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Hayes TK, Aquilanti E, Persky NS, Yang X, Kim EE, Brenan L, Goodale AB, Alan D, Sharpe T, Shue RE, Westlake L, Golomb L, Silverman BR, Morris MD, Fisher TR, Beyene E, Li YY, Cherniack AD, Piccioni F, Hicks JK, Chi AS, Cahill DP, Dietrich J, Batchelor TT, Root DE, Johannessen CM, Meyerson M. Author Correction: Comprehensive mutational scanning of EGFR reveals TKI sensitivities of extracellular domain mutants. Nat Commun 2024; 15:3273. [PMID: 38627431 PMCID: PMC11021560 DOI: 10.1038/s41467-024-47675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Affiliation(s)
- Tikvah K Hayes
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA
| | - Elisa Aquilanti
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Nicole S Persky
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Aera Therapeutics, Cambridge, MA, USA
| | - Xiaoping Yang
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Erica E Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
| | - Lisa Brenan
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Amy B Goodale
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Douglas Alan
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Ted Sharpe
- Data Science Platform, The Broad Institute of M.I.T. and Harvard Cambridge, Cambridge, MA, USA
| | - Robert E Shue
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Lindsay Westlake
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Lior Golomb
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Brianna R Silverman
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
| | - Myshal D Morris
- Summer Honors Undergraduate Research Program, Harvard Medical School, Boston, MA, USA
| | - Ty Running Fisher
- Summer Honors Undergraduate Research Program, Harvard Medical School, Boston, MA, USA
| | - Eden Beyene
- Summer Honors Undergraduate Research Program, Harvard Medical School, Boston, MA, USA
| | - Yvonne Y Li
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Andrew D Cherniack
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Federica Piccioni
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Merck Research Laboratories, Cambridge, MA, USA
| | - J Kevin Hicks
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrew S Chi
- Center for Neuro-Oncology, Division of Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel P Cahill
- Center for Neuro-Oncology, Division of Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jorg Dietrich
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - David E Root
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Cory M Johannessen
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Department of Oncology, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA.
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA.
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Hayes TK, Aquilanti E, Persky NS, Yang X, Kim EE, Brenan L, Goodale AB, Alan D, Sharpe T, Shue RE, Westlake L, Golomb L, Silverman BR, Morris MD, Fisher TR, Beyene E, Li YY, Cherniack AD, Piccioni F, Hicks JK, Chi AS, Cahill DP, Dietrich J, Batchelor TT, Root DE, Johannessen CM, Meyerson M. Comprehensive mutational scanning of EGFR reveals TKI sensitivities of extracellular domain mutants. Nat Commun 2024; 15:2742. [PMID: 38548752 PMCID: PMC10978866 DOI: 10.1038/s41467-024-45594-4] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/30/2024] [Indexed: 04/01/2024] Open
Abstract
The epidermal growth factor receptor, EGFR, is frequently activated in lung cancer and glioblastoma by genomic alterations including missense mutations. The different mutation spectra in these diseases are reflected in divergent responses to EGFR inhibition: significant patient benefit in lung cancer, but limited in glioblastoma. Here, we report a comprehensive mutational analysis of EGFR function. We perform saturation mutagenesis of EGFR and assess function of ~22,500 variants in a human EGFR-dependent lung cancer cell line. This approach reveals enrichment of erlotinib-insensitive variants of known and unknown significance in the dimerization, transmembrane, and kinase domains. Multiple EGFR extracellular domain variants, not associated with approved targeted therapies, are sensitive to afatinib and dacomitinib in vitro. Two glioblastoma patients with somatic EGFR G598V dimerization domain mutations show responses to dacomitinib treatment followed by within-pathway resistance mutation in one case. In summary, this comprehensive screen expands the landscape of functional EGFR variants and suggests broader clinical investigation of EGFR inhibition for cancers harboring extracellular domain mutations.
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Affiliation(s)
- Tikvah K Hayes
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA
| | - Elisa Aquilanti
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Nicole S Persky
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Aera Therapeutics, Cambridge, MA, USA
| | - Xiaoping Yang
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Erica E Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
| | - Lisa Brenan
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Amy B Goodale
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Douglas Alan
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Ted Sharpe
- Data Science Platform, The Broad Institute of M.I.T. and Harvard Cambridge, Cambridge, MA, USA
| | - Robert E Shue
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Lindsay Westlake
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Lior Golomb
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Brianna R Silverman
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
| | - Myshal D Morris
- Summer Honors Undergraduate Research Program, Harvard Medical School, Boston, MA, USA
| | - Ty Running Fisher
- Summer Honors Undergraduate Research Program, Harvard Medical School, Boston, MA, USA
| | - Eden Beyene
- Summer Honors Undergraduate Research Program, Harvard Medical School, Boston, MA, USA
| | - Yvonne Y Li
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Andrew D Cherniack
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Federica Piccioni
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Merck Research Laboratories, Cambridge, MA, USA
| | - J Kevin Hicks
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrew S Chi
- Center for Neuro-Oncology, Division of Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel P Cahill
- Center for Neuro-Oncology, Division of Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jorg Dietrich
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - David E Root
- Genetic Perturbation Platform, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
| | - Cory M Johannessen
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA
- Department of Oncology, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA, USA.
- Cancer Program, The Broad Institute of M.I.T. and Harvard, Cambridge, MA, USA.
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Kurz SC, Zan E, Cordova C, Troxel AB, Barbaro M, Silverman JS, Snuderl M, Zagzag D, Kondziolka D, Golfinos JG, Chi AS, Sulman EP. Evaluation of the SSTR2-targeted Radiopharmaceutical 177Lu-DOTATATE and SSTR2-specific 68Ga-DOTATATE PET as Imaging Biomarker in Patients with Intracranial Meningioma. Clin Cancer Res 2024; 30:680-686. [PMID: 38048045 DOI: 10.1158/1078-0432.ccr-23-2533] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/12/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE There are no effective medical therapies for patients with meningioma who progress beyond surgical and radiotherapeutic interventions. Somatostatin receptor type 2 (SSTR2) represents a promising treatment target in meningiomas. In this multicenter, single-arm phase II clinical study (NCT03971461), the SSTR2-targeting radiopharmaceutical 177Lu-DOTATATE is evaluated for its feasibility, safety, and therapeutic efficacy in these patients. PATIENTS AND METHODS Adult patients with progressive intracranial meningiomas received 177Lu-DOTATATE at a dose of 7.4 GBq (200 mCi) every eight weeks for four cycles. 68Ga-DOTATATE PET-MRI was performed before and six months after the start of the treatment. The primary endpoint was progression-free survival (PFS) at 6 months (PFS-6). Secondary endpoints were safety and tolerability, overall survival (OS) at 12 months (OS-12), median PFS, and median OS. RESULTS Fourteen patients (female = 11, male = 3) with progressive meningiomas (WHO 1 = 3, 2 = 10, 3 = 1) were enrolled. Median age was 63.1 (range 49.7-78) years. All patients previously underwent tumor resection and at least one course of radiation. Treatment with 177Lu-DOTATATE was well tolerated. Seven patients (50%) achieved PFS-6. Best radiographic response by modified Macdonald criteria was stable disease (SD) in all seven patients. A >25% reduction in 68Ga-DOTATATE uptake (PET) was observed in five meningiomas and two patients. In one lesion, this corresponded to >50% reduction in bidirectional tumor measurements (MRI). CONCLUSIONS Treatment with 177Lu-DOTATATE was well tolerated. The predefined PFS-6 threshold was met in this interim analysis, thereby allowing this multicenter clinical trial to continue enrollment. 68Ga-DOTATATE PET may be a useful imaging biomarker to assess therapeutic outcome in patients with meningioma.
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Affiliation(s)
- Sylvia C Kurz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospitals Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany
| | - Elcin Zan
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | | | - Andrea B Troxel
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Marissa Barbaro
- Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, New York
| | - Joshua S Silverman
- Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, New York
- Department of Radiation Oncology, New York University Grossman School of Medicine, New York, New York
| | - Matija Snuderl
- Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, New York
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - David Zagzag
- Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, New York
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - Douglas Kondziolka
- Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, New York
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - John G Golfinos
- Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, New York
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | | | - Erik P Sulman
- Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, New York
- Department of Radiation Oncology, New York University Grossman School of Medicine, New York, New York
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Yekula A, Hsia T, Kitchen RR, Chakrabortty SK, Yu W, Batool SM, Lewis B, Szeglowski AJ, Weissleder R, Lee H, Chi AS, Batchelor T, Carter BS, Breakefield XO, Skog J, Balaj L. Longitudinal analysis of serum-derived extracellular vesicle RNA to monitor dacomitinib treatment response in EGFR-amplified recurrent glioblastoma patients. Neurooncol Adv 2023; 5:vdad104. [PMID: 37811539 PMCID: PMC10559837 DOI: 10.1093/noajnl/vdad104] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Background Glioblastoma (GBM) is a highly aggressive and invasive brain tumor associated with high patient mortality. A large fraction of GBM tumors have been identified as epidermal growth factor receptor (EGFR) amplified and ~50% also are EGFRvIII mutant positive. In a previously reported multicenter phase II study, we have described the response of recurrent GBM (rGBM) patients to dacomitinib, an EGFR tyrosine kinase inhibitor (TKI). As a continuation of that report, we leverage the tumor cargo-encapsulating extracellular vesicles (EVs) and explore their genetic composition as carriers of tumor biomarker. Methods Serum samples were longitudinally collected from EGFR-amplified rGBM patients who clinically benefitted from dacomitinib therapy (responders) and those who did not (nonresponders), as well as from a healthy cohort of individuals. The serum EV transcriptome was evaluated to map the RNA biotype distribution and distinguish GBM disease. Results Using long RNA sequencing, we show enriched detection of over 10 000 coding RNAs from serum EVs. The EV transcriptome yielded a unique signature that facilitates differentiation of GBM patients from healthy donors. Further analysis revealed genetic enrichment that enables stratification of responders from nonresponders prior to dacomitinib treatment as well as following administration. Conclusion This study demonstrates that genetic composition analysis of serum EVs may aid in therapeutic stratification to identify patients with dacomitinib-responsive GBM.
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Affiliation(s)
- Anudeep Yekula
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffaney Hsia
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert R Kitchen
- Exosome Diagnostics, Inc., a Bio-Techne Brand, Waltham, Massachusetts, USA
| | | | - Wei Yu
- Exosome Diagnostics, Inc., a Bio-Techne Brand, Waltham, Massachusetts, USA
| | - Syeda M Batool
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Lewis
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antoni J Szeglowski
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew S Chi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tracy Batchelor
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Bob S Carter
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xandra O Breakefield
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Johan Skog
- Exosome Diagnostics, Inc., a Bio-Techne Brand, Waltham, Massachusetts, USA
| | - Leonora Balaj
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Heist RS, Yu J, Donderici EY, Zhang N, Espenschied CR, Lang K, Korytowsky B, Chi AS, Christensen JG. Impact of STK11 mutation on first-line immune checkpoint inhibitor (ICI) outcomes in a real-world KRAS G12C mutant lung adenocarcinoma cohort. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9106 Background: The introduction of KRAS G12C inhibitors into clinical trials has demonstrated promise and may provide a new therapeutic option for patients (pts) harboring KRAS G12C mutations. Recent data has also indicated that immune checkpoint inhibitors (ICI) have shown benefit in KRAS G12C mutant lung adenocarcinoma (LUAD); however, data on the impact of co-occurring STK11 mutations on outcomes are conflicting. We utilized the Guardant INFORM real-world clinical-genomic database to assess the impact of co-occurring STK11 mutations on outcomes in pts with KRAS G12C mutant LUAD treated with a first-line ICI containing regimen. Methods: This retrospective matched cohort observational study was conducted in a nationally representative clinical-genomic database covering over 137,000 pts with comprehensive ctDNA results and associated clinical information. Adult pts with metastatic LUAD who received ≥ 1 dose of first-line anti-PD1/PD-L1 ± chemotherapy and had at least 90 days follow-up after first KRAS G12C detection were included. A cohort of pts without KRAS G12C, including KRAS wildtype pts and pts with other KRAS mutations, were matched 3:1 for age, gender, year of index and baseline comorbidity. Time to next treatment (TTNT), time to discontinuation (TTD), real-world overall survival (rwOS) were compared with vs. without STK11 mutations for both cohorts using cox proportional-hazards model. Results: Among 330 pts in the KRAS G12C cohort, 21% (n = 70) had an STK11 mutation. Among the matched cohort (n = 938), 754 pts were KRAS wildtype, of whom 6% (n = 49) had STK11 mutations. Within the KRAS G12C cohort, pts with STK11 mutations had statistically significant shorter TTNT (hazard ratio [HR] 2.7, 95% confidence internal [CI] 1.8-4.0, p < 0.0001), TTD (HR 1.4, 95% CI 1.0-2.0, p < 0.04) and rwOS (HR 3.2, 95% CI 2.0-5.1, p < 0.0001) than pts without STK11 mutations. Within the matched KRAS wildtype cohort, the differences in TTD (HR 1.4, 95% CI = 1.0-2.0, p = 0.08) and rwOS (HR 1.4, 95% CI = 0.8-2.4, p = 0.3) in patients with vs. without STK11 mutation did not reach statistical significance (Table). Conclusions: This study provides real-world evidence that STK11 co-mutations are associated with worse outcomes among pts with KRAS G12C mutant LUAD treated with first-line ICI. These inferior outcomes indicate a high unmet medical need among LUAD pts harboring co-occurring KRAS G12C and STK11 mutations and demonstrate the need for effective targeted and/or combination therapies in this patient population.[Table: see text]
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Jain R, Johnson DR, Patel SH, Castillo M, Smits M, van den Bent MJ, Chi AS, Cahill DP. "Real world" use of a highly reliable imaging sign: "T2-FLAIR mismatch" for identification of IDH mutant astrocytomas. Neuro Oncol 2021; 22:936-943. [PMID: 32064507 DOI: 10.1093/neuonc/noaa041] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AbstractThe T2-FLAIR (fluid attenuated inversion recovery) mismatch sign is an easily detectable imaging sign on routine clinical MRI studies that suggests diagnosis of isocitrate dehydrogenase (IDH)-mutant 1p/19q non-codeleted gliomas. Multiple independent studies show that the T2-FLAIR mismatch sign has near-perfect specificity, but low sensitivity for diagnosing IDH-mutant astrocytomas. Thus, the T2-FLAIR mismatch sign represents a non-invasive radiogenomic diagnostic finding with potential clinical impact. Recently, false positive cases have been reported, many related to variable application of the sign's imaging criteria and differences in image acquisition, as well as to differences in the included patient populations. Here we summarize the imaging criteria for the T2-FLAIR mismatch sign, review similarities and differences between the multiple validation studies, outline strategies to optimize its clinical use, and discuss potential opportunities to refine imaging criteria in order to maximize its impact in glioma diagnostics.
