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Meric-Bernstam F, Rothe M, Mangat PK, Garrett-Mayer E, Gutierrez R, Ahn ER, Cannon TL, Powell S, Krauss JC, Reynolds CM, von Mehren M, Behl D, Calfa CJ, Duvivier HL, Kaplan HG, Livingston MB, Sharma MR, Urba WJ, Grantham GN, Hinshaw DC, Gregory A, Halabi S, Schilsky RL. Cobimetinib Plus Vemurafenib in Patients With Solid Tumors With BRAF Mutations: Results From the Targeted Agent and Profiling Utilization Registry Study. JCO Precis Oncol 2023; 7:e2300385. [PMID: 38096472 PMCID: PMC10735080 DOI: 10.1200/po.23.00385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 07/31/2023] [Accepted: 09/27/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE The Targeted Agent and Profiling Utilization Registry Study is a phase II basket study evaluating antitumor activity of commercially available targeted agents in patients with advanced cancers with genomic alterations known to be drug targets. The results in a cohort of patients with solid tumors with BRAF mutations treated with cobimetinib plus vemurafenib are reported. METHODS Eligible patients had measurable disease (RECIST v.1.1), Eastern Cooperative Oncology Group performance status 0-2, adequate organ function, and no standard treatment options. The primary end point was disease control (DC), defined as complete response (CR) or partial response (PR) or stable disease of at least 16-weeks duration (SD16+). Low-accruing histology-specific cohorts with BRAF mutations treated with cobimetinib plus vemurafenib were collapsed into a single histology-pooled cohort for this analysis. The results were evaluated on the basis of a one-sided exact binomial test with a null DC rate of 15% versus 35% (power, .82; α, .10). The secondary end points were objective response (OR), progression-free survival, overall survival, duration of response, duration of stable disease, and safety. RESULTS Thirty-one patients with solid tumors with BRAF mutations were enrolled. Twenty-eight patients were evaluable for efficacy. Patients had tumors with BRAF V600E (n = 26), K601E (n = 2), or other (n = 3) mutations. Two patients with CR (breast and ovarian cancers; V600E), 14 with PR (13 V600E, one N581I), and three with SD16+ (two V600E, one T599_V600insT) were observed with a DC rate of 68% (P < .0001; one-sided 90% CI, 54 to 100) and an OR rate of 57% (95% CI, 37 to 76). Nineteen patients experienced ≥one drug-related grade 3-5 adverse event or serious adverse event including one death attributed to treatment-related kidney injury. CONCLUSION Cobimetinib plus vemurafenib showed antitumor activity in patients with advanced solid tumors with BRAF V600E mutations; additional study is warranted to confirm the antitumor activity in tumors with non-V600E BRAF mutations.
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Affiliation(s)
| | - Michael Rothe
- American Society of Clinical Oncology, Alexandria, VA
| | - Pam K. Mangat
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Rodolfo Gutierrez
- The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Santa Monica, CA
| | | | | | | | - John C. Krauss
- University of Michigan Rogel Comprehensive Cancer Center, Ann Arbor, MI
| | | | | | - Deepti Behl
- Sutter Sacramento Medical Center, Sacramento, CA
| | - Carmen J. Calfa
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Muniz TP, Mason WP. BRAF Mutations in CNS Tumors-Prognostic Markers and Therapeutic Targets. CNS Drugs 2023; 37:587-598. [PMID: 37268805 DOI: 10.1007/s40263-023-01016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Abstract
Gliomas are a heterogeneous group of brain tumors with limited therapeutic options. However, identification of BRAF V600E mutations in a subset of gliomas has provided a genomic-targeted approach for management of these diseases. In this review, we aimed to review the role of BRAF V600E in gliomagenesis, to characterize concurrent genomic alterations and their potential prognostic implications, and to review comprehensively the efficacy data of BRAF inhibitors (combined or not with MEK inhibitors) for the treatment of low- and high-grade gliomas. We also provide a summary of the toxicity of these agents and describe resistance mechanisms that may be circumvented by alternative genomic approaches. Although the efficacy of targeted therapy for management of BRAF V600E-mutant gliomas has mostly been assessed in small retrospective and phase 2 studies with heterogeneous populations, the data generated so far are a proof of concept that genomic-directed therapies improve outcomes of patients with refractory/relapsed glioma and underpin the need of comprehensive genomic assessments for these difficult-to-treat diseases. In the future, the role of targeted therapy in the first-line setting and of genomic-directed therapies to overcome resistance mechanisms should be assessed in well-designed clinical trials.
