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Pellerino A, Bertero L, Pronello E, Rudà R, Soffietti R. The early recognition and diagnosis of neoplastic meningitis. Expert Rev Neurother 2024; 24:105-116. [PMID: 38145502 DOI: 10.1080/14737175.2023.2295999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION The diagnosis and monitoring of leptomeningeal metastases (LM) from solid tumors are challenging, and the combination of neurological symptoms, MRI findings, and cerebrospinal fluid (CSF) cytology does not always allow to achieve a definitive diagnosis. AREAS COVERED This review summarizes the studies that have investigated CSF liquid biopsy to improve the initial diagnosis of LM in case the CSF cytology is negative or only suspicious for tumor cells, and monitoring of tumor response following targeted therapies or immunotherapy. In this regard, the early detection of LM recurrence and the development of resistant mutations are critical issues. Moreover, the early identification of subgroups of patients with a higher risk of LM progression, as well as the correlation of LM burden with survival, are discussed. EXPERT OPINION There is an urgent need of prospective studies to monitor longitudinally LM using CSF liquid biopsy and investigate the role of CTC, ctDNA or novel assays. The optimal setting for the longitudinal CSF and blood collection can be clinical trials focused on the molecular diagnosis of LM as well as the response and monitoring following targeted agents.
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Affiliation(s)
- Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Edoardo Pronello
- Neurology Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin, Italy
| | - Riccardo Soffietti
- Department of Oncology, Candiolo Institute for Cancer Research, FPO-IRCCS, Turin, Candiolo, Italy
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Primdahl D, Cohen-Nowak A, Kumthekar P. Novel approaches to treatment of leptomeningeal metastases. Curr Opin Neurol 2023; 36:592-602. [PMID: 37865856 DOI: 10.1097/wco.0000000000001218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW The incidence of leptomeningeal metastases is increasing in the setting of improved survival from systemic cancers. In more recent years, our understanding of leptomeningeal metastasis pathogenesis, how to diagnose and treat has been evolving. RECENT FINDINGS Diagnosing leptomeningeal metastasis has been challenging due to the limitations of cytology and neuroimaging; However, newer techniques detecting circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) have shown potential advantage with diagnosis, quantification and detection of oncogenic mutations. The use of small molecule inhibitors and immunotherapy has shown some promise in specific leptomeningeal metastasis subtypes. SUMMARY These new discoveries have improved clinical trials' ability to assess treatment response and thereby more optimally compare different treatments. Furthermore, they have helped the individual clinician better diagnose, monitor the disease and provide novel therapies.
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Affiliation(s)
- Ditte Primdahl
- Department of Neurology at The Feinberg School of Medicine at Northwestern University and The Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Adam Cohen-Nowak
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Priya Kumthekar
- Department of Neurology at The Feinberg School of Medicine at Northwestern University and The Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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Steininger J, Gellrich FF, Engellandt K, Meinhardt M, Westphal D, Beissert S, Meier F, Glitza Oliva IC. Leptomeningeal Metastases in Melanoma Patients: An Update on and Future Perspectives for Diagnosis and Treatment. Int J Mol Sci 2023; 24:11443. [PMID: 37511202 PMCID: PMC10380419 DOI: 10.3390/ijms241411443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Leptomeningeal disease (LMD) is a devastating complication of cancer with a particularly poor prognosis. Among solid tumours, malignant melanoma (MM) has one of the highest rates of metastasis to the leptomeninges, with approximately 10-15% of patients with advanced disease developing LMD. Tumour cells that metastasise to the brain have unique properties that allow them to cross the blood-brain barrier, evade the immune system, and survive in the brain microenvironment. Metastatic colonisation is achieved through dynamic communication between metastatic cells and the tumour microenvironment, resulting in a tumour-permissive milieu. Despite advances in treatment options, the incidence of LMD appears to be increasing and current treatment modalities have a limited impact on survival. This review provides an overview of the biology of LMD, diagnosis and current treatment approaches for MM patients with LMD, and an overview of ongoing clinical trials. Despite the still limited efficacy of current therapies, there is hope that emerging treatments will improve the outcomes for patients with LMD.
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Affiliation(s)
- Julian Steininger
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, 01307 Dresden, Germany
| | - Frank Friedrich Gellrich
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, 01307 Dresden, Germany
| | - Kay Engellandt
- Department of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, 01307 Dresden, Germany
| | - Matthias Meinhardt
- Institute of Pathology, University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, 01307 Dresden, Germany
| | - Dana Westphal
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, 01307 Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, 01307 Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Freret ME, Wijetunga NA, Shamseddine AA, Higginson DS, Schmitt AM, Yamada Y, Lis E, Boire A, Yang JT, Xu AJ. Early Detection of Leptomeningeal Metastases Among Patients Undergoing Spinal Stereotactic Radiosurgery. Adv Radiat Oncol 2023; 8:101154. [PMID: 36845624 PMCID: PMC9943781 DOI: 10.1016/j.adro.2022.101154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 12/15/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose The management of patients with advanced solid malignancies increasingly uses stereotactic body radiation therapy (SBRT). Advanced cancer patients are at risk for developing leptomeningeal metastasis (LM), a fatal complication of metastatic cancer. Cerebrospinal fluid (CSF) is routinely collected during computed tomography (CT) myelography for spinal SBRT planning, offering an opportunity for early LM detection by CSF cytology in the absence of radiographic LM or LM symptoms (subclinical LM). This study tested the hypothesis that early detection of tumor cells in CSF in patients undergoing spine SBRT portends a similarly poor prognosis compared with clinically overt LM. Methods and Materials We retrospectively analyzed clinical records for 495 patients with metastatic solid tumors who underwent CT myelography for spinal SBRT planning at a single institution from 2014 to 2019. Results Among patients planned for SBRT, 51 (10.3%) developed LM. Eight patients (1.6%) had subclinical LM. Median survival with LM was similar between patients with subclinical versus clinically evident LM (3.6 vs 3.0 months, P = .30). Patients harboring both parenchymal brain metastases and LM (29/51) demonstrated shorter survival than those with LM alone (2.4 vs 7.1 months, P = .02). Conclusions LM remains a fatal complication of metastatic cancer. Subclinical LM detected by CSF cytology in spine SBRT patients has a similarly poor prognosis compared with standardly detected LM and warrants consideration of central nervous system-directed therapies. As aggressive local therapies are increasingly used for metastatic patients, more sensitive CSF evaluation may further identify patients with subclinical LM and should be evaluated prospectively.