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Affiliation(s)
- Rajan Jain
- Departments of Radiology and Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sohil H Patel
- Department of Radiology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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7
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Affiliation(s)
- Rajan Jain
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA.,Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA
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Sabari JK, Park H, Tolcher AW, Ou SHI, Garon EB, George B, Janne PA, Moody SE, Tan EY, Sen SK, Peters D, Yan X, Christensen JG, Chi AS, Heist RS. KRYSTAL-2: A phase I/II trial of adagrasib (MRTX849) in combination with TNO155 in patients with advanced solid tumors with KRAS G12C mutation. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.tps146] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS146 Background: KRAS is the most frequently mutated oncogene in cancer and a key mediator of the RAS/MAPK signaling cascade that promotes cellular growth and proliferation. KRAS G12C tumor mutations occur in approximately 14% of patients with lung adenocarcinoma and 3-4% of colorectal adenocarinoma. SHP2 is a phosphatase that acts as a key mediator of signaling from receptor tyrosine kinases (RTKs) to downstream RAS/MAPK pathways. Adagrasib (MRTX849) is a specific small-molecule investigational inhibitor of KRAS G12C that covalently binds to and locks mutant KRAS in its GDP-bound inactive form. Adagrasib has been optimized for a long half-life and extensive tissue distribution to enable inhibition throughout the entire dosing interval. Preliminary results from a Phase 1/2 study of adagrasib demonstrated promising antitumor activity and tolerability across multiple KRAS G12C tumor types. TNO155 is a selective inhibitor of SHP2 with demonstrated inhibition of RTK signaling and significant antitumor activity in preclinical models. Preclinical studies have shown that resistance to KRAS G12C inhibition may be mediated by SHP2-dependent feedback loops. Because KRAS G12C retains some level of cycling between GTP- and GDP-bound states, KRAS G12C that is not bound by inhibitor can activate downstream signaling. Active SHP2 functions to increase the active state of RAS proteins (including mutant KRAS) and also increases ERK pathway activation. Therefore, the addition of TNO155 to adagrasib may augment antitumor activity and overcome resistance by inhibiting cycling to GTP-bound KRAS and/or through inhibition of feedback activation and more comprehensively inhibiting downstream ERK signaling. In KRAS G12C human tumor models, adagrasib combined with a SHP2 inhibitor demonstrated greater activity compared to each agent alone. These data provide support for clinical evaluation of this combination in KRAS G12C tumors. Methods: KRYSTAL-2 is a multicenter Phase 1/2 study evaluating adagrasib and TNO155 in patients with advanced solid tumors harboring a KRAS G12C mutation. Overall objectives of the trial include evaluating safety, tolerability, and PK. The Phase 1 portion will evaluate adagrasib and TNO155 utilizing a modified Toxicity Probability Interval dose escalation design to identify maximum tolerated dose and recommended Phase 2 dose. The Phase 2 portion utilizes a Simon's optimal two-stage design to evaluate the clinical activity of adagrasib with TNO155 in 2 cohorts of up to 108 patients—CRC (54 patients) and NSCLC (54 patients). Efficacy endpoints include Objective Response Rate (RECIST 1.1), Duration of Response (DOR), Progression-free Survival (PFS), and Overall Survival (OS). The study is currently enrolling and patients will receive study treatment until disease progression, unacceptable adverse events, patient withdrawal, or death. Clinical trial information: NCT04330664.
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Affiliation(s)
| | - Haeseong Park
- Washington University School of Medicine, St. Louis, MO
| | | | - Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Edward B. Garon
- David Geffen School of Medicine, University of California/TRIO-US Network, Los Angeles, CA
| | - Ben George
- Froedtert & The Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Eugene Y. Tan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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9
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Chen H, Thomas C, Munoz FA, Alexandrescu S, Horbinski CM, Olar A, McGuone D, Camelo-Piragua S, Wang L, Pentsova E, Phillips J, Aldape K, Chen W, Iafrate AJ, Chi AS, Zagzag D, Golfinos JG, Placantonakis DG, Rosenblum M, Ohman-Strickland P, Hameed M, Snuderl M. Polysomy is associated with poor outcome in 1p/19q codeleted oligodendroglial tumors. Neuro Oncol 2020; 21:1164-1174. [PMID: 31140557 DOI: 10.1093/neuonc/noz098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chromosomal instability is associated with earlier progression in isocitrate dehydrogenase (IDH)-mutated astrocytomas. Here we evaluated the prognostic significance of polysomy in gliomas tested for 1p/19q status. METHODS We analyzed 412 histologic oligodendroglial tumors with use of 1p/19q testing at 8 institutions from 1996 to 2013; fluorescence in situ hybridization (FISH) for 1p/19q was performed. Polysomy was defined as more than two 1q and 19p signals in cells. Tumors were divided into groups on the basis of their 1p/19q status and polysomy and were compared for progression-free survival (PFS) and overall survival (OS). RESULTS In our cohort, 333 tumors (81%) had 1p/19q loss; of these, 195 (59%) had concurrent polysomy and 138 (41%) lacked polysomy, 79 (19%) had 1p/19q maintenance; of these, 30 (38%) had concurrent polysomy and 49 (62%) lacked polysomy. In agreement with prior studies, the group with 1p/19q loss had significantly better PFS and OS than did the group with 1p/19q maintenance (P < 0.0001 each). Patients with 1p/19q loss and polysomy showed significantly shorter PFS survival than patients with 1p/19q codeletion only (P < 0.0001), but longer PFS and OS than patients with 1p/19q maintenance (P < 0.01 and P < 0.0001). There was no difference in survival between tumors with >30% polysomic cells and those with <30% polysomic cells. Polysomy had no prognostic significance on PFS or OS in patients with 1p/19q maintenance. CONCLUSIONS The presence of polysomy in oligodendroglial tumors with codeletion of 1p/19q predicts early recurrence and short survival in patients with 1p/19q codeleted tumors.
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Affiliation(s)
- Hui Chen
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Cheddhi Thomas
- Department of Pathology, NYU Langone Health, New York, New York
| | - Felipe Andres Munoz
- Department of Biostatistics and Epidemiology, Rutgers University, School of Public Health, Piscataway Township, New Jersey
| | - Sanda Alexandrescu
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Craig M Horbinski
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adriana Olar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Declan McGuone
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sandra Camelo-Piragua
- Department of Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Lu Wang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Elena Pentsova
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joanna Phillips
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Kenneth Aldape
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wen Chen
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - A John Iafrate
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew S Chi
- Neuro-Oncology Program, Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - David Zagzag
- Department of Neurosurgery, Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - John G Golfinos
- Department of Neurosurgery, Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Dimitris G Placantonakis
- Department of Neurosurgery, Perlmutter Cancer Center, NYU Langone Health, New York, New York.,Kimmel Center for Stem Cell Biology, Neuroscience Institute, NYU Langone Health, New York, New York
| | - Marc Rosenblum
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Pamela Ohman-Strickland
- Department of Biostatistics and Epidemiology, Rutgers University, School of Public Health, Piscataway Township, New Jersey
| | - Meera Hameed
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, New York
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10
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Tateishi K, Miyake Y, Kawazu M, Sasaki N, Nakamura T, Sasame J, Yoshii Y, Ueno T, Miyake A, Watanabe J, Matsushita Y, Shiba N, Udaka N, Ohki K, Fink AL, Tummala SS, Natsumeda M, Ikegaya N, Nishi M, Ohtake M, Miyazaki R, Suenaga J, Murata H, Aoki I, Miller JJ, Fujii Y, Ryo A, Yamanaka S, Mano H, Cahill DP, Wakimoto H, Chi AS, Batchelor TT, Nagane M, Ichimura K, Yamamoto T. A Hyperactive RelA/p65-Hexokinase 2 Signaling Axis Drives Primary Central Nervous System Lymphoma. Cancer Res 2020; 80:5330-5343. [PMID: 33067267 DOI: 10.1158/0008-5472.can-20-2425] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/08/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is an isolated type of lymphoma of the central nervous system and has a dismal prognosis despite intensive chemotherapy. Recent genomic analyses have identified highly recurrent mutations of MYD88 and CD79B in immunocompetent PCNSL, whereas LMP1 activation is commonly observed in Epstein-Barr virus (EBV)-positive PCNSL. However, a lack of clinically representative preclinical models has hampered our understanding of the pathogenic mechanisms by which genetic aberrations drive PCNSL disease phenotypes. Here, we establish a panel of 12 orthotopic, patient-derived xenograft (PDX) models from both immunocompetent and EBV-positive PCNSL and secondary CNSL biopsy specimens. PDXs faithfully retained their phenotypic, metabolic, and genetic features, with 100% concordance of MYD88 and CD79B mutations present in PCNSL in immunocompetent patients. These models revealed a convergent functional dependency upon a deregulated RelA/p65-hexokinase 2 signaling axis, codriven by either mutated MYD88/CD79B or LMP1 with Pin1 overactivation in immunocompetent PCNSL and EBV-positive PCNSL, respectively. Notably, distinct molecular alterations used by immunocompetent and EBV-positive PCNSL converged to deregulate RelA/p65 expression and to drive glycolysis, which is critical for intracerebral tumor progression and FDG-PET imaging characteristics. Genetic and pharmacologic inhibition of this key signaling axis potently suppressed PCNSL growth in vitro and in vivo. These patient-derived models offer a platform for predicting clinical chemotherapeutics efficacy and provide critical insights into PCNSL pathogenic mechanisms, accelerating therapeutic discovery for this aggressive disease. SIGNIFICANCE: A set of clinically relevant CNSL xenografts identifies a hyperactive RelA/p65-hexokinase 2 signaling axis as a driver of progression and potential therapeutic target for treatment and provides a foundational preclinical platform. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/23/5330/F1.large.jpg.
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Affiliation(s)
- Kensuke Tateishi
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan. .,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Yohei Miyake
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Masahito Kawazu
- Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan
| | - Nobuyoshi Sasaki
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Neurosurgery, Kyorin University Graduate School of Medicine, Mitaka, Tokyo, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Jo Sasame
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Yukie Yoshii
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Toshihide Ueno
- Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan
| | - Akio Miyake
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Jun Watanabe
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yuko Matsushita
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Norio Shiba
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Naoko Udaka
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Kentaro Ohki
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Alexandria L Fink
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Shilpa S Tummala
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Naoki Ikegaya
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Mayuko Nishi
- Department of Microbiology, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Makoto Ohtake
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Ryohei Miyazaki
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Jun Suenaga
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Ichio Aoki
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Julie J Miller
- Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.,Stephen E. and Catherine Papas Center for Neuro-Oncology, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akihide Ryo
- Department of Microbiology, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Hiroyuki Mano
- Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | | | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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11
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Cui X, Ma C, Vasudevaraja V, Serrano J, Tong J, Peng Y, Delorenzo M, Shen G, Frenster J, Morales RTT, Qian W, Tsirigos A, Chi AS, Jain R, Kurz SC, Sulman EP, Placantonakis DG, Snuderl M, Chen W. Dissecting the immunosuppressive tumor microenvironments in Glioblastoma-on-a-Chip for optimized PD-1 immunotherapy. eLife 2020; 9:52253. [PMID: 32909947 PMCID: PMC7556869 DOI: 10.7554/elife.52253] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [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: 09/26/2019] [Accepted: 08/27/2020] [Indexed: 12/13/2022] Open
Abstract
Programmed cell death protein-1 (PD-1) checkpoint immunotherapy efficacy remains unpredictable in glioblastoma (GBM) patients due to the genetic heterogeneity and immunosuppressive tumor microenvironments. Here, we report a microfluidics-based, patient-specific 'GBM-on-a-Chip' microphysiological system to dissect the heterogeneity of immunosuppressive tumor microenvironments and optimize anti-PD-1 immunotherapy for different GBM subtypes. Our clinical and experimental analyses demonstrated that molecularly distinct GBM subtypes have distinct epigenetic and immune signatures that may lead to different immunosuppressive mechanisms. The real-time analysis in GBM-on-a-Chip showed that mesenchymal GBM niche attracted low number of allogeneic CD154+CD8+ T-cells but abundant CD163+ tumor-associated macrophages (TAMs), and expressed elevated PD-1/PD-L1 immune checkpoints and TGF-β1, IL-10, and CSF-1 cytokines compared to proneural GBM. To enhance PD-1 inhibitor nivolumab efficacy, we co-administered a CSF-1R inhibitor BLZ945 to ablate CD163+ M2-TAMs and strengthened CD154+CD8+ T-cell functionality and GBM apoptosis on-chip. Our ex vivo patient-specific GBM-on-a-Chip provides an avenue for a personalized screening of immunotherapies for GBM patients.