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Affiliation(s)
- Thiago P Muniz
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Warren P Mason
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Chen J, Niu C, Yang N, Liu C, Zou SS, Zhu S. Biomarker discovery and application-An opportunity to resolve the challenge of liver cancer diagnosis and treatment. Pharmacol Res 2023; 189:106674. [PMID: 36702425 DOI: 10.1016/j.phrs.2023.106674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Liver cancer is one of the most common malignancies, with severe morbidity and mortality. While considerable progress has been made in liver cancer treatment, the 5-year overall survival (OS) of patients has not improved significantly. Reasons include the inadequate capability of early screening and diagnosis, a high incidence of recurrence and metastasis, a high degree of tumor heterogeneity, and an immunosuppressive tumor microenvironment. Therefore, the identification and validation of specific and robust liver cancer biomarkers are of major importance for early screening, timely diagnosis, accurate prognosis, and the prevention of tumor progression. In this review, we highlight some of the latest research progress and potential applications of liver cancer biomarkers, describing hotspots and prospective directions in biomarker discovery.
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Affiliation(s)
- Jingtao Chen
- Cancer Center, The First Hospital of Jilin University, Changchun 130021, China; Laboratory for Tumor Immunology, The First Hospital of Jilin University, Changchun 130021, China
| | - Chao Niu
- Cancer Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Ning Yang
- Laboratory for Tumor Immunology, The First Hospital of Jilin University, Changchun 130021, China
| | - Chunyan Liu
- Laboratory for Tumor Immunology, The First Hospital of Jilin University, Changchun 130021, China
| | - Shan-Shan Zou
- Laboratory for Tumor Immunology, The First Hospital of Jilin University, Changchun 130021, China
| | - Shan Zhu
- Cancer Center, The First Hospital of Jilin University, Changchun 130021, China; Laboratory for Tumor Immunology, The First Hospital of Jilin University, Changchun 130021, China.
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Capogiri M, De Micheli AJ, Lassaletta A, Muñoz DP, Coppé JP, Mueller S, Guerreiro Stucklin AS. Response and resistance to BRAF V600E inhibition in gliomas: Roadblocks ahead? Front Oncol 2023; 12:1074726. [PMID: 36698391 PMCID: PMC9868954 DOI: 10.3389/fonc.2022.1074726] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
BRAFV600E represents the most common BRAF mutation in all human cancers. Among central nervous system (CNS) tumors, BRAFV600E is mostly found in pediatric low-grade gliomas (pLGG, ~20%) and, less frequently, in pediatric high-grade gliomas (pHGG, 5-15%) and adult glioblastomas (GBM, ~5%). The integration of BRAF inhibitors (BRAFi) in the treatment of patients with gliomas brought a paradigm shift to clinical care. However, not all patients benefit from treatment due to intrinsic or acquired resistance to BRAF inhibition. Defining predictors of response, as well as developing strategies to prevent resistance to BRAFi and overcome post-BRAFi tumor progression/rebound growth are some of the main challenges at present in the field. In this review, we outline current achievements and limitations of BRAF inhibition in gliomas, with a special focus on potential mechanisms of resistance. We discuss future directions of targeted therapy for BRAFV600E mutated gliomas, highlighting how insights into resistance to BRAFi could be leveraged to improve outcomes.
