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Shatara M, Blue M, Stanek J, Liu YA, Prevedello DM, Giglio P, Puduvalli VK, Gardner SL, Allen JC, Wong KK, Nelson MD, Gilles FH, Adams RH, Pauly J, O’Halloran K, Margol AS, Dhall G, Finlay JL. Final report of the phase II NEXT/CNS-GCT-4 trial: GemPOx followed by marrow-ablative chemotherapy for recurrent intracranial germ cell tumors. Neurooncol Pract 2024; 11:188-198. [PMID: 38496907 PMCID: PMC10940828 DOI: 10.1093/nop/npad067] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background Patients with relapsed intracranial germinoma can achieve durable remission with standard chemotherapy regimens and/or reirradiation; however, innovative therapies are required for patients with relapsed and/or refractory intracranial nongerminomatous germ cell tumors (NGGCTs) due to their poor prognosis. Improved outcomes have been reported using reinduction chemotherapy to achieve minimal residual disease, followed by marrow-ablative chemotherapy (HDCx) with autologous hematopoietic progenitor cell rescue (AuHPCR). We conducted a phase II trial evaluating the response and toxicity of a 3-drug combination developed for recurrent intracranial germ cell tumors consisting of gemcitabine, paclitaxel, and oxaliplatin (GemPOx). Methods A total of 9 patients with confirmed relapsed or refractory intracranial GCT were enrolled after signing informed consent, and received at least 2 cycles of GemPOx, of which all but 1 had relapsed or refractory NGGCTs. One patient with progressive disease was found to have pathologically confirmed malignant transformation to pure embryonal rhabdomyosarcoma (without GCT elements), hence was ineligible and not included in the analysis. Patients who experienced sufficient responses proceeded to receive HDCx with AuHPCR. Treatment response was determined based on radiographic tumor assessments and tumor markers. Results A total of 7 patients achieved sufficient response and proceeded with HDCx and AuHPCR, and 5 subsequently received additional radiotherapy. A total of 2 patients developed progressive disease while receiving GemPOx. Myelosuppression and transaminitis were the most common treatment-related adverse events. With a mean follow-up of 44 months, 4 patients (3 NGGCTs, 1 germinoma) are alive without evidence of disease. Conclusions GemPOx demonstrates efficacy in facilitating stem cell mobilization, thus facilitating the feasibility of both HDCx and radiotherapy.
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Affiliation(s)
- Margaret Shatara
- Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan Blue
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph Stanek
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Yin A Liu
- Departments of Ophthalmology, Neurology, and Neurosurgery, University of California, Davis, Sacramento, California, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Pierre Giglio
- Division of Neuro-Oncology, Ohio State University Wexner Medical Center, James Cancer Center, Columbus, Ohio, USA
| | - Vinay K Puduvalli
- Department of Neuro-oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon L Gardner
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA
| | - Jeffrey C Allen
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA
| | - Kenneth K Wong
- Division of Hematology and Oncology, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Marvin D Nelson
- Department of Radiology, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Floyd H Gilles
- Department of Pathology, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Roberta H Adams
- Phoenix Children’s Center for Cancer & Blood Disorders, University of Arizona School of Medicine—Phoenix, and Mayo Clinic, Arizona, USA
| | - Jasmine Pauly
- Division of Hematology and Oncology, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, California, USA
| | - Katrina O’Halloran
- Division of Hematology and Oncology, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ashley S Margol
- Division of Hematology and Oncology, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Girish Dhall
- Division of Pediatric Hematology/Oncology, Children’s Hospital of Alabama and the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jonathan L Finlay
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
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Cappellano AM, Dassi N, Mançano BM, Epelman S, Almeida DB, Cavalheiro S, Dastoli PA, Alves MTS, Nicacio JM, Costa MDS, Silva FA, Aguiar SS, Figueiredo ML, Chen M, Silva NS, Finlay JL. Intracranial non-germinomatous germ cell tumors in children and adolescents: how can the experience from an uppermiddle-income country contribute to the worldwide effort to improve outcomes? Front Oncol 2024; 14:1308128. [PMID: 38500657 PMCID: PMC10947194 DOI: 10.3389/fonc.2024.1308128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Background Non-germinomatous germ cell tumors (NGGCT) accounts for one third of intracranial GCT. While the germinoma group have an excellent overall survival, the standard of practice for children with NGGCT is still under evaluation. Aims Describe the results of the of the Brazilian consortium protocol. Methods Since 2013, 15 patients with a diagnosis of NGGCT by histopathology and/or serum/cerebrospinal fluid (CSF) tumor markers, βHCG >200mlU/ml and/or positive alpha-fetoprotein were treated with neoadjuvant chemotherapy with carboplatin, cyclophosphamide and etoposide followed by ventricular radiotherapy (RTV) of 18Gy with boost (32Gy) to the primary site. Metastatic patients underwent craniospinal irradiation (CSI) and "slow responders" to the four initial cycles of CT, to autologous stem cell transplantation (ASCT) followed by CSI. Results Mean age, 13.1 years. Thirteen males. Primary sites: pineal (n=12), suprasellar (n=2) and bifocal (n=1). Four patients were metastatic at diagnosis. Eight patients had CSF and/or serum alpha-fetoprotein levels > 1,000ng/ml. Tumor responses after chemotherapy demonstrated complete in six cases and partial in seven, with "second-look" surgery being performed in five cases, and two patients presenting viable lesions being referred to ASCT. The main toxicity observed was hematological grades 3/4. Two patients with metastatic disease, one with Down Syndrome and AFP > 1,000ng/ml and the other with choriocarcinoma and pulmonary metastases, developed progressive disease resulting in death, as well as two other patients without evidence of disease, due to endocrinological disorders. Event-free and overall survival at 2 and 5 years were 80% and 72.7%, respectively, with a mean follow-up of 48 months (range, 7-107). Conclusions Despite the small number of patients, in our series, treatment with six cycles of chemotherapy and RTV with focal boost for localized disease (n=11) and ACST for identified slow responders (n=2) seem to be effective strategies contributing to the overall effort to improve outcomes of this group of patients.
