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Ghisai SA, van Hijfte L, Vallentgoed WR, Tesileanu CMS, de Heer I, Kros JM, Sanson M, Gorlia T, Wick W, Vogelbaum MA, Brandes AA, Franceschi E, Clement PM, Nowak AK, Golfinopoulos V, van den Bent MJ, French PJ, Hoogstrate Y. Epigenetic landscape reorganization and reactivation of embryonic development genes are associated with malignancy in IDH-mutant astrocytoma. bioRxiv 2024:2024.03.19.585212. [PMID: 38562747 PMCID: PMC10983878 DOI: 10.1101/2024.03.19.585212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Accurate grading of IDH-mutant gliomas defines patient prognosis and guides the treatment path. Histological grading is however difficult and, apart from CDKN2A/B homozygous deletions in IDH-mutant astrocytomas, there are no other objective molecular markers used for grading. Experimental Design: RNA-sequencing was conducted on primary IDH-mutant astrocytomas (n=138) included in the prospective CATNON trial, which was performed to assess the prognostic effect of adjuvant and concurrent temozolomide. We integrated the RNA sequencing data with matched DNA-methylation and NGS data. We also used multi-omics data from IDH-mutant astrocytomas included in the TCGA dataset and validated results on matched primary and recurrent samples from the GLASS-NL study. We used the DNA-methylation profiles to generate a Continuous Grading Coefficient (CGC) that is based on classification scores derived from a CNS-tumor classifier. We found that the CGC was an independent predictor of survival outperforming current WHO-CNS5 and methylation-based classification. Our RNA-sequencing analysis revealed four distinct transcription clusters that were associated with i) an upregulation of cell cycling genes; ii) a downregulation of glial differentiation genes; iii) an upregulation of embryonic development genes (e.g. HOX, PAX and TBX) and iv) an upregulation of extracellular matrix genes. The upregulation of embryonic development genes was associated with a specific increase of CpG island methylation near these genes.
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Tesileanu CMS, Pignatti F, Tognana E, Humphreys A. Queries Raised During Oncology Business Pipeline Meetings at the European Medicines Agency: A 5-Year Retrospective Analysis. Clin Pharmacol Ther 2023; 114:1043-1049. [PMID: 37539657 DOI: 10.1002/cpt.3015] [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] [Received: 05/24/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
The European Medicines Agency (EMA) offers guidance and support to pharmaceutical companies through bilateral discussions called business pipeline meetings (BPMs). An analysis of BPMs in oncology over a 5-year period was conducted to identify common topics and recurring queries. The documents of all BPMs available at the EMA regarding the field of oncology from January 1, 2018, to Decemer 31, 2022, were reviewed. For every query, a main category was assigned, and in case of multiple relevant topics, a secondary category was appointed too. For all queries, the follow-up offered by the EMA was documented, and whether the requested information was available. Subsequently, all queries were scanned for overlapping topics between meetings. From 2018 to 2022, 31 BPMs were held between the EMA and pharmaceutical companies to discuss oncology-related questions, for a total of 397 queries raised. They were classified into 24 topics, of which 15 were common topics (n ≥ 10 queries) with regulatory pathways/guidelines and trial design having the most queries. Post-BPM actions were taken or recommended by the EMA for 41.3% of queries, such as referrals to scientific advice or published guidelines. Forty-three queries were raised at more than one BPM. Targeted therapy, companion diagnostics, institutional collaboration, trial design, and regulatory pathways/guidelines were the most discussed topics in oncology BPMs, with molecular developments being the common denominator. Creating Q&A documents, publishing new guidelines, providing a framework for discussions, and questionnaire-based follow-up research can improve the quality of BPMs, and the accessibility of the information requested during the BPMs.
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Affiliation(s)
- C Mircea S Tesileanu
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, The Netherlands
- Department of Neurology, The Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Francesco Pignatti
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Enrico Tognana
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, The Netherlands
| | - Anthony Humphreys
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, The Netherlands
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Kros JM, Rushing E, Uwimana AL, Hernández-Laín A, Michotte A, Al-Hussaini M, Bielle F, Mawrin C, Marucci G, Tesileanu CMS, Stupp R, Baumert B, van den Bent M, French PJ, Gorlia T. Mitotic count is prognostic in IDH mutant astrocytoma without homozygous deletion of CDKN2A/B. Results of consensus panel review of EORTC trial 26053 (CATNON) and EORTC trial 22033-26033. Neuro Oncol 2023; 25:1443-1449. [PMID: 36571817 PMCID: PMC10398806 DOI: 10.1093/neuonc/noac282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Gliomas with IDH1/2 mutations without 1p19q codeletion have been identified as the distinct diagnostic entity of IDH mutant astrocytoma (IDHmut astrocytoma). Homozygous deletion of Cyclin-dependent kinase 4 inhibitor A/B (CDKN2A/B) has recently been incorporated in the grading of these tumors. The question of whether histologic parameters still contribute to prognostic information on top of the molecular classification, remains unanswered. Here we evaluated consensus histologic parameters for providing additional prognostic value in IDHmut astrocytomas. METHODS An international panel of seven neuropathologists scored 13 well-defined histologic features in virtual microscopy images of 192 IDHmut astrocytomas from EORTC trial 22033-26033 (low-grade gliomas) and 263 from EORTC 26053 (CATNON) (1p19q non-codeleted anaplastic glioma). For 192 gliomas the CDKN2A/B status was known. Consensus (agreement ≥ 4/7 panelists) histologic features were tested together with homozygous deletion (HD) of CDKN2A/B for independent prognostic power. RESULTS Among consensus histologic parameters, the mitotic count (cut-off of 2 mitoses per 10 high power fields standardized to a field diameter of 0.55 mm and an area of 0.24 mm2) significantly influences PFS (P = .0098) and marginally the OS (P = .07). Mitotic count also significantly affects the PFS of tumors with HD CDKN2A/B, but not the OS, possibly due to limited follow-up data. CONCLUSION The mitotic index (cut-off 2 per 10 40× HPF) is of prognostic significance in IDHmut astrocytomas without HD CDKN2A/B. Therefore, the mitotic index may direct the therapeutic approach for patients with IDHmut astrocytomas with native CDKN2A/B status.