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Affiliation(s)
- Monica Capogiri
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zurich, Switzerland
| | - Andrea J. De Micheli
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zurich, Switzerland
| | - Alvaro Lassaletta
- Department of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Denise P. Muñoz
- Department of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States
| | - Jean-Philippe Coppé
- Department of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States
| | - Sabine Mueller
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zurich, Switzerland,Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, United States
| | - Ana S. Guerreiro Stucklin
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zurich, Switzerland,*Correspondence: Ana S. Guerreiro Stucklin,
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Arbour G, Ellezam B, Weil AG, Cayrol R, Vanan MI, Coltin H, Larouche V, Erker C, Jabado N, Perreault S. Upfront BRAF/MEK inhibitors for treatment of high-grade glioma: A case report and review of the literature. Neurooncol Adv 2022; 4:vdac174. [PMID: 36567957 PMCID: PMC9772816 DOI: 10.1093/noajnl/vdac174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background High-grade gliomas (HGG) with BRAFV600E mutation represent a unique subset of central nervous system tumors. Targeted therapies including BRAF and MEK inhibitors are now being explored as possible new treatment options. Methods We report an 18-year-old female with a grade 3 pleomorphic xanthoastrocytoma treated upfront with dabrafenib and trametinib. We also conducted a systematic literature review of patients with HGG and BRAFV600E mutations treated with BRAF inhibitors. Results Despite local recurrences resected surgically, the patient has been on dabrafenib and trametinib for more than 54 months. Thirty-two patients with HGG and BRAFV600E mutations treated with BRAF inhibitors were retrieved through our systematic review of the literature. Only 1 young patient with an anaplastic ganglioglioma was treated upfront with a BRAF inhibitor with a curative intent. Best response reported with radiation therapy and systemic therapy was a stable disease (SD) for 18 patients (56.3%) and progressive disease (PD) for 9 patients (28.1%). Responses to treatment regimens that included BRAF inhibitors were reported in 31 patients and included 4 complete responses (12.9%), 23 partial responses (74.2%), 2 SDs (6.5%), and 2 PDs (6.5%). Conclusions Our patient had durable disease control with dabrafenib and trametinib. Given favorable responses reported in patients with HGG treated with BRAF inhibitors, we believe that upfront targeted therapy is a possible treatment approach that should be studied in the context of a clinical trial.
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Affiliation(s)
- Gabrielle Arbour
- Division of Child Neurology, Department of Neurosciences, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Benjamin Ellezam
- Department of Pathology, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Department of Surgery, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Romain Cayrol
- Division of Pathology, Department of Pathology and Cell Biology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Magimairajan Issai Vanan
- Pediatric Neuro-Oncology, Cancer Care Manitoba and Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Hallie Coltin
- Division of Hemato-Oncology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Valérie Larouche
- Division of Hemato-Oncology, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, QC, Canada
| | - Craig Erker
- Division of Hemato-Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Nada Jabado
- Division of Hemato-Oncology, Department of Pediatrics, McGill University Health Center, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Sébastien Perreault
- Corresponding Author: Sébastien Perreault, MD, MSc, Division of Child Neurology, Department of Neurosciences, CHU Sainte-Justine, Université de Montréal, 3175 Chemin Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada ()
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Hörnschemeyer J, Kirschstein T, Reichart G, Sasse C, Venus J, Einsle A, Porath K, Linnebacher M, Köhling R, Lange F. Studies on Biological and Molecular Effects of Small-Molecule Kinase Inhibitors on Human Glioblastoma Cells and Organotypic Brain Slices. Life (Basel) 2022; 12:life12081258. [PMID: 36013437 PMCID: PMC9409734 DOI: 10.3390/life12081258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022]
Abstract
Glioblastoma is the most common and aggressive primary brain tumor. Multiple genetic and epigenetic alterations in several major signaling pathways—including the phosphoinositide 3-kinases (PI3K)/AKT/mTOR and the Raf/MEK/ERK pathway—could be found. We therefore aimed to investigate the biological and molecular effects of small-molecule kinase inhibitors that may interfere with those pathways. For this purpose, patient-derived glioblastoma cells were challenged with dactolisib, ipatasertib, MK-2206, regorafenib, or trametinib. To determine the effects of the small-molecule kinase inhibitors, assays of cell proliferation and apoptosis and immunoblot analyses were performed. To further investigate the effects of ipatasertib on organotypic brain slices harboring glioblastoma cells, the tumor growth was estimated. In addition, the network activity in brain slices was assessed by electrophysiological field potential recordings. Multi-kinase inhibitor regorafenib and both MK-2206 and dactolisib were very effective in all preclinical tumor models, while with respect to trametinib, two cell lines were found to be highly resistant. Only in HROG05 cells, ipatasertib showed anti-tumoral effects in vitro and in organotypic brain slices. Additionally, ipatasertib diminished synchronous network activity in organotypic brain slices. Overall, our data suggest that ipatasertib was only effective in selected tumor models, while especially regorafenib and MK-2206 presented a uniform response pattern.
