[[TOC]]

Overview

EZH2 encodes a histone methyltransferase that is a component of the polycomb repressive complex 2 (PRC2). This gene is recurrently mutated in both FL and DLBCL and has a common mutation hot spot (Y646) that affects the SET domain.1 EZH2 mutations are one of the defining features of the EZB genetic subgroup of DLBCL.2 Although mutations in EZH2 have been described in some BL patients, they are extremely rare in most BL cohorts that have been sequenced.3,4

Experimental Evidence

Mutations at the canonical hotspot (Y646) and some less common hotspots lead to enhanced histone H3 lysince 27 (H3K27) tri-methylation by PRC2.5

Clinical Relevance

A number of small molecule/pharmacologic inhibitors of EZH2 activity have been described.6,7 At least one of these, tazemetostat, has shown benefit in FL.8 Tazemetostat (TAZVERIK) has FDA approval for adult patients with relapsed or refractory (R/R) follicular lymphoma (FL) whose tumors are positive for an EZH2 mutation as detected by an FDA-approved test and who have received at least 2 prior systemic therapies, and for adult patients with R/R FL who have no satisfactory alternative treatment options. Combination therapies including EZH2 inhibitors are also under exploration for DLBCL patients with mutant EZH2.9

Relevance tier by entity

[[include:tables/table1_EZH2]]

Mutation incidence in large patient cohorts (GAMBL reanalysis)

DLBCL

[[include:tables/DLBCL_EZH2.md]]

FL

[[include:tables/FL_EZH2.md]]

BL

[[include:tables/BL_EZH2.md]]

Mutation pattern and selective pressure estimates

[[include:tables/dnds_EZH2.md]]

EZH2 Hotspots

Chromosome Coordinate (hg19) ref>alt HGVSp
chr7 148508745 T>C N640S
chr7 148508740 A>G F642L
chr7 148508728 A>T Y646N
chr7 148508728 A>G Y646H
chr7 148508727 T>G Y646S
chr7 148508727 T>C Y646C
chr7 148508727 T>A Y646F
chr7 148506466 TG>GC A682G
chr7 148506467 G>C A682G
chr7 148506437 GC>AA A692L
chr7 148506437 G>A A692V
EZH2 3D structure with HotMAPS hotspots

[[include:tables/browser_EZH2.md]]

Expression

Representative Mutations

BL

Rating ★ ★ ★ ★ ★

All Mutations

BL

3

1092 671 672 675

[[include:tables/mermaid_EZH2.md]]

References

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2.
Wright GW, Huang DW, Phelan JD, Coulibaly ZA, Roulland S, Young RM, Wang JQ, Schmitz R, Morin RD, Tang J, Jiang A, Bagaev A, Plotnikova O, Kotlov N, Johnson CA, Wilson WH, Scott DW, Staudt LM. A Probabilistic Classification Tool for Genetic Subtypes of Diffuse Large B Cell Lymphoma with Therapeutic Implications. Cancer Cell. 2020 Apr 13;37(4):551–568.e14.
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6.
Garapaty-Rao S, Nasveschuk C, Gagnon A, Chan EY, Sandy P, Busby J, Balasubramanian S, Campbell R, Zhao F, Bergeron L, Audia JE, Albrecht BK, Harmange JC, Cummings R, Trojer P. Identification of EZH2 and EZH1 Small Molecule Inhibitors with Selective Impact on Diffuse Large B Cell Lymphoma Cell Growth. Chemistry & Biology. 2013 Nov;20(11):1329–1339.
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Knutson SK, Kawano S, Minoshima Y, Warholic NM, Huang KC, Xiao Y, Kadowaki T, Uesugi M, Kuznetsov G, Kumar N, Wigle TJ, Klaus CR, Allain CJ, Raimondi A, Waters NJ, Smith JJ, Porter-Scott M, Chesworth R, Moyer MP, Copeland RA, Richon VM, Uenaka T, Pollock RM, Kuntz KW, Yokoi A, Keilhack H. Selective Inhibition of EZH2 by EPZ-6438 Leads to Potent Antitumor Activity in EZH2-Mutant Non-Hodgkin Lymphoma. Molecular Cancer Therapeutics [Internet]. 2014;13(4):842–854. Available from: http://dx.doi.org/10.1158/1535-7163.mct-13-0773
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Morin RD, Arthur SE, Assouline S. Treating lymphoma is now a bit EZ-er. Blood Adv. 2021 Apr 27;5(8):2256–2263. PMCID: PMC8095133
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Scholze H, Stephenson RE, Reynolds R, Shah SB, Puri R, Butler SD, Trujillo-Alonso V, Teater M, Besien H van, Gibbs-Curtis D, Ueno H, Parvin S, Letai A, Mathew S, Singh A, Cesarman E, Melnick A, Giulino‐Roth L. Combined EZH2 and Bcl-2 inhibitors as precision therapy for genetically defined DLBCL subtypes. Blood advances. 2020;4 20:5226–5231.
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Mottok A, Hung SS, Chavez EA, Woolcock B, Telenius A, Chong LC, Meissner B, Nakamura H, Rushton C, Viganò E, Sarkozy C, Gascoyne RD, Connors JM, Ben-Neriah S, Mungall A, Marra MA, Siebert R, Scott DW, Savage KJ, Steidl C. Integrative genomic analysis identifies key pathogenic mechanisms in primary mediastinal large B-cell lymphoma. Blood. 2019 Sept 5;134(10):802–813.