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Affiliation(s)
- Johan M Kros
- Department of Pathology, Laboratory for Tumor Immunopathology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Elisabeth Rushing
- Department of Neuropathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Aimé L Uwimana
- European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Aurelio Hernández-Laín
- Department of Pathology (Neuropathology), Hospital Universitario 12 de Octubre Research Institute, Madrid, Spain
| | - Alex Michotte
- Medische Oncologie, Oncologisch Centrum, Academisch Ziekenhuis Vrije Universiteit Brussel (AZ-VUB), Brussel, Belgium
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Franck Bielle
- Sorbonne Université, AP-HP, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière, Charles Foix, Service de Neuropathologie, Paris, France
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - C Mircea S Tesileanu
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Roger Stupp
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brigitta Baumert
- Department of Radiation Oncology, MediClin Robert Janker Clinic and Clinical Cooperation Unit Neurooncology, University of Bonn Medical Centre, Bonn, Germany
| | | | - Pim J French
- Neurooncology Unit, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Thierry Gorlia
- European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium
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Tesileanu CMS, Michaleas S, Gonzalo Ruiz R, Mariz S, Fabriek BO, van Hennik PB, Dedorath J, Dekic B, Unkrig C, Brandt A, Koenig J, Enzmann H, Delgado J, Pignatti F. The EMA Assessment of Asciminib for the Treatment of Adult Patients With Philadelphia Chromosome-Positive Chronic Myeloid Leukemia in Chronic Phase Who Were Previously Treated With At Least 2 Tyrosine Kinase Inhibitors. Oncologist 2023:7152421. [PMID: 37141403 DOI: 10.1093/oncolo/oyad119] [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] [Received: 01/16/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023] Open
Abstract
Asciminib is an allosteric high-affinity tyrosine kinase inhibitor (TKI) of the BCR-ABL1 protein kinase. This kinase is translated from the Philadelphia chromosome in chronic myeloid leukemia (CML). Marketing authorization for asciminib was granted on August 25, 2022 by the European Commission. The approved indication was for patients with Philadelphia chromosome-positive CML in the chronic phase which have previously been treated with at least 2 TKIs. Clinical efficacy and safety of asciminib were evaluated in the open-label, randomized, phase III ASCEMBL study. The primary endpoint of this trial was major molecular response (MMR) rate at 24 weeks. A significant difference in MRR rate was shown between the asciminib treated population and the bosutinib control group (25.5% vs. 13.2%, respectively, P = .029). In the asciminib cohort, adverse reactions of at least grade 3 with an incidence ≥ 5% were thrombocytopenia, neutropenia, increased pancreatic enzymes, hypertension, and anemia. The aim of this article is to summarize the scientific review of the application which led to the positive opinion by the European Medicines Agency's Committee for Medicinal Products for Human Use.
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Affiliation(s)
- C Mircea S Tesileanu
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, The Netherlands
- Department of Neurology, The Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sotirios Michaleas
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Rocio Gonzalo Ruiz
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Segundo Mariz
- Orphan Medicines Office, European Medicines Agency, Amsterdam, The Netherlands
| | | | - Paula B van Hennik
- Medicines Evaluation Board, Utrecht, The Netherlands
- Committee for Medicinal Products for Human Use (CHMP), European Medicines Agency, Amsterdam, The Netherlands
| | - Jutta Dedorath
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Bruna Dekic
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | | | - Andreas Brandt
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Janet Koenig
- Committee for Medicinal Products for Human Use (CHMP), European Medicines Agency, Amsterdam, The Netherlands
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Harald Enzmann
- Committee for Medicinal Products for Human Use (CHMP), European Medicines Agency, Amsterdam, The Netherlands
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Julio Delgado
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, The Netherlands
- Department of Hematology, Hospital Clinic, Barcelona, Spain
| | - Francesco Pignatti
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, The Netherlands
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van Opijnen MP, Tesileanu CMS, Dirven L, van der Meer PB, Wijnenga MMJ, Vincent AJPE, Broekman MLD, Dubbink HJ, Kros JM, van Duinen SG, Smits M, French PJ, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. IDH1/2 wildtype gliomas grade 2 and 3 with molecular glioblastoma-like profile have a distinct course of epilepsy compared to IDH1/2 wildtype glioblastomas. Neuro Oncol 2023; 25:701-709. [PMID: 35972438 PMCID: PMC10076940 DOI: 10.1093/neuonc/noac197] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND IDH1/2 wildtype (IDHwt) glioma WHO grade 2 and 3 patients with pTERT mutation and/or EGFR amplification and/or + 7/-10 chromosome gain/loss have a similar overall survival time as IDHwt glioblastoma patients, and are both considered glioblastoma IDHwt according to the WHO 2021 classification. However, differences in seizure onset have been observed. This study aimed to compare the course of epilepsy in the 2 glioblastoma subtypes. METHODS We analyzed epilepsy data of an existing cohort including IDHwt histologically lower-grade glioma WHO grade 2 and 3 with molecular glioblastoma-like profile (IDHwt hLGG) and IDHwt glioblastoma patients. Primary outcome was the incidence proportion of epilepsy during the disease course. Secondary outcomes included, among others, onset of epilepsy, number of seizure days, and antiepileptic drug (AED) polytherapy. RESULTS Out of 254 patients, 78% (50/64) IDHwt hLGG and 68% (129/190) IDHwt glioblastoma patients developed epilepsy during the disease (P = .121). Epilepsy onset before histopathological diagnosis occurred more frequently in IDHwt hLGG compared to IDHwt glioblastoma patients (90% vs 60%, P < .001), with a significantly longer median time to diagnosis (3.5 vs 1.3 months, P < .001). Median total seizure days was also longer for IDHwt hLGG patients (7.0 vs 3.0, P = .005), and they received more often AED polytherapy (32% vs 17%, P = .028). CONCLUSIONS Although the incidence proportion of epilepsy during the entire disease course is similar, IDHwt hLGG patients show a significantly higher incidence of epilepsy before diagnosis and a significantly longer median time between first seizure and diagnosis compared to IDHwt glioblastoma patients, indicating a distinct clinical course.
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Affiliation(s)
- Mark P van Opijnen
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - C Mircea S Tesileanu
- Department of Neurology, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten M J Wijnenga
- Department of Neurology, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marike L D Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, the Brain Tumor Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johan M Kros
- Department of Pathology, the Brain Tumor Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Pim J French
- Department of Neurology, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Martin J van den Bent
- Department of Neurology, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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6
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Wijnenga MMJ, Maas SLN, van Dis V, Tesileanu CMS, Kros JM, Dirven L, Hazelbag HM, Dubbink HJ, Vincent AJPE, French PJ, van den Bent MJ. Glioblastoma lacking necrosis or vascular proliferations: Different clinical presentation but similar outcome, regardless of histology or isolated TERT promoter mutation. Neurooncol Adv 2023; 5:vdad075. [PMID: 37441086 PMCID: PMC10335373 DOI: 10.1093/noajnl/vdad075] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Affiliation(s)
- Maarten M J Wijnenga
- Corresponding Author: Maarten M.J. Wijnenga, MD PhD, Department of Neurology, Erasmus MC Cancer Institute, PO Box 5201, 3008AE Rotterdam, The Netherlands()
| | - Sybren L N Maas
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera van Dis
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - C Mircea S Tesileanu
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Johan M Kros
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans M Hazelbag
- Department of Pathology, Medical Center Haaglanden, The Hague, The Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Pim J French
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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7
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van Opijnen MP, Tesileanu CMS, Dirven L, van der Meer PB, Wijnenga MMJ, Vincent AJPE, Broekman MLD, Dubbink HJ, Kros JM, van Duinen SG, Smits M, French PJ, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. P11.69.B IDH1/2wildtype gliomas grade 2 and 3 with molecular glioblastoma-like profile have a distinct course of epilepsy compared to IDH1/2wildtype glioblastomas. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.258] [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: 11/14/2022] Open
Abstract
Abstract
Background
IDH1/2 wildtype (IDHwt) glioma WHO grade 2 and 3 patients with pTERT mutation and/or EGFR amplification and/or +7/−10 chromosome gain/loss have a similar overall survival time as IDHwt glioblastoma patients, and are both considered glioblastoma IDHwt according to the WHO 2021 classification. However, differences in seizure onset have been observed. This study aimed to compare the course of epilepsy in the two glioblastoma subtypes.