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Affiliation(s)
- Julia Hörnschemeyer
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Timo Kirschstein
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University of Rostock, 18147 Rostock, Germany
| | - Gesine Reichart
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Christin Sasse
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Jakob Venus
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Anne Einsle
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Katrin Porath
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Michael Linnebacher
- Clinic for General Surgery, Molecular Oncology and Immunotherapy, Rostock University Medical Center, 18057 Rostock, Germany
| | - Rüdiger Köhling
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University of Rostock, 18147 Rostock, Germany
| | - Falko Lange
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University of Rostock, 18147 Rostock, Germany
- Correspondence:
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Jayarama-Naidu R, Gallus E. Abnormal Schwannoma-like Growth of multiple, multifocal BRAF V600E-positive Glioblastoma in the Interior Acoustic Canal with Leptomeningeal Infiltration: a case report. J Med Case Rep 2022; 16:50. [PMID: 35130969 PMCID: PMC8822757 DOI: 10.1186/s13256-022-03272-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/13/2022] [Indexed: 02/07/2023] Open
Abstract
Background Glioblastoma belongs to the most common and most aggressive tumor entity of the central nervous system with a poor prognosis of only few months. Once manifested, it grows fast and diffusely by infiltrating the surrounding brain parenchyma. Despite its aggressive behavior, glioblastoma rarely presents with multiple lesions and metastasis to intra- and extracranial tissues. Therefore, metastasized, multiple glioblastoma is limited to case reports. Our case describes an atypical primary bilateral manifestation of BRAF V600E-positive epithelioid glioblastoma with rapid metastasis and meningeosis glioblastoma while under adjuvant chemoradiotherapy. Case presentation A 60-year-old Caucasian male patient presented with a seizure and numbness in his left arm. He was diagnosed with an abnormal primary bilateral manifestation of multiple, multifocal BRAF V600E-positive and isocitrate dehydrogenase (IDH) wild-type intracranial epithelioid glioblastoma with O6-methylguanine-DNA methyltransferase methylation (MGMT) at 12%. While being under the adjuvant chemoradiotherapy with temozolomide, the patient developed left-sided facial nerve weakness and hearing loss, dysarthria, and severe gait instability. Cranial magnetic resonance imaging showed that glioblastoma lesions advanced rapidly with a schwannoma-like growth pattern by invading the left internal acoustic meatus, adjacent cranial nerves, and leptomeninges. A lumbar puncture confirmed meningeosis glioblastoma. Four months after the initial diagnosis of glioblastoma, the patient died from the complications of the fast and diffuse metastasis. Conclusions Glioblastoma rarely presents with metastases despite its aggressive and rapidly growing nature. Our case should increase awareness of symptom tracking in patients with glioblastoma to intervene early and efficiently. Moreover, refractory therapies for glioblastoma should underline the importance of personalized medicine.
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Affiliation(s)
- Roopa Jayarama-Naidu
- Department Internal Medicine, Kantonsspital Frauenfeld, Spital Thurgau AG, 8501, Frauenfeld, Switzerland.
| | - Evelyn Gallus
- Department Radiology, Kantonsspital Frauenfeld, Spital Thurgau AG, 8501, Frauenfeld, Switzerland
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Ayoub G, Chalhoub E, Kourie HR. BRAF: a biomarker not to be missed in glioblastoma. Per Med 2022; 19:79-82. [DOI: 10.2217/pme-2021-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Georges Ayoub
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Elie Chalhoub
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
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Abstract
Glioblastoma remains incurable despite advances in surgery, radiation, and chemotherapy, underscoring the need for new therapies. The genetic heterogenicity, presence of redundant molecular pathways, and the blood-brain barrier have limited the applicability of molecularly targeted agents. The therapeutic benefit seen with a small subset of patients suggests, however, that patient selection is critical. Recent investigations show that molecularly targeted synthetic lethality is a promising complementary approach. The article provides an overview of the challenges of molecularly targeted therapy in adults with glioblastoma, including current trials and future therapeutic directions.