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Affiliation(s)
- Morgan E. Freret
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - N. Ari Wijetunga
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Achraf A. Shamseddine
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel S. Higginson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adam M. Schmitt
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adrienne Boire
- Department of Neurology, Human Oncology and Pathogenesis Program, Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan T. Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy J. Xu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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YOKAWA K, MATSUMOTO Y, NAGAKITA K, SHINNO Y, KUDO K, NIGUMA N, SUENOBU K, YOSHIDA H. Solitary Leptomeningeal Metastasis from Lung Cancer: A Case Report. NMC Case Rep J 2022; 9:323-328. [PMCID: PMC9560545 DOI: 10.2176/jns-nmc.2022-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Leptomeningeal metastasis (LM) is a rare but devastating cancer complication. LM occurs when cancer spreads into the leptomeningeal layer or cerebrospinal fluid. Intracranial magnetic resonance (MR) images of LM are characterized by the diffuse enhancement of the leptomeninges along the cerebral sulci, cerebellar folia, and cranial nerves. Here, we report an extremely rare case of LM with an atypical MR image revealing tumor mass confinement to the arachnoid membrane. The case involves an 85-year-old man who was referred to our hospital with a three-day history of dysarthria. Radiological examination revealed a solid lesion with heterogeneous enhancement and a cystic component in the extra-axial region of the right parietal lobe. Upon subsequent general examination, multiple lung cancer metastases were suspected. The patient underwent gross total resection of the brain mass in the right parietal region. Although the tumor slightly adhered to the dura mater, it was sharply demarcated from the surrounding parenchyma and pia mater. Based on pathological examination, the tumor was diagnosed as small cell lung cancer metastasis. This metastatic brain tumor was exclusively confined to the arachnoid membrane and, except for a few blood vessels, the dura mater was not infiltrated by metastatic tumor cells. To our knowledge, this is the first reported case of LM in which the tumor mass is confined only to the arachnoid membrane. Thus, in cases with atypical MR images, a general examination considering the possibility of LM is important for prompt and accurate diagnosis.
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Affiliation(s)
- Keita YOKAWA
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center
| | - Yuji MATSUMOTO
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center
| | - Keina NAGAKITA
- Department of Pathology, National Hospital Organization Okayama Medical Center
| | - Yoko SHINNO
- Department of Pathology, National Hospital Organization Okayama Medical Center
| | - Kenichiro KUDO
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center
| | - Nanami NIGUMA
- Department of Plastic Surgery, National Hospital Organization Okayama Medical Center
| | - Kosaku SUENOBU
- Department of Plastic Surgery, National Hospital Organization Okayama Medical Center
| | - Hideyuki YOSHIDA
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center
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Gao T, Chen F, Li M. Development of Two Diagnostic Prediction Models for Leptomeningeal Metastasis in Patients With Solid Tumors. Front Neurol 2022; 13:899153. [PMID: 35677335 PMCID: PMC9168081 DOI: 10.3389/fneur.2022.899153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesFor accurate diagnosis of leptomeningeal metastasis (LM) and to avoid unnecessary examinations or lumber puncture (LP), we develop two diagnostic prediction models for patients with solid tumors.Study Design, Setting, and ParticipantsThis is a retrospective cohort study launched at the Second Affiliated Hospital of Dalian Medical University. In total, 206 patients who had been admitted between January 2005 and December 2021 with a solid tumor and clinical suspicion of LM were enrolled to develop model A. In total, 152 patients of them who underwent LPs for cytology and biochemistry were enrolled to develop model B.Model DevelopmentDiagnostic factors included skull metastasis, active brain metastasis, progressed extracranial disease, number of extracranial organs involved, number of symptoms, cerebrospinal fluid (CSF) protein, and CSF glucose. The outcome predictor was defined as the clinical diagnosis of LM. Logistic least absolute shrinkage and selection operator (LASSO) regression was used to identify relevant variables and fit the prediction model. A calibration curve and the concordance index (c-index) were used to evaluate calibration and discrimination ability. The n-fold cross-validation method was used to internally validate the models. The decision curve analysis (DCA) and the interventions avoided analysis (IAA) were used to evaluate the clinical application.ResultsThe area under the curve (AUC) values of models A and B were 0.812 (95% CI: 0.751–0.874) and 0.901 (95% CI: 0.852–0.949). Respectively, compared to the first magnetic resonance imaging (MRI) and first LP, models A and B showed a higher AUC (model A vs. first MRI: 0.812 vs. 0.743, p = 0.087; model B vs. first LP: 0.901 vs. 0.800, p = 0.010). The validated c-indexes were 0.810 (95% CI: 0.670–0.952) and 0.899 (95% CI: 0.823–0.977). The calibration curves show a good calibrated ability. The evaluation of clinical application revealed a net clinical benefit and a reduction of unnecessary interventions using the models.ConclusionsThe models can help improve diagnostic accuracy when used alone or in combination with conventional work-up. They also exhibit a net clinical benefit in medical decisions and in avoiding unnecessary interventions for patients with LM. Studies focused on external validation of our models are necessary in the future.