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Affiliation(s)
- Andrea M. Cappellano
- Pediatric Oncology, Pediatric Oncology Institute-GRAACC/Federal University of São Paulo, São Paulo, Brazil
| | - Natalia Dassi
- Pediatric Oncology, Pediatric Oncology Institute-GRAACC/Federal University of São Paulo, São Paulo, Brazil
| | | | - Sidnei Epelman
- Pediatric Oncology, Hospital Santa Marcelina-TUCCA, São Paulo, Brazil
| | - Daniela B. Almeida
- Nursing Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio Cavalheiro
- Neurosurgery Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Patricia A. Dastoli
- Neurosurgery Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Maria T. S. Alves
- Pathology Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Jardel M. Nicacio
- Neurosurgery Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Marcos D. S. Costa
- Neurosurgery Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Frederico A. Silva
- Radiology Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Simone S. Aguiar
- Pediatric Oncology, Pediatric Oncology Institute-GRAACC/Federal University of São Paulo, São Paulo, Brazil
| | - Maria L. Figueiredo
- Radiotherapy Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Michael Chen
- Radiotherapy Department, Pediatric Oncology Institute-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Nasjla S. Silva
- Pediatric Oncology, Pediatric Oncology Institute-GRAACC/Federal University of São Paulo, São Paulo, Brazil
| | - Jonathan L. Finlay
- Paediatric Oncology, The Ohio State University, Columbus, OH, United States
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Adamski J, Langford V, Finlay JL. Approaches to Minimise the Neurodevelopmental Impact of Choroid Plexus Carcinoma and Its Treatment. Life (Basel) 2023; 13:1855. [PMID: 37763259 PMCID: PMC10533047 DOI: 10.3390/life13091855] [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: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
Choroid plexus carcinomas (CPC) are rare aggressive tumours that primarily affect very young children. Treatment for CPC typically involves a combination of surgery, chemotherapy, and radiation therapy. Whilst considered necessary for a cure, these therapies have significant neurocognitive consequences for patients, negatively impacting cognitive function including memory, attention, executive functioning, and full-scale intelligence quotients (FSIQ). These challenges significantly impact the quality of life and ultimately socioeconomic parameters such as the level of educational attainment, marital status, and socioeconomic status. This review looks at the tumour- and treatment-related causes of neurocognitive damage in CPC patients and the progress made in finding strategies to reduce these. Opportunities to mitigate the neurodevelopmental consequences of surgery, chemotherapy, and radiation therapy are explored in the context of CPC treatment. Evaluation of the pathological and biological mechanisms of injury has identified innovative approaches to neurocognitive protection and neurorehabilitation, which aim to limit the neurocognitive damage. This review aims to highlight multiple approaches physicians can use when treating young children with CPC, to focus on neurocognitive outcomes as a measure of success.
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Affiliation(s)
- Jenny Adamski
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Vikki Langford
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Jonathan L. Finlay
- Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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4
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Subasri V, Light N, Kanwar N, Brzezinski J, Luo P, Hansford JR, Cairney E, Portwine C, Elser C, Finlay JL, Nichols KE, Alon N, Brunga L, Anson J, Kohlmann W, de Andrade KC, Khincha PP, Savage SA, Schiffman JD, Weksberg R, Pugh TJ, Villani A, Shlien A, Goldenberg A, Malkin D. Multiple Germline Events Contribute to Cancer Development in Patients with Li-Fraumeni Syndrome. Cancer Res Commun 2023; 3:738-754. [PMID: 37377903 PMCID: PMC10150777 DOI: 10.1158/2767-9764.crc-22-0402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/19/2023] [Accepted: 03/29/2023] [Indexed: 06/29/2023]
Abstract
Li-Fraumeni syndrome (LFS) is an autosomal dominant cancer-predisposition disorder. Approximately 70% of individuals who fit the clinical definition of LFS harbor a pathogenic germline variant in the TP53 tumor suppressor gene. However, the remaining 30% of patients lack a TP53 variant and even among variant TP53 carriers, approximately 20% remain cancer-free. Understanding the variable cancer penetrance and phenotypic variability in LFS is critical to developing rational approaches to accurate, early tumor detection and risk-reduction strategies. We leveraged family-based whole-genome sequencing and DNA methylation to evaluate the germline genomes of a large, multi-institutional cohort of patients with LFS (n = 396) with variant (n = 374) or wildtype TP53 (n = 22). We identified alternative cancer-associated genetic aberrations in 8/14 wildtype TP53 carriers who developed cancer. Among variant TP53 carriers, 19/49 who developed cancer harbored a pathogenic variant in another cancer gene. Modifier variants in the WNT signaling pathway were associated with decreased cancer incidence. Furthermore, we leveraged the noncoding genome and methylome to identify inherited epimutations in genes including ASXL1, ETV6, and LEF1 that confer increased cancer risk. Using these epimutations, we built a machine learning model that can predict cancer risk in patients with LFS with an area under the receiver operator characteristic curve (AUROC) of 0.725 (0.633-0.810). Significance Our study clarifies the genomic basis for the phenotypic variability in LFS and highlights the immense benefits of expanding genetic and epigenetic testing of patients with LFS beyond TP53. More broadly, it necessitates the dissociation of hereditary cancer syndromes as single gene disorders and emphasizes the importance of understanding these diseases in a holistic manner as opposed to through the lens of a single gene.
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Affiliation(s)
- Vallijah Subasri
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | - Nicholas Light
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nisha Kanwar
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jack Brzezinski
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ping Luo
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Jordan R. Hansford
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
- Michael Rice Cancer Centre, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- South Australia Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - Elizabeth Cairney
- Department of Paediatrics, London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Carol Portwine
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Christine Elser
- Department of Medical Oncology, Princess Margaret Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan L. Finlay
- Neuro-Oncology Program, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Kim E. Nichols
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Noa Alon
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ledia Brunga
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jo Anson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Kelvin C. de Andrade
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Payal P. Khincha
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Sharon A. Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Joshua D. Schiffman
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
- PEEL Therapeutics, Inc., Salt Lake City, Utah
| | - Rosanna Weksberg
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Trevor J. Pugh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Anita Villani
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adam Shlien
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anna Goldenberg
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
- CIFAR: Child and Brain Development, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - David Malkin
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Ronsley R, Triscott J, Stanek J, Rassekh SR, Lum A, Cheng S, Goddard K, McConnell D, Strahlendorf C, Singhal A, Finlay JL, Yip S, Dunham C, Hukin J. Outcomes of a radiation sparing approach in medulloblastoma by subgroup in young children: an institutional review. Childs Nerv Syst 2023:10.1007/s00381-023-05918-z. [PMID: 37022464 PMCID: PMC10390609 DOI: 10.1007/s00381-023-05918-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/12/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To describe disease outcomes including overall survival and relapse patterns by subgroup in young pediatric patients treated for medulloblastoma with a radiation-sparing approach. METHODS Retrospective analysis of clinical outcomes includes treatment, relapse, and salvage therapy and late effects in children treated for medulloblastoma with a radiation-sparing approach at British Columbia Children's Hospital (BCCH) between 2000 and 2020. RESULTS There were 30 patients (median age 2.8 years, 60% male) treated for medulloblastoma with a radiation-sparing approach at BCCH. Subgroups included Sonic Hedgehog (SHH) (n = 14), group 3 (n = 7), group 4 (n = 6), and indeterminate status (n = 3). Three- and 5-year event-free survival (EFS) were 49.0% (30.2-65.4%) and 42.0% (24.2-58.9%) and overall survival (OS) 66.0% (95% CI 46.0-80.1%) and 62.5% (95% CI 42.5 and 77.2%), respectively, with a median follow-up of 9.5 years. Relapse occurred in 12/25 patients following a complete response, of whom six (group 4: n = 4; group 3: n = 1; unknown: n = 1) were successfully salvaged with craniospinal axis (CSA) RT and remain alive at a median follow-up of 7 years. Disease/treatment-related morbidity included endocrinopathies (n = 8), hearing loss n = 16), and neurocognitive abnormalities (n = 9). CONCLUSIONS This radiation sparing treatment approach for young patients with medulloblastoma resulted in a durable cure in most patients with SHH subgroup medulloblastoma. In those patients with groups 3 and 4 medulloblastoma, relapse rates were high; however, most group 4 patients were salvaged with RT.