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Affiliation(s)
- Matthew A Smith-Cohn
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, 37 Convent Drive, Building 37, Room 1016, Bethesda, MD 20892, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Orieta Celiku
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, 37 Convent Drive, Building 37, Room 1142, Bethesda, MD 20892, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Sun K, Zhou X, Li T, Zuo M, Li J, Liu Y. Clinicopathological characteristics and treatment outcomes of epithelioid glioblastoma. Neurosurg Rev 2021; 44:3335-3348. [PMID: 33598819 DOI: 10.1007/s10143-021-01492-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
Epithelioid glioblastoma is a new variant of glioblastoma that has been recently recognized in the 2016 WHO classification of brain tumors. Given the rarity of epithelioid glioblastoma, the clinical characteristics, pathological features, radiological findings, and treatment outcomes are still not well characterized. Therefore, we identified eighty-four epithelioid glioblastoma cases to investigate these characteristics and identify the possible prognostic factors of survival. There were 55 male and 29 female patients with a mean age of 33.6 years. Headache (77.3%) was the most common clinical symptom, and other common symptoms included nausea or vomiting (34%), dizziness (20.5%), seizures (13.6%), and limb weakness (13.6%). Most lesions (88.1%) were located in cerebral lobes, especially in the frontal lobe and temporal lobe. One hundred percent of the patients were IDH1 wild-type (75/75) and INI-1 positive (58/58), and 57.3% (47/82) of patients harbored BRAFV600E mutation. The median overall survival (OS) of all patients was 10.5 months. Patients who received chemotherapy (p = 0.006) or radiotherapy (p = 0.022) had a longer survival than patients who did not. In addition, the K-M curve showed that the BRAFV600E mutation status was not associated with survival (p = 0.724). These findings may assist clinicians with better understanding and management of epithelioid glioblastoma.
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Affiliation(s)
- Kaijun Sun
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Xingwang Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Tengfei Li
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Mingrong Zuo
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Junhong Li
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
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Fusco MJ, Piña Y, Macaulay RJ, Sahebjam S, Forsyth PA, Peguero E, Walko CM. Durable Progression-Free Survival With the Use of BRAF and MEK Inhibitors in Four Cases With BRAF V600E-Mutated Gliomas. Cancer Control 2021; 28:10732748211040013. [PMID: 34620004 PMCID: PMC8506147 DOI: 10.1177/10732748211040013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION BRAF V600 E mutations have been identified in a subset of patients with primary brain tumors. Combination therapy with BRAF and Mitogen-activated protein kinase (MEK) inhibitors (BRAF/MEKi) targeting sequential steps in the MAPK pathway has replaced BRAFi monotherapy as the standard of care in multiple tumors with BRAF V600 E mutations, and clinical evidence for this strategy continues to grow in primary brain tumors. CASE SERIES We describe four patients with BRAF V600 E mutated gliomas, including a 21-year-old woman with a ganglioglioma WHO grade I, a 19-year-old man with a pleomorphic xanthoastrocytoma WHO grade III, and 21-year-old and 33-year-old women with epithelioid GBM WHO grade IV, who achieved durable progression-free survival with combination BRAF/MEKi. CONCLUSION Combination of BRAF/MEK inhibition can be a novel, promising approach as targeted therapy in gliomas with BRAF V600 E mutations, especially those that are resistant to standard therapy. Our cases, along with other early reports utilizing dabrafenib/trametinib, highlight the importance of somatic next-generation sequencing, particularly in younger patients. Interim results from clinical trials utilizing dabrafenib/trametinib have been promising thus far, and our case series suggests that durable clinical benefit is possible, even in the setting of glioblastoma, WHO grade IV.