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Advances in the Diagnosis and Treatment of Leptomeningeal Disease. Curr Neurol Neurosci Rep 2022; 22:413-425. [PMID: 35588045 DOI: 10.1007/s11910-022-01198-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Leptomeningeal disease (LMD) is a rare, late complication of systemic cancer and is associated with significant neurological morbidity and high mortality. Here we provide an overview of this condition, summarizing key recent research findings and clinical practice trends in its diagnosis and treatment. We also review current clinical trials for LMD. RECENT FINDINGS Improved molecular diagnostic tools are in development to enable more sensitive detection of LMD, including circulating tumor cells and circulating tumor DNA. The use of targeted and CNS-penetrant therapeutics has shown survival improvements with tyrosine kinase inhibitors, antibody-drug conjugates, and select chemotherapy. However, these studies have primarily been phase I/II and retrospective analyses. There remains a dearth of clinical trials that include LMD patients. The combination of patient-specific molecular information and novel therapeutic approaches holds significant promise for improving outcomes in patients with LMD.
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Wang Y, Luo N, Gao Y, Wu Y, Qin X, Qi Y, Sun T, Tao R, Qi C, Liu B, Yuan S. The joint detection of CEA and ctDNA in cerebrospinal fluid: an auxiliary tool for the diagnosis of leptomeningeal metastases in cancer. J Cancer Res Clin Oncol 2022; 149:1679-1690. [PMID: 35583828 DOI: 10.1007/s00432-022-04053-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Leptomeningeal metastases (LMs) are highly invasive which leads to poor prognosis, but the accurate diagnosis of LM is challenging. It is necessary to investigate more advanced diagnostic methods to realize precision medicine. The main purpose of this study was to select a more effective method for the auxiliary diagnosis of LM by comparing various detection methods. The secondary purpose was to explore the value of cerebrospinal fluid (CSF) tumor markers (TMs) and circulating tumor DNA (ctDNA) testing in guiding clinical treatment. METHODS TMs in serum and CSF of patients were detected by chemiluminescence. The ctDNA of CSF and plasma were detected by the next-generation sequencing (NGS) technology. RESULTS In total, 54 tumor patients participated in this study, in which 39 with LM and 15 without LM (8 with parenchymal tumor and 7 without brain metastasis). The results showed that the sensitivity and accuracy of CSF cytology isolated during the first lumbar puncture were 0.31 (95% CI 0.17-0.48) and 0.50 (95% CI 0.36-0.64), respectively. The sensitivity and accuracy of CSF_CEA were 0.71 (95% CI 0.54-0.85) and 0.78 (95% CI 0.64-0.89), which were better than those of CSF_NSE and CSF_CFRA-211. The sensitivity and accuracy of CSF_ctDNA were 0.92 (95% CI 0.79-0.98) and 0.91 (95% CI 0.80-0.97), significantly higher than that of CSF cytology (P < 0.01). The sensitivity and accuracy of CSF_CEA combined with CSF_ctDNA were 0.97 (95% CI, 0.87-1.00) and 0.94 (95% CI 0.85-0.99), which were significantly higher than the traditional methods CSF cytology (P < 0.01). For LM patients with hydrocephalus, the sensitivity of CSF ctDNA even achieved 100% (14/14). CONCLUSION CSF_CEA combined with CSF_ctDNA could be used to accurately distinguish patients with LM from those with no brain metastasis and from those with parenchymal tumors. CSF_ctDNA testing reveals a unique mutation profile for patients with LM. Dynamic detection of CSF TM and ctDNA can better predict the efficacy and reveal the cause of drug resistance to guide subsequent treatment. CLINICAL TRIAL REGISTRATION Clinical trial registration number: NCT03029065.