Material and Methods
We analyzed epilepsy data of an existing cohort including IDHwt histologically lower-grade glioma WHO grade 2 and 3 with molecular glioblastoma-like profile (IDHwt hLGG) and IDHwt glioblastoma patients. Primary outcome was the incidence proportion of epilepsy during the disease course. Major secondary outcomes included onset of epilepsy, number of seizure days and antiepileptic drug (AED) polytherapy.
Results
Out of 254 patients, 78% (50/64) IDHwt hLGG and 68% (129/190) IDHwt glioblastoma patients developed epilepsy during the disease course (p=0.121). Epilepsy onset before histopathological diagnosis occurred more frequently in IDHwt hLGG compared to IDHwt glioblastoma patients (90% versus 60%, p<0.001), with a significantly longer median time to diagnosis (3.5 versus 1.3 months, p<0.001). Median total seizure days was also longer for IDHwt hLGG patients (7.0 versus 3.0, p=0.005), and they received more often AED polytherapy (32% versus 17%, p=0.028).
Conclusion
Although the incidence proportion of epilepsy during the entire disease course is similar, IDHwt hLGG patients show a significantly higher incidence of epilepsy before diagnosis and a significantly longer median time between first seizure and diagnosis compared to IDHwt glioblastoma patients, indicating a distinct clinical course.
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Affiliation(s)
| | | | - L Dirven
- Leiden University Medical Center , Leiden , Netherlands
| | | | | | | | | | - H J Dubbink
- Erasmus Medical Center , Rotterdam , Netherlands
| | - J M Kros
- Erasmus Medical Center , Rotterdam , Netherlands
| | | | - M Smits
- Erasmus Medical Center , Rotterdam , Netherlands
| | - P J French
- Erasmus Medical Center , Rotterdam , Netherlands
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Draaisma K, Tesileanu CMS, de Heer I, Klein M, Smits M, Reijneveld JC, Clement PM, De Vos F, Wick A, Mulholland P, Taphoorn M, Weller M, Chinot OL, Kros JM, Verschuere T, Coens C, Golfinopoulos V, Gorlia T, Idbaih A, Robe PA, van den Bent MJ, French PJ. Prognostic significance of DNA methylation profiles at MRI enhancing tumor recurrence: a report from the EORTC 26091 TAVAREC trial. Clin Cancer Res 2022; 28:2440-2448. [PMID: 35294545 DOI: 10.1158/1078-0432.ccr-21-3725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/19/2021] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite recent advances in the molecular characterization of gliomas, it remains unclear which patients benefit most from which second line treatments. The TAVAREC trial was a randomized, open-label phase 2 trial assessing the benefit of the addition of the angiogenesis inhibitor bevacizumab to treatment with temozolomide in patients with a first enhancing recurrence of WHO grade 2 or 3 glioma without 1p/19q codeletion. We evaluated the prognostic significance of genome wide DNA methylation profiles and copy number variations on the TAVAREC trial samples. EXPERIMENTAL DESIGN IDH-mutation status was determined via Sanger sequencing and immunohistochemistry. DNA methylation analysis was performed using the MethylationEPIC BeadChip (Illumina) from which 1p/19q codeletion, MGMT promoter methylation (MGMT-STP27) and homozygous deletion of CDKN2A/B were determined. DNA-methylation classes were determined according to classifiers developed in Heidelberg and TCGA ("Heidelberg" and "TCGA" classifier respectively). RESULTS DNA methylation profiles of 122 samples were successfully determined. As expected, most samples were IDH-mutant (89/122) and MGMT promotor methylated (89/122). Methylation classes were prognostic for time to progression. However, Heidelberg methylation classes determined at time of diagnosis were no longer prognostic following enhancing recurrence of the tumor. In contrast, TCGA methylation classes of primary samples remained prognostic also following enhancing recurrence. Homozygous deletions in CDKN2A/B were found in 10/87 IDH-mutated samples and were prognostically unfavorable at recurrence. CONCLUSIONS DNA methylome Heidelberg classification at time of diagnosis is no longer of prognostic value at the time of enhancing recurrence. CDKN2A/B deletion status was predictive of survival from progression of IDH-mutated tumors.
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Affiliation(s)
- Kaspar Draaisma
- Erasmus MC Cancer Institute, Rotterdam, Rotterdam, Netherlands
| | | | | | - Martin Klein
- Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Filip De Vos
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Antje Wick
- University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Thierry Gorlia
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | - Pierre A Robe
- University Medical Center Utrecht, Utrecht, Utrecht, Netherlands
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9
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Tesileanu CMS, Sanson M, Wick W, Brandes AA, Clement PM, Erridge SC, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Rudà R, Weller M, McBain C, van Linde ME, Aldape K, Jenkins RB, Kros JM, Wesseling P, von Deimling A, Hoogstrate Y, de Heer I, Atmodimedjo PN, Dubbink HJ, Brouwer RWW, van IJcken WFJ, Cheung KJ, Golfinopoulos V, Baumert BG, Gorlia T, French PJ, van den Bent MJ. Temozolomide and radiotherapy versus radiotherapy alone in patients with glioblastoma, IDH-wildtype: post-hoc analysis of the EORTC randomized phase 3 CATNON trial. Clin Cancer Res 2022; 28:2527-2535. [PMID: 35275197 DOI: 10.1158/1078-0432.ccr-21-4283] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 12/03/2021] [Revised: 01/10/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE In a post-hoc analysis of the CATNON trial (NCT00626990), we explored whether adding temozolomide to radiotherapy improves outcome in patients with IDH1/2wt anaplastic astrocytomas with molecular features of glioblastoma (redesignated as glioblastoma, IDH-wildtype in the 2021 WHO classification of CNS tumors). EXPERIMENTAL DESIGN From the randomized phase 3 CATNON study examining the addition of adjuvant and concurrent temozolomide to radiotherapy in anaplastic astrocytomas, we selected a subgroup of IDH1/2wt and H3F3Awt tumors with presence of TERT promoter mutations and/or EGFR amplifications and/or combined gain of chromosome 7 and loss of chromosome 10. Molecular abnormalities including MGMT promoter methylation status were determined by next-generation sequencing, DNA methylation profiling, and SNaPshot analysis. RESULTS Of the 751 patients entered in the CATNON study, 670 had fully molecularly characterized tumors. 159 of these tumors met the WHO 2021 molecular criteria for glioblastoma, IDH-wildtype. Of these patients, 47 received radiotherapy only and 112 received a combination of radiotherapy and temozolomide. There was no added effect of temozolomide on either overall survival (HR 1.19, 95%CI 0.82-1.71) or progression-free survival (HR 0.87, 95%CI 0.61-1.24). MGMT promoter methylation was prognostic for overall survival, but was not predictive for outcome to temozolomide treatment either with respect to overall survival or progression-free survival. CONCLUSIONS In this cohort of patients with glioblastoma, IDH-wildtype temozolomide treatment did not add benefit beyond that observed from radiotherapy, regardless of MGMT promoter status. These findings require a new well-powered prospective clinical study to explore the efficacy of temozolomide treatment in this patient population.
