Fowler J et al., Nature Genetics - Normal esophageal lining is a patchwork of mutant clones that compete for space as we age. This study asked whether cancer treatment changes which of those clones win. Normal esophagus removed at surgery from 70 patients with esophageal cancer, who had received no treatment, combination chemotherapy (ECX, EOX or FLOT) or chemoradiation (CROSS), was analyzed with duplex (NanoSeq), whole-genome and targeted sequencing, alongside protein structure modeling and a CRISPR experiment in mouse esophageal cultures. Key terms: somatic mutation, clonal selection, esophagus, chemoradiation, TP53. Study Highlights: Targeted sequencing of 1,995 samples of 2 mm2 across 324 cancer-associated genes found 23,692 independent mutations, and no chemotherapy mutational signature was detected, suggesting most clones existed before treatment. In patients given CROSS, the proportion of epithelium mutant for TP53 and PPM1D was double that of the other groups, their mutational burden and deletion burden were higher, and over 5% of samples carried a copy number event covering the TP53 locus. HLA-B and SPOP mutants were selected only in CROSS patients, with 13 of 22 HLA-B nonsynonymous mutations predicted to abolish the protein. RAC1, NFE2L2 and MTOR mutants were under positive selection only in the FLOT group, the only regimen giving 5-fluorouracil together with leucovorin, and structural modeling suggested the MTOR mutants would likely remain sensitive to rapalogs. In mouse esophageal cultures, guide RNAs targeting exon 6 of Ppm1d were enriched after irradiation but not after 5-fluorouracil. Conclusion: Weeks of neoadjuvant treatment can reshape a mutational landscape built over decades, selectively expanding preexisting mutant clones in a treatment-specific way, which may point to genes involved in cellular resilience to therapy. The groups were small (FLOT had seven patients), exposure data were limited, the mouse experiment did not test the full CROSS combination, the selection of MTOR, RAC1 and NFE2L2 mutants by 5-fluorouracil is inferred rather than tested, and selection in normal tissue cannot be assumed to match selection in cancer cells. Article title: Cancer treatment alters mutant selection in normal esophagus First author: Fowler J Journal: Nature Genetics DOI: 10.1038/s41588-026-02738-0 Reference: Fowler J.C., Arbore G., Sood R.K., Abnizova I., Albarello L., Pickering O., et al. Cancer treatment alters mutant selection in normal esophagus. Nature Genetics, 58, 2566-2578. (2026). https://doi.org/10.1038/s41588-026-02738-0 License: This episode is based on an open-access article published under the Creative Commons Attribution 4.0 International License (CC BY 4.0) – https://creativecommons.org/licenses/by/4.0/ Support: Base by Base is independent and ad-free — no sponsors, no paywall. If an episode was worth your time, chip in and keep the papers audited and the original songs coming: ❤️ Support monthly: https://buy.stripe.com/cNifZhclVebvagk2JDgEg01 ☕ One-time donation: https://donate.stripe.com/7sY4gz71B2sN3RWac5gEg00 ▶️ Watch with chapters on YouTube: https://www.youtube.com/@basebybase More at basebybase.com On PaperCast Base by Base you'll discover the latest in genomics, functional genomics, structural genomics, and proteomics. Episode link: https://basebybase.com/episodes/cancer-treatment-mutant-selection-normal-esophagus QC: This episode's script was checked sentence by sentence against the full text of the original article, by an automated process with human review, before it was recorded. QC Summary: - sentences checked: 171 - supported by the article: 167 - flagged and reviewed by a human: 4 - metadata checks passed: 4 of 4 QC result: Pass. Chapters (00:00:03) - The Forest Fire Analogy: Introduction(00:00:37) - Introducing Base by Base and the Paper(00:00:58) - Mutant Clones in the Aging Esophagus(00:01:29) - The Research Question and Team(00:02:21) - Treatment Regimens: Chemotherapy and CROSS(00:03:04) - The Study Opportunity at Surgery(00:03:44) - Mutational Signatures Explained(00:04:23) - Patient Cohort and Tissue Sampling(00:05:07) - Sequencing Methods: Mapping the Clones(00:06:16) - Measuring Selection in Genes(00:06:49) - Protein Structure Modeling and Lab Tests(00:07:23) - No Treatment-Specific Mutational Signature Found(00:07:50) - CROSS Group Stands Out: Mutation Load(00:09:01) - PPM1D Mutations and Radiation Resistance(00:10:07) - Chromosome 17 and TP53 Disruption in CROSS(00:10:41) - HLA-B and SPOP Selection in CROSS Patients(00:11:15) - FLOT-Selected Genes: NFE2L2, RAC1, MTOR(00:12:25) - RAC1 and MTOR Mechanisms in FLOT(00:13:44) - Interpreting the Findings: Speed of Change(00:14:16) - Why TP53 Results Matter for Cancer Risk(00:14:57) - The FLOT Question: Resistance Implications(00:15:34) - Study Limitations(00:16:12) - Summary: Different Fires, Different Winners(00:16:50) - Closing Thoughts and Credits