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Affiliation(s)
- Yong Wang
- Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, No.440. Jiyan Road, Jinan, 250117, Shandong, People's Republic of China
| | - Ningning Luo
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd; Nanjing Simcere Medical Laboratory Science Co., Ltd; The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, People's Republic of China
| | - Ye Gao
- Department of Neurosurgery, Zhangqiu District People's Hospital, Jinan, Shandong, People's Republic of China
| | - Yaqing Wu
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd; Nanjing Simcere Medical Laboratory Science Co., Ltd; The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, People's Republic of China
| | - Xueting Qin
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, No.440. Jiyan Road, Jinan, 250117, Shandong, People's Republic of China
| | - Yingxue Qi
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd; Nanjing Simcere Medical Laboratory Science Co., Ltd; The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, People's Republic of China
| | - Tingting Sun
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd; Nanjing Simcere Medical Laboratory Science Co., Ltd; The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, People's Republic of China
| | - Rongjie Tao
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, No.440. Jiyan Road, Jinan, 250117, Shandong, People's Republic of China
| | - Chuang Qi
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd; Nanjing Simcere Medical Laboratory Science Co., Ltd; The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, People's Republic of China
| | - Baoyan Liu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Academy of Occupational Health and Occupational Medicine, No. 18877 Jingshi Road, Jinan, 250062, Shandong, People's Republic of China.
| | - Shuanghu Yuan
- Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China. .,Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, No.440. Jiyan Road, Jinan, 250117, Shandong, People's Republic of China.
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Evolving management of HER2+ breast cancer brain metastases and leptomeningeal disease. J Neurooncol 2022; 157:249-269. [PMID: 35244835 DOI: 10.1007/s11060-022-03977-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/23/2022] [Indexed: 12/14/2022]
Abstract
Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a particularly high risk of breast cancer brain metastasis (BCBM) and leptomeningeal disease (LMD). Improvements in systemic therapy have translated to improved survival for patients with HER2-positive BCBM and LMD. However, the optimal management of these cases is rapidly evolving and requires a multidisciplinary approach. Herein, a team of radiation oncologists, medical oncologists, neuro-oncologists, and breast surgeon created a review of the evolving management of HER2-positive BCBM and LMD. We assess the epidemiology, diagnosis, and evolving treatment options for patients with HER2-positive BCBM and LMD, as well as the ongoing prospective clinical trials enrolling these patients. The management of HER2-positive BCBM and LMD represents an increasingly common challenge that involves the coordination of local and systemic therapy. Advances in systemic therapy have resulted in an improved prognosis, and promising targeted therapies currently under prospective investigation have the potential to further benefit these patients.
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Deciphering Biomarkers for Leptomeningeal Metastasis in Malignant Hemopathies (Lymphoma/Leukemia) Patients by Comprehensive Multipronged Proteomics Characterization of Cerebrospinal Fluid. Cancers (Basel) 2022; 14:cancers14020449. [PMID: 35053611 PMCID: PMC8773653 DOI: 10.3390/cancers14020449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The early diagnosis of leptomeningeal disease is a challenge because it is asymptomatic in the early stages. Consequently, it is important to identify a panel of biomarkers to help in its diagnosis and/or prognosis. For this purpose, we explored a multipronged proteomics approach in cerebrospinal fluid (CSF) to determine a potential panel of biomarkers. Thus, a systematic and exhaustive characterization of more than 300 CSF samples was performed by an integrated approach by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) and functional proteomics analysis to establish protein profiles, which were useful for developing a panel of biomarkers validated by in silico approaches. Abstract In the present work, leptomeningeal disease, a very destructive form of systemic cancer, was characterized from several proteomics points of view. This pathology involves the invasion of the leptomeninges by malignant tumor cells. The tumor spreads to the central nervous system through the cerebrospinal fluid (CSF) and has a very grim prognosis; the average life expectancy of patients who suffer it does not exceed 3 months. The early diagnosis of leptomeningeal disease is a challenge because, in most of the cases, it is an asymptomatic pathology. When the symptoms are clear, the disease is already in the very advanced stages and life expectancy is low. Consequently, there is a pressing need to determine useful CSF proteins to help in the diagnosis and/or prognosis of this disease. For this purpose, a systematic and exhaustive proteomics characterization of CSF by multipronged proteomics approaches was performed to determine different protein profiles as potential biomarkers. Proteins such as PTPRC, SERPINC1, sCD44, sCD14, ANPEP, SPP1, FCGR1A, C9, sCD19, and sCD34, among others, and their functional analysis, reveals that most of them are linked to the pathology and are not detected on normal CSF. Finally, a panel of biomarkers was verified by a prediction model for leptomeningeal disease, showing new insights into the research for potential biomarkers that are easy to translate into the clinic for the diagnosis of this devastating disease.
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Diaz M, Fleisher M, Pentsova EI. Cerebrospinal fluid circulating tumor cells for diagnosis, response evaluation, and molecular profiling of leptomeningeal metastases from solid tumors. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sener U, Kumthekar P, Boire A. Advances in the diagnosis, evaluation, and management of leptomeningeal disease. Neurooncol Adv 2021; 3:v86-v95. [PMID: 34859236 PMCID: PMC8633748 DOI: 10.1093/noajnl/vdab108] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Leptomeningeal metastasis (LM) is a devastating complication of cancer with variable clinical presentation and limited benefit from existing treatment options. In this review, we discuss advances in LM diagnostics and therapeutics with the potential to reverse this grim course. Emerging cerebrospinal fluid circulating tumor cell and cell-free tumor DNA analysis technologies will improve diagnosis of LM, while providing crucial genetic information, capturing tumor heterogeneity, and quantifying disease burden. Circulating tumor cells and cell-free tumor DNA have utility as biomarkers to track disease progression and treatment response. Treatment options for LM include ventriculoperitoneal shunting for symptomatic relief, radiation therapy including whole-brain radiation and focal radiation for bulky leptomeningeal involvement, and systemic and intrathecal medical therapies, including targeted and immunotherapies based on tumor mutational profiling. While existing treatments for LM have limited efficacy, recent advances in liquid biopsy together with increasing availability of targeted treatments will lead to rational multimodal individualized treatments and improved patient outcomes.