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Affiliation(s)
- Xin Cui
- Department of Mechanical and Aerospace Engineering, New York University, Brooklyn, United States.,Department of Biomedical Engineering, New York University, Brooklyn, United States.,Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Chao Ma
- Department of Mechanical and Aerospace Engineering, New York University, Brooklyn, United States.,Department of Biomedical Engineering, New York University, Brooklyn, United States
| | | | - Jonathan Serrano
- Department of Pathology, NYU Langone Health, New York, United States
| | - Jie Tong
- Department of Mechanical and Aerospace Engineering, New York University, Brooklyn, United States.,Department of Biomedical Engineering, New York University, Brooklyn, United States
| | - Yansong Peng
- Department of Biomedical Engineering, New York University, Brooklyn, United States
| | - Michael Delorenzo
- Department of Pathology, NYU Langone Health, New York, United States
| | - Guomiao Shen
- Department of Pathology, NYU Langone Health, New York, United States
| | - Joshua Frenster
- Stem Cell Biology Program, NYU School of Medicine, New York, United States
| | | | - Weiyi Qian
- Department of Mechanical and Aerospace Engineering, New York University, Brooklyn, United States
| | | | - Andrew S Chi
- Perlmutter Cancer Center, NYU Langone Health, New York, United States.,Department of Neurology, NYU Langone Health, New York, United States
| | - Rajan Jain
- Department of Neuroradiology, NYU Langone Health, New York, United States.,Department of Neurosurgery, NYU Langone Health, New York, United States
| | - Sylvia C Kurz
- Perlmutter Cancer Center, NYU Langone Health, New York, United States.,Department of Neurosurgery, NYU Langone Health, New York, United States
| | - Erik P Sulman
- Perlmutter Cancer Center, NYU Langone Health, New York, United States.,Department of Radiation Oncology, NYU Langone Health, New York, United States
| | - Dimitris G Placantonakis
- Perlmutter Cancer Center, NYU Langone Health, New York, United States.,Department of Neurosurgery, NYU Langone Health, New York, United States
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, United States.,Perlmutter Cancer Center, NYU Langone Health, New York, United States
| | - Weiqiang Chen
- Department of Mechanical and Aerospace Engineering, New York University, Brooklyn, United States.,Department of Biomedical Engineering, New York University, Brooklyn, United States.,Perlmutter Cancer Center, NYU Langone Health, New York, United States
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12
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Fogh SE, Boreta L, Nakamura JL, Johnson DR, Chi AS, Kurz SC. Neuro-Oncology Practice Clinical Debate: Early treatment or observation for patients with newly diagnosed oligodendroglioma and small-volume residual disease. Neurooncol Pract 2020; 8:11-17. [PMID: 33664965 DOI: 10.1093/nop/npaa037] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Advances in treatment of oligodendroglioma represent arguably the most significant recent development in the treatment of brain tumors, with multiple clinical trials demonstrating that median survival is approximately doubled in patients with World Health Organization grade II and III 1p/19q codeleted gliomas (ie, oligodendrogliomas) treated with procarbazine, lomustine, vincristine chemotherapy and radiation vs radiation alone. However, chemoradiotherapy itself is not without morbidity, including both short-term toxicities primarily related to chemotherapy and longer-term cognitive issues likely due to radiation. Patients and physicians both desire maximally effective therapy with minimal toxicity, and it remains unclear whether some patients with macroscopic residual disease after surgery can safely delay therapy, to avoid or delay toxicity, while simultaneously preserving the full benefits of treatment. In this article, experts in the field discuss the rationale for the approaches of up-front treatment with chemoradiotherapy and initial observation, respectively.
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Affiliation(s)
- Shannon E Fogh
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Lauren Boreta
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Jean L Nakamura
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | | | | | - Sylvia C Kurz
- Department of Hematology and Medical Oncology, New York University, New York, NY, USA
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13
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Chi AS, Cahill DP, Reardon DA, Wen PY, Mikkelsen T, Peereboom DM, Wong ET, Gerstner ER, Dietrich J, Plotkin SR, Norden AD, Lee EQ, Nayak L, Tanaka S, Wakimoto H, Lelic N, Koerner MV, Klofas LK, Bertalan MS, Arrillaga-Romany IC, Betensky RA, Curry WT, Borger DR, Balaj L, Kitchen RR, Chakrabortty SK, Valentino MD, Skog J, Breakefield XO, Iafrate AJ, Batchelor TT. Exploring Predictors of Response to Dacomitinib in EGFR-Amplified Recurrent Glioblastoma. JCO Precis Oncol 2020; 4:1900295. [PMID: 32923886 DOI: 10.1200/po.19.00295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Despite the high frequency of EGFR genetic alterations in glioblastoma (GBM), EGFR-targeted therapies have not had success in this disease. To improve the likelihood of efficacy, we targeted adult patients with recurrent GBM enriched for EGFR gene amplification, which occurs in approximately half of GBM, with dacomitinib, a second-generation, irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor that penetrates the blood-brain barrier, in a multicenter phase II trial. PATIENTS AND METHODS We retrospectively explored whether previously described EGFR extracellular domain (ECD)-sensitizing mutations in the context of EGFR gene amplification could predict response to dacomitinib, and in a predefined subset of patients, we measured post-treatment intratumoral dacomitinib levels to verify tumor penetration. RESULTS We found that dacomitinib effectively penetrates contrast-enhancing GBM tumors. Among all 56 treated patients, 8 (14.3%) had a clinical benefit as defined by a duration of treatment of at least 6 months, of whom 5 (8.9%) remained progression free for at least 1 year. Presence of EGFRvIII or EGFR ECD missense mutation was not associated with clinical benefit. We evaluated the pretreatment transcriptome in circulating extracellular vesicles (EVs) by RNA sequencing in a subset of patients and identified a signature that distinguished patients who had durable benefit versus those with rapid progression. CONCLUSION While dacomitinib was not effective in most patients with EGFR-amplified GBM, a subset experienced a durable, clinically meaningful benefit. Moreover, EGFRvIII and EGFR ECD mutation status in archival tumors did not predict clinical benefit. RNA signatures in circulating EVs may warrant investigation as biomarkers of dacomitinib efficacy in GBM.
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Affiliation(s)
- Andrew S Chi
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Daniel P Cahill
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David A Reardon
- Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA
| | - Patrick Y Wen
- Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA
| | - Tom Mikkelsen
- Ontario Brain Institute, Toronto, Ontario, Canada.,Henry Ford Hospital, Detroit, MI
| | | | - Eric T Wong
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Jorg Dietrich
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Scott R Plotkin
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrew D Norden
- Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA
| | - Eudocia Q Lee
- Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA
| | - Lakshmi Nayak
- Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA
| | - Shota Tanaka
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Hiroaki Wakimoto
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Nina Lelic
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Mara V Koerner
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Lindsay K Klofas
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Mia S Bertalan
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | | | - William T Curry
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Darrel R Borger
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Leonora Balaj
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | | | - A John Iafrate
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Tracy T Batchelor
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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14
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Cordova C, Syeda MM, Corless B, Wiggins JM, Patel A, Kurz SC, Delara M, Sawaged Z, Utate M, Placantonakis D, Golfinos J, Schafrick J, Silverman JS, Jain R, Snuderl M, Zagzag D, Karlin-Neumann G, Polsky D, Chi AS. Abstract A65: Longitudinal detection of TERT-mutant plasma cell-free circulating tumor DNA in newly diagnosed glioblastoma patients. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.liqbiop20-a65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Liquid biopsies, especially plasma cell-free circulating tumor DNA (ctDNA), provide a potential opportunity to be a noninvasive biomarker for the diagnosis and monitoring of glioblastoma (GBM) patients. Previously, we detected TERT promoter hotspot mutations (C228T and C250T) in ctDNA of IDH wild-type (IDHwt) TERT promoter mutant GBM patients with 100% specificity using mutation-specific droplet digital PCR (ddPCR) assays. Here, we examine the association between mutant TERT ctDNA levels and clinical outcomes in newly diagnosed GBM patients undergoing chemoradiation.
Methods: We analyzed 76 serially collected plasma samples from 17 patients with suspected IDHwt GBM based on MRI before surgery. Twenty mL of whole blood was collected in EDTA tubes at predetermined times: pre- and postoperatively, at the end of chemoradiation, and 1, 3, and 6 months from the end of chemoradiation. TERT promoter mutations C228T or C250T were identified in FFPE tumor samples using ddPCR assays specific for these mutations. Plasma samples were analyzed for the patient’s tumor TERT mutation using the ddPCR assays. The analytically validated thresholds for positive ctDNA detection were 1.5 and 1.7 copies/mL for C228T and C250T, respectively.
Results: Sixteen of 17 (94%) IDHwt tumors had TERT mutations (10 C228T, 6 C250T) with MGMT methylated, unmethylated, or unknown status in 10, 5, and 1, respectively. Fourteen of the 16 patients (87.5%) had detectable mutant ctDNA at one or more time points (range 1.66 to 22.13 copies/mL). Of the 2 patients with undetectable ctDNA, one had diffuse and non-avidly enhancing disease and the other only had pre/postop plasma samples collected. Six patients had detectable ctDNA preop, and most had a dominant rim-enhancing mass with additional nonenhancing or enhancing lesion(s). Ten patients had detectable ctDNA up to 4 days postop, half of whom had undergone gross total resection. For 3 of 5 patients for whom there was a question of pseudoprogression versus true progression, ctDNA kinetics matched the clinical outcome. One patient with MGMT unmethylated multifocal GBM achieved ctDNA zeroconversion at 6 months post radiation (RT), and did not progress for another five months. Another patient was negative at all time points until their 3-month post RT follow-up, at which time they developed a recurrence. Another patient achieved zeroconversion at the end of RT but developed a borderline positive ctDNA at 6 months after RT, 2 months before documented radiographic progression.
Conclusions: In this pilot, prospective ctDNA monitoring study of IDHwt GBM, TERT mutant ctDNA was detected at one or more time points in the majority of patients. ctDNA kinetics were associated with clinical outcomes for some patients. These data suggest that additional, larger studies could refine how ctDNA monitoring may be used to enhance the clinical management of IDHwt GBM patients.
Citation Format: Christine Cordova, Mahrukh M. Syeda, Broderick Corless, Jennifer M. Wiggins, Amie Patel, Sylvia C. Kurz, Malcolm Delara, Zacharia Sawaged, Minerva Utate, Dimitris Placantonakis, John Golfinos, Jessica Schafrick, Joshua S. Silverman, Rajan Jain, Matija Snuderl, David Zagzag, George Karlin-Neumann, David Polsky, Andrew S. Chi. Longitudinal detection of TERT-mutant plasma cell-free circulating tumor DNA in newly diagnosed glioblastoma patients [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr A65.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Andrew S. Chi
- 3NYU Langone Health, New York, NY; Neon Therapeutics, Boston, MA
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15
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Arrillaga-Romany I, Kurz SC, Tarapore R, Sumrall A, Butowski NA, Harrison RA, De Groot JF, Chi AS, Shonka NA, Umemura Y, Odia Y, Mehta MP, Nghiemphu PL, Cloughesy TF, Lu G, Oster W, Allen JE, Batchelor T, Lassman AB, Wen PY. Single-agent ONC201 in recurrent H3 K27M-mutant diffuse midline glioma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3615 Background: Recurrent H3 K27M-mutant diffuse midline glioma is a lethal brain tumor that predominantly affects children and young adults and has no effective therapy. ONC201 is a first-in-class orally administered, anti-cancer small molecule that selectively antagonizes the dopamine receptors DRD2/DRD3 and agonizes ClpP, a mitochondrial protease. Prior studies have indicated dysregulated dopamine receptor expression and enhanced ONC201 sensitivity among H3 K27M-mutant gliomas. Methods: Adults with midline H3 K27M-mutant glioma patients were enrolled to a dedicated Phase II clinical trial (NCT03295396), a multi-arm Phase II clinical trial (NCT02525692), and expanded access protocols under the Sponsor’s IND. Results were pooled among patients treated with ONC201 monotherapy through any of these trial with H3 K27M confirmed glioma, progressive and measurable disease by RANO, > 90 days from completion of prior radiation, no evidence of leptomeningeal dissemination, midline location other than primarily pons or spinal cord, and baseline KPS > 60. Using an enrollment cutoff of February 15, 2019 and data cutoff of July 31, 2019, there were 20 patients (NCT03295396, 12; NCT02525692, 7; expanded access, 1). Dosage was 625 mg weekly in 19 and once every 3 weeks in 1. Results: No DLTs or treatment discontinuations due to toxicity occurred. Midline gliomas can exhibit minimal contrast enhancement or exhibit a mixture of contrast-enhancing and non-contrast enhancing regions in the tumor. As a result, blinded independent central review (BICR) of tumor response by MRI was assessed by RANO-HGG and RANO-LGG for each patient to capture contrast-enhancing lesions by T1 post-contrast and non-contrast-enhancing assessments by T2/FLAIR, respectively, in the object response rate. The best response by RANO-HGG or RANO-LGG is 30% (95% CI, 11.9-54.3%). Duration of response by RANO-HGG is median 52.7 weeks (range 15.9-138.3). One patient with stable disease as of this data cutoff has continued on treatment beyond 12 months and recently underwent an investigator-reported PR by RANO-HGG that is pending confirmation. Conclusions: Single agent ONC201 is well tolerated and clinically active in recurrent H3 K27M-mutant diffuse midline glioma patients. Clinical trial information: NCT03295396, NCT02525692 .
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Affiliation(s)
| | | | | | | | | | - Rebecca A. Harrison
- The University of Texas, MD Anderson Cancer Center, Department of Neuro-Oncology, Houston, TX
| | - John Frederick De Groot
- The University of Texas, MD Anderson Cancer Center, Department of Neuro-Oncology, Houston, TX
| | | | | | | | - Yazmin Odia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - Minesh P. Mehta
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | | | | | | | | | | | | | | | - Patrick Y. Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
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16
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Kurz SC, Tarapore R, Odia Y, Butowski NA, Koschmann CJ, Aguilera D, MacDonald TJ, Lu G, Allen JE, Oster W, Mehta MP, Chi AS, Wen PY. Clinical experience of ONC201 in patients with recurrent H3 K27M-mutant spinal cord glioma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2563 Background: High-grade gliomas of the spinal cord are a rare and understudied entity, representing < 5% of all spinal cord tumors. Reported median survival times range from 10-16 months. Up to 53% of tumors harbor the H3 K27M mutation, which is associated with an unfavorable prognosis. Postsurgical treatment often includes radiation ± temozolomide, although the role of chemotherapy has not been conclusively established. At recurrence, there are no effective therapies and most clinical studies exclude patients with spinal cord tumors. We report our clinical experience with ONC201, a small molecule DRD2 antagonist and caseinolytic protease P agonist, in patients with recurrent H3 K27M-mutant diffuse gliomas of the spinal cord (scDG). Methods: Adults and children with recurrent H3 K27M-mutant scDG received ONC201 in two Phase II clinical trials enrolling adult recurrent H3 K27M-mutant glioma patients (NCT02525692; NCT03295396) and in one Phase I clinical trial enrolling pediatric patients (NCT03416530). Adult patients received ONC201 at the RP2D dose of 625 mg weekly and pediatric patients received the RP2D of 625 mg weekly, scaled by body weight. All patients began ONC201 as a single agent until disease progression. Five patients continued ONC201 combined with bevacizumab beyond progression. Results: As of January 15, 2020, 12 evaluable patients (adult n = 8, pediatric n = 4) received ONC201. The median age was 20.9 (range: 7-72) years. The median follow-up time for the single agent ONC201 group was 5.4 (range 1.3-9.7) months while that of the combination group is 7.4 (range 6.2-25.1) months. The median number of ONC201 doses was 10 (range: 5-39) for the ONC201 single agent group and 34 (range: 21-100) for the combination group. Five of 7 patients remain alive in the ONC201 single agent group while 3 of 5 patients remain alive in the combination group. Three patients in the ONC201 single agent group and 2 patients in the combination group continue on treatment. There were no drug-related toxicities requiring dose reduction or discontinuation. Conclusions: Treatment with ONC201 alone or combined with bevacizumab is well tolerated in patients with recurrent H3 K27M-mutant scDG and a subset of patients experiences prolonged survival that exceeds historical outcomes. Clinical trial information: NCT02525692; NCT03295396; NCT03416530 .
