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Baumgartner A, Stepien N, Mayr L, Madlener S, Dorfer C, Schmook MT, Traub-Weidinger T, Lötsch-Gojo D, Kirchhofer D, Reisinger D, Hedrich C, Arshad S, Irschik S, Boztug H, Engstler G, Bernkopf M, Rifatbegovic F, Höller C, Slavc I, Berger W, Müllauer L, Haberler C, Azizi AA, Peyrl A, Gojo J. Novel Insights into Diagnosis, Biology and Treatment of Primary Diffuse Leptomeningeal Melanomatosis. J Pers Med 2021; 11:292. [PMID: 33921303 PMCID: PMC8069125 DOI: 10.3390/jpm11040292] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
Primary diffuse leptomeningeal melanomatosis (PDLMM) is an extremely rare and aggressive cancer type for which best treatment strategies remain to be elucidated. Herein, we present current and prospective diagnostic strategies and treatment management of PDLMM. Against the background of an extensive literature review of published PDLMM cases and currently employed therapeutic strategies, we present an illustrative case of a pediatric patient suffering from PDLMM. We report the first case of a pediatric patient with PDLMM who received combination treatment including trametinib and everolimus, followed by intravenous nivolumab and ipilimumab with concomitant intensive intraventricular chemotherapy, resulting in temporary significant clinical improvement and overall survival of 7 months. Following this clinical experience, we performed a comprehensive literature review, identifying 26 additional cases. By these means, we provide insight into current knowledge on clinical and molecular characteristics of PDLMM. Analysis of these cases revealed that the unspecific clinical presentation, such as unrecognized increased intracranial pressure (present in 67%), is a frequent reason for the delay in diagnosis. Mortality remains substantial despite diverse therapeutic approaches with a median overall survival of 4 months from diagnosis. On the molecular level, to date, the only oncogenic driver reported so far is mutation of NRAS (n = 3), underlining a close biological relation to malignant melanoma and neurocutaneous melanosis. We further show, for the first time, that this somatic mutation can be exploited for cerebrospinal fluid liquid biopsy detection, revealing a novel potential biomarker for diagnosis and monitoring of PDLMM. Last, we use a unique patient derived PDLMM cell model to provide first insights into in vitro drug sensitivities. In summary, we provide future diagnostic and therapeutic guidance for PDLMM and first insights into the use of liquid biopsy and in vitro models for this orphan cancer type.
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Affiliation(s)
- Alicia Baumgartner
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Natalia Stepien
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Lisa Mayr
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, 1090 Vienna, Austria; (D.L.-G.); (W.B.)
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Sibylle Madlener
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Maria T. Schmook
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (M.T.S.); (T.T.-W.)
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (M.T.S.); (T.T.-W.)
| | - Daniela Lötsch-Gojo
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, 1090 Vienna, Austria; (D.L.-G.); (W.B.)
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Dominik Kirchhofer
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Dominik Reisinger
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Cora Hedrich
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Saleha Arshad
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Stefan Irschik
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Heidrun Boztug
- Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Medical University of Vienna, 1090 Vienna, Austria; (H.B.); (G.E.)
| | - Gernot Engstler
- Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Medical University of Vienna, 1090 Vienna, Austria; (H.B.); (G.E.)
| | - Marie Bernkopf
- Children’s Cancer Research Institute, 1090 Vienna, Austria; (M.B.); (F.R.)
| | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Walter Berger
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, 1090 Vienna, Austria; (D.L.-G.); (W.B.)
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Amedeo A. Azizi
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
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