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Affiliation(s)
- C Mircea S Tesileanu
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marc Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Paris Brain Institute - Institut du Cerveau (ICM), AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Wolfgang Wick
- Neurology Department, University of Heidelberg, and Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alba A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Paul M Clement
- Oncology Department, KU Leuven and General Medical Oncology Department, UZ Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Anna K Nowak
- Medical School, University of Western Australia, Crawley, Western Australia
- Medical Oncology Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia
- CoOperative Group for NeuroOncology, University of Sydney, New South Wales, Australia
| | - Jean-Francois Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Warren P Mason
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Helen Wheeler
- Northern Sydney Cancer Centre, University of Sydney, St Leonards, New South Wales, Australia
| | - Olivier L Chinot
- Aix-Marseille University, AP-HM, Neuro-Oncology division, Marseille, France
| | - Sanjeev Gill
- Medical Oncology Department, Alfred Hospital, Melbourne, Australia
| | - Matthew Griffin
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Leland Rogers
- Radiation Oncology Department, Gammawest Cancer Services, Salt Lake City, Utah
| | - Walter Taal
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Roberta Rudà
- Neuro-Oncology Department, City of Health and Science Hospital and University of Turin, Turin, Italy
| | - Michael Weller
- Neurology Department, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Catherine McBain
- Clinical Oncology Department, The Christie NHS FT, Manchester, United Kingdom
| | - Myra E van Linde
- Medical Oncology Department, Brain Tumor Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kenneth Aldape
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Johan M Kros
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Pieter Wesseling
- Pathology Department, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Andreas von Deimling
- Neuropathology Department, Ruprecht-Karls-University, and CCU Neuropathology German Cancer Institute and Consortium, DKFZ, and DKTK, Heidelberg, Germany
| | - Youri Hoogstrate
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Iris de Heer
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Peggy N Atmodimedjo
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Hendrikus J Dubbink
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | | | | | - Brigitta G Baumert
- Radiation-Oncology Department (MAASTRO), Maastricht University Medical Center (MUMC) and GROW (School for Oncology), Maastricht, the Netherlands
- Institute of Radiation-Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Pim J French
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martin J van den Bent
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Tesileanu CMS, Gorlia T, Golfinopoulos V, French PJ, van den Bent MJ. MGMT promoter methylation determined by the MGMT-STP27 algorithm is not predictive for outcome to temozolomide in IDH-mutant anaplastic astrocytomas. Neuro Oncol 2022; 24:665-667. [PMID: 35099533 PMCID: PMC8972205 DOI: 10.1093/neuonc/noac014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- C Mircea S Tesileanu
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Pim J French
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martin J van den Bent
- Corresponding Author: Martin J. van den Bent, MD, Neuro-Oncology Unit, Brain Tumor Center at Erasmus MC Cancer Institute, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands ()
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Tesileanu CMS, French PJ, Sanson M, Brandes AA, Wick W, Clement PM, Kros JM, Gorlia T, Golfinopoulos V, van den Bent MJ. OS05.2.A MGMT promoter status in IDH1/2 mutant anaplastic astrocytoma patients assessed by DNA methylation profiling and qMS-PCR: a report from the EORTC Brain Tumor Group. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.019] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Temozolomide (TMZ) efficacy in high-grade glioma is related to O 6-methylguanine DNA methyltransferase promoter (MGMTp) methylation. We compared the prognostic and predictive effect of MGMTp between DNA methylation profiling (the MGMT-STP27 model) and quantitative methylation specific polymerase chain reaction (qMS-PCR) in isocitrate dehydrogenase 1 and 2 (IDH1/2) mutant (mt) anaplastic astrocytoma patients.
MATERIAL AND METHODS
The 2x2 factorial design phase III CATNON trial randomized 751 adult patients with newly diagnosed 1p/19q non-codeleted anaplastic glioma to 59.4 Gy radiotherapy (RT), RT with concurrent TMZ, RT with 12 cycles of adjuvant TMZ, or RT with concurrent and adjuvant TMZ. MGMTp methylation status was assessed with the MGMT-STP27 model using 850k EPIC data, and qMS-PCR. IDH1/2 mutation status was determined with a next-generation sequencing panel. Overall survival (OS) was measured from date of randomization.
RESULTS
We identified 444 IDH1/2mt anaplastic astrocytoma patients of which MGMT-STP27 data was available for 440 patients (99.1%), qMS-PCR data for 361 patients (81.3%), and both for 357 patients (80.4%). MGMTp was methylated in 365 patients (83.0%) for the MGMT-STP27 model, and 168 patients (46.5%) for qMS-PCR. The agreement between the MGMT-STP27 model and qMS-PCR is 59.9% with a Cohen’s Kappa score of 0.229. At database lock, 289 patients with MGMT-STP27 data were still alive and 236 patients with qMS-PCR data. The median OS of MGMTp methylated glioma patients was 9.1 yrs [95 % confidence interval (CI) 7.5-not reached] for the MGMT-STP27 model, and not reached [95 % CI 9.1-not reached] for the qMS-PCR data. For MGMTp unmethylated glioma patients, the median OS was 6.9 yrs [95% CI 6.2-not reached] for the MGMT-STP27 model, and 6.8 yrs [95% CI 6.2–9.7] for the qMS-PCR data. The hazard ratio (HR) for OS based on MGMTp methylation was 0.88 [95% CI 0.58–1.31] for the MGMT-STP27 data, and 0.72 [95% CI 0.50–1.03]) for the qMS-PCR data. The HR for OS after RT with any TMZ vs RT alone for the MGMT-STP27 model was 0.53 [95% CI 0.37–0.78] for MGMTp methylated, and 0.54 [95% CI 0.25–1.18] for MGMTp unmethylated glioma patients; and for the MS-PCR data was 0.34 [95% CI 0.19–0.61] for MGMTp methylated, and 0.53 [95% CI 0.33–0.85] for MGMTp unmethylated glioma patients.
CONCLUSION
MGMTp methylation, regardless of assay, was neither prognostic nor predictive for outcome to temozolomide in IDH1/2mt anaplastic astrocytoma patients.