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Affiliation(s)
| | | | - Yazmin Odia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | | | | | - Dolly Aguilera
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Tobey J. MacDonald
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Minesh P. Mehta
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
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17
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Frenster JD, Kader M, Kamen S, Sun J, Chiriboga L, Serrano J, Bready D, Golub D, Ravn-Boess N, Stephan G, Chi AS, Kurz SC, Jain R, Park CY, Fenyo D, Liebscher I, Schöneberg T, Wiggin G, Newman R, Barnes M, Dickson JK, MacNeil DJ, Huang X, Shohdy N, Snuderl M, Zagzag D, Placantonakis DG. Expression profiling of the adhesion G protein-coupled receptor GPR133 (ADGRD1) in glioma subtypes. Neurooncol Adv 2020; 2:vdaa053. [PMID: 32642706 PMCID: PMC7262742 DOI: 10.1093/noajnl/vdaa053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 12/12/2022] Open
Abstract
Background Glioma is a family of primary brain malignancies with limited treatment options and in need of novel therapies. We previously demonstrated that the adhesion G protein-coupled receptor GPR133 (ADGRD1) is necessary for tumor growth in adult glioblastoma, the most advanced malignancy within the glioma family. However, the expression pattern of GPR133 in other types of adult glioma is unknown. Methods We used immunohistochemistry in tumor specimens and non-neoplastic cadaveric brain tissue to profile GPR133 expression in adult gliomas. Results We show that GPR133 expression increases as a function of WHO grade and peaks in glioblastoma, where all tumors ubiquitously express it. Importantly, GPR133 is expressed within the tumor bulk, as well as in the brain-infiltrating tumor margin. Furthermore, GPR133 is expressed in both isocitrate dehydrogenase (IDH) wild-type and mutant gliomas, albeit at higher levels in IDH wild-type tumors. Conclusion The fact that GPR133 is absent from non-neoplastic brain tissue but de novo expressed in glioma suggests that it may be exploited therapeutically.
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Affiliation(s)
- Joshua D Frenster
- Departments of Neurosurgery, New York, New York, USA.,NYU Grossman School of Medicine, New York, New York, USA; Kimmel Center for Stem Cell Biology, NYU Grossman School of Medicine, New York, New York, USA
| | - Michael Kader
- Departments of Neurosurgery, New York, New York, USA
| | | | - James Sun
- Departments of Neurosurgery, New York, New York, USA
| | - Luis Chiriboga
- Pathology, New York, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Devin Bready
- Departments of Neurosurgery, New York, New York, USA
| | | | | | | | - Andrew S Chi
- Neurology, New York, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York, USA.,Brain and Spine Tumor Center, NYU Grossman School of Medicine, New York, New York, USA
| | - Sylvia C Kurz
- Neurology, New York, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York, USA.,Brain and Spine Tumor Center, NYU Grossman School of Medicine, New York, New York, USA
| | - Rajan Jain
- Radiology, New York, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York, USA.,Brain and Spine Tumor Center, NYU Grossman School of Medicine, New York, New York, USA
| | | | - David Fenyo
- Biochemistry and Molecular Pharmacology, New York, New York, USA.,Institute for Systems Genetics, NYU Grossman School of Medicine, New York, New York, USA
| | - Ines Liebscher
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Torsten Schöneberg
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | | | | | | | | | - Douglas J MacNeil
- Office for Therapeutic Alliances, NYU Grossman School of Medicine, New York, New York, USA
| | - Xinyan Huang
- Office for Therapeutic Alliances, NYU Grossman School of Medicine, New York, New York, USA
| | - Nadim Shohdy
- Office for Therapeutic Alliances, NYU Grossman School of Medicine, New York, New York, USA
| | - Matija Snuderl
- Pathology, New York, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York, USA.,Brain and Spine Tumor Center, NYU Grossman School of Medicine, New York, New York, USA
| | - David Zagzag
- Departments of Neurosurgery, New York, New York, USA.,Pathology, New York, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York, USA.,Brain and Spine Tumor Center, NYU Grossman School of Medicine, New York, New York, USA
| | - Dimitris G Placantonakis
- Departments of Neurosurgery, New York, New York, USA.,NYU Grossman School of Medicine, New York, New York, USA; Kimmel Center for Stem Cell Biology, NYU Grossman School of Medicine, New York, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York, USA.,Brain and Spine Tumor Center, NYU Grossman School of Medicine, New York, New York, USA.,Neuroscience Institute, NYU Grossman School of Medicine, New York, New York, USA
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18
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Arrillaga I, Kurz S, Sumrall A, Butowski NA, Harrison RA, De Groot JF, Shonka NA, Lieberman FS, Odia Y, Tarapore R, Merdinger K, Allen JE, Oster W, Mehta MP, Cloughesy TF, Chi AS, Lassman AB, Batchelor T, Wen PY. Single agent ONC201 in adult recurrent H3 K27M-mutant glioma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3005 Background: H3 K27M-mutant glioma is associated with a poor prognosis and there is no effective therapy following radiation. We report the clinical experience with single agent ONC201, the first small molecule DRD2 antagonist in oncology, in adults with recurrent H3 K27M-mutant glioma. Methods: Twenty-nine adult patients with recurrent H3 K27M-mutant glioma have been treated with single agent ONC201 as of January 20, 2019: 19 patients on NCT03295396; 8 patients on NCT02525692; 2 patients on compassionate use protocols under the Sponsor’s IND. Median age was 57 years old (range: 17-74), median prior lines of therapy was 2 (range: 1-4) and all patients received prior radiation (median 8.5 months from radiation completion to ONC201 initiation). ONC201 was orally administered at 625 mg weekly, except for one patient dosed once every 3 weeks. Results: As of February 5, 2019, 13 of 29 patients remain on-trial within median follow up of 6.5 months (range: 0.6-33.6), 8 patients are alive but off-trial with median follow up of 2.4 months (range: 0.2-9), and 8 patients have expired. Nine of 29 patients (31%) remain progression-free on ONC201 with a median follow up of 6.5 months (range 0.6-33.6). No dose-limiting toxicities or treatment discontinuations due to toxicity occurred. Three patients have experienced durable partial responses by RANO (4.3-28.5 months). In addition, one patient experienced complete regression that continues for > 14 months of all < 1 cm tumor lesions that are not measurable by RANO. Furthermore, 10 patients had a best response of stable disease by RANO, 12 patients experienced progressive disease, and 3 patients are not yet evaluable. Among the patients with a best response of stable disease by RANO, one patient had > 50% tumor regression in the basal ganglia that did not qualify as a partial response by RANO due to a new lesion on a confirmatory scan. Another patient with stable disease by RANO has had 37% tumor regression so far in the brainstem and remains on-treatment for 6 months. All tumor regressions remain durable to date and some were associated with improvements in disease-associated neurological symptoms. Conclusions: Single agent ONC201 is well tolerated and clinically active in adult recurrent H3 K27M-mutant glioma patients. Clinical trial information: NCT03295396; NCT02525692.
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Affiliation(s)
| | - Sylvia Kurz
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | | | | | | | | | | | - Yazmin Odia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | | | | | | | | | - Minesh P. Mehta
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | | | - Andrew S. Chi
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | | | - Patrick Y. Wen
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA
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19
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Gardner SL, Allen JC, Zaky WT, Odia Y, Daghistani D, Khatib Z, Koschmann CJ, Aguilera D, MacDonald TJ, Chi AS, Tarapore R, Merdinger K, Oster W, Allen JE, Khatua S. ONC201 in previously-irradiated pediatric H3 K27M-mutant glioma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10046 Background: ONC201 is the first DRD2 antagonist for clinical oncology. The recommended phase 2 dose (RP2D) of 625mg ONC201 orally once a week has been established in adult patients. ONC201 efficacy has been shown in high-grade glioma preclinical models and radiographic regressions with single agent ONC201 have been reported in adult recurrent H3 K27M-mutant glioma patients. We report results from the first Phase I pediatric clinical trial of ONC201. Methods: This multicenter, open-label, dose-escalation and dose-expansion clinical trial (NCT03416530) determined the RP2D of ONC201 in pediatric H3 K27M-mutant glioma patients as a single agent. ONC201 was orally administered once a week and scaled by body weight. Dose escalation was performed by a 3 + 3 design beginning with one 125mg capsule less than the adult RP2D equivalent. Three patients were treated at the starting dose and 19 were treated at the adult RP2D equivalent. Results: The primary endpoint was achieved by establishing the safety of the adult RP2D scaled by body weight to pediatric patients. Twenty-two patients with a median age of 9 (range 3-18) years old who received at least prior radiation have been treated with ONC201: 15 with diffuse intrinsic pontine glioma (DIPG) (4 recurrent; 11 not recurrent) and 7 with non-DIPG H3 K27M-mutant glioma (all not recurrent). As of February 5, 2019, patients have received a median of 18 ONC201 doses (range 3-41) without instance of dose-limiting toxicity. Pharmacokinetic profiles were comparable to those observed in adults (Cmax ~2.1ug/mL; AUC ~2.3hr*ug/mL) and exposure was similar across body weights. Nine of 22 patients remain on therapy, 13 have discontinued due to progression, and 4 off-study patients are alive with a median follow up of 5.8 months. Five of the 11 (45%) DIPG patients who initiated ONC201 following radiation, but prior to recurrence, remain on therapy (median 7.4 months; range 4.4-9.6): median PFS is 4.4 months from initiation of ONC201 and 9.7 months from diagnosis; 7 of 11 (64%) patients are alive with median follow up of 11.8 months from diagnosis. Conclusions: ONC201 was well tolerated and achieved therapeutic exposure in pediatric H3 K27M-mutant glioma patients at the adult RP2D scaled by body weight. Further investigation of first-line ONC201 to treat H3 K27M-mutant glioma and/or DIPG is ongoing. Clinical trial information: NCT03416530.
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Affiliation(s)
| | | | | | - Yazmin Odia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | | | | | | | - Dolly Aguilera
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Tobey J. MacDonald
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Andrew S. Chi
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | | | | | | | - Soumen Khatua
- The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Cordova C, Syeda MM, Corless B, Wiggins JM, Patel A, Kurz SC, Delara M, Sawaged Z, Utate M, Placantonakis D, Golfinos J, Schafrick J, Silverman JS, Jain R, Snuderl M, Zagzag D, Shao Y, Karlin-Neumann GA, Polsky D, Chi AS. Plasma cell-free circulating tumor DNA (ctDNA) detection in longitudinally followed glioblastoma patients using TERT promoter mutation-specific droplet digital PCR assays. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2026 Background: There is a critical need for more specific and less invasive diagnostic and pharmacodynamic biomarkers in glioblastoma (GBM) patients (pts). Previously, we detected TERT promoter hotspot mutations (C228T and C250T) in the ctDNA of IDH wildtype ( IDHwt) TERT promoter mutant GBM pts with 100% specificity using mutation-specific droplet digital PCR (ddPCR) assays. Here, we explored the dynamics and clinical associations of mutant TERT ctDNA levels in GBM pts undergoing therapy. Methods: We examined 14 pts with suspected IDHwt GBM based on preoperative MRI. Plasma was isolated and frozen from ~15 mL whole blood samples collected pre- and post-op, at end of radiation (RT), and 1, 3, and 6 m after end of RT. TERT promoter mutations were identified in FFPE tumor samples using ddPCR assays for C228T/C250T. Plasma samples were analyzed using ddPCR assays specific for the corresponding tumor mutation. The validated thresholds for positive detection were 1.5 (C228T) and 1.7 copies/mL (C250T). Results: 13/14 (92.9%) IDHwt tumors had TERT mutations (7 C228T and 6 C250T). Six of these 13 (46%) pts had positive plasma TERT ctDNA preop (4 C228T, 2 C250T). The mean cross sectional area of enhancing disease at presentation for positive or negative preop mutant ctDNA was similar. All 4 pts with multiple contrast enhancing lesions had positive preop mutant ctDNA. 2 pts who were negative initially developed detectable mutant ctDNA preceding progression. 3/4 pts with equivocal radiographic pseudoprogression had ctDNA dynamics that correlated with eventual clinical outcome. One patient with unresectable GBM had declining mutant ctDNA in later collections during clinical stability. Conclusions: We detected plasma TERT ctDNA in 46% of TERT mutant GBM pts before surgery, and in 100% of pts with multiple contrast enhancing lesions. TERT mutant ctDNA levels correlated with pseudoprogression or true disease progression and predicted progression before MRI. These data suggest that larger studies to test circulating cell-free TERT mutation as a diagnostic and pharmacodynamic biomarker in GBM are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Golfinos
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | | | - Rajan Jain
- NYU Langone Medical Center, New York, NY
| | - Matija Snuderl
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - David Zagzag
- New York University School of Medicine, New York, NY
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, NY
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21
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Tanaka S, Batchelor TT, Iafrate AJ, Dias-Santagata D, Borger DR, Ellisen LW, Yang D, Louis DN, Cahill DP, Chi AS. PIK3CA activating mutations are associated with more disseminated disease at presentation and earlier recurrence in glioblastoma. Acta Neuropathol Commun 2019; 7:66. [PMID: 31036078 PMCID: PMC6487518 DOI: 10.1186/s40478-019-0720-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Received: 03/21/2019] [Accepted: 04/16/2019] [Indexed: 12/22/2022] Open
Abstract
Phosphatidylinositol 3-kinase signaling promotes cell growth and survival and is frequently activated in infiltrative gliomas. Activating mutations in PIK3CA gene are observed in 6-15% of glioblastomas, although their clinical significance is largely undescribed. The objective of this study was to examine whether PIK3CA mutations are associated with a specific clinical phenotype in glioblastoma. We retrospectively reviewed 157 consecutive newly diagnosed glioblastoma patients from December 2009 to June 2012 who underwent molecular profiling consisting of targeted hotspot genotyping, fluorescence in situ hybridization for gene amplification, and methylation-specific PCR for O6-methylguanine-DNA methyltransferase promoter methylation. Molecular alterations were correlated with clinical features, imaging and outcome. The Cancer Genome Atlas data was analyzed as a validation set. There were 91 males; median age was 58 years (range, 23-85). With a median follow-up of 20.9 months, median progression-free survival (PFS) and estimated overall survival (OS) were 11.9 and 24.0 months, respectively. Thirteen patients (8.3%) harbored PIK3CA mutation, which was associated with younger age (mean 49.4 vs. 58.1 years, p = 0.02). PIK3CA mutation correlated with shorter PFS (median 6.9 vs. 12.4 months, p = 0.01) and OS (median 21.2 vs. 24.2 months, p = 0.049) in multivariate analysis. A significant association between PIK3CA mutation and more disseminated disease at diagnosis, as defined by gliomatosis, multicentric lesions, or distant leptomeningeal lesions, was observed (46.2% vs. 11.1%, p = 0.004). In conclusion, despite the association with younger age, PIK3CA activating mutations are associated with earlier recurrence and shorter survival in adult glioblastoma. The aggressive course of these tumors may be related to their propensity for disseminated presentation.