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Affiliation(s)
- Rebecca Ronsley
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada
| | - Joanna Triscott
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Joseph Stanek
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
| | - S Rod Rassekh
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada
| | - Amy Lum
- Department of Pathology, Vancouver General Hospital, Vancouver, Canada
| | - Sylvia Cheng
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Dina McConnell
- Department of Psychology, British Columbia Children's Hospital, Vancouver, Canada
| | - Caron Strahlendorf
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada
| | - Ash Singhal
- Division of Pediatric Neurosurgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, Canada
| | - Jonathan L Finlay
- Departments of Pediatrics and Radiation Oncology, the Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephen Yip
- Department of Pathology, Vancouver General Hospital, Vancouver, Canada
| | - Christopher Dunham
- Department of Pathology, British Columbia Children's Hospital, Vancouver, Canada
| | - Juliette Hukin
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada.
- Division of Neurology and Division of Hematology Oncology Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada.
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Cappellano AM, Dassi N, Mançano B, Epelman S, Almeida DB, Cavalheiro S, Dastoli PA, Seixas MT, Nicacio JM, Costa MD, Silva FA, Aguiar SS, Almeida CR, Teixeira GR, Chen M, Figueiredo ML, Silva NS, Finlay JL. Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience. JCO Glob Oncol 2023; 9:e2200257. [PMID: 37075267 PMCID: PMC10497279 DOI: 10.1200/go.22.00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE This prospective Brazilian single-arm trial was conducted to determine response to chemotherapy and survival after response-based radiotherapy in children with intracranial germinomas, in the setting of a multi-institutional study in a middle-income country (MIC) with significant disparity of subspecialty care. PATIENTS AND METHODS Since 2013, 58 patients with histologic and/or serum and CSF tumor marker evaluations of primary intracranial germ cell tumors were diagnosed; 43 were germinoma with HCGβ levels ≤200 mIU/mL and five between 100 and 200 mIU/mL. The treatment plan consisted of four cycles of carboplatin and etoposide followed by 18 Gy whole-ventricular field irradiation (WVFI) and primary site(s) boost up to 30 Gy; 24 Gy craniospinal was prescribed for disseminated disease. RESULTS Mean age 13.2 years (range, 4.7-25.5 years); 29 were males. Diagnosis was made by tumor markers (n = 6), surgery (n = 25), or both (n = 10). Two bifocal cases with negative tumor markers were treated as germinoma. Primary tumor location was pineal (n = 18), suprasellar (n = 14), bifocal (n = 10), and basal ganglia/thalamus (n = 1). Fourteen had ventricular/spinal spread documented by imaging studies. Second-look surgery occurred in three patients after chemotherapy. Thirty-five patients achieved complete responses after chemotherapy, and eight showed residual teratoma/scar. Toxicity was mostly grade 3/4 neutropenia/thrombocytopenia during chemotherapy. At a median follow-up of 44.5 months, overall and event-free survivals were 100%. CONCLUSION The treatment is tolerable, and WVFI dose reduction to 18 Gy preserves efficacy; we have demonstrated the feasibility of successfully conducting a prospective multicenter trial in a large MIC despite resource disparity.
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Affiliation(s)
| | - Natalia Dassi
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Bruna Mançano
- Pediatric Oncology, Hospital do Amor, Barretos, Brazil
| | - Sidnei Epelman
- Pediatric Oncology, Hospital Santa Marcelina, TUCCA, São Paulo, Brazil
| | - Daniela B. Almeida
- Nursing Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio Cavalheiro
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Patricia A. Dastoli
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Teresa Seixas
- Pathology Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Jardel M. Nicacio
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Marcos D. Costa
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Frederico A. Silva
- Radiology Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Simone S. Aguiar
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Michael Chen
- Radiotherapy Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | | | - Nasjla S. Silva
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
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7
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Erker C, Mynarek M, Bailey S, Mazewski CM, Baroni L, Massimino M, Hukin J, Aguilera D, Cappellano AM, Ramaswamy V, Lassaletta A, Perreault S, Kline CN, Rajagopal R, Michaiel G, Zapotocky M, Santa-Maria Lopez V, La Madrid AM, Cacciotti C, Sandler ES, Hoffman LM, Klawinski D, Khan S, Salloum R, Hoppmann AL, Larouche V, Dorris K, Toledano H, Gilheeney SW, Abdelbaki MS, Wilson B, Tsang DS, Knipstein J, Oren MY, Shah S, Murray JC, Ginn KF, Wang ZJ, Fleischhack G, Obrecht D, Tonn S, Harrod VL, Matheson K, Crooks B, Strother DR, Cohen KJ, Hansford JR, Mueller S, Margol A, Gajjar A, Dhall G, Finlay JL, Northcott PA, Rutkowski S, Clifford SC, Robinson G, Bouffet E, Lafay-Cousin L. Outcomes of Infants and Young Children With Relapsed Medulloblastoma After Initial Craniospinal Irradiation-Sparing Approaches: An International Cohort Study. J Clin Oncol 2023; 41:1921-1932. [PMID: 36548930 DOI: 10.1200/jco.21.02968] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/28/2021] [Revised: 07/18/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Infant and young childhood medulloblastoma (iMB) is usually treated without craniospinal irradiation (CSI) to avoid neurocognitive late effects. Unfortunately, many children relapse. The purpose of this study was to assess salvage strategies and prognostic features of patients with iMB who relapse after CSI-sparing therapy. METHODS We assembled a large international cohort of 380 patients with relapsed iMB, age younger than 6 years, and initially treated without CSI. Univariable and multivariable Cox models of postrelapse survival (PRS) were conducted for those treated with curative intent using propensity score analyses to account for confounding factors. RESULTS The 3-year PRS, for 294 patients treated with curative intent, was 52.4% (95% CI, 46.4 to 58.3) with a median time to relapse from diagnosis of 11 months. Molecular subgrouping was available for 150 patients treated with curative intent, and 3-year PRS for sonic hedgehog (SHH), group 4, and group 3 were 60%, 84%, and 18% (P = .0187), respectively. In multivariable analysis, localized relapse (P = .0073), SHH molecular subgroup (P = .0103), CSI use after relapse (P = .0161), and age ≥ 36 months at initial diagnosis (P = .0494) were associated with improved survival. Most patients (73%) received salvage CSI, and although salvage chemotherapy was not significant in multivariable analysis, its use might be beneficial for a subset of children receiving salvage CSI < 35 Gy (P = .007). CONCLUSION A substantial proportion of patients with relapsed iMB are salvaged after initial CSI-sparing approaches. Patients with SHH subgroup, localized relapse, older age at initial diagnosis, and those receiving salvage CSI show improved PRS. Future prospective studies should investigate optimal CSI doses and the role of salvage chemotherapy in this population.
