G.H. contributed to the study design and collection and interpretation of the data. R.P.K. performed the analysis of Circle-seq and whole-genome sequencing. E.R.F. performed the data analysis of the whole-genome sequencing data. I.

Intratumour heterogeneity is a major cause of treatment failure in cancer. We present in-depth analyses combining transcriptomic and genomic profiling with ultra-deep targeted sequencing of multiregional biopsies in 10 patients with neuroblastoma, a devastating childhood tumour. We observe high spatial and temporal heterogeneity in somatic mutations and somatic copy-number alterations which are reflected on the transcriptomic level. Mutations in some druggable target genes including ALK and FGFR1 are heterogeneous at diagnosis and/or relapse, raising the issue whether current target prioritization and molecular risk stratification procedures in single biopsies are sufficiently reliable for therapy decisions. The genetic heterogeneity in gene mutations and chromosome aberrations observed in deep analyses from patient courses suggest clonal evolution before treatment and under treatment pressure, and support early emergence of metastatic clones and ongoing chromosomal instability during disease evolution. We report continuous clonal evolution on mutational and copy number levels in neuroblastoma, and detail its implications for therapy selection, risk stratification and therapy resistance.

In the version of the paper initially published, funding information for author Zsuzsanna Izsvák was missing. The Acknowledgements should have included the sentence 'Z.I. is funded by European Research Council-2011-ADG-TRANSPOSOstress-294742' .