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Affiliation(s)
- Shota Tanaka
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Boston, USA
- Department of Neurosurgery, Boston, USA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
- The University of Tokyo Hospital, Tokyo, Japan
| | - Tracy T Batchelor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Boston, USA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
- Present Address: Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Present Address: Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - A John Iafrate
- Translational Research Laboratory, Cancer Center, Boston, USA
- Department of Pathology, Boston, USA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Dora Dias-Santagata
- Translational Research Laboratory, Cancer Center, Boston, USA
- Department of Pathology, Boston, USA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Darrell R Borger
- Translational Research Laboratory, Cancer Center, Boston, USA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Leif W Ellisen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Daniel Yang
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Boston, USA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - David N Louis
- Department of Pathology, Boston, USA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Boston, USA.
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA.
| | - Andrew S Chi
- Perlmutter Cancer Center, New York University Langone Health and School of Medicine, New York, USA.
- Present Address: Neon Therapeutics, 40 Erie Street, Suite 110, Cambridge, MA, USA.
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22
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Tateishi K, Nakamura T, Juratli TA, Williams EA, Matsushita Y, Miyake S, Nishi M, Miller JJ, Tummala SS, Fink AL, Lelic N, Koerner MVA, Miyake Y, Sasame J, Fujimoto K, Tanaka T, Minamimoto R, Matsunaga S, Mukaihara S, Shuto T, Taguchi H, Udaka N, Murata H, Ryo A, Yamanaka S, Curry WT, Dias-Santagata D, Yamamoto T, Ichimura K, Batchelor TT, Chi AS, Iafrate AJ, Wakimoto H, Cahill DP. PI3K/AKT/mTOR Pathway Alterations Promote Malignant Progression and Xenograft Formation in Oligodendroglial Tumors. Clin Cancer Res 2019; 25:4375-4387. [PMID: 30975663 DOI: 10.1158/1078-0432.ccr-18-4144] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/14/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Oligodendroglioma has a relatively favorable prognosis, however, often undergoes malignant progression. We hypothesized that preclinical models of oligodendroglioma could facilitate identification of therapeutic targets in progressive oligodendroglioma. We established multiple oligodendroglioma xenografts to determine if the PI3K/AKT/mTOR signaling pathway drives tumor progression. EXPERIMENTAL DESIGN Two anatomically distinct tumor samples from a patient who developed progressive anaplastic oligodendroglioma (AOD) were collected for orthotopic transplantation in mice. We additionally implanted 13 tumors to investigate the relationship between PI3K/AKT/mTOR pathway alterations and oligodendroglioma xenograft formation. Pharmacologic vulnerabilities were tested in newly developed AOD models in vitro and in vivo. RESULTS A specimen from the tumor site that subsequently manifested rapid clinical progression contained a PIK3CA mutation E542K, and yielded propagating xenografts that retained the OD/AOD-defining genomic alterations (IDH1 R132H and 1p/19q codeletion) and PIK3CA E542K, and displayed characteristic sensitivity to alkylating chemotherapeutic agents. In contrast, a xenograft did not engraft from the region that was clinically stable and had wild-type PIK3CA. In our panel of OD/AOD xenografts, the presence of activating mutations in the PI3K/AKT/mTOR pathway was consistently associated with xenograft establishment (6/6, 100%). OD/AOD that failed to generate xenografts did not have activating PI3K/AKT/mTOR alterations (0/9, P < 0.0001). Importantly, mutant PIK3CA oligodendroglioma xenografts were vulnerable to PI3K/AKT/mTOR pathway inhibitors in vitro and in vivo-evidence that mutant PIK3CA is a tumorigenic driver in oligodendroglioma. CONCLUSIONS Activation of the PI3K/AKT/mTOR pathway is an oncogenic driver and is associated with xenograft formation in oligodendrogliomas. These findings have implications for therapeutic targeting of PI3K/AKT/mTOR pathway activation in progressive oligodendrogliomas.
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Affiliation(s)
- Kensuke Tateishi
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. .,Division of Brain Tumor Translational Research, National Cancer Center Institute, Tokyo, Japan.,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Tareq A Juratli
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erik A Williams
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yuko Matsushita
- Division of Brain Tumor Translational Research, National Cancer Center Institute, Tokyo, Japan
| | - Shigeta Miyake
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Mayuko Nishi
- Department of Microbiology, Yokohama City University Hospital, Yokohama, Japan
| | - Julie J Miller
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Shilpa S Tummala
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandria L Fink
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nina Lelic
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mara V A Koerner
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yohei Miyake
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Jo Sasame
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Kenji Fujimoto
- Division of Brain Tumor Translational Research, National Cancer Center Institute, Tokyo, Japan
| | - Takahiro Tanaka
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryogo Minamimoto
- Department of Radiology, Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shigeo Matsunaga
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Shigeo Mukaihara
- Department of Neurosurgery, Fujisawa Municipal Hospital, Fujisawa, Japan
| | - Takashi Shuto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Hiroki Taguchi
- Department of Neurosurgery, Taguchi Neurosurgery Clinic, Yokohama, Japan
| | - Naoko Udaka
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akihide Ryo
- Department of Microbiology, Yokohama City University Hospital, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - William T Curry
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Institute, Tokyo, Japan
| | - Tracy T Batchelor
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew S Chi
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, New York
| | - A John Iafrate
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hiroaki Wakimoto
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. .,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel P Cahill
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. .,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Hall MD, Odia Y, Allen JE, Tarapore R, Khatib Z, Niazi TN, Daghistani D, Schalop L, Chi AS, Oster W, Mehta MP. First clinical experience with DRD2/3 antagonist ONC201 in H3 K27M-mutant pediatric diffuse intrinsic pontine glioma: a case report. J Neurosurg Pediatr 2019; 23:719-725. [PMID: 30952114 DOI: 10.3171/2019.2.peds18480] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 02/04/2019] [Indexed: 11/06/2022]
Abstract
Diffuse intrinsic pontine gliomas (DIPGs) frequently harbor the histone H3 K27M mutation. Gliomas with this mutation commonly overexpress dopamine receptor (DR) D2 and suppress DRD5, leading to enhanced sensitivity to DRD2 antagonism. This study reports the first clinical experience with the DRD2/3 antagonist ONC201 as a potential targeted therapy for H3 K27M-mutant DIPG. One pediatric patient (a 10-year-old girl) with H3 K27M-mutant DIPG was enrolled in an investigator-initiated, IRB-approved compassionate-use study and began single-agent ONC201 treatment 1 month after completing radiotherapy. The study endpoints were clinical and radiographic response (primary) and toxicities (secondary).The patient presented with House-Brackmann grade IV facial palsy and unilateral hearing loss. MRI demonstrated a 2.3 × 2.1 × 2.8-cm pontomedullary tumor. Stereotactic biopsy confirmed H3 K27M-mutated DIPG. The tumor was treated with radiotherapy, but 1 month after completion of that treatment, the tumor and neurological symptoms showed only minimal change, and ONC201 treatment was initiated as described above. The tumor volume sequentially decreased by 26%, 40%, and 44% over the next 6 months, and remained stable at 18 months. Ipsilateral hearing normalized and the facial palsy improved to House-Brackmann grade I by 4 months. After 1 year of ONC201 treatment, 2 new lesions were identified outside of the prior high-dose radiotherapy volume. The patient was treated with dexamethasone, bevacizumab, and additional focal radiotherapy to these new tumors. These tumors remained stable in size over the subsequent 6 months on MRI. To date, no adverse events have been observed or reported due to ONC201. The patient remains clinically improved as of the latest follow-up visit, 19 months after starting ONC201 and 22 months from diagnosis. This case supports further investigation of this novel agent targeting H3 K27M-mutated DIPG.
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Affiliation(s)
| | | | | | | | | | - Toba N Niazi
- 6Pediatric Neurosurgery, Nicklaus Children's Hospital, Miami, Florida
| | | | - Lee Schalop
- 4Oncoceutics, Philadelphia, Pennsylvania; and
| | - Andrew S Chi
- 8NYU Langone Medical Center and School of Medicine, New York, New York
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24
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Wen PY, Touat M, Alexander BM, Mellinghoff IK, Ramkissoon S, McCluskey CS, Pelton K, Haidar S, Basu SS, Gaffey SC, Brown LE, Martinez-Ledesma JE, Wu S, Kim J, Wei W, Park MA, Huse JT, Kuhn JG, Rinne ML, Colman H, Agar NYR, Omuro AM, DeAngelis LM, Gilbert MR, de Groot JF, Cloughesy TF, Chi AS, Roberts TM, Zhao JJ, Lee EQ, Nayak L, Heath JR, Horky LL, Batchelor TT, Beroukhim R, Chang SM, Ligon AH, Dunn IF, Koul D, Young GS, Prados MD, Reardon DA, Yung WKA, Ligon KL. Buparlisib in Patients With Recurrent Glioblastoma Harboring Phosphatidylinositol 3-Kinase Pathway Activation: An Open-Label, Multicenter, Multi-Arm, Phase II Trial. J Clin Oncol 2019; 37:741-750. [PMID: 30715997 DOI: 10.1200/jco.18.01207] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Phosphatidylinositol 3-kinase (PI3K) signaling is highly active in glioblastomas. We assessed pharmacokinetics, pharmacodynamics, and efficacy of the pan-PI3K inhibitor buparlisib in patients with recurrent glioblastoma with PI3K pathway activation. METHODS This study was a multicenter, open-label, multi-arm, phase II trial in patients with PI3K pathway-activated glioblastoma at first or second recurrence. In cohort 1, patients scheduled for re-operation after progression received buparlisib for 7 to 13 days before surgery to evaluate brain penetration and modulation of the PI3K pathway in resected tumor tissue. In cohort 2, patients not eligible for re-operation received buparlisib until progression or unacceptable toxicity. Once daily oral buparlisib 100 mg was administered on a continuous 28-day schedule. Primary end points were PI3K pathway inhibition in tumor tissue and buparlisib pharmacokinetics in cohort 1 and 6-month progression-free survival (PFS6) in cohort 2. RESULTS Sixty-five patients were treated (cohort 1, n = 15; cohort 2, n = 50). In cohort 1, reduction of phosphorylated AKTS473 immunohistochemistry score was achieved in six (42.8%) of 14 patients, but effects on phosphoribosomal protein S6S235/236 and proliferation were not significant. Tumor-to-plasma drug level was 1.0. In cohort 2, four (8%) of 50 patients reached 6-month PFS6, and the median PFS was 1.7 months (95% CI, 1.4 to 1.8 months). The most common grade 3 or greater adverse events related to treatment were lipase elevation (n = 7 [10.8%]), fatigue (n = 4 [6.2%]), hyperglycemia (n = 3 [4.6%]), and elevated ALT (n = 3 [4.6%]). CONCLUSION Buparlisib had minimal single-agent efficacy in patients with PI3K-activated recurrent glioblastoma. Although buparlisib achieved significant brain penetration, the lack of clinical efficacy was explained by incomplete blockade of the PI3K pathway in tumor tissue. Integrative results suggest that additional study of PI3K inhibitors that achieve more-complete pathway inhibition may still be warranted.
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Affiliation(s)
- Patrick Y Wen
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | - Mehdi Touat
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | - Brian M Alexander
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | - Sam Haidar
- 1 Dana-Farber Cancer Institute, Boston, MA
| | - Sankha S Basu
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Shaofang Wu
- 4 The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Jungwoo Kim
- 5 California Institute of Technology, Pasadena, CA
| | - Wei Wei
- 6 David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.,10 Institute for Systems Biology, Seattle, WA
| | - Mi-Ae Park
- 1 Dana-Farber Cancer Institute, Boston, MA
| | - Jason T Huse
- 4 The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - John G Kuhn
- 7 The University of Texas, San Antonio, San Antonio, TX
| | - Mikael L Rinne
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | - Howard Colman
- 8 Huntsman Cancer Institute and University of Utah, Salt Lake City, UT
| | - Nathalie Y R Agar
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | | | | | - Mark R Gilbert
- 4 The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - John F de Groot
- 4 The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Timothy F Cloughesy
- 6 David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Andrew S Chi
- 9 New York University School of Medicine, New York, NY
| | | | | | - Eudocia Q Lee
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | - Lakshmi Nayak
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Rameen Beroukhim
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | - Susan M Chang
- 12 University of California, San Francisco, San Francisco, CA
| | | | - Ian F Dunn
- 2 Brigham and Women's Hospital, Boston, MA
| | - Dimpy Koul
- 4 The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | | | - David A Reardon
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
| | - W K Alfred Yung
- 4 The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Keith L Ligon
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Brigham and Women's Hospital, Boston, MA
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25
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Teng J, Hejazi S, Hiddingh L, Carvalho L, de Gooijer MC, Wakimoto H, Barazas M, Tannous M, Chi AS, Noske DP, Wesseling P, Wurdinger T, Batchelor TT, Tannous BA. Recycling drug screen repurposes hydroxyurea as a sensitizer of glioblastomas to temozolomide targeting de novo DNA synthesis, irrespective of molecular subtype. Neuro Oncol 2019; 20:642-654. [PMID: 29099956 DOI: 10.1093/neuonc/nox198] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Glioblastoma (GBM) is the most common and most aggressive primary malignant brain tumor. Standard-of-care treatment involves maximal surgical resection of the tumor followed by radiation and chemotherapy (temozolomide [TMZ]). The 5-year survival rate of patients with GBM is <10%, a colossal failure that has been partially attributed to intrinsic and/or acquired resistance to TMZ through O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status in the tumor. Methods A drug screening aimed at evaluating the potential recycling and repurposing of known drugs was conducted in TMZ-resistant GBM cell lines and primary cultures of newly diagnosed GBM with different MGMT promoter methylation status, phenotypic/genotypic background and subtype, and validated with sphere formation, cell migration assays, and quantitative invasive orthotopic in vivo models. Results We identified hydroxyurea (HU) to synergize with TMZ in GBM cells in culture and in vivo, irrespective of MGMT promoter methylation status, subtype, and/or stemness. HU acts specifically on the S-phase of the cell cycle by inhibiting the M2 unit of enzyme ribonucleotide reductase. Knockdown of this enzyme using RNA interference and other known chemical inhibitors exerted a similar effect to HU in combination with TMZ both in culture and in vivo. Conclusions We demonstrate preclinical efficacy of repurposing hydroxyurea in combination with TMZ for adjuvant GBM therapy. This combination benefit is of direct clinical interest given the extensive use of TMZ and the associated problems with TMZ-related resistance and treatment failure.