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Affiliation(s)
- Michael J. Fusco
- Department of Individualized Cancer Medicine, Moffitt Cancer Center, Tampa, FL, USA
| | - Yolanda Piña
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Robert J. Macaulay
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA
| | - Solmaz Sahebjam
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Peter A. Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Edwin Peguero
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Christine M. Walko
- Department of Individualized Cancer Medicine, Moffitt Cancer Center, Tampa, FL, USA
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Khaddour K, Chicoine MR, Huang J, Dahiya S, Ansstas G. Successful Use of BRAF/MEK Inhibitors as a Neoadjuvant Approach in the Definitive Treatment of Papillary Craniopharyngioma. J Natl Compr Canc Netw 2020; 18:1590-1595. [PMID: 33285519 DOI: 10.6004/jnccn.2020.7624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Abstract
Craniopharyngiomas are rare tumors that arise in the suprasellar region of the brain and are known for their aggressive nature despite their WHO grade I. This is due to the complex neuroanatomy of the sellar/suprasellar region and their proximity to the optic nerve apparatus, hypothalamic-pituitary tract, and other critical neuroanatomical structures. Definitive treatment is based on a multidisciplinary approach and often involves a combination of surgical, radiation, and medical therapy. However, there is high morbidity associated with surgery and RT due to the complex neuroanatomy of this region. Recently, BRAFV600E somatic mutation has been identified in most papillary craniopharyngiomas. This discovery has led to the novel use of RAF pathway inhibitors to treat these tumors. We report the successful use of dabrafenib (BRAF inhibitor) and trametinib (mitogen-activated protein kinase kinase inhibitor) in the neoadjuvant setting followed by definitive stereotactic radiosurgery. We propose an algorithm based on available literature on the integration of targeted therapy in the management of papillary craniopharyngiomas. Our observations, together with prior case reports, advocate the incorporation of targeted therapy for unresectable craniopharyngiomas and reinforce that treatment with dual-targeted therapy is safe and effective.
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Affiliation(s)
| | | | | | - Sonika Dahiya
- 4Division of Neuropathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
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13
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Ingersoll MA, Malloy EA, Caster LE, Holland EM, Xu Z, Zallocchi M, Currier D, Liu H, He DZZ, Min J, Chen T, Zuo J, Teitz T. BRAF inhibition protects against hearing loss in mice. Sci Adv 2020; 6:6/49/eabd0561. [PMID: 33268358 PMCID: PMC7821884 DOI: 10.1126/sciadv.abd0561] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/20/2020] [Indexed: 05/13/2023]
Abstract
Hearing loss caused by noise, aging, antibiotics, and chemotherapy affects 10% of the world population, yet there are no Food and Drug Administration (FDA)-approved drugs to prevent it. Here, we screened 162 small-molecule kinase-specific inhibitors for reduction of cisplatin toxicity in an inner ear cell line and identified dabrafenib (TAFINLAR), a BRAF kinase inhibitor FDA-approved for cancer treatment. Dabrafenib and six additional kinase inhibitors in the BRAF/MEK/ERK cellular pathway mitigated cisplatin-induced hair cell death in the cell line and mouse cochlear explants. In adult mice, oral delivery of dabrafenib repressed ERK phosphorylation in cochlear cells, and protected from cisplatin- and noise-induced hearing loss. Full protection was achieved in mice with co-treatment with oral AZD5438, a CDK2 kinase inhibitor. Our study explores a previously unidentified cellular pathway and molecular target BRAF kinase for otoprotection and may advance dabrafenib into clinics to benefit patients with cisplatin- and noise-induced ototoxicity.
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Affiliation(s)
- Matthew A Ingersoll
- Department of Pharmacology and Neuroscience, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Emma A Malloy
- Department of Pharmacology and Neuroscience, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Lauryn E Caster
- Department of Pharmacology and Neuroscience, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Eva M Holland
- Department of Pharmacology and Neuroscience, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Zhenhang Xu
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
- Department of Otolaryngology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Marisa Zallocchi
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Duane Currier
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Huizhan Liu
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - David Z Z He
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Jaeki Min
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Taosheng Chen
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jian Zuo
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Tal Teitz
- Department of Pharmacology and Neuroscience, School of Medicine, Creighton University, Omaha, NE 68178, USA.
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14
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Abstract
Neuro-oncology is a rapidly developing field. A continuous evolution in the understanding of the molecular underpinnings of central nervous system tumors has helped reconfigure the classification of brain tumors. More importantly, it has laid the path forward for the development and investigation of new therapeutics. The authors discuss the classification of brain tumors and novel therapies in brain tumors as well as promising treatments underway.
