Hospitalier Jacques Coeur
🇫🇷Bourges, France
CHU Morvan de Brest
🇫🇷Brest, France
Centre François Baclesse
🇫🇷Caen, France
Centre Jean Perrin
🇫🇷Clermont-Ferrand, France
Centre Hospitalier Hôtel Dieu
🇫🇷Chambery, France
Hôpital Civil de Colmar
🇫🇷Colmar, France
CHU de Dijon
🇫🇷Dijon, France
CHU de Grenoble
🇫🇷Grenoble, France
Groupe Hospitalier La Rochelle-Ré-Aunis
🇫🇷La Rochelle, France
Centre Oscar Lambret
🇫🇷Lille, France
Chru Lille
🇫🇷Lille, France
Hôpital Flaubert
🇫🇷Le Havre, France
CHU Dupuytren
🇫🇷Limoges, France
Hospices Civils de Lyon
🇫🇷Lyon, France
Institut Paoli Calmettes
🇫🇷Marseille, France
CHU La Timone
🇫🇷Marseille, France
CHU Arnaud de Villeneuve
🇫🇷Montpellier, France
Centre Antoine Lacassagne
🇫🇷Nice, France
Centre Catherine de Sienne
🇫🇷Nantes, France
Centre Hospitalier Georges Renon
🇫🇷Niort, France
CHRU Caremeau
🇫🇷Nîmes, France
Hôpital de la Source
🇫🇷Orléans, France
Hôpital Saint-Antoine
🇫🇷Paris, France
Groupe Hospitalier Pitié-Salpêtrière
🇫🇷Paris, France
CHU de Reims
🇫🇷Reims, France
Hôpital Tenon
🇫🇷Paris, France
HEGP
🇫🇷Paris, France
Hôpital Saint-Louis
🇫🇷Paris, France
Institut Jean Godinot
🇫🇷Reims, France
ICO - Centre René Gauducheau
🇫🇷Saint-Herblain, France
CHU La Milétrie
🇫🇷Poitiers, France
ICC Courlancy
🇫🇷Reims, France
CHU de Rouen
🇫🇷Rouen, France
CHU Saint Etienne
🇫🇷Saint-Étienne, France
Centre Eugène Marquis
🇫🇷Rennes, France
Institut de Cancérologie Strasbourg Europe ICANS
🇫🇷Strasbourg, France
Hopital de Hautepierre - Hôpital Universitaire
🇫🇷Strasbourg, France
Institut Claudius Regaud - IUCT - Oncopole
🇫🇷Toulouse, France
CH Simone VEIL
🇫🇷Troyes, France
Centre Alexis Vautrin
🇫🇷Vandoeuvre les Nancy, France
Centre Hospitalier de Valence
🇫🇷Valence, France
Gustave Roussy
🇫🇷Villejuif, France
CHU Nancy - Hôpital Brabois
🇫🇷Vandoeuvre les Nancy, France
CHU de Pointe à Pitre
🇬🇵Pointe à Pitre, Guadeloupe
CHU Sud Réunion Saint-Pierre
🇷🇪Saint-Pierre, Réunion