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Affiliation(s)
- Jian Teng
- Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.,NeuroDiscovery Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Seyedali Hejazi
- Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.,NeuroDiscovery Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lotte Hiddingh
- Department of Neurosurgery, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pediatric Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Litia Carvalho
- Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.,NeuroDiscovery Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark C de Gooijer
- Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marco Barazas
- Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Marie Tannous
- Faculty of Natural and Applied Sciences, Notre Dame University-Louaize, Zouk Mosbeh, Lebanon
| | - Andrew S Chi
- Division of Neuro-Oncology, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York, USA
| | - David P Noske
- Department of Neurosurgery, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.,Neuro-oncology Research Group, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Pieter Wesseling
- Neuro-oncology Research Group, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Wurdinger
- Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.,NeuroDiscovery Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.,Neuro-oncology Research Group, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Tracy T Batchelor
- Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.,Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bakhos A Tannous
- Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.,NeuroDiscovery Center, Harvard Medical School, Boston, Massachusetts, USA
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26
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Johnson DR, Kaufmann TJ, Patel SH, Chi AS, Snuderl M, Jain R. There is an exception to every rule—T2-FLAIR mismatch sign in gliomas. Neuroradiology 2018; 61:225-227. [DOI: 10.1007/s00234-018-2148-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
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27
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Spino M, Kurz SC, Chiriboga L, Serrano J, Zeck B, Sen N, Patel S, Shen G, Vasudevaraja V, Tsirigos A, Suryadevara CM, Frenster JD, Tateishi K, Wakimoto H, Jain R, Riina HA, Nicolaides TP, Sulman EP, Cahill DP, Golfinos JG, Isse K, Saunders LR, Zagzag D, Placantonakis DG, Snuderl M, Chi AS. Cell Surface Notch Ligand DLL3 is a Therapeutic Target in Isocitrate Dehydrogenase-mutant Glioma. Clin Cancer Res 2018; 25:1261-1271. [PMID: 30397180 DOI: 10.1158/1078-0432.ccr-18-2312] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Isocitrate dehydrogenase (IDH)-mutant glioma is a distinct glioma molecular subtype for which no effective molecularly directed therapy exists. Low-grade gliomas, which are 80%-90% IDH-mutant, have high RNA levels of the cell surface Notch ligand DLL3. We sought to determine DLL3 expression by IHC in glioma molecular subtypes and the potential efficacy of an anti-DLL3 antibody-drug conjugate (ADC), rovalpituzumab tesirine (Rova-T), in IDH-mutant glioma. EXPERIMENTAL DESIGN We evaluated DLL3 expression by RNA using TCGA data and by IHC in a discovery set of 63 gliomas and 20 nontumor brain tissues and a validation set of 62 known IDH wild-type and mutant gliomas using a monoclonal anti-DLL3 antibody. Genotype was determined using a DNA methylation array classifier or by sequencing. The effect of Rova-T on patient-derived endogenous IDH-mutant glioma tumorspheres was determined by cell viability assay. RESULTS Compared to IDH wild-type glioblastoma, IDH-mutant gliomas have significantly higher DLL3 RNA (P < 1 × 10-15) and protein by IHC (P = 0.0014 and P < 4.3 × 10-6 in the discovery and validation set, respectively). DLL3 immunostaining was intense and homogeneous in IDH-mutant gliomas, retained in all recurrent tumors, and detected in only 1 of 20 nontumor brains. Patient-derived IDH-mutant glioma tumorspheres overexpressed DLL3 and were potently sensitive to Rova-T in an antigen-dependent manner. CONCLUSIONS DLL3 is selectively and homogeneously expressed in IDH-mutant gliomas and can be targeted with Rova-T in patient-derived IDH-mutant glioma tumorspheres. Our findings are potentially immediately translatable and have implications for therapeutic strategies that exploit cell surface tumor-associated antigens.
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Affiliation(s)
- Marissa Spino
- Department of Pathology, NYU Langone Health, New York, New York
| | - Sylvia C Kurz
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Luis Chiriboga
- Department of Pathology, NYU Langone Health, New York, New York
| | | | - Briana Zeck
- Department of Pathology, NYU Langone Health, New York, New York
| | - Namita Sen
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Seema Patel
- Department of Pathology, NYU Langone Health, New York, New York
| | - Guomiao Shen
- Department of Pathology, NYU Langone Health, New York, New York
| | | | - Aristotelis Tsirigos
- Department of Pathology, NYU Langone Health, New York, New York.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | | | | | - Kensuke Tateishi
- Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Rajan Jain
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York.,Department of Neurosurgery, NYU Langone Health, New York, New York.,Department of Radiology, NYU Langone Health, New York, New York
| | - Howard A Riina
- Department of Neurosurgery, NYU Langone Health, New York, New York
| | - Theodore P Nicolaides
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York.,Department of Pediatrics, NYU Langone Health, New York, New York
| | - Erik P Sulman
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York.,Departments of Radiation Oncology, Translational Molecular Pathology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Radiation Oncology, NYU Langone Health, New York, New York
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John G Golfinos
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York.,Department of Neurosurgery, NYU Langone Health, New York, New York
| | - Kumiko Isse
- AbbVie Stemcentrx LLC, San Francisco, California
| | | | - David Zagzag
- Department of Pathology, NYU Langone Health, New York, New York.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Dimitris G Placantonakis
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York.,Department of Neurosurgery, NYU Langone Health, New York, New York
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, New York.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Andrew S Chi
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York. .,Department of Neurosurgery, NYU Langone Health, New York, New York
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28
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Wu CC, Jain R, Radmanesh A, Poisson LM, Guo WY, Zagzag D, Snuderl M, Placantonakis DG, Golfinos J, Chi AS. Predicting Genotype and Survival in Glioma Using Standard Clinical MR Imaging Apparent Diffusion Coefficient Images: A Pilot Study from The Cancer Genome Atlas. AJNR Am J Neuroradiol 2018; 39:1814-1820. [PMID: 30190259 DOI: 10.3174/ajnr.a5794] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Few studies have shown MR imaging features and ADC correlating with molecular markers and survival in patients with glioma. Our purpose was to correlate MR imaging features and ADC with molecular subtyping and survival in adult diffuse gliomas. MATERIALS AND METHODS Presurgical MRIs and ADC maps of 131 patients with diffuse gliomas and available molecular and survival data from The Cancer Genome Atlas were reviewed. MR imaging features, ADC (obtained by ROIs within the lowest ADC area), and mean relative ADC values were evaluated to predict isocitrate dehydrogenase (IDH) mutation, 1p/19q codeletion status, MGMT promoter methylation, and overall survival. RESULTS IDH wild-type gliomas tended to exhibit enhancement, necrosis, and edema; >50% enhancing area (P < .001); absence of a cystic area (P = .013); and lower mean relative ADC (median, 1.1 versus 1.6; P < .001) than IDH-mutant gliomas. By means of a cutoff value of 1.08 for mean relative ADC, IDH-mutant and IDH wild-type gliomas with lower mean relative ADC (<1.08) had poorer survival than those with higher mean relative ADC (median survival time, 24.2 months; 95% CI, 0.0-54.9 months versus 62.0 months; P = .003; and median survival time, 10.4 months; 95% CI, 4.4-16.4 months versus 17.7 months; 95% CI, 11.6-23.7 months; P = .041, respectively), regardless of World Health Organization grade. Median survival of those with IDH-mutant glioma with low mean relative ADC was not significantly different from that in those with IDH wild-type glioma. Other MR imaging features were not statistically significant predictors of survival. CONCLUSIONS IDH wild-type glioma showed lower ADC values, which also correlated with poor survival in both IDH-mutant and IDH wild-type gliomas, irrespective of histologic grade. A subgroup with IDH-mutant gliomas with lower ADC had dismal survival similar to that of those with IDH wild-type gliomas.
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Affiliation(s)
- C-C Wu
- From the Department of Radiology (C.-C.W., W.-Y.G.), Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine (C.-C.W., W.-Y.G.), National Yang-Ming University, Taipei, Taiwan, Republic of China
- Departments of Radiology (C.-C.W., R.J., A.R.)
| | - R Jain
- Departments of Radiology (C.-C.W., R.J., A.R.)
- Neurosurgery (R.J., D.P., J.G.)
| | - A Radmanesh
- Departments of Radiology (C.-C.W., R.J., A.R.)
| | - L M Poisson
- Department of Public Health Sciences and Hermelin Brain Tumor Center (L.M.P.), Henry Ford Hospital, Detroit, Michigan
| | - W-Y Guo
- From the Department of Radiology (C.-C.W., W.-Y.G.), Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine (C.-C.W., W.-Y.G.), National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - D Zagzag
- Pathology (D.Z., M.S.), NYU School of Medicine, New York, New York
| | - M Snuderl
- Pathology (D.Z., M.S.), NYU School of Medicine, New York, New York
| | | | | | - A S Chi
- Neuro-Oncology Program (A.S.C.), Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine and Langone Health, New York, New York
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Blakeley JO, Grossman SA, Chi AS, Mikkelsen T, Rosenfeld MR, Ahluwalia MS, Nabors LB, Eichler A, Ribas IG, Desideri S, Ye X. Phase II Study of Iniparib with Concurrent Chemoradiation in Patients with Newly Diagnosed Glioblastoma. Clin Cancer Res 2018; 25:73-79. [PMID: 30131387 DOI: 10.1158/1078-0432.ccr-18-0110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/04/2018] [Accepted: 08/16/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Iniparib is a purported prodrug causing cell death through intracellular conversion to nitro radical ions. We assessed the efficacy and safety of iniparib with standard radiotherapy and temozolomide in patients with newly diagnosed glioblastoma (GBM). PATIENTS AND METHODS Adults meeting eligibility criteria were enrolled in this prospective, single-arm, open-label multi- institution phase II trial with median overall survival (mOS) compared with a historical control as the primary objective. A safety run-in component of radiotherapy + temozolomide + iniparib (n = 5) was followed by an efficacy study (n = 76) with the recommended phase II doses of iniparib (8.0 mg/kg i.v. twice/week with radiotherapy + daily temozolomide followed by 8.6 mg/kg i.v. twice/week with 5/28-day temozolomide). RESULTS The median age of the 81 evaluable participants was 58 years (63% male). Baseline KPS was ≥ 80% in 87% of participants. The mOS was 22 months [95% confidence interval (CI), 17-24] and the HR was 0.44 (95% CI, 0.35-0.55) per-person-year of follow-up. The 2- and 3-year survival rates were 38% and 25%, respectively. Treatment-related grade 3 adverse events (AEs) occurred in 27% of patients; 9 patients had AEs requiring drug discontinuation including infusion-related reaction, rash, gastritis, increased liver enzymes, and thrombocytopenia. CONCLUSIONS Iniparib is well tolerated with radiotherapy and temozolomide in patients with newly diagnosed GBM at up to 17.2 mg/kg weekly. The primary objective of improved mOS compared with a historical control was met, indicating potential antitumor activity of iniparib in this setting. Dosing optimization (frequency and sequence) is needed prior to additional efficacy studies.
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Affiliation(s)
- Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland. .,Department of Oncology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stuart A Grossman
- Department of Oncology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew S Chi
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | | | - Myrna R Rosenfeld
- Institute for Biomedical Research (IDIBAPS)/Hospital Clinic, Barcelona, Spain
| | | | - L Burt Nabors
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - April Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Serena Desideri
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaobu Ye
- Department of Oncology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Modrek AS, Golub D, Khan T, Bready D, Prado J, Bowman C, Deng J, Zhang G, Rocha PP, Raviram R, Lazaris C, Stafford JM, LeRoy G, Kader M, Dhaliwal J, Bayin NS, Frenster JD, Serrano J, Chiriboga L, Baitalmal R, Nanjangud G, Chi AS, Golfinos JG, Wang J, Karajannis MA, Bonneau RA, Reinberg D, Tsirigos A, Zagzag D, Snuderl M, Skok JA, Neubert TA, Placantonakis DG. Low-Grade Astrocytoma Mutations in IDH1, P53, and ATRX Cooperate to Block Differentiation of Human Neural Stem Cells via Repression of SOX2. Cell Rep 2018; 21:1267-1280. [PMID: 29091765 DOI: 10.1016/j.celrep.2017.10.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/24/2017] [Accepted: 10/02/2017] [Indexed: 02/07/2023] Open
Abstract
Low-grade astrocytomas (LGAs) carry neomorphic mutations in isocitrate dehydrogenase (IDH) concurrently with P53 and ATRX loss. To model LGA formation, we introduced R132H IDH1, P53 shRNA, and ATRX shRNA into human neural stem cells (NSCs). These oncogenic hits blocked NSC differentiation, increased invasiveness in vivo, and led to a DNA methylation and transcriptional profile resembling IDH1 mutant human LGAs. The differentiation block was caused by transcriptional silencing of the transcription factor SOX2 secondary to disassociation of its promoter from a putative enhancer. This occurred because of reduced binding of the chromatin organizer CTCF to its DNA motifs and disrupted chromatin looping. Our human model of IDH mutant LGA formation implicates impaired NSC differentiation because of repression of SOX2 as an early driver of gliomagenesis.