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Affiliation(s)
- Craig Erker
- Division of Hematology/Oncology, Department of Paediatrics, IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Bailey
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, United Kingdom
| | | | - Lorena Baroni
- Hospital of Pediatrics SAMIC Prof. Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Maura Massimino
- Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - Juliette Hukin
- Divisions of Neurology and Hematology, Oncology/ Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Dolly Aguilera
- Children's Healthcare of Atlanta & Emory University, Atlanta, GA
| | - Andrea M Cappellano
- Division of Pediatric Oncology/BMT, Instituto de Oncologia Pediátrica-GRAACC-UNIFESP, São Paulo, Brazil
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Alvaro Lassaletta
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sébastien Perreault
- Centre Hospitalier Universitaire Sainte, Justine, Université de Montreal, Montreal, QC, Canada
| | - Cassie N Kline
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Revathi Rajagopal
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - George Michaiel
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Michal Zapotocky
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | | | | | - Chantel Cacciotti
- Division of Pediatric Hematology/Oncology, Western University, London, ON, Canada
- Dana Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA
| | - Eric S Sandler
- Nemours Children's Health, Wolfson's Children's Hospital & University of Florida, Jacksonville, FL
| | - Lindsey M Hoffman
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ
| | - Darren Klawinski
- Nemours Children's Health, Wolfson's Children's Hospital & University of Florida, Jacksonville, FL
| | - Sara Khan
- Monash Children's Cancer Centre, Monash Children's Hospital. Monash Health. Center for Cancer Research, Hudson Institute of Medical Research, and Department of Molecular and Translational Science, School of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
- Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Ralph Salloum
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Anna L Hoppmann
- Department of Pediatrics, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Valérie Larouche
- Department of Pediatrics, Centre Mère-enfant Soleil du CHU de Québec, CRCHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Kathleen Dorris
- Children's Hospital of Colorado & University of Colorado School of Medicine, Denver, CO
| | - Helen Toledano
- Schneider Children's Medical Center of Israel, Petah Tikva, and Sackler faculty of Medicine, Tel Aviv University, Israel
| | - Stephen W Gilheeney
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mohamed S Abdelbaki
- Division of Hematology, Oncology and Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
- Division of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Washington University School of Medicine in St Louis, St Louis, MO
| | - Beverly Wilson
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey Knipstein
- Division of Pediatric Hematology/Oncology/BMT, Medical College of Wisconsin, Milwaukee, WI
| | - Michal Yalon Oren
- Pediatric Hemato-Oncology Department, Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
| | - Shafqat Shah
- The University of Texas Health Science Center, Department of Pediatric Hematology-Oncology, San Antonio, TX
| | - Jeffrey C Murray
- Division of Pediatric Hematology/Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Kevin F Ginn
- Division of Pediatric Hematology and Oncology, Children's Mercy Hospital, Kansas City, MO
| | - Zhihong J Wang
- Division of Hematology and Oncology, Children's Hospital of Richmond and Virginia Commonwealth University, Richmond, VA
| | - Gudrun Fleischhack
- Pediatric Hematology and Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Svenja Tonn
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Virginia L Harrod
- Departments of Pediatric Hematology and Oncology, Dell Children's Medical Center of Central Texas and University of Texas, Austin, TX
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Bruce Crooks
- Division of Haematology/Oncology, Department of Paediatrics, IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | - Douglas R Strother
- Section of Pediatric Hematology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, AB, Canada
| | - Kenneth J Cohen
- Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital; Murdoch Children's Research Institute; University of Melbourne, Melbourne, Australia
| | - Sabine Mueller
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ashley Margol
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Amar Gajjar
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Girish Dhall
- Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Jonathan L Finlay
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Paul A Northcott
- Department of Developmental Neurobiology, St Jude Children's Research Hospital, Memphis, TN
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, United Kingdom
| | - Giles Robinson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Eric Bouffet
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Lucie Lafay-Cousin
- Section of Pediatric Hematology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, AB, Canada
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8
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De Faria FW, Schieffer KM, Pierson CR, Boue DR, LaHaye S, Miller KE, Amayiri N, Koboldt DC, Lichtenberg T, Leraas K, Brennan P, Kelly B, White P, Magrini V, Wilson RK, Mardis ER, Cottrell CE, Rusin J, Finlay JL, Osorio DS. Infantile metastatic ependymoma with a novel molecular profile and favorable outcome to intensive chemotherapy without irradiation: Case-based review. Genes Chromosomes Cancer 2023; 62:39-46. [PMID: 35716171 DOI: 10.1002/gcc.23081] [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: 12/26/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/06/2022] Open
Abstract
Ependymal tumors are the third most common brain tumor under 14 years old. Even though metastatic disease is a rare event, it affects mostly young children and carries an adverse prognosis. The factors associated with dissemination and the best treatment approach have not yet been established and there is limited published data on how to manage metastatic disease, especially in patients under 3 years of age. We provide a review of the literature on clinical characteristics and radiation-sparing treatments for metastatic ependymoma in children under 3 years of age treated. The majority (73%) of the identified cases were above 12 months old and had the PF as the primary site at diagnosis. Chemotherapy-based approaches, in different regimens, were used with radiation reserved for progression or relapse. The prognosis varied among the studies, with an average of 50%-58% overall survival. This study also describes the case of a 7-month-old boy with metastatic posterior fossa (PF) ependymoma, for whom we identified a novel SPECC1L-RAF1 gene fusion using a patient-centric comprehensive molecular profiling protocol. The patient was successfully treated with intensive induction chemotherapy followed by high-dose chemotherapy and autologous hematopoietic progenitor cell rescue (AuHSCR). Currently, the patient is in continuous remission 5 years after his diagnosis, without radiation therapy. The understanding of the available therapeutic approaches may assist physicians in their management of such patients. This report also opens the perspective of newly identified molecular alterations in metastatic ependymomas that might drive more chemo-sensitive tumors.