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Affiliation(s)
| | | | - M Sanson
- Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - A A Brandes
- AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - W Wick
- Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - J M Kros
- Erasmus MC, Rotterdam, Netherlands
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van den Bent MJ, Tesileanu CMS, Wick W, Sanson M, Brandes AA, Clement PM, Erridge S, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Rudà R, Weller M, McBain C, Reijneveld J, Enting RH, Caparrotti F, Lesimple T, Clenton S, Gijtenbeek A, Lim E, Herrlinger U, Hau P, Dhermain F, de Heer I, Aldape K, Jenkins RB, Dubbink HJ, Kros JM, Wesseling P, Nuyens S, Golfinopoulos V, Gorlia T, French P, Baumert BG. Adjuvant and concurrent temozolomide for 1p/19q non-co-deleted anaplastic glioma (CATNON; EORTC study 26053-22054): second interim analysis of a randomised, open-label, phase 3 study. Lancet Oncol 2021; 22:813-823. [PMID: 34000245 PMCID: PMC8191233 DOI: 10.1016/s1470-2045(21)00090-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [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: 10/13/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The CATNON trial investigated the addition of concurrent, adjuvant, and both current and adjuvant temozolomide to radiotherapy in adults with newly diagnosed 1p/19q non-co-deleted anaplastic gliomas. The benefit of concurrent temozolomide chemotherapy and relevance of mutations in the IDH1 and IDH2 genes remain unclear. METHODS This randomised, open-label, phase 3 study done in 137 institutions across Australia, Europe, and North America included patients aged 18 years or older with newly diagnosed 1p/19q non-co-deleted anaplastic gliomas and a WHO performance status of 0-2. Patients were randomly assigned (1:1:1:1) centrally using a minimisation technique to radiotherapy alone (59·4 Gy in 33 fractions; three-dimensional conformal radiotherapy or intensity-modulated radiotherapy), radiotherapy with concurrent oral temozolomide (75 mg/m2 per day), radiotherapy with adjuvant oral temozolomide (12 4-week cycles of 150-200 mg/m2 temozolomide given on days 1-5), or radiotherapy with both concurrent and adjuvant temozolomide. Patients were stratified by institution, WHO performance status score, age, 1p loss of heterozygosity, the presence of oligodendroglial elements on microscopy, and MGMT promoter methylation status. The primary endpoint was overall survival adjusted by stratification factors at randomisation in the intention-to-treat population. A second interim analysis requested by the independent data monitoring committee was planned when two-thirds of total required events were observed to test superiority or futility of concurrent temozolomide. This study is registered with ClinicalTrials.gov, NCT00626990. FINDINGS Between Dec 4, 2007, and Sept 11, 2015, 751 patients were randomly assigned (189 to radiotherapy alone, 188 to radiotherapy with concurrent temozolomide, 186 to radiotherapy and adjuvant temozolomide, and 188 to radiotherapy with concurrent and adjuvant temozolomide). Median follow-up was 55·7 months (IQR 41·0-77·3). The second interim analysis declared futility of concurrent temozolomide (median overall survival was 66·9 months [95% CI 45·7-82·3] with concurrent temozolomide vs 60·4 months [45·7-71·5] without concurrent temozolomide; hazard ratio [HR] 0·97 [99·1% CI 0·73-1·28], p=0·76). By contrast, adjuvant temozolomide improved overall survival compared with no adjuvant temozolomide (median overall survival 82·3 months [95% CI 67·2-116·6] vs 46·9 months [37·9-56·9]; HR 0·64 [95% CI 0·52-0·79], p<0·0001). The most frequent grade 3 and 4 toxicities were haematological, occurring in no patients in the radiotherapy only group, 16 (9%) of 185 patients in the concurrent temozolomide group, and 55 (15%) of 368 patients in both groups with adjuvant temozolomide. No treatment-related deaths were reported. INTERPRETATION Adjuvant temozolomide chemotherapy, but not concurrent temozolomide chemotherapy, was associated with a survival benefit in patients with 1p/19q non-co-deleted anaplastic glioma. Clinical benefit was dependent on IDH1 and IDH2 mutational status. FUNDING Merck Sharpe & Dohme.
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Affiliation(s)
| | | | - Wolfgang Wick
- Neurologische Klinik und Nationales Zentrum für Tumorerkrankungen Universitätsklinik Heidelberg, Heidelberg, Germany
| | - Marc Sanson
- Sorbonne Universités, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM AP-HP, Paris, France; Hôpital Univeristaires Pitié-salpêtrière -Chales Foix, service de Neurologie 2-Mazarin, Paris, France
| | - Alba Ariela Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Paul M Clement
- Department of Oncology, KU Leuven and Department of General Medical Oncology, UZ Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Sarah Erridge
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | | | - Anna K Nowak
- Medical School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia; CoOperative Group for NeuroOncology, University of Sydney, Camperdown, NSW, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Jean Français Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Warren P Mason
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Helen Wheeler
- Northern Sydney Cancer Centre, St Leonards, Sydney, NSW, Australia
| | - Olivier L Chinot
- Aix-Marseille University, AP-HM, Neuro-Oncology division, Marseille, France
| | - Sanjeev Gill
- Department of Medical Oncology, Alfred Hospital, Melbourne, QLD, Australia
| | - Matthew Griffin
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Leland Rogers
- Department of Radiation Oncology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Walter Taal
- Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science Hospital and University of Turin, Turin, Italy
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jaap Reijneveld
- Brain Tumor Center Amsterdam and Department of Neurology, VU University Medical Center, Amsterdam, Netherlands; Department of Neurology, Academic Medical Center, Amsterdam, Netherlands
| | - Roelien H Enting
- Department of Neurology, UMCG, University of Groningen, Groningen, Netherlands
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Thierry Lesimple
- Department of Clinical Oncology, Comprehensive Cancer Center Eugène Marquis, Rennes, France
| | | | - Anja Gijtenbeek
- Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Elizabeth Lim
- Department of Clinical Oncology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Peter Hau
- Wilhelm Sander-NeuroOncology Unit and Department of Neurology, University Hospital, Regensburg, Regensburg, Germany
| | - Frederic Dhermain
- Radiotherapy Department, Gustave Roussy University Hospital, Villejuif, Cedex, France
| | - Iris de Heer
- Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | | | - Johan M Kros
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pieter Wesseling
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | | | | | - Pim French
- Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Brigitta G Baumert
- Department of Radiation-Oncology (MAASTRO), Maastricht University Medical Center (MUMC) GROW (School for Oncology), Maastricht, Netherlands; Institute of Radiation-Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
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Tesileanu CMS, Vallentgoed WR, Sanson M, Taal W, Clement PM, Wick W, Brandes AA, Baurain JF, Chinot OL, Wheeler H, Gill S, Griffin M, Rogers L, Rudà R, Weller M, McBain C, Reijneveld J, Enting RH, Caparrotti F, Lesimple T, Clenton S, Gijtenbeek A, Lim E, de Vos F, Mulholland PJ, Taphoorn MJB, de Heer I, Hoogstrate Y, de Wit M, Boggiani L, Venneker S, Oosting J, Bovée JVMG, Erridge S, Vogelbaum MA, Nowak AK, Mason WP, Kros JM, Wesseling P, Aldape K, Jenkins RB, Dubbink HJ, Baumert B, Golfinopoulos V, Gorlia T, van den Bent M, French PJ. Non-IDH1-R132H IDH1/2 mutations are associated with increased DNA methylation and improved survival in astrocytomas, compared to IDH1-R132H mutations. Acta Neuropathol 2021; 141:945-957. [PMID: 33740099 PMCID: PMC8113211 DOI: 10.1007/s00401-021-02291-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023]
Abstract
Somatic mutations in the isocitrate dehydrogenase genes IDH1 and IDH2 occur at high frequency in several tumour types. Even though these mutations are confined to distinct hotspots, we show that gliomas are the only tumour type with an exceptionally high percentage of IDH1R132H mutations. Patients harbouring IDH1R132H mutated tumours have lower levels of genome-wide DNA-methylation, and an associated increased gene expression, compared to tumours with other IDH1/2 mutations ("non-R132H IDH1/2 mutations"). This reduced methylation is seen in multiple tumour types and thus appears independent of the site of origin. For 1p/19q non-codeleted glioma (astrocytoma) patients, we show that this difference is clinically relevant: in samples of the randomised phase III CATNON trial, patients harbouring tumours with IDH mutations other than IDH1R132H have a better outcome (hazard ratio 0.41, 95% CI [0.24, 0.71], p = 0.0013). Such non-R132H IDH1/2-mutated tumours also had a significantly lower proportion of tumours assigned to prognostically poor DNA-methylation classes (p < 0.001). IDH mutation-type was independent in a multivariable model containing known clinical and molecular prognostic factors. To confirm these observations, we validated the prognostic effect of IDH mutation type on a large independent dataset. The observation that non-R132H IDH1/2-mutated astrocytomas have a more favourable prognosis than their IDH1R132H mutated counterpart indicates that not all IDH-mutations are identical. This difference is clinically relevant and should be taken into account for patient prognostication.