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Affiliation(s)
- Aram S Modrek
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA
| | - Danielle Golub
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA
| | - Themasap Khan
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA
| | - Devin Bready
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA
| | - Jod Prado
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA
| | - Christopher Bowman
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA
| | - Jingjing Deng
- Department of Cell Biology, NYU School of Medicine, New York, NY 10016, USA
| | - Guoan Zhang
- Department of Cell Biology, NYU School of Medicine, New York, NY 10016, USA
| | - Pedro P Rocha
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA
| | - Ramya Raviram
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA
| | - Charalampos Lazaris
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA; Applied Bioinformatics Center, NYU School of Medicine, New York, NY 10016, USA
| | - James M Stafford
- Department of Biochemistry and Molecular Pharmacology, NYU School of Medicine, New York, NY 10016, USA
| | - Gary LeRoy
- Department of Biochemistry and Molecular Pharmacology, NYU School of Medicine, New York, NY 10016, USA
| | - Michael Kader
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA
| | - Joravar Dhaliwal
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA
| | - N Sumru Bayin
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA; Kimmel Center for Stem Cell Biology, NYU School of Medicine, New York, NY 10016, USA
| | - Joshua D Frenster
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA; Kimmel Center for Stem Cell Biology, NYU School of Medicine, New York, NY 10016, USA
| | - Jonathan Serrano
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA
| | - Luis Chiriboga
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA
| | - Rabaa Baitalmal
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA
| | - Gouri Nanjangud
- Molecular Cytogenetics Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andrew S Chi
- Department of Neurology, NYU School of Medicine, New York, NY 10016, USA; Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY 10016, USA; Brain Tumor Center, NYU School of Medicine, New York, NY 10016, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA; Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY 10016, USA; Brain Tumor Center, NYU School of Medicine, New York, NY 10016, USA
| | - Jing Wang
- Department of Anesthesiology, NYU School of Medicine, New York, NY 10016, USA
| | - Matthias A Karajannis
- Department of Pediatrics, NYU School of Medicine, New York, NY 10016, USA; Department of Otolaryngology, NYU School of Medicine, New York, NY 10016, USA
| | - Richard A Bonneau
- Department of Biology, New York University, New York, New York, 10003, USA; Department of Computer Science, New York University, New York, New York, 10003, USA; Simons Center for Data Analysis, New York, NY 10010, USA
| | - Danny Reinberg
- Department of Biochemistry and Molecular Pharmacology, NYU School of Medicine, New York, NY 10016, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
| | - Aristotelis Tsirigos
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA; Applied Bioinformatics Center, NYU School of Medicine, New York, NY 10016, USA
| | - David Zagzag
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA; Department of Pathology, NYU School of Medicine, New York, NY 10016, USA; Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY 10016, USA; Brain Tumor Center, NYU School of Medicine, New York, NY 10016, USA
| | - Matija Snuderl
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA; Department of Neurology, NYU School of Medicine, New York, NY 10016, USA; Brain Tumor Center, NYU School of Medicine, New York, NY 10016, USA
| | - Jane A Skok
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA
| | - Thomas A Neubert
- Department of Cell Biology, NYU School of Medicine, New York, NY 10016, USA
| | - Dimitris G Placantonakis
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA; Kimmel Center for Stem Cell Biology, NYU School of Medicine, New York, NY 10016, USA; Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY 10016, USA; Brain Tumor Center, NYU School of Medicine, New York, NY 10016, USA; Neuroscience Institute, NYU School of Medicine, New York, NY 10016, USA.
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31
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Kurz SC, Kelly S, Vasudevaraja V, Liechty B, Bledea R, Wu P, Serrano J, Katz LM, Silverman JS, Pacione D, Russel S, Sen C, Golfinos J, Chi AS, Snuderl M. Characterization of clinically aggressive meningiomas by mutational signatures associated with DNA mismatch repair and aging. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e14044] [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: 11/20/2022] Open
Affiliation(s)
| | - Stephen Kelly
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | | | - Ramona Bledea
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - Peter Wu
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | - Leah M. Katz
- New York Presbyterian Hudson Valley Hospital, Peekskill, NY
| | | | - Donato Pacione
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | - Chandra Sen
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - John Golfinos
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - Andrew S. Chi
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - Matija Snuderl
- NYU Langone Medical Center and School of Medicine, New York, NY
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32
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Albacker LA, Pavlick D, Ross JS, Lesser GJ, Corona RJ, Colman H, Groves MD, Hsu SH, Chi AS, Miller VA, Frampton GM, Ramkissoon S. Comprehensive genomic profiling of brain tumors to provide targeted therapy options and diagnostic certainty for oligodendrogliomas. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2039] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Andrew S. Chi
- NYU Langone Medical Center and School of Medicine, New York, NY
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Chi AS, Gardner SL, Arrillaga I, Wen PY, Batchelor T, Hall MD, Odia Y, Zaky WT, Khatua S, Shonka NA, Khatib Z, Tarapore R, Schalop L, Allen JE, Oster W, Mehta MP. Integrated clinical experience with ONC201 in H3 K27M glioma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrew S. Chi
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | | | | | - Patrick Y. Wen
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA
| | | | | | - Yazmin Odia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | | | - Soumen Khatua
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Andronesi OC, Arrillaga-Romany IC, Ly KI, Bogner W, Ratai EM, Reitz K, Iafrate AJ, Dietrich J, Gerstner ER, Chi AS, Rosen BR, Wen PY, Cahill DP, Batchelor TT. Pharmacodynamics of mutant-IDH1 inhibitors in glioma patients probed by in vivo 3D MRS imaging of 2-hydroxyglutarate. Nat Commun 2018; 9:1474. [PMID: 29662077 PMCID: PMC5902553 DOI: 10.1038/s41467-018-03905-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 03/21/2018] [Indexed: 12/27/2022] Open
Abstract
Inhibitors of the mutant isocitrate dehydrogenase 1 (IDH1) entered recently in clinical trials for glioma treatment. Mutant IDH1 produces high levels of 2-hydroxyglurate (2HG), thought to initiate oncogenesis through epigenetic modifications of gene expression. In this study, we show the initial evidence of the pharmacodynamics of a new mutant IDH1 inhibitor in glioma patients, using non-invasive 3D MR spectroscopic imaging of 2HG. Our results from a Phase 1 clinical trial indicate a rapid decrease of 2HG levels by 70% (CI 13%, P = 0.019) after 1 week of treatment. Importantly, inhibition of mutant IDH1 may lead to the reprogramming of tumor metabolism, suggested by simultaneous changes in glutathione, glutamine, glutamate, and lactate. An inverse correlation between metabolic changes and diffusion MRI indicates an effect on the tumor-cell density. We demonstrate a feasible radiopharmacodynamics approach to support the rapid clinical translation of rationally designed drugs targeting IDH1/2 mutations for personalized and precision medicine of glioma patients.
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Affiliation(s)
- Ovidiu C Andronesi
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, 02129, USA.
| | - Isabel C Arrillaga-Romany
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| | - K Ina Ly
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| | - Wolfgang Bogner
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, 1090, Austria
| | - Eva M Ratai
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, 02129, USA
| | - Kara Reitz
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Center for Integrated Diagnostics, Harvard Medical School, Boston, MA, 02114, USA
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| | - Elizabeth R Gerstner
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrew S Chi
- Brain Tumor Center, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center and School of Medicine, New York, NY, 10016, USA
| | - Bruce R Rosen
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, 02129, USA
| | - Patrick Y Wen
- Dana-Farber Cancer Institute, Boston, MA, 02284, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Tracy T Batchelor
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
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Affiliation(s)
| | - Christine Cordova
- Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY
| | - Andrew S Chi
- Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY
| | - Rajan Jain
- Department of Radiology, NYU School of Medicine, New York, NY; Department of Neurosurgery, NYU School of Medicine, New York, NY.
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Tateishi K, Miller J, Higuchi F, Koerner MVA, Lelic N, Curry W, Batchelor T, Wakimoto H, Chi AS, Cahill D. EXTH-14. THE ALKYLATING CHEMOTHERAPEUTIC TEMOZOLOMIDE INDUCES METABOLIC STRESS AND POTENTIATES NAD+ DEPLETION-MEDIATED CELL DEATH IN IDH1 MUTANT CANCERS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chi AS, Stafford JM, Sen N, Possemato R, Placantonakis D, Hidalgo ET, Harter D, Wisoff J, Golfinos J, Arrillaga-Romany I, Batchelor T, Wen P, Wakimoto H, Cahill D, Allen JE, Oster W, Snuderl M. EXTH-42. H3 K27M MUTANT GLIOMAS ARE SELECTIVELY KILLED BY ONC201, A SMALL MOLECULE INHIBITOR OF DOPAMINE RECEPTOR D2. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kader M, Frenster J, Liechty B, Modrek A, Tsirigos A, Golfinos J, Eisele S, Jain R, Shepherd T, Fatterpekar G, MacNeil D, Shohdy N, Huang X, Chi AS, Snuderl M, Zagzag D, Placantonakis D. CBIO-19. CHARACTERIZATION OF GPR133 EXPRESSION IN GLIOMA SUBTYPES. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jain R, Poisson LM, Littig I, Neto L, Wu CC, Ng V, Patel SH, Snuderl M, Zagzag D, Golfinos J, Chi AS. NIMG-33. CORRELATION BETWEEN IDH MUTATION STATUS, PATIENT SURVIVAL, AND BLOOD VOLUME ESTIMATES IN DIFFUSE GLIOMAS: A TCGA/TCIA PROJECT. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cordova C, Corless B, Syeda M, Patel A, Delara M, Eisele S, Schafrick J, Placantonakis D, Pacione D, Silverman J, Fatterpekar G, Shepherd T, Jain R, Snuderl M, Zagzag D, Golfinos J, Jafar JJ, Shao Y, Karlin-Neumann G, Polsky D, Chi AS. PATH-42. DETECTION OF TERT MUTATIONS IN CELL-FREE CIRCULATING TUMOR DNA (ctDNA) OF GLIOBLASTOMA PATIENTS USING DROPLET DIGITAL PCR. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kloetgen A, Serrano J, Patel S, Bowman C, Shen G, Zagzag D, Karajannis M, Golfinos J, Placantonakis D, Tsirigos A, Chi AS, Snuderl M. GENE-02. PERIPHERAL BLOOD DNA METHYLATION PROFILES IDENTIFY IDH1/2 MUTATION STATUS IN ADULTS WITH DIFFUSE GLIOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wu CC, Jain R, Patel S, Neto L, Zagzag D, Placantonakis D, Golfinos J, Chi AS, Snuderl M. NIMG-48. MR IMAGING PHENOTYPE CORRELATES WITH EXTENT OF GENOME-WIDE COPY NUMBER ABUNDANCE IN IDH MUTATED GLIOMAS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cordova C, Chi AS, Chachoua A, Kondziolka D, Silverman JS, Shepherd TM, Jain R, Snuderl M. Osimertinib Dose Escalation Induces Regression of Progressive EGFR T790M–Mutant Leptomeningeal Lung Adenocarcinoma. J Thorac Oncol 2017; 12:e188-e190. [DOI: 10.1016/j.jtho.2017.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
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Esaki S, Nigim F, Moon E, Luk S, Kiyokawa J, Curry W, Cahill DP, Chi AS, Iafrate AJ, Martuza RL, Rabkin SD, Wakimoto H. Blockade of transforming growth factor-β signaling enhances oncolytic herpes simplex virus efficacy in patient-derived recurrent glioblastoma models. Int J Cancer 2017; 141:2348-2358. [PMID: 28801914 DOI: 10.1002/ijc.30929] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 05/05/2017] [Revised: 07/17/2017] [Accepted: 08/02/2017] [Indexed: 12/13/2022]
Abstract
Despite the current standard of multimodal management, glioblastoma (GBM) inevitably recurs and effective therapy is not available for recurrent disease. A subset of tumor cells with stem-like properties, termed GBM stem-like cells (GSCs), are considered to play a role in tumor relapse. Although oncolytic herpes simplex virus (oHSV) is a promising therapeutic for GBM, its efficacy against recurrent GBM is incompletely characterized. Transforming growth factor beta (TGF-β) plays vital roles in maintaining GSC stemness and GBM pathogenesis. We hypothesized that oHSV and TGF-β inhibitors would synergistically exert antitumor effects for recurrent GBM. Here we established a panel of patient-derived recurrent tumor models from GBMs that relapsed after postsurgical radiation and chemotherapy, based on GSC-enriched tumor sphere cultures. These GSCs are resistant to the standard-of-care temozolomide but susceptible to oHSVs G47Δ and MG18L. Inhibition of TGF-β receptor kinase with selective targeted small molecules reduced clonogenic sphere formation in all tested recurrent GSCs. The combination of oHSV and TGF-βR inhibitor was synergistic in killing recurrent GSCs through, in part, an inhibitor-induced JNK-MAPK blockade and increase in oHSV replication. In vivo, systemic treatment with TGF-βR inhibitor greatly enhanced the antitumor effects of single intratumoral oHSV injections, resulting in cures in 60% of mice bearing orthotopic recurrent GBM. These results reveal a novel synergistic interaction of oHSV therapy and TGF-β signaling blockade, and warrant further investigations aimed at clinical translation of this combination strategy for GBM patients.
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Affiliation(s)
- Shinichi Esaki
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Fares Nigim
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Esther Moon
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Samantha Luk
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Juri Kiyokawa
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - William Curry
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andrew S Chi
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert L Martuza
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Samuel D Rabkin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Prabhu VV, Lulla AR, Madhukar NS, Ralff MD, Zhao D, Kline CLB, Van den Heuvel APJ, Lev A, Garnett MJ, McDermott U, Benes CH, Batchelor TT, Chi AS, Elemento O, Allen JE, El-Deiry WS. Cancer stem cell-related gene expression as a potential biomarker of response for first-in-class imipridone ONC201 in solid tumors. PLoS One 2017; 12:e0180541. [PMID: 28767654 PMCID: PMC5540272 DOI: 10.1371/journal.pone.0180541] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/16/2017] [Indexed: 11/21/2022] Open
Abstract
Cancer stem cells (CSCs) correlate with recurrence, metastasis and poor survival in clinical studies. Encouraging results from clinical trials of CSC inhibitors have further validated CSCs as therapeutic targets. ONC201 is a first-in-class small molecule imipridone in Phase I/II clinical trials for advanced cancer. We have previously shown that ONC201 targets self-renewing, chemotherapy-resistant colorectal CSCs via Akt/ERK inhibition and DR5/TRAIL induction. In this study, we demonstrate that the anti-CSC effects of ONC201 involve early changes in stem cell-related gene expression prior to tumor cell death induction. A targeted network analysis of gene expression profiles in colorectal cancer cells revealed that ONC201 downregulates stem cell pathways such as Wnt signaling and modulates genes (ID1, ID2, ID3 and ALDH7A1) known to regulate self-renewal in colorectal, prostate cancer and glioblastoma. ONC201-mediated changes in CSC-related gene expression were validated at the RNA and protein level for each tumor type. Accordingly, we observed inhibition of self-renewal and CSC markers in prostate cancer cell lines and patient-derived glioblastoma cells upon ONC201 treatment. Interestingly, ONC201-mediated CSC depletion does not occur in colorectal cancer cells with acquired resistance to ONC201. Finally, we observed that basal expression of CSC-related genes (ID1, CD44, HES7 and TCF3) significantly correlate with ONC201 efficacy in >1000 cancer cell lines and combining the expression of multiple genes leads to a stronger overall prediction. These proof-of-concept studies provide a rationale for testing CSC expression at the RNA and protein level as a predictive and pharmacodynamic biomarker of ONC201 response in ongoing clinical studies.