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Affiliation(s)
- Ugur Sener
- Department of Neurology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Priya Kumthekar
- Department of Neurology, Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adrienne Boire
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Song J, Yang P, Li X, Zhu X, Liu M, Duan X, Liu R. Esophageal Cancer-Derived Extracellular Vesicle miR-21-5p Contributes to EMT of ESCC Cells by Disorganizing Macrophage Polarization. Cancers (Basel) 2021; 13:4122. [PMID: 34439276 PMCID: PMC8392810 DOI: 10.3390/cancers13164122] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/31/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022] Open
Abstract
The disorganized polarization of tumor-associated macrophages (TAMs) exerts a critical effect on tumor progression. MicroRNAs (miRNAs) in extracellular vesicles (EVs) secreted from cancer cells may contribute to this process. However, the relationship between TAMs and EVs-miRNAs-mediated regulation in esophageal squamous cell carcinoma (ESCC) remains unclear. In the present study, immunoaffinity magnetic beads combined with antiepithelial cell adhesion molecules (EpCAM) were used to isolate and identify EVs-miR-21-5p from the plasma of ESCC patients. An in vitro coculture system was designed to evaluate the effect of esophageal cancer cells with miR-21-5p overexpression on macrophage polarization. We found that phorbol myristate acetate-induced THP-1 macrophages took up EVs-miR-21-5p from EC109 or EC9706 cells and were transformed into M2 macrophages. This, in turn, contributed to the excessive migration and invasion of esophageal cancer cells. The mechanism underlying these changes may involve activation of M2 macrophages by upregulated ESCC-derived EVs-miR-21-5p through the PTEN/AKT/STAT6 pathway. This may result in esophageal cancer cell epithelial-mesenchymal transition (EMT) via TGF-β/Smad2 signaling. Our results indicate positive feedback between M2 macrophage polarization and EMT of esophageal cancer cells in the tumor microenvironment via shuttling of miR-21-5p in tumor-derived EVs.
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Affiliation(s)
- Jing Song
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (J.S.); (P.Y.); (M.L.)
- The Affiliated Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China; (X.L.); (X.Z.)
| | - Peiyan Yang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (J.S.); (P.Y.); (M.L.)
| | - Xiuwen Li
- The Affiliated Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China; (X.L.); (X.Z.)
| | - Xinyi Zhu
- The Affiliated Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China; (X.L.); (X.Z.)
| | - Mengxin Liu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (J.S.); (P.Y.); (M.L.)
| | - Xuexin Duan
- State Key Laboratory of Precision Measuring Technology & Instruments, College of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin 300072, China;
| | - Ran Liu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (J.S.); (P.Y.); (M.L.)
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14
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Pellerino A, Brastianos PK, Rudà R, Soffietti R. Leptomeningeal Metastases from Solid Tumors: Recent Advances in Diagnosis and Molecular Approaches. Cancers (Basel) 2021; 13:2888. [PMID: 34207653 PMCID: PMC8227730 DOI: 10.3390/cancers13122888] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/05/2021] [Indexed: 12/13/2022] Open
Abstract
Leptomeningeal metastases (LM) from solid tumors represent an unmet need of increasing importance due to an early use of MRI for diagnosis and improvement of outcome of some molecular subgroups following targeted agents and immunotherapy. In this review, we first discussed factors limiting the efficacy of targeted agents in LM, such as the molecular divergence between primary tumors and CNS lesions and CNS barriers at the level of the normal brain, brain tumors and CSF. Further, we reviewed pathogenesis and experimental models and modalities, such as MRI (with RANO and ESO/ESMO criteria), CSF cytology and liquid biopsy, to improve diagnosis and monitoring following therapy. Efficacy and limitations of targeted therapies for LM from EGFR-mutant and ALK-rearranged NSCLC, HER2-positive breast cancer and BRAF-mutated melanomas are reported, including the use of intrathecal administration or modification of traditional cytotoxic compounds. The efficacy of checkpoint inhibitors in LM from non-druggable tumors, in particular triple-negative breast cancer, is discussed. Last, we focused on some recent techniques to improve drug delivery.
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Affiliation(s)
- Alessia Pellerino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, 10126 Turin, Italy; (R.R.); (R.S.)
| | - Priscilla K. Brastianos
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02115, USA;
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, 10126 Turin, Italy; (R.R.); (R.S.)
- Department of Neurology, Castelfranco Veneto and Brain Tumor Board Treviso Hospital, 31100 Treviso, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, 10126 Turin, Italy; (R.R.); (R.S.)