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Affiliation(s)
- Flavia Watusi De Faria
- Department of Pediatric Hematology and Oncology, Hospital da Criança de Brasilia, Brasilia, Distrito Federal, Brazil.,Department of Pediatric Hematology and Oncology, University Hospital Münster, Münster, Germany
| | - Kathleen M Schieffer
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Christopher R Pierson
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University, Columbus, Ohio, USA.,The Department of Biomedical Education and Anatomy, Division of Anatomy, The Ohio State University, Columbus, Ohio, USA
| | - Daniel R Boue
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Stephanie LaHaye
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Katherine E Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nisreen Amayiri
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Daniel C Koboldt
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Tara Lichtenberg
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kristen Leraas
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Patrick Brennan
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ben Kelly
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter White
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Vincent Magrini
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Richard K Wilson
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Elaine R Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Catherine E Cottrell
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jerome Rusin
- Department of Radiology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Jonathan L Finlay
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Diana S Osorio
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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9
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Diaz-Coronado RY, Reinecke JB, Stanek JR, Finlay JL, Hernández Broncano E, Chávez Paredes S, Tunque YM, Heredia Zelaya A, Casavilca Zambrano S, García-Corrochano Medina P, Ojeda Medina L, Orrego Puelles E, Torres Malca E, Sernaque Quintana R, Quispe Valverde W, García León JL, Osorio DS. Factors influencing outcomes of older children with medulloblastoma over 15 years in Peru, a resource-limited setting. Pediatr Blood Cancer 2022; 69:e29770. [PMID: 35593532 DOI: 10.1002/pbc.29770] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Medulloblastoma is the most common malignant brain tumor in children. While survival has improved in high-income countries (HIC), the outcomes for patients in low-to-middle-income countries (LMIC) are unclear. Therefore, we sought to determine the survival of children with medulloblastoma at the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 1997 and 2013 in Peru. METHODS Between 1997 and 2013, data from 103 children older than 3 years with medulloblastoma were analyzed. Fourteen patients were excluded. The patients were split into two distinct cohorts, 1997-2008 and 2009-2013, corresponding with chemotherapy regimen changes. Event-free (EFS) and overall survival (OS) were calculated using the Kaplan-Meier method, whereas prognostic factors were determined by univariate analysis (log-rank test). RESULTS Eighty-nine patients were included; median age was 8.1 years (range: 3-13.9 years). The 5-year OS was 62% (95% CI: 53%-74%), while EFS was 57% (95% CI: 48%-69%). The variables adversely affecting survival were anaplastic histology (compared to desmoplastic; OS: HR = 3.4, p = .03), metastasis (OS: HR = 3.5, p = .01; EFS: HR = 4.3, p = .004), delay in radiation therapy of 31-60 days (compared to ≤30 days; EFS: HR = 2.1, p = .04), and treatment 2009-2013 cohort (OS: HR = 2.2, p = .02; EFS: HR = 2.0, p = .03). CONCLUSIONS Outcomes for medulloblastoma at INEN were low compared with HIC. Anaplastic subtype, metastasis at diagnosis, delay in radiation therapy, and treatment in the period 2009-2013 negatively affected the outcomes in our study. Multidisciplinary teamwork, timely delivery of treatment, and partnerships with loco-regional groups and colleagues in HIC is likely beneficial.
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Affiliation(s)
| | - James Brandon Reinecke
- Pediatrics Department, Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Hematology, Oncology, Blood and Marrow Transplant Department, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Joseph R Stanek
- Division of Hematology, Oncology, Blood and Marrow Transplant Department, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Jonathan L Finlay
- Pediatrics Department, Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Hematology, Oncology, Blood and Marrow Transplant Department, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | | | - Sharon Chávez Paredes
- Pediatric Oncology Department, Instituto Nacional de Enfermedades Neoplásica, Lima, Perú
| | | | - Adela Heredia Zelaya
- Radiotherapy Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Perú
| | | | | | - Luis Ojeda Medina
- Neurosurgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Perú
| | | | - Ebert Torres Malca
- Pathology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Perú
| | | | | | - Juan L García León
- Pediatric Oncology Department, Instituto Nacional de Enfermedades Neoplásica, Lima, Perú
| | - Diana S Osorio
- Pediatrics Department, Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Hematology, Oncology, Blood and Marrow Transplant Department, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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10
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Takaoka K, Cioffi G, Waite KA, Finlay JL, Landi D, Greppin K, Kruchko C, Ostrom QT, Barnholtz-Sloan JS. Incidence and survival of choroid plexus tumors in the United States. Neurooncol Pract 2022; 10:41-49. [PMID: 36659972 PMCID: PMC9837781 DOI: 10.1093/nop/npac062] [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: 01/22/2023] Open
Abstract
Background There are limited data available on incidence and survival of patients with choroid plexus tumors (CPT). This study provides the most current epidemiological analysis of choroid plexus tumors from 2004 to 2017 in the United States. Methods Data on 2013 patients with CPT were acquired from the Central Brain Tumor Registry of the United States in collaboration with the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute, from 2004 to 2017. CPT cases were classified by the following pathological subtypes: choroid plexus papilloma (CPP), atypical choroid plexus papilloma (aCPP), and choroid plexus carcinoma (CPC). Frequencies and age-adjusted incidence rates (AAIR) per 100 000 and rate ratios per 100 000 (IRR) were reported for age, sex, race, and ethnicity for each pathological subtype with 95% confidence intervals (95% CI). Using CDC's National Program of Cancer Registries survival database, survival curves and hazard ratios (HRs) evaluated overall survival from 2001 to 2016. Results CPP had the highest overall incidence (AAIR: 0.034, 95% CI: 0.033-0.036), followed by CPC (AAIR: 0.008, 95% CI: 0.008-0.009) and aCPP (AAIR: 0.005, 95% CI: 0.005-0.006). Incidence was highest among children less than one year old among all subtypes (CPP AAIR: 0.278; aCPP AAIR: 0.140; CPC AAIR: 0.195), reducing as patients aged. Overall survival was worse among patients with CPC, being five times more likely to die compared to patients with CPP (HR: 5.23, 95% CI: 4.05-7.54, P < .001). Conclusions This analysis is the most current and comprehensive study in the US on the incidence and survival for CPT. Population based statistics provide critical information in understanding disease characteristics, which impact patient care and prognosis.