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Tesileanu CMS, van den Bent MJ, Sanson M, Wick W, Brandes AA, Clement PM, Erridge SC, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Rudà R, Weller M, McBain C, van Linde ME, Sabedot TS, Hoogstrate Y, von Deimling A, de Heer I, van IJcken WFJ, Brouwer RWW, Aldape K, Jenkins RB, Dubbink HJ, Kros JM, Wesseling P, Cheung KJ, Golfinopoulos V, Baumert BG, Gorlia T, Noushmehr H, French PJ. Prognostic significance of genome-wide DNA methylation profiles within the randomised, phase 3, EORTC CATNON trial on non-1p/19q deleted anaplastic glioma. Neuro Oncol 2021; 23:1547-1559. [PMID: 33914057 PMCID: PMC8408862 DOI: 10.1093/neuonc/noab088] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 12/27/2022] Open
Abstract
Background Survival in patients with IDH1/2-mutant (mt) anaplastic astrocytomas is highly variable. We have used the prospective phase 3 CATNON trial to identify molecular factors related to outcome in IDH1/2mt anaplastic astrocytoma patients. Methods The CATNON trial randomized 751 adult patients with newly diagnosed 1p/19q non-codeleted anaplastic glioma to 59.4 Gy radiotherapy +/− concurrent and/or adjuvant temozolomide. The presence of necrosis and/or microvascular proliferation was scored at central pathology review. Infinium MethylationEPIC BeadChip arrays were used for genome-wide DNA methylation analysis and the determination of copy number variations (CNV). Two DNA methylation-based tumor classifiers were used for risk stratification. Next-generation sequencing (NGS) was performed using 1 of the 2 glioma-tailored NGS panels. The primary endpoint was overall survival measured from the date of randomization. Results Full analysis (genome-wide DNA methylation and NGS) was successfully performed on 654 tumors. Of these, 432 tumors were IDH1/2mt anaplastic astrocytomas. Both epigenetic classifiers identified poor prognosis patients that partially overlapped. A predictive prognostic Cox proportional hazard model identified that independent prognostic factors for IDH1/2mt anaplastic astrocytoma patients included; age, mini-mental state examination score, treatment with concurrent and/or adjuvant temozolomide, the epigenetic classifiers, PDGFRA amplification, CDKN2A/B homozygous deletion, PI3K mutations, and total CNV load. Independent recursive partitioning analysis highlights the importance of these factors for patient prognostication. Conclusion Both clinical and molecular factors identify IDH1/2mt anaplastic astrocytoma patients with worse outcome. These results will further refine the current WHO criteria for glioma classification.
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Affiliation(s)
- C M S Tesileanu
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | | | - M Sanson
- Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - W Wick
- Neurology Department, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - A A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - P M Clement
- Oncology Department, KU Leuven and Medical Oncology Department, UZ Leuven, Leuven, Belgium
| | - S C Erridge
- Neuro-Oncology Centre Edinburgh, Western General Hospital, Edinburgh, UK
| | - M A Vogelbaum
- Neuro-Oncology Department, Moffitt Cancer Center, Tampa, Florida, USA
| | - A K Nowak
- University of Western Australia, Perth, Australia; Co-Operative Group for Neuro-Oncology, University of Sydney, Sydney, Australia; Medical Oncology Department, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - J F Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - W P Mason
- Princess Margaret Cancer Centre, Toronto, Canada
| | - H Wheeler
- Northern Sydney Cancer Centre, Sydney, Australia
| | - O L Chinot
- Neuro-Oncology Department, Aix-Marseille University, Marseille, France
| | - S Gill
- Medical Oncology Department, Alfred Hospital, Melbourne, Australia
| | - M Griffin
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Rogers
- Radiation Oncology Department, Gammawest Cancer Services, Salt Lake City, UT, USA
| | - W Taal
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | - R Rudà
- Neuro-Oncology Department, University of Turin, Turin, Italy
| | - M Weller
- Neurology Department, University Hospital of Zurich, Zurich, Switzerland
| | - C McBain
- Clinical Oncology Department, The Christie NHS FT, Manchester, UK
| | - M E van Linde
- Medical Oncology Department, Amsterdam UMC, Amsterdam, the Netherlands
| | - T S Sabedot
- Neurosurgery Department, Henry Ford Health System, Detroit, MI, USA
| | - Y Hoogstrate
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | - A von Deimling
- Neuropathology Department, Ruprecht-Karls-University and, CCU Neuropathology, German Cancer Institute and Consortium, DKFZ, and DKTK, Heidelberg, Germany
| | - I de Heer
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | | | - R W W Brouwer
- Biomics Center, Erasmus MC, Rotterdam, the Netherlands
| | - K Aldape
- Princess Margaret Cancer Centre, Toronto, Canada
| | - R B Jenkins
- Pathology Department, Mayo Clinic, Rochester, MN, USA
| | - H J Dubbink
- Pathology Department, Erasmus MC, Rotterdam, the Netherlands
| | - J M Kros
- Pathology Department, Erasmus MC, Rotterdam, the Netherlands
| | - P Wesseling
- Pathology Department, Amsterdam UMC, Amsterdam, the Netherlands; Princess Máxima Center, Utrecht, the Netherlands
| | | | | | - B G Baumert
- Radiation-Oncology Department, Maastricht UMC, Maastricht, the Netherlands; Radiation-Oncology Institute, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - H Noushmehr
- Neurosurgery Department, Henry Ford Health System, Detroit, MI, USA
| | - P J French
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
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Tesileanu CMS, Dirven L, Wijnenga MMJ, Koekkoek JAF, Vincent AJPE, Dubbink HJ, Atmodimedjo PN, Kros JM, van Duinen SG, Smits M, Taphoorn MJB, French PJ, van den Bent MJ. Survival of diffuse astrocytic glioma, IDH1/2 wildtype, with molecular features of glioblastoma, WHO grade IV: a confirmation of the cIMPACT-NOW criteria. Neuro Oncol 2021; 22:515-523. [PMID: 31637414 DOI: 10.1093/neuonc/noz200] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [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
BACKGROUND The Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) has recommended that isocitrate dehydrogenase 1 and 2 wildtype (IDH1/2wt) diffuse lower-grade gliomas (LGGs) World Health Organization (WHO) grade II or III that present with (i) a telomerase reverse transcriptase promoter mutation (pTERTmt), and/or (ii) gain of chromosome 7 combined with loss of chromosome 10, and/or (iii) epidermal growth factor receptor (EGFR) amplification should be reclassified as diffuse astrocytic glioma, IDH1/2 wildtype, with molecular features of glioblastoma, WHO grade IV (IDH1/2wt astrocytomas WHO IV). This paper describes the overall survival (OS) of IDH1/2wt astrocytoma WHO IV patients, and more in detail patients with tumors with pTERTmt only. METHODS In this retrospective multicenter study, we compared the OS of 71 IDH1/2wt astrocytomas WHO IV patients, with radiological characteristics of LGGs, with the OS of 197 IDH1/2wt glioblastoma patients. Moreover, we compared the OS of 22 pTERTmt only astrocytoma patients with the OS of the IDH1/2wt glioblastoma patients. RESULTS Median OS was similar for IDH1/2wt astrocytoma WHO IV patients (23.8 mo) and IDH1/2wt glioblastoma patients (19.2 mo) (Cox proportional hazards model: hazard ratio [HR] 1.27, 95% CI: 0.85-1.88, P = 0.242). OS was also similar in patients with IDH1/2wt astrocytomas WHO IV, pTERTmt only, and IDH1/2wt glioblastomas (HR 1.15, 95% CI: 0.64-2.10, P = 0.641). CONCLUSIONS The presented data confirm the cIMPACT-NOW recommendation and we propose that IDH1/2wt astrocytomas WHO IV in the absence of other qualifying mutations should be classified as IDH1/2wt glioblastomas.