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15
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Lin Y, Li H, Huang M, Yin Z, Wu J. [Auxiliary Diagnostic Value of Tumor Markers in the Cerebrospinal Fluid and Blood for Leptomeningeal Metastasis from Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:516-525. [PMID: 32517459 PMCID: PMC7309546 DOI: 10.3779/j.issn.1009-3419.2020.103.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
背景与目的 软脑膜转移(leptomeningeal metastasis, LM)是指恶性肿瘤细胞浸润软脑膜,并在脑脊液(cerebrospinal fluid, CSF)中播散,预后极差,是晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者致死的重要原因之一,因此早期的诊断和及时的治疗具有重要意义,CSF细胞学是LM诊断的金标准,但常常伴随着检测敏感性低、无法评估疗效等问题。本文旨在探讨血清及CSF中肿瘤标志物(tumor markers, TM)在NSCLC伴LM患者诊治的临床价值。 方法 选取NSCLC伴LM患者19例,另选同期27例神经系统良性肿瘤(nonmalignant neurological diseases, NMNDs)患者作为对照组。观察比较两组患者血清和CSF中癌胚抗原(carbohydrate antigen, CEA)、糖类抗原125(carbohydrate antigen-125, CA125)、细胞角蛋白19片断抗原(cytokeratin 19 fragments, CYFRA21-1)和神经元烯醇化酶(neurone specific enolase, NSE)检测水平和检出阳性率,比较不同组TM的敏感性和特异性,并分析血清与CSF中TM检出情况相关性,最后动态监测2例LM患者血清和CSF中TM水平,分别评估颅外和颅内治疗疗效。 结果 LM组CSF和血清中TM水平和检出阳性率均高于对照组(P < 0.05),同时LM组CSF中CEA、CYFRA21-1、NSE水平高于血清,差异有统计学意义(P < 0.05)。CSF中TM检出阳性率与血清差异不具有统计学意义(P > 0.05)。CSF中CYFRA21-1敏感性最高(88.2%),CEA特异性最好(92.3%),联合指标中CEA或NSE任一项超过临界值则敏感性和阴性预测值为100%,特异性为74.1%。CYFRA21-1和NSE同时超过临界值时特异性和阳性预测值为100%,敏感性为78.9%。亚组分析显示,CSF细胞学阳性人群TM检出阳性率超过有磁共振成像(magnetic resonance imaging, MRI)异常的人群,但不具有统计学差异(P > 0.05)。LM组血清与CSF中TM检出阳性率不一致。另外,脑室中CSF与腰穿中CSF具有相同的生化性质,动态监测血清和CSF中TM浓度,可分别评估颅外和颅内病灶的疗效。 结论 血清和CSF中TM为NSCLC伴LM患者增加了一个早期辅助诊断指标,动态监测可评估治疗疗效,值得临床推广应用。
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Affiliation(s)
- Yongjuan Lin
- Department of Geriatric, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Department of Geriatric, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Huiying Li
- Department of Geriatric, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Mingmin Huang
- Department of Geriatric, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Zhenyu Yin
- Department of Geriatric, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Jianqing Wu
- Department of Geriatric, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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16
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Dankner M, Lam S, Degenhard T, Garzia L, Guiot MC, Petrecca K, Siegel PM. The Underlying Biology and Therapeutic Vulnerabilities of Leptomeningeal Metastases in Adult Solid Cancers. Cancers (Basel) 2021; 13:cancers13040732. [PMID: 33578853 PMCID: PMC7916586 DOI: 10.3390/cancers13040732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 01/18/2023] Open
Abstract
Metastasis to the central nervous system occurs in approximately 20% of patients with advanced solid cancers such as lung cancer, breast cancer, and melanoma. While central nervous system metastases most commonly form in the brain parenchyma, metastatic cancer cells may also reside in the subarachnoid space surrounding the brain and spinal cord to form tumors called leptomeningeal metastases. Leptomeningeal metastasis involves cancer cells that reach the subarachnoid space and proliferate in the cerebrospinal fluid compartment within the leptomeninges, a sequela associated with a myriad of symptoms and poor prognosis. Cancer cells exposed to cerebrospinal fluid in the leptomeninges must contend with a unique microenvironment from those that establish within the brain or other organs. Leptomeningeal lesions provide a formidable clinical challenge due to their often-diffuse infiltration within the subarachnoid space. The molecular mechanisms that promote the establishment of leptomeningeal metastases have begun to be elucidated, demonstrating that it is a biological entity distinct from parenchymal brain metastases and is associated with specific molecular drivers. In this review, we outline the current state of knowledge pertaining to the diagnosis, treatment, and molecular underpinnings of leptomeningeal metastasis.
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Affiliation(s)
- Matthew Dankner
- Goodman Cancer Research Centre, Faculty of Medicine, McGill University, Montreal, QC H3A 1A3, Canada; (M.D.); (M.-C.G.)
| | - Stephanie Lam
- Department of Diagnostic Radiology, Faculty of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC H3T 1E2, Canada;
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Theresa Degenhard
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 2B4, Canada; (T.D.); (K.P.)
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Livia Garzia
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Marie-Christine Guiot
- Goodman Cancer Research Centre, Faculty of Medicine, McGill University, Montreal, QC H3A 1A3, Canada; (M.D.); (M.-C.G.)
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 2B4, Canada; (T.D.); (K.P.)
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, QC H3A 2B4, Canada
- Department of Pathology, McGill University, Montreal, QC H3A 1A3, Canada
| | - Kevin Petrecca
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 2B4, Canada; (T.D.); (K.P.)
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Peter M. Siegel
- Goodman Cancer Research Centre, Faculty of Medicine, McGill University, Montreal, QC H3A 1A3, Canada; (M.D.); (M.-C.G.)
- Department of Diagnostic Radiology, Faculty of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC H3T 1E2, Canada;
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 2B4, Canada; (T.D.); (K.P.)