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Affiliation(s)
| | | | | | - Jonathan L Finlay
- Pediatrics and Radiation Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Daniel Landi
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kaitlyn Greppin
- Science Research & Engineering Program, Hathaway Brown School, Shaker Heights, Ohio, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, Illinois, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, Illinois, USA,The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA,Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Jill S Barnholtz-Sloan
- Corresponding Author: Jill S. Barnholtz-Sloan, PhD, National Cancer Institute, Shady Grove Campus, 9609 Medical Center Dr, Rockville, MD 20850, USA ()
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11
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Subasri V, Brew B, Erdman L, Guha T, Hansford JR, Cairney E, Portwine C, Elser C, Finlay JL, Nichols KE, Kohlmann W, Alon N, Novokmet A, Brunga L, Villani A, de Andrade KC, Khincha PP, Savage SA, Schiffman JD, Malkin D, Goldenberg A. Abstract 1428: DNA methylation predicts early onset of primary tumor in patients with Li-Fraumeni syndrome. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1428] [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
Background: Li-Fraumeni syndrome (LFS) is an autosomal dominant cancer predisposition syndrome. Approximately 80% of individuals with LFS harbor a germline TP53 pathogenic variant rendering them susceptible to a wide spectrum of early-onset malignancies. A comprehensive surveillance regimen termed the ‘Toronto Protocol’, has recently been adopted for early tumor detection, demonstrating significant improvement in survival among TP53 pathogenic variant carriers. However, the protocol’s “one-size-fits-all” approach fails to consider an individual patient's risk of cancer. We built a machine learning model that predicts early-onset of primary tumors in LFS by estimating the probability of cancer onset before the age of six years, leveraging patient peripheral blood leukocyte methylation profiles.
Methods: We built a gradient-boosted tree model to predict the probability of cancer onset before the age of six using methylation data from 288 TP53 pathogenic variant carriers. An external test set of 82 TP53 pathogenic variant carriers was used to validate our model. To increase the signal-to-noise ratio, methylation probes associated with TP53 status were retained and probes associated with aging were removed. In our study, we were primarily interested in minimizing the false negative rate (i.e. to reduce the number of patients who developed cancer before the age of six but were undetected by our algorithm.
Findings: We correctly predicted whether the first tumor will occur before the age of six with an accuracy of 79% in our external test set. Importantly, our model classified 90% of the patients that developed cancer prior to the age of six correctly. In addition, 81% of the individuals without cancer in the external test set were predicted correctly.
Interpretation: Our tool provides additional value to clinicians in stratifying patients into low- or high-risk groups of developing early-onset malignancies, and helps inform rational use of clinical surveillance tools for early cancer detection, with the ultimate aim to improve overall patient outcomes.
Citation Format: Vallijah Subasri, Benjamin Brew, Lauren Erdman, Tanya Guha, Jordan R. Hansford, Elizabeth Cairney, Carol Portwine, Christine Elser, Jonathan L. Finlay, Kim E. Nichols, Wendy Kohlmann, Noa Alon, Ana Novokmet, Ledia Brunga, Anita Villani, Kelvin C. de Andrade, Payal P. Khincha, Sharon A. Savage, Joshua D. Schiffman, David Malkin, Anna Goldenberg. DNA methylation predicts early onset of primary tumor in patients with Li-Fraumeni syndrome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1428.
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Affiliation(s)
| | - Benjamin Brew
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren Erdman
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tanya Guha
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Noa Alon
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ana Novokmet
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ledia Brunga
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anita Villani
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - David Malkin
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Cappellano AM, Dassi N, Mançano B, Epelman S, Almeida DB, Cavalheiro S, Dastoli PA, Seixas MT, Nicácio JM, Costa MD, Silva FA, Aguiar SS, Almeida Jr CR, Teixeira GR, Silva NS, Finlay JL. LINC-10. The Adequate Treatment of Children and Adolescents with Primary Central Nervous System Germ Cell Tumors (CNS GCT) in a Developing Country. Neuro Oncol 2022. [PMCID: PMC9164831 DOI: 10.1093/neuonc/noac079.609] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION: Primary central nervous system germ cell tumors (CNS GCT) are a heterogeneous group of malignancies that can be divided into germinomas and non-germinomatous GCT (NGGCT), accounting for 2-3% of brain tumors in children/adolescents in the Western hemisphere. The study aim is to report the ability to adequately treat Brazilian patients with CNSGCT through a consortium protocol, reporting their treatment, response and survival. Methods: Since 2013, 58 patients with histologic and/or tumor marker (TM) diagnosis of germinoma with/without HCGβ levels ≤200mIU/ml (n=43), five of them between 100-200mIU/ml, received carboplatin/ etoposide (4 cycles) and NGGCT (n=15), received carboplatin/etoposide/cyclophosphamide (6 cycles), all followed by 18Gy ventricular field irradiation and primary site(s) boost. Autologous hematopoietic cell transplant (AuHCT) was undertaken for NGGCT slow responders. Results: Mean age 13.2 years, 42 males. Diagnosis was made by TM (n=19), surgery (n=25) and both (n=12). Two bifocal cases with negative TM and inconclusive biopsy were treated as germinoma. Primary tumor location was pineal (n=30), suprasellar (n=16), bifocal (n=11) and basal ganglia/thalamus (n=1). Eighteen had ventricular/spinal spread. Second-look surgery occurred in seven patients. For the germinoma group, 36 achieved complete responses (CR) after chemotherapy, seven showed residual teratoma/scar. For the NGGCT after 4/6 cycles, six patients showed CR, two failure/progression and seven partial responses (five with negative TM). Two with positive TM underwent AuHCT. Radiotherapy was utilized as described, except in three patients. Four NGGCT patients died (two disease progression, two other causes with no disease). Toxicity was mostly grade 3/4 neutropenia/thrombocytopenia during chemotherapy. At a median follow-up of 40 months, event-free and overall survival was 100% for germinoma and 64.5% NGGCT. Conclusion: The proposed treatment was feasible to be performed in a developing country, with suitable survival even with VFI dose reduction to 18Gy.
