Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor in humans
[1]–
[3], and the first cancer type to undergo comprehensive genomic characterization by The Cancer Genome Atlas (TCGA) project
[4]. Glioblastoma is classified into two broad categories: primary and secondary. Primary glioblastomas (accounting for

90% of cases and most of the TCGA cases profiled) manifest
de novo without prior evidence of preexisting tumor; secondary glioblastomas develop through malignant progression from lower grade astrocytomas
[3]. Prognosis for glioblastoma patients remains dismal, as most patients die within one year after diagnosis
[3] and generally respond poorly to current therapeutic approaches
[4],
[5].
High-throughput cancer genomic studies, such as those being organized by the TCGA and the International Cancer Genome Consortium (ICGC)
[6], are now enabling the research community to examine the cancer genome in a comprehensive and unbiased manner
[7]. These efforts will soon lead to a comprehensive catalog of altered genes, altered biological processes and, by implication, therapeutic vulnerabilities in cancer. For example, the TCGA GBM project has cataloged somatic mutations and recurrent copy number alterations in GBM, and has identified frequent alterations in the p53, RB, PI3-kinase (PI3K) and receptor tyrosine kinase (RTK) signaling pathways
[4].
A fundamental and open challenge in cancer genomics is the ability to distinguish “driver” from incidental “passenger” mutations. To first approximation, driver mutations are those that confer the tumor with some selective advantage in growth and contribute to tumorigenesis, whereas passenger mutations do not
[8]. A number of approaches have been developed to distinguish drivers from passengers, including those that examine the rate of synonymous versus non-synonymous mutations
[8], those that predict the functional consequence of mutations
[9], and newer approaches that assess the overall rate of recurrence, based on combined rates of sequence mutation and copy number alteration
[10]. A more recent approach by Torkamani et. al.
[11] sought to identify cancer drivers by identifying an enrichment of rare cancer mutations within network modules reconstructed from gene expression studies. Here, we also present a network-based approach to identifying driver mutations in cancer, apply this approach to GBM, and discuss potential applicability to other cancer types.
Our network-based approach is based on the hypothesis that cellular networks are modular, and consist of inter-connected proteins responsible for specific cellular functions
[12],
[13]. It is further based on the hypothesis that the cancer phenotype is based on the inability of multiple genetic functional modules to carry out their basic functions, and that functional modules are critical to the “hallmarks of cancer”, including self-sufficiency in growth signals, evasion of apoptosis, sustained angiogenesis, tissue invasion and metastasis
[14]. Furthermore, different combinations of perturbed genes can incapacitate each module
[15], and each tumor can perturb individual genes via multiple mechanisms including sequence mutations, copy number alterations, gene fusion events, or epigenetic changes. Evidence for such universality at the module-level, but diversity at the genetic level can be seen in multiple cancer types, including in glioblastoma. For example, nearly all GBM tumors contain alterations in the p53 tumor suppressor pathway, but individual tumors exhibit diverse mechanisms for pathway alteration – mutation or homozygous deletion of
TP53, mutation or homozygous deletion of
CDKN2A/ARF, or amplification of
MDM2/
MDM4. If tumors frequently target biological modules that execute key biological processes, and network knowledge about such modules is available, we hypothesized that it would be possible to algorithmically identify frequently perturbed modules, and from these modules identify candidate driver mutations.