- Department of Biochemistry, McGill University, Montreal, QC H3A 1A3, Canada
- Department of Anatomy & Cell Biology, McGill University, Montreal, QC H3A 1A3, Canada
- Department of Oncology, McGill University, Montreal, QC H3A 1A3, Canada
- Correspondence: ; Tel.: +1-514-398-4259; Fax: +1-514-398-6769
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17
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Brandsma D, van den Bent MJB. Quantification of leptomeningeal metastases from solid tumors remains a challenging issue. Neuro Oncol 2020; 22:592-593. [PMID: 32149351 DOI: 10.1093/neuonc/noaa056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dieta Brandsma
- Department of Neuro-oncology, Netherlands Cancer Institute‒Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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18
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Wong‐Arteta J, Rey M, Aragón L, Gil‐Rodríguez E, Bujanda L. The utility of flow cytometry in the diagnostic work up of malignant effusions due to nonhematopoietic neoplasms. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 98:504-515. [PMID: 32506689 DOI: 10.1002/cyto.b.21886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Jhonatan Wong‐Arteta
- Biochemistry Donostia University Hospital San Sebastián País Vasco Spain
- School of Medicine University of the Basque Country (UPV‐EHU) San Sebastián País Vasco Spain
- Hematology Asuncion Clinic Tolosa País Vasco Spain
| | - Mercedes Rey
- Immunology Donostia University Hospital San Sebastián País Vasco Spain
| | - Larraitz Aragón
- Immunology Donostia University Hospital San Sebastián País Vasco Spain
| | - Eva Gil‐Rodríguez
- Biochemistry Donostia University Hospital San Sebastián País Vasco Spain
| | - Luis Bujanda
- School of Medicine University of the Basque Country (UPV‐EHU) San Sebastián País Vasco Spain
- Gastroenterology Donostia University Hospital San Sebastián País Vasco Spain
- Department of Liver and Gastrointestinal Diseases Biodonostia Health Research Institute San Sebastián País Vasco Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd) Carlos III National Institute of Health Madrid Spain
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19
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Zhao B, Li G, Peng J, Ren L, Lei L, Ye H, Wang Z, Zhao S. CircMACF1 Attenuates Acute Myocardial Infarction Through miR-500b-5p-EMP1 Axis. J Cardiovasc Transl Res 2020; 14:161-172. [PMID: 32162171 DOI: 10.1007/s12265-020-09976-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/21/2020] [Indexed: 12/30/2022]
Abstract
It is widely accepted that circular RNA (circRNA) plays an important role in cardiovascular diseases. Therefore, this experiment aimed to investigate the pathogenesis of circMACF1 in acute myocardial infarction (AMI). qRT-PCR and immunoblotting were used to detect the expression levels of circMACF1, miR-500b-5p, and epithelial membrane protein 1 (EMP1). The role of circMACF1, miR-500b-5p, and EMP1 in cardiomyocyte apoptosis was assessed using annexin V-FITC/PI. Echocardiographic assessment, serum creatine kinase MB (CK-MB) and lactate dehydrogenase (LDH), myocardial infarct size, and TUNEL staining were applied in our research. In the MI group, the expression levels of circMACF1 and EMP1 were decreased with the increasing expression level of miR-500b-5p. CircMACF1 upregulated the expression of EMP1 as a sponge of miR-500b-5p, and circMACF1 was a direct target of miR-500b-5p. CircMACF1 impaired the progression of AMI by modulating the miR-500b-5p/EMP1 axis. CircMACF1 may be a potential therapeutic target for treating AMI. Graphical Abstract CircMACF1 upregulated EMP1 expression by sponge miR-500b-5p.
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Affiliation(s)
- Bo Zhao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Guangping Li
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China.
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
| | - Jianjun Peng
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Lihui Ren
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Licheng Lei
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Huiming Ye
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Zuoyan Wang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Sheng Zhao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
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20
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van Bussel MTJ, Pluim D, Milojkovic Kerklaan B, Bol M, Sikorska K, Linders DTC, van den Broek D, Beijnen JH, Schellens JHM, Brandsma D. Circulating epithelial tumor cell analysis in CSF in patients with leptomeningeal metastases. Neurology 2020; 94:e521-e528. [PMID: 31907288 DOI: 10.1212/wnl.0000000000008751] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The primary objective was to determine the sensitivity and specificity of epithelial cell adhesion molecule (EpCAM) immunoflow cytometry circulating tumor cells (CTC) analysis in CSF in patients with suspected leptomeningeal metastases (LM). The secondary objective was to explore the distribution of driver mutations in the primary tumor, plasma, cell free CSF (cfCSF), and isolated CTC from CSF in non-small cell lung cancer (NSCLC). METHODS We tested the performance of the CTC assay vs CSF cytology in a prospective study in 81 patients with a clinical suspicion of LM but a nonconfirmatory MRI. In an NSCLC subcohort, we analyzed circulating tumor (ct)DNA of the selected driver mutations by digital droplet PCR (ddPCR). RESULTS The sensitivity of the CTC assay was 94% (95% confidence interval [CI] 80-99) and the specificity was 100% (95% CI 91-100) at the optimal cutoff of 0.9 CTC/mL. The sensitivity of cytology was 76% (95% CI 58-89). Twelve of the 23 patients with NSCLC had mutated epidermal growth factor receptor (EGFR). All 5 tested patients with LM demonstrated the primary EGFR driver mutation in cfCSF. The driver mutation could also be detected in CTC isolated from CSF. CONCLUSION CTC in CSF are detected with a high sensitivity for the diagnosis of LM. ddPCR can determine EGFR mutations in both cfCSF and isolated CTC from CSF of patients with EGFR-mutated NSCLC and LM. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that EpCAM-based immunoflow cytometry analysis of CSF accurately identifies patients with LM.