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Affiliation(s)
- Jigisha P Thakkar
- Department of Neurology, Division of Neuro-oncology, Loyola University Chicago, Stritch School of Medicine, 2160 South 1st Avenue, Building 105, Room 2716, Maywood, IL 60153, USA.
| | - Vikram C Prabhu
- Department of Neurological Surgery, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27711, USA
| | - Katherine B Peters
- Department of Neurology, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27711, USA
| | - Rimas V Lukas
- Department of Neurology, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA; Lou & Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center
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15
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Nakagomi N, Sakamoto D, Hirose T, Takagi T, Murase M, Nakagomi T, Yoshimura S, Hirota S. Epithelioid glioblastoma with microglia features: potential for novel therapy. Brain Pathol 2020; 30:1119-1133. [PMID: 32687679 PMCID: PMC7754497 DOI: 10.1111/bpa.12887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/23/2020] [Accepted: 07/05/2020] [Indexed: 12/20/2022] Open
Abstract
Epithelioid glioblastoma (E‐GBM) was recently designated as a subtype of glioblastoma (GBM) by the World Health Organization (2016). E‐GBM is an aggressive and rare variant of GBM that primarily occurs in children and young adults. Although most characterized cases of E‐GBM harbor a mutation of the BRAF gene in which valine (V) is substituted by glutamic acid (E) at amino acid 600 (BRAF‐V600E), in addition to telomerase reverse transcriptase promoter mutations and homozygous CDKN2A/B deletions, the origins and cellular nature of E‐GBM remain uncertain. Here, we present a case of E‐GBM that exhibits antigenic and functional traits suggestive of microglia. Although no epithelial [e.g., CKAE1/3, epithelial membrane antigen (EMA)] or glial (e.g., GFAP, Olig2) markers were detected by immunohistochemical staining, the microglial markers CD68 and Iba1 were readily apparent. Furthermore, isolated E‐GBM‐derived tumor cells expressed microglial/macrophage‐related genes including cytokines, chemokines, MHC class II antigens, lysozyme and the critical functional receptor, CSF‐1R. Isolated E‐GBM‐derived tumor cells were also capable of phagocytosis and cytokine production. Treating E‐GBM‐derived tumor cells with the BRAF‐V600E inhibitor, PLX4032 (vemurafenib), resulted in a dose‐dependent reduction in cell viability that was amplified by addition of the CSF‐1R inhibitor, BLZ945. The present case provides insight into the cellular nature of E‐GBM and introduces several possibilities for effective targeted therapy for these patients.
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Affiliation(s)
- Nami Nakagomi
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Daisuke Sakamoto
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takanori Hirose
- Department of Surgical Pathology, Hyogo Cancer Center, Akashi, Japan
| | - Toshinori Takagi
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Makiko Murase
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takayuki Nakagomi
- Institute for Advanced Medical Sciences, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Therapeutic Progress in Brain Diseases, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
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16
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Kowalewski A, Durślewicz J, Zdrenka M, Grzanka D, Szylberg Ł. Clinical Relevance of BRAF V600E Mutation Status in Brain Tumors with a Focus on a Novel Management Algorithm. Target Oncol 2020; 15:531-40. [PMID: 32648041 DOI: 10.1007/s11523-020-00735-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The possible application of BRAF-targeted therapy in brain tumors is growing continuously. We have analyzed clinical strategies that address BRAF activation in primary brain tumors and verified current recommendations regarding screening for BRAF mutations. There is preliminary evidence for a range of positive responses in certain brain tumor types harboring the BRAF V600E mutation. National Comprehensive Cancer Network Guidelines for central nervous system cancers recommend screening for the BRAF V600E mutation in pilocytic astrocytoma, pleomorphic xanthoastrocytoma, and ganglioglioma. We suggest additional testing in glioblastomas WHO grade IV below the age of 30 years, especially those with epithelioid features, papillary craniopharyngiomas, and pediatric low-grade astrocytomas. BRAF-targeted therapy should be limited to the setting of a clinical trial. If the patient harboring a V600E mutation does not qualify for a trial, multimodality treatment is recommended. Dual inhibition of both RAF and MEK is expected to provide more potent and durable effects than anti-BRAF monotherapy. First-generation RAF inhibitors should be avoided. Gain-of-function mutations of EGFR and KIAA fusions may compromise BRAF-targeted therapy. BRAF alterations that result in MAPK pathway activation are common events in several types of brain tumors. BRAF V600E mutation emerges as a promising molecular target. The proposed algorithm was designed to help oncologists to provide the best therapeutic options for brain tumor patients.
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