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Affiliation(s)
- Varun V. Prabhu
- Oncoceutics, Inc., Philadelphia, Pennsylvania, United States of America
- * E-mail: (WSED); (VVP)
| | - Amriti R. Lulla
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
- Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Neel S. Madhukar
- Weill Cornell Medicine, New York, New York, United States of America
| | - Marie D. Ralff
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - Dan Zhao
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Avital Lev
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | | | | | - Cyril H. Benes
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tracy T. Batchelor
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andrew S. Chi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Olivier Elemento
- Weill Cornell Medicine, New York, New York, United States of America
| | - Joshua E. Allen
- Oncoceutics, Inc., Philadelphia, Pennsylvania, United States of America
| | - Wafik S. El-Deiry
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
- * E-mail: (WSED); (VVP)
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46
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Affiliation(s)
- Andrew S Chi
- a Laura and Isaac Perlmutter Cancer Center and Brain Tumor Center , NYU Langone Medical Center and School of Medicine , New York , NY , USA
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47
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Patel SH, Poisson LM, Brat DJ, Zhou Y, Cooper L, Snuderl M, Thomas C, Franceschi AM, Griffith B, Flanders AE, Golfinos JG, Chi AS, Jain R. T2-FLAIR Mismatch, an Imaging Biomarker for IDH and 1p/19q Status in Lower-grade Gliomas: A TCGA/TCIA Project. Clin Cancer Res 2017; 23:6078-6085. [PMID: 28751449 DOI: 10.1158/1078-0432.ccr-17-0560] [Citation(s) in RCA: 231] [Impact Index Per Article: 33.0] [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: 02/24/2017] [Revised: 05/11/2017] [Accepted: 07/19/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Lower-grade gliomas (WHO grade II/III) have been classified into clinically relevant molecular subtypes based on IDH and 1p/19q mutation status. The purpose was to investigate whether T2/FLAIR MRI features could distinguish between lower-grade glioma molecular subtypes.Experimental Design: MRI scans from the TCGA/TCIA lower grade glioma database (n = 125) were evaluated by two independent neuroradiologists to assess (i) presence/absence of homogenous signal on T2WI; (ii) presence/absence of "T2-FLAIR mismatch" sign; (iii) sharp or indistinct lesion margins; and (iv) presence/absence of peritumoral edema. Metrics with moderate-substantial agreement underwent consensus review and were correlated with glioma molecular subtypes. Somatic mutation, DNA copy number, DNA methylation, gene expression, and protein array data from the TCGA lower-grade glioma database were analyzed for molecular-radiographic associations. A separate institutional cohort (n = 82) was analyzed to validate the T2-FLAIR mismatch sign.Results: Among TCGA/TCIA cases, interreader agreement was calculated for lesion homogeneity [κ = 0.234 (0.111-0.358)], T2-FLAIR mismatch sign [κ = 0.728 (0.538-0.918)], lesion margins [κ = 0.292 (0.135-0.449)], and peritumoral edema [κ = 0.173 (0.096-0.250)]. All 15 cases that were positive for the T2-FLAIR mismatch sign were IDH-mutant, 1p/19q non-codeleted tumors (P < 0.0001; PPV = 100%, NPV = 54%). Analysis of the validation cohort demonstrated substantial interreader agreement for the T2-FLAIR mismatch sign [κ = 0.747 (0.536-0.958)]; all 10 cases positive for the T2-FLAIR mismatch sign were IDH-mutant, 1p/19q non-codeleted tumors (P < 0.00001; PPV = 100%, NPV = 76%).Conclusions: Among lower-grade gliomas, T2-FLAIR mismatch sign represents a highly specific imaging biomarker for the IDH-mutant, 1p/19q non-codeleted molecular subtype. Clin Cancer Res; 23(20); 6078-85. ©2017 AACR.
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Affiliation(s)
- Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
| | - Laila M Poisson
- Department of Public Health, Henry Ford Health System, Detroit, Michigan
| | - Daniel J Brat
- Department of Pathology and Laboratory Medicine, Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Yueren Zhou
- Department of Public Health, Henry Ford Health System, Detroit, Michigan
| | - Lee Cooper
- Department of Biomedical Informatics, Emory School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia
| | - Matija Snuderl
- Department of Pathology, NYU Langone Medical Center, New York, New York
| | - Cheddhi Thomas
- Department of Pathology, NYU Langone Medical Center, New York, New York
| | - Ana M Franceschi
- Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Adam E Flanders
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
| | - Andrew S Chi
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
- Division of Neuro-Oncology, NYU Langone Medical Center, New York, New York
| | - Rajan Jain
- Department of Radiology, NYU Langone Medical Center, New York, New York.
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
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48
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Tateishi K, Higuchi F, Miller JJ, Koerner MVA, Lelic N, Shankar GM, Tanaka S, Fisher DE, Batchelor TT, Iafrate AJ, Wakimoto H, Chi AS, Cahill DP. The Alkylating Chemotherapeutic Temozolomide Induces Metabolic Stress in IDH1-Mutant Cancers and Potentiates NAD + Depletion-Mediated Cytotoxicity. Cancer Res 2017. [PMID: 28625978 DOI: 10.1158/0008-5472.can-16-2263] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IDH1-mutant gliomas are dependent upon the canonical coenzyme NAD+ for survival. It is known that PARP activation consumes NAD+ during base excision repair (BER) of chemotherapy-induced DNA damage. We therefore hypothesized that a strategy combining NAD+ biosynthesis inhibitors with the alkylating chemotherapeutic agent temozolomide could potentiate NAD+ depletion-mediated cytotoxicity in mutant IDH1 cancer cells. To investigate the impact of temozolomide on NAD+ metabolism, patient-derived xenografts and engineered mutant IDH1-expressing cell lines were exposed to temozolomide, in vitro and in vivo, both alone and in combination with nicotinamide phosphoribosyltransferase (NAMPT) inhibitors, which block NAD+ biosynthesis. The acute time period (<3 hours) after temozolomide treatment displayed a burst of NAD+ consumption driven by PARP activation. In IDH1-mutant-expressing cells, this consumption reduced further the abnormally lowered basal steady-state levels of NAD+, introducing a window of hypervulnerability to NAD+ biosynthesis inhibitors. This effect was selective for IDH1-mutant cells and independent of methylguanine methyltransferase or mismatch repair status, which are known rate-limiting mediators of adjuvant temozolomide genotoxic sensitivity. Combined temozolomide and NAMPT inhibition in an in vivo IDH1-mutant cancer model exhibited enhanced efficacy compared with each agent alone. Thus, we find IDH1-mutant cancers have distinct metabolic stress responses to chemotherapy-induced DNA damage and that combination regimens targeting nonredundant NAD+ pathways yield potent anticancer efficacy in vivo Such targeting of convergent metabolic pathways in genetically selected cancers could minimize treatment toxicity and improve durability of response to therapy. Cancer Res; 77(15); 4102-15. ©2017 AACR.
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Affiliation(s)
- Kensuke Tateishi
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Yokohama City University, Yokohama, Kanagawa, Japan.,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Fumi Higuchi
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Julie J Miller
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Mara V A Koerner
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Nina Lelic
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Shota Tanaka
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - David E Fisher
- Department of Dermatology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Tracy T Batchelor
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - A John Iafrate
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. .,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew S Chi
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. .,Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. .,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
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49
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Andronesi OC, Esmaeili M, Borra RJH, Emblem K, Gerstner ER, Pinho MC, Plotkin SR, Chi AS, Eichler AF, Dietrich J, Ivy SP, Wen PY, Duda DG, Jain R, Rosen BR, Sorensen GA, Batchelor TT. Early changes in glioblastoma metabolism measured by MR spectroscopic imaging during combination of anti-angiogenic cediranib and chemoradiation therapy are associated with survival. NPJ Precis Oncol 2017; 1:20. [PMID: 29202103 PMCID: PMC5708878 DOI: 10.1038/s41698-017-0020-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/13/2022] Open
Abstract
Precise assessment of treatment response in glioblastoma during combined anti-angiogenic and chemoradiation remains a challenge. In particular, early detection of treatment response by standard anatomical imaging is confounded by pseudo-response or pseudo-progression. Metabolic changes may be more specific for tumor physiology and less confounded by changes in blood-brain barrier permeability. We hypothesize that metabolic changes probed by magnetic resonance spectroscopic imaging can stratify patient response early during combination therapy. We performed a prospective longitudinal imaging study in newly diagnosed glioblastoma patients enrolled in a phase II clinical trial of the pan-vascular endothelial growth factor receptor inhibitor cediranib in combination with standard fractionated radiation and temozolomide (chemoradiation). Forty patients were imaged weekly during therapy with an imaging protocol that included magnetic resonance spectroscopic imaging, perfusion magnetic resonance imaging, and anatomical magnetic resonance imaging. Data were analyzed using receiver operator characteristics, Cox proportional hazards model, and Kaplan-Meier survival plots. We observed that the ratio of total choline to healthy creatine after 1 month of treatment was significantly associated with overall survival, and provided as single parameter: (1) the largest area under curve (0.859) in receiver operator characteristics, (2) the highest hazard ratio (HR = 85.85, P = 0.006) in Cox proportional hazards model, (3) the largest separation (P = 0.004) in Kaplan-Meier survival plots. An inverse correlation was observed between total choline/healthy creatine and cerebral blood flow, but no significant relation to tumor volumetrics was identified. Our results suggest that in vivo metabolic biomarkers obtained by magnetic resonance spectroscopic imaging may be an early indicator of response to anti-angiogenic therapy combined with standard chemoradiation in newly diagnosed glioblastoma.
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Affiliation(s)
- Ovidiu C. Andronesi
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Morteza Esmaeili
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Present Address: Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ronald J. H. Borra
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Medical Imaging Centre of Southwest Finland, Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland
- Present Address: Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kyrre Emblem
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Present Address: The Intervention Centre, Clinic for Diagnostics and Intervention, Oslo University Hospital, Oslo, Norway
| | - Elizabeth R. Gerstner
- Stephen E. and Catherine Pappas Center of Neuro-Oncology, Departments of Neurology, Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Marco C. Pinho
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Present Address: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75235 USA
| | - Scott R. Plotkin
- Stephen E. and Catherine Pappas Center of Neuro-Oncology, Departments of Neurology, Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Andrew S. Chi
- Stephen E. and Catherine Pappas Center of Neuro-Oncology, Departments of Neurology, Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Present Address: Brain Tumor Center, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center and School of Medicine, New York, NY 10016 USA
| | - April F. Eichler
- Stephen E. and Catherine Pappas Center of Neuro-Oncology, Departments of Neurology, Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Present Address: Department of Neurology, Maine Medical Center, Portland, ME 04074 USA
| | - Jorg Dietrich
- Stephen E. and Catherine Pappas Center of Neuro-Oncology, Departments of Neurology, Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - S. Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD 20892 USA
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02114 USA
| | - Dan G. Duda
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Rakesh Jain
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Bruce R. Rosen
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Gregory A. Sorensen
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Present Address: IMRIS, Deerfield Imaging, Minnetonka, MN 55343 USA
| | - Tracy T. Batchelor
- Stephen E. and Catherine Pappas Center of Neuro-Oncology, Departments of Neurology, Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
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50
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Kalpathy-Cramer J, Chandra V, Da X, Ou Y, Emblem KE, Muzikansky A, Cai X, Douw L, Evans JG, Dietrich J, Chi AS, Wen PY, Stufflebeam S, Rosen B, Duda DG, Jain RK, Batchelor TT, Gerstner ER. Phase II study of tivozanib, an oral VEGFR inhibitor, in patients with recurrent glioblastoma. J Neurooncol 2017; 131:603-610. [PMID: 27853960 PMCID: PMC7672995 DOI: 10.1007/s11060-016-2332-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
Targeting tumor angiogenesis is a potential therapeutic strategy for glioblastoma because of its high vascularization. Tivozanib is an oral pan-VEGF receptor tyrosine kinase inhibitor that hits a central pathway in glioblastoma angiogenesis. We conducted a phase II study to test the effectiveness of tivozanib in patients with recurrent glioblastoma. Ten adult patients were enrolled and treated with tivozanib 1.5 mg daily, 3 weeks on/1 week off in 28-day cycles. Brain MRI and blood biomarkers of angiogenesis were performed at baseline, within 24-72 h of treatment initiation, and monthly thereafter. Dynamic contrast enhanced MRI, dynamic susceptibility contrast MRI, and vessel architecture imaging were used to assess vascular effects. Resting state MRI was used to assess brain connectivity. Best RANO criteria responses were: 1 complete response, 1 partial response, 4 stable diseases, and 4 progressive disease (PD). Two patients were taken off study for toxicity and 8 patients were taken off study for PD. Median progression-free survival was 2.3 months and median overall survival was 8.1 months. Baseline abnormal tumor vascular permeability, blood flow, tissue oxygenation and plasma sVEGFR2 significantly decreased and plasma PlGF and VEGF increased after treatment, suggesting an anti-angiogenic effect of tivozanib. However, there were no clear structural changes in vasculature as vessel caliber and enhancing tumor volume did not significantly change. Despite functional changes in tumor vasculature, tivozanib had limited anti-tumor activity, highlighting the limitations of anti-VEGF monotherapy. Future studies in glioblastoma should leverage the anti-vascular activity of agents targeting VEGF to enhance the activity of other therapies.
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Affiliation(s)
| | - Vyshak Chandra
- Martinos Center for Biomedical Imaging, Charlestown, USA
| | - Xiao Da
- Martinos Center for Biomedical Imaging, Charlestown, USA
| | - Yangming Ou
- Martinos Center for Biomedical Imaging, Charlestown, USA
| | - Kyrre E Emblem
- Martinos Center for Biomedical Imaging, Charlestown, USA
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Alona Muzikansky
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Yawkey 9E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Xuezhu Cai
- Martinos Center for Biomedical Imaging, Charlestown, USA
| | - Linda Douw
- Martinos Center for Biomedical Imaging, Charlestown, USA
- Department of Anatomy and Neuroscience/VUmc CCA Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - John G Evans
- Martinos Center for Biomedical Imaging, Charlestown, USA
| | - Jorg Dietrich
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Yawkey 9E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Andrew S Chi
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | | | | | - Bruce Rosen
- Martinos Center for Biomedical Imaging, Charlestown, USA
| | - Dan G Duda
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Yawkey 9E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Rakesh K Jain
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Yawkey 9E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Tracy T Batchelor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Yawkey 9E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Elizabeth R Gerstner
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Yawkey 9E, 55 Fruit Street, Boston, MA, 02114, USA.
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