Widespread Epistasis between Cancer Driver Mutations and Allele-Specific Copy Number Variations.

Cancer driver mutations alone are often insufficient to fully explain tumorigenesis. We demonstrate that these mutations cooperate with somatic copy number variations (CNVs) in a tissue-specific pattern of genomic epistasis. Analyzing 93,462 tumors, we identified 54 gene-cancer type pairs with significant co-occurrence of somatic mutations and CNVs. Our new Binoculars algorithm, which resolved phased DNA/RNA reads, revealed frequent preferential amplification in oncogenic mutation alleles, including AKT1 p.E17K, BRAF p.V600E, KRAS p.G12C/D/V, NRAS p.Q61K, and a fraction of gain-of-function TP53 p.R175H. Conversely, deletions selectively targeted the reference alleles, leading to loss of heterozygosity of IDH1 p.R132H and tumor suppressor mutations, including CDKN2A and TP53 truncations. Lung cancer patients carrying co-occurrences of somatic mutation-CNVs in TP53 and KRAS showed poorer survival than those carrying the same gene mutations. These findings reveal epistasis of cancer mutations and CNVs at an allelic resolution, suggesting specific genomic events to enhance patient stratification and therapeutic targeting.