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Affiliation(s)
- C Mircea S Tesileanu
- Department of Neurology, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Maarten M J Wijnenga
- Department of Neurology, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, the Brain Tumor Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peggy N Atmodimedjo
- Department of Pathology, the Brain Tumor Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johan M Kros
- Department of Pathology, the Brain Tumor Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Pim J French
- Department of Neurology, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Martin J van den Bent
- Department of Neurology, the Brain Tumor Center, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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16
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Tesileanu CMS, French P, Erridge S, Vogelbaum M, Nowak A, Sanson M, Brandes A, Wick W, Clement P, Baurain J, Mason W, Wheeler H, Weller M, Aldape K, Wesseling P, Kros JM, Golfinopoulos V, Gorlia T, Baumert B, van den Bent M. CTNI-23. IDH1/2wt ANAPLASTIC GLIOMAS OF THE EORTC RANDOMIZED PHASE III INTERGROUP CATNON TRIAL: OVERALL SURVIVAL RELATED TO TREATMENT, MGMT STATUS AND MOLECULAR FEATURES OF GLIOBLASTOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The phase III CATNON trial randomized 751 adult patients with newly diagnosed 1p/19q non-codeleted anaplastic glioma to 59.4 Gy radiotherapy +/- concurrent and/or adjuvant TMZ. Here, we present the molecular analysis of the IDH1/2wt subgroup, and associations between molecular characteristics and patient outcomes.
METHODS
CNV data and MGMT promoter methylation status were assessed from EPIC methylation array data. IDH1/2 and H3F3A mutation status were determined with a glioma tailored next-generation sequencing panel and TERT promoter mutation status using a SNaPshot assay. Overall survival (OS) was measured from date of randomization.
RESULTS
Of 654 assessed tumors, 211 (32%) were IDH1/2wt. An H3F3A mutation was present in 14 tumors (K27M: n=10; G34R: n=4). Of the remaining 197 patients, 154 tumors had molecular features of glioblastoma according to cIMPACT-NOW 3 criteria (‘IDH1/2wt astrocytomas WHO IV’), 39 tumors did not (‘IDH1/2wt astrocytomas WHO III’), and 4 had inconclusive molecular data. IDH1/2wt astrocytomas WHO III patients had significantly better survival than WHO IV patients: median OS of 2.83 yrs vs 1.43 yrs respectively [log-rank test: p< 0.001]. Of the 154 IDH1/2wt astrocytoma WHO IV, 55 (36%) were found MGMT promoter methylated. MGMT promoter methylation was prognostic in IDH1/2wt astrocytomas WHO IV patients, with a median OS of 1.86 yrs for methylated vs 1.34 yrs for unmethylated [HR 1.62, p=0.006]. In the IDH1/2wt astrocytomas WHO IV, no effect of concurrent and/or adjuvant TMZ was observed; the HR for OS after RT with any TMZ vs RT alone was 1.31 [95% CI 0.73–2.36, p=0.4] for MGMT promoter methylated and 0.90 [95% CI 0.55–1.45, p=0.7] for unmethylated glioma patients.
CONCLUSIONS
Our study validated the prognostic value of the cIMPACT-NOW 3 criteria. MGMT promoter methylation is prognostic but not predictive for outcome to TMZ treatment in this cohort of IDH1/2wt anaplastic gliomas with molecular features of glioblastoma.
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Affiliation(s)
| | - Pim French
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Anna Nowak
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | | | - Wolfgang Wick
- University of Heidelberg and DKFZ, Heidelberg, Germany
| | | | | | - Warren Mason
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Helen Wheeler
- Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michael Weller
- UniversitätsSpital Zürich - Klinik für Neurologie, Zurich, Switzerland
| | - Kenneth Aldape
- National Cancer Institute, National Institute of Health, Bethesda, MD, MD, USA
| | | | - Johan M Kros
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
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17
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Tesileanu CMS, van den Bent M, Sabedot T, Sanson M, Brandes A, Wick W, Clement P, Erridge S, Vogelbaum M, Nowak A, Baurain J, Mason W, Wheeler H, Weller M, de Heer I, Dubbink H, Kros JM, Aldape K, Wesseling P, Golfinopoulos V, Gorlia T, Baumert B, Noushmehr H, French P. PATH-11. PROGNOSTIC SIGNIFICANCE OF EPIGENETIC SUBTYPES AND CpGs ASSOCIATED WITH PROGRESSION TO G-CIMP LOW IN THE EORTC RANDOMIZED PHASE III INTERGROUP CATNON. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
Uncontrolled studies have suggested that methylation-based epigenetic subtypes can be used for prognostication of glioma. We used the prospective randomized CATNON trial to validate the clinical relevance of these epigenetic subtypes.
METHODS
The phase III CATNON trial randomized 751 adult patients with newly diagnosed 1p/19q non-codeleted anaplastic glioma to 59.4 Gy radiotherapy +/- concurrent and/or adjuvant TMZ. CNV data and methylation data were derived from Infinium MethylationEPIC arrays. Epigenetic subtyping and risk of progression to G-CIMP low were determined from random forest models and 7 specific CpGs (PMID: 29642018). IDH1/2 status was determined with a glioma-tailored NGS panel. Overall survival (OS) was measured from date of randomization.
RESULTS
Methylation analysis was performed on 654 tumors: 440 were IDH1/2mt, 204 IDH1/2wt and of 10 IDH1/2 status was unknown; 8 IDH1/2mt were 1p/19q codeleted. Based on methylation, tumors were classified as G-CIMP high (n=409), G-CIMP low (n=19), codel-like (n=18), mesenchymal-like (n=107), classic-like (n=48), and PA-like tumors (n=53). Median OS between these epigenetic subtypes varied considerably: codel-like 9.1 yrs, G-CIMP high 9.5 yrs, G-CIMP low 2.8 yrs, mesenchymal-like 1.3 yrs, classic-like 1.6 yrs, and PA-like 2.8 yrs. The difference in OS of the IDH1/2mt astrocytoma subgroup patients was prominent [G-CIMP low vs G-CIMP high: HR 4.12, 95% CI 2.37-7.19, p < 0.001]. Within the IDH1/2mt G-CIMP high astrocytoma patients, 115 tumors were predicted to have risk of progression to G-CIMP low and patients with such tumors indeed had poorer survival [risk vs no-risk: HR 1.59, 95% CI 1.10-2.31, p = 0.02]. Median OS in G-CIMP high tumors with (n=37) and without (n=366) CDKN2A/B HD was 3.3 yrs versus not reached [p< 0.001], in G-CIMP low tumors it was 1.2 yrs (n=6) versus 4.4 yrs (n=12) [p=0.008].
CONCLUSIONS
In IDH1/2mt anaplastic astrocytoma, G-CIMP status and CDKN2A/B HD are of independent prognostic value.