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Affiliation(s)
- Mark T J van Bussel
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dick Pluim
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Bojana Milojkovic Kerklaan
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Mijke Bol
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Karolina Sikorska
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dorothé T C Linders
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Daan van den Broek
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Jos H Beijnen
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Jan H M Schellens
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dieta Brandsma
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands.
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21
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Sener U, Matin N, Yu H, Lin A, Yang TJ, Malani R. Radiographic appearance of leptomeningeal disease in patients with EGFR-mutated non-small-cell lung carcinoma treated with tyrosine kinase inhibitors: a case series. CNS Oncol 2019; 8:CNS42. [PMID: 31777268 PMCID: PMC6912846 DOI: 10.2217/cns-2019-0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
EGFR is frequently mutated in non-small-cell lung carcinomas (NSCLCs). Clinically available tyrosine kinase inhibitors (TKIs) are effective in treating EGFR-mutant NSCLC. In this case series, we present five patients with TKI-treated EGFR-mutated NSCLC who developed leptomeningeal disease (LMD) lacking characteristic imaging findings. All five patients received TKIs prior to development of cytology-confirmed LMD. Clinical signs of LMD preceded radiographic evidence by 2–12 months. T790M, the most common resistance mutation to first-generation EGFR inhibitors, was identified in four cases. These cases illustrate that in patients with EGFR-mutant NSCLC, TKIs may effectively control LMD, creating a lag between onset of symptoms and observation of radiographic findings.
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Affiliation(s)
- Ugur Sener
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Nassim Matin
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Helena Yu
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Andrew Lin
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - T Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Rachna Malani
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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22
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Boire A, Brandsma D, Brastianos PK, Le Rhun E, Ahluwalia M, Junck L, Glantz M, Groves MD, Lee EQ, Lin N, Raizer J, Rudà R, Weller M, Van den Bent MJ, Vogelbaum MA, Chang S, Wen PY, Soffietti R. Liquid biopsy in central nervous system metastases: a RANO review and proposals for clinical applications. Neuro Oncol 2019; 21:571-584. [PMID: 30668804 PMCID: PMC6502489 DOI: 10.1093/neuonc/noz012] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Liquid biopsies collect and analyze tumor components in body fluids, and there is an increasing interest in the investigation of liquid biopsies as a surrogate for tumor tissue in the management of both primary and secondary brain tumors. Herein we critically review available literature on spinal fluid and plasma circulating tumor cells (CTCs) and cell-free tumor (ctDNA) for diagnosis and monitoring of leptomeningeal and parenchymal brain metastases. We discuss technical issues and propose several potential applications of liquid biopsies in different clinical settings (ie, for initial diagnosis, for assessment during treatment, and for guidance of treatment decisions). Last, ongoing clinical studies on CNS metastases that include liquid biopsies are summarized, and recommendations for future clinical studies are provided.
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Affiliation(s)
- Adrienne Boire
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute‒Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Priscilla K Brastianos
- Departments of Medicine and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Emilie Le Rhun
- Department of Neuro-Oncology/Neurosurgery, University Hospital, Lille, France
| | - Manmeet Ahluwalia
- Department of Medicine, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Larry Junck
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Glantz
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA
| | - Morris D Groves
- Department of Neuro-Oncology, Austin Brain Tumor Center and University of Texas, Austin, Texas, USA
| | - Eudocia Q Lee
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Raizer
- Department of Neurology and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, University Hospital, Zurich, Switzerland
| | | | - Michael A Vogelbaum
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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23
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Pellerino A, Bertero L, Rudà R, Soffietti R. Neoplastic meningitis in solid tumors: from diagnosis to personalized treatments. Ther Adv Neurol Disord 2018. [PMID: 29535794 PMCID: PMC5844521 DOI: 10.1177/1756286418759618] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Neoplastic meningitis (NM) is a devastating complication of solid tumors with poor outcome. Some randomized clinical trials have been conducted with heterogeneous inclusion criteria, diagnostic parameters, response evaluation and primary endpoints. Recently, the Leptomeningeal Assessment in Neuro-Oncology (LANO) Group and the European Society for Medical Oncology/European Association for Neuro-Oncology have proposed some recommendations in order to provide diagnostic criteria and response evaluation scores for NM. The aim of these guidelines is to integrate the neurological examination with magnetic resonance imaging and cerebrospinal fluid findings as well as to provide a framework for use in clinical trials. However, this composite assessment needs further validation. Since intrathecal therapy represents a treatment with limited efficacy in NM, many studies have been conducted on systemic therapies, including target therapies, with some encouraging results in terms of disease control. In this review, we have analyzed the clinical aspects and the most recent diagnostic tools and therapeutic options in NM.
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Affiliation(s)
- Alessia Pellerino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, Turin, 10126 Italy
| | - Luca Bertero
- Section of Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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