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Affiliation(s)
| | - Natalia Dassi
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Sidnei Epelman
- Hospital Santa Marcelina/TUCCA, São Paulo, São Paulo, Brazil
| | - Daniela B Almeida
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Sergio Cavalheiro
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Patricia A Dastoli
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Jardel M Nicácio
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marcos D Costa
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Frederico A Silva
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Simone S Aguiar
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Nasjla S Silva
- IOP/GRAACC/Federal University of São Paulo, São Paulo, São Paulo, Brazil
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13
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Erker C, Craig B, Bailey S, Massimino M, Larouche V, L Finlay J, Kline C, Michaiel G, Margol A, Cohen K, Cacciotti C, Harrods V, Doris K, AbdelBaki M, Amayiri N, Wang Z, Hansford J, Hukin J, Salloum R, Hoffman L, Muray J, Ginn K, Zapotocky Z, Baroni L, Ramaswamy V, Gilheens S, Aguiera D, Mazewski C, Shah S, Strother D, Muller S, Gajjar A, Northcott P, Clifford S, Robinson G, Bouffet E, Lafay-Cousin L. MEDB-49. Relapsed SHH medulloblastomas in young children. Are there alternatives to full-dose craniospinal irradiation? Neuro Oncol 2022. [PMCID: PMC9165324 DOI: 10.1093/neuonc/noac079.423] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/RATIONAL: Following initial irradiation sparing therapy, many young children with relapsed medulloblastoma can be salvaged with craniospinal irradiation (CSI). However, the interval to relapse is short and neurocognitive sequelae remain a major concern. The contribution of molecular subgrouping may help refine indications and modalities of salvage strategies in this population. METHOD: From a cohort of 151 young children with molecularly characterized relapsed medulloblastoma, subset analysis of the SHH medulloblastoma was conducted to describe the practice of salvage radiotherapy and associated post-relapse survival (PRS). RESULTS: Sixty-seven SHH medulloblastoma patients (46 M0; 54 GTR; 11 non-ND/MBEN) received salvage therapy with curative intent. Before relapse, 54 (80.6%) received conventional chemotherapy (CC), 13 (19.4%) high-dose chemotherapy (HDC), while seven had additional focal radiotherapy (fRT). Median time to relapse was 11.1 months (range 3.8-41.0) and 43.3% were localized. Thirty patients (16 localized relapse) underwent surgery. Forty-seven (71.2%) received salvage radiotherapy (20 with CC; 10 with HDC; 15 alone, two unknown). CSI and fRT accounted for 82% and 18% respectively. CSI median dose was 36Gy (range 18-39Gy). Ten patients (eight with localized relapse) received CSI doses ≤23.4Gy. Nineteen patients (28.8%) did not receive any radiotherapy (nine HDC; 10 CC only). Radiotherapy was associated with better 3-year PRS (73.0% versus 36.1%; p=0.001). All patients treated with CSI ≤ 23.4Gy were alive at median follow-up of 69 months(24-142). Six of nine patients treated with HDC without irradiation were alive at last follow-up. Sixty-three percent of patients received reduced dose CSI(≤23.4Gy), fRT, or no radiotherapy, and their PRS did not significantly differ from those who received CSI ≥ 30.6Gy (p = 0.54). CONCLUSION: While salvage CSI provided PRS benefit in this SHH medulloblastoma cohort, we report the use of reduced salvage radiotherapy and irradiation avoidance in 63% of the patients, with 60% alive at last follow-up.
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Affiliation(s)
| | | | - Simon Bailey
- Great North Children's Hospital , Newcastle , United Kingdom
| | | | - Valerie Larouche
- Centre Hosptitalier Universitaire de Quebec, Quebec City , QC , Canada
| | | | - Cassie Kline
- Children's Hospital of Philadelphia , Philadelphia, PA , USA
| | - George Michaiel
- British Columbia CHildren's Hospital , Vancouver, BC , Canada
| | - Ashley Margol
- Children's Hospital of Los ANgeles, Los Angeless , CA , USA
| | - Kenneth Cohen
- Sidney Kimmel Comprehensive Cancer Center Johns Hopkins , Baltimore, MD , USA
| | - Chantel Cacciotti
- Children’s Hospital, London Health Sciences Centre , London, ON , Canada
| | - Virginia Harrods
- Dell Children's Medical Center of Central Texas , Austin, TX , USA
| | | | | | | | - Zhihong Wang
- Virginia Commonwealth University Massey Cancer Center , Richmond, VA , USA
| | - Jordan Hansford
- Children’s Cancer Centre, Royal Children’s Hospital , Melbourne , Australia
| | - Juliette Hukin
- British Columbia CHildren;s Hospital , Vancouver, BC , Canada
| | | | | | - Jeffrey Muray
- Cook Children's Medical Center, Fort Worth , TX , USA
| | - Kevin Ginn
- Children's Mercy Hospitals and Clinics, Kansas City , MO , USA
| | - Zapotocky Zapotocky
- University Hospital Motol, Prague, Czech RepublicUniversity Hospital Motol , Prague , Czech Republic
| | - Lorena Baroni
- Hospital of Pediatrics SAMIC Prof. Dr Juan P. Garrahan , Bueno Aeres , Argentina
| | | | | | - Dolli Aguiera
- Children’s Health Care of Atlanta, Emory University , Atlanta, GA , USA
| | - Claire Mazewski
- Children’s Health Care of Atlanta, Emory University , Atlanta, GA , USA
| | - Shafqat Shah
- University of Texas Health Science Center, San Antonio , TX , USA
| | | | - Sabine Muller
- University of California San Francisco, San Francisco , CA , USA
| | - Amar Gajjar
- St Jude Research Hospital , Memphis, TN , USA
| | | | - Steve Clifford
- Wolfson Childhood Cancer Research Centre , Newcastle , United Kingdom
| | | | - Eric Bouffet
- Hospital for Sick Children , Toronto, ON , Canada
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14
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Diaz-Coronado R, Reinecke JB, Stanek JR, Finlay JL, Hernandez-Broncano E, Chavez-Paredes S, Miranda-Tunque Y, Heredia-Zelaya A, Casavilca-Zambrano S, Garcia-Corrochano P, Ojeda-Medina L, Orrego-Puelles E, Torres-Malca E, Sernaque-Quintana R, Quispe-Valverde W, Garcia-Leon J, Osorio DS. LINC-23. Factors influencing outcomes of older children with Medulloblastoma over 15 years in Peru, a resource limited setting. Neuro Oncol 2022. [PMCID: PMC9165001 DOI: 10.1093/neuonc/noac079.622] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. While survival has improved in high-income countries (HIC), the outcomes for patients in low-middle-income countries (LMIC) are unclear. Therefore, we sought to determine the survival of children with Medulloblastoma at the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 1997 and 2013 in Peru. METHODS: Between 1997-2013, data from 103 children older than three years with Medulloblastoma were analyzed. Fourteen patients were excluded. The patients were split into two distinct cohorts, 1997 – 2008 and 2009 – 2013, corresponding with chemotherapy regimen changes. Event-free (EFS) and overall survival (OS) were calculated using the Kaplan-Meier method, while prognostic factors were determined by univariate analysis (log-rank test). RESULTS: Eighty-nine patients were included; median age was 8.1 years (range: 3-13.9 years). The five-year OS was 62% (95% CI: 53 – 74%) while EFS was 57% (95% CI: 48 – 69%). The variables adversely affecting survival were anaplastic histology [compared to desmoplastic; OS: HR=3.4, p=0.03], metastasis [OS: HR=3.5, p=0.01; EFS: HR=4.3, p=0.004], delay in radiation therapy of 31-60 days [compared to ≤30 days; EFS: HR=2.1, p=0.04], and treatment 2009 – 2013 cohort[OS: HR=2.2, p=0.02; EFS: HR=2.0; p=0.03]. CONCLUSIONS: Outcomes for Medulloblastoma at INEN were low compared with HIC. Anaplastic sub-type, metastasis at diagnosis, delay in radiation therapy, and treatment in the period 2009 - 2013 negatively affected the outcomes in our study. Multidisciplinary teamwork, timely delivery of treatment and partnerships with loco-regional groups and colleagues in HIC is likely beneficial.