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Affiliation(s)
| | | | | | | | | | - Wolfgang Wick
- University of Heidelberg and DKFZ, Heidelberg, Germany
| | | | | | | | - Anna Nowak
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | - Warren Mason
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Helen Wheeler
- Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michael Weller
- UniversitätsSpital Zürich - Klinik für Neurologie, Zurich, Switzerland
| | - Iris de Heer
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Johan M Kros
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Kenneth Aldape
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | | | | | | | | | | | - Pim French
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
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18
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Tesileanu CMS, Koekkoek JAF, Dirven L, Dubbink HJ, Kros JM, van Duinen SG, Smits M, French PJ, Taphoorn MJB, van den Bent MJ. OS10.1 Survival analysis of IDH wildtype astrocytomas with molecular features of glioblastoma, WHO grade IV. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.067] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Recently, isocitrate dehydrogenase wildtype (IDHwt) lower grade gliomas (LGGs) that have a telomerase reverse transcriptase (TERT) promoter mutation and/or gain of chromosome 7 combined with loss of chromosome 10 and/or epidermal growth factor receptor amplification have been reclassified as IDHwt astrocytomas with molecular features of glioblastoma, WHO grade IV (‘astrocytomas IDHwt, WHO IV’). Survival of these tumors meeting the criteria of these tumors is less well studied. The objective of this study is to compare the overall survival (OS) between the IDHwt astrocytomas, WHO IV and histological glioblastomas (GBMs).
MATERIAL AND METHODS
In this retrospective multicenter cohort study, all adult patients with a newly diagnosed IDHwt LGG (histologically WHO grade II or III) and with molecular data available were selected from the Erasmus MC and the LUMC from October 2002 to April 2019. LGG patients showing contrast enhancement with necrosis on the MRI at the time of histological diagnosis were excluded. Molecular data were determined using a diagnostic NGS panel. A historical cohort of 195 patients with IDHwt GBMs with molecular data available was used to compare OS. OS was measured from the date of the first diagnostic MR scan.
RESULTS
79 IDHwt LGG patients were identified of which 62 patients had molecular features of glioblastoma (‘astrocytomas IDHwt, WHO IV’), 11 patients did not have these molecular features (‘astrocytomas IDHwt, WHO II & III’). In the remaining 6 patients the molecular data were not conclusive (astrocytomas IDHwt, WHO NOS). Patients with astrocytomas IDHwt, WHO IV were slightly older at diagnosis (median age = 57 years) than patients with GBMs IDHwt in the reference cohort or astrocytomas IDHwt, WHO II & III (respectively: median age 55 years, p=0.032 and 47 years, p=0.035). The relatively young age of our GBM IDHwt cohort reflects more extensive molecular testing in younger patients and histologically lower grade tumors. The median OS of astrocytomas IDHwt, WHO IV (23.8 months) was similar to the median OS of GBMs (19.2 months, log-rank test p=0.37). The median OS in 19 patients with only TERT promoter mutations was 16.8 months, similar to GBMs (p=0.94).
CONCLUSION
There is no statistically significant difference between the OS of IDHwt astrocytomas with molecular features of glioblastoma and the OS of true glioblastomas. Grade II and III IDHwt astrocytoma with molecular features of glioblastoma should be designated WHO grade IV. The presence of TERT promoter mutations alone in this histological context also qualifies for this designation.
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Affiliation(s)
| | | | | | | | - J M Kros
- Erasmus MC, Rotterdam, Netherlands
| | | | - M Smits
- Erasmus MC, Rotterdam, Netherlands
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19
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van den Bent MJ, Erridge S, Vogelbaum MA, Nowak AK, Sanson M, Brandes AA, Wick W, Clement PM, Baurain JF, Mason W, Wheeler H, Weller M, Aldape K, Wesseling P, Kros JM, Tesileanu CMS, Golfinopoulos V, Gorlia T, Baumert BG, French PJ. PL3.3 Second interim and first molecular analysis of the EORTC randomized phase III intergroup CATNON trial on concurrent and adjuvant temozolomide in anaplastic glioma without 1p/19q codeletion. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.006] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The 1st interim analysis of the CATNON trial showed benefit from adjuvant (adj) temozolomide (TMZ) on overall survival (OS) but remained inconclusive about concurrent (conc) TMZ. A 2nd interim analysis was planned after 356 events.
MATERIAL AND METHODS
The 2x2 factorial design phase III CATNON trial randomized 751 adult patients with newly diagnosed non-codeleted anaplastic glioma to either 59.4 Gy radiotherapy (RT) alone; the same RT with concTMZ; the same RT and 12 cycles of adjTMZ or the same RT with both concTMZ and adjTMZ (doi: 10.1016/S0140-6736(17)31442-3). MGMT promoter methylation (MGMTmeth) status was re-assessed with the Infinium Methylation EPIC Beadchip using the MGMT_STP27 model. Isocitrate dehydrogenase 1 and 2 (IDH) mutation (mt) status was assessed with glioma targeted Agilent SureSelect baits sequence using an Illumina HiSeq2500 Rapid PE100.
RESULTS
With a median follow-up of 56 months and 356 events, the hazard ratio (HR) for OS adjusted for stratification factors after concTMZ was 0.968 (99.1% CI 0.73, 1.28). 5-year OS was 50.2% with and 52.7% without concTMZ (95% CI [44.4, 55.7] and [46.9, 58.1]). An IDHmt was found in 335 of 480 assessed cases (70%). Median OS was 19 mo (95% CI 16.3, 22.3) in IDHwt tumors and 116 mo (95% CI 82.0, 116.6) in IDHmt tumors. The interaction test based on IDH status was significant (p=0.016) in the univariate HR analysis for OS after concTMZ (IDHwt, n=145, events=120, HR = 1.27, 95% CI 0.89, 1.82, p=0.19; IDHmt, n=335, events=92, HR= 0.67, 95% CI 0.44, 1.03, p=0.06). IDHmt was predictive of benefit from adjTMZ (IDHmt HR: 0.41, 95% CI 0.27, 0.64; IDHwt: HR 1.05, 95% CI 0.73, 1.52; interaction test p = 0.001). In IDHmt patients that received adjTMZ, the HR for OS after concTMZ was 0.71 (95% CI 0.35, 1.42, p=0.32). MGMTmeth was found in 288 of 410 assessed cases (70%), interaction test for concTMZ (p = 0.092) and adjTMZ (p = 0.166) did not reach statistical significance.
CONCLUSION
In the entire study cohort, concTMZ did not increase OS. However, in IDHmt tumors a trend towards benefit of concTMZ is present. AdjTMZ increased OS in IDHmt but not in IDHwt tumors. Further analyses and follow-up will allow full assessment of efficacy in the molecular subgroups.
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Affiliation(s)
| | - S Erridge
- Western General Hospital, Edinburgh, United Kingdom
| | - M A Vogelbaum
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - A K Nowak
- Sir Charles Gairdner Hospital, Nedlands, Australia
| | - M Sanson
- Erasmus MC, Rotterdam, Netherlands
| | - A A Brandes
- Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - W Wick
- Ospedale Bellaria, Bologna, Italy
| | - P M Clement
- UniversitaetsKlinikum Heidelberg, Heidelberg, Germany
| | | | - W Mason
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - H Wheeler
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M Weller
- Royal North Shore Hospital, Sydney, Australia
| | - K Aldape
- Universitätsspital Zürich, Zürich, Switzerland
| | - P Wesseling
- National Institutes of Health, Bethesda, MD, United States
| | - J M Kros
- Erasmus MC, Rotterdam, Netherlands
| | | | | | - T Gorlia
- Amsterdam UMC, Amsterdam, Netherlands
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