Rate of germline pathogenic sequence variants in cancer susceptibility genes in an Israeli pediatric and adolescent cancer cohort: a single institute experience

Multi-cancer predisposition gene panel testing (MCPGT) enables simultaneous deep-coverage genotyping of multiple CPGs (cancer predisposing genes) and detects germline pathogenic sequence variants (PSVs). Reported PSV carrier rates among pediatric and adolescent cancer patients range from 8 to 17.6%, with variability attributed to ethnic background, the number of genes tested, cancer phenotypes, and patient selection criteria. This study aimed to assess the rate and spectrum of germline PSVs in consecutive pediatric and adolescent cancer patients treated at the Sheba Medical Center, a tertiary medical center. All cancer patients aged 0–18 years treated between 01.2021 and 12.2022 were offered MCPGT. Overall, 257 eligible cancer patients were treated during the study period, of whom 116 Israeli patients underwent MCGPT (Invitae, San Francisco, CA), with complete data available for 108. The range of malignancies included central nervous system (CNS) tumors (n = 45), solid tumors (n = 37), hematological malignancies (n = 14), and retinoblastoma (RB) (n = 12). PSVs were detected in 17/108—15.7% of patients, with the highest rates in patients with RB (7/12, 58.3%) and CNS tumors (6/45, 13.3%). A significant association was found between younger age at diagnosis and PSV carrier status (4.7 years in carriers vs. 9.3 years in non-carriers, p = 0.003). Fulfilling Jongmans' criteria was correlated with PSV detection. The study highlights the importance of genetic testing in children meeting specific clinical criteria, particularly those diagnosed with RB and CNS tumors. Further studies with larger, ethnically diverse cohorts are needed to validate these findings to expand the scientific basis for personalized care strategies.