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Affiliation(s)
| | - James B Reinecke
- Nationwide Children's Hospital and The Ohio State University , Columbus, Ohio , USA
| | - Joseph R Stanek
- Nationwide Children's Hospital and The Ohio State University , Columbus, Ohio , USA
| | - Jonathan L Finlay
- Nationwide Children's Hospital and The Ohio State University , Columbus, Ohio , USA
| | | | | | | | | | | | | | | | | | | | | | | | - Juan Garcia-Leon
- Instituto Nacional de Enfermedades Neoplasicas , Lima, Lima , Peru
| | - Diana S Osorio
- Nationwide Children's Hospital and The Ohio State University , Columbus, Ohio , USA
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15
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Mobark NA, Alharbi M, Ballourah W, AlSultan A, Manjomi FA, Alotabi F, Balbaid AAO, Rayis M, AlNaqib ZG, Aljabarat WAR, Finlay JL. GCT-10. Successful Salvage of Relapsed intracranial Non-Germinaoteous Germ Cell Tumors NGGCTs in a Child With Renal Insufficiency with Novel platinum-Free chemotherapy Regimen. Neuro Oncol 2022. [PMCID: PMC9165315 DOI: 10.1093/neuonc/noac079.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Outcome for relapsed NGGCT is poor. Salvage therapy usually consist of reinduction platinum-based chemotherapy regimen followed by high-dose-chemotherapy and autologous-stem-cell-rescue (HDC/AuSCR) and re-irradiation with no consensus on optimal management and usually associated with remarkable toxicity. We present a 12-year-old boy diagnosed with a localized pineal Non-Germinaoteous Germ Cell Tumors NGGCTs of mixed origin with elevated AFP he had ETV and biopsy started on COG ACNS0122 protocol after receiving first cycle (carbo/Etoposide) he developed acute renal failure investigation showed small dysplastic kidney to avoid nephrotoxicity of platinum agents chemotherapy changed to VBE (Vinblastine, Bleomycin and Etoposide) post 3rd cycle MRI showed increase in size of the pineal mass with normal tumor markers representing Growing Teratoma Syndrome He had total surgical resection of the tumor Pathology showed predominant teratoma component He received radiation therapy CSI then another 3 cycles of VBE 4 months following treatment completion he presented with elevated AFB and new right anterior temporal lesion Spinal MRI and CSF were negative. He had 2 cycles of Salvage Non-nephrotoxic 4-drug regimens GEMPIV Gemcitabine 800 mg/m2 days 1 and 14. Paclitaxel 80 mg/m2 days 1 and14, Irinotecan 50 mg/m2 daily for 5 days Vinblastine 6 mg/m2 weekly days 1,8,14 MRI after 2 cycles showed remission with undetectable AFP then 2 consolidation cycles of etoposide and thiotepa (HDC/AuSCR) The 3rd consolidation cycles were cancelled due to hematological toxicity During treatment phases chemotherapy was well tolerated doses were adjusted according to his GFR with renal conservative and supportive therapy.post (HDC/AuSCR) he experienced delayed hematological recovery with persistent thrombocytopenia responded to Eltrombopag then he had focal Temporal lobe irradiation Currently patients in remission with chronic stage 3 renal Insufficiency Conclusions: this case showed that relapsed intracranial NGGCT can be successfully salvaged without platinum-based chemotherapy in patients with renal insufficiency.
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Affiliation(s)
- Nahla Ali Mobark
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Musa Alharbi
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Walid Ballourah
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Abdulrahman AlSultan
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Fahad Al Manjomi
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Fahad Alotabi
- Pediatric Neurosurgical Department, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Ali Abdullah O Balbaid
- Radiation Oncology Department, Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Mohammed Rayis
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Zaid G AlNaqib
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Wael abdel Rahman Aljabarat
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City , RIYADH , Saudi Arabia
| | - Jonathan L Finlay
- Emeritus Professor of Pediatrics and Radiation Oncology, The Ohio State University, Columbus , OH , USA
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16
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Harris MK, Shatara M, Funk Z, Stanek J, Boué DR, Jones J, Finlay JL, Abdelbaki MS. Recurrent Wnt medulloblastoma treated with marrow-ablative chemotherapy and autologous hematopoietic progenitor cell rescue: a dual case report and review of the literature. Childs Nerv Syst 2022; 38:465-472. [PMID: 33948723 DOI: 10.1007/s00381-021-05197-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022]
Abstract
Wnt-activated medulloblastoma (MB) confers an excellent prognosis. However, specific treatment strategies for patients with relapsed Wnt-MB are unknown. We report two patients with recurrent beta-catenin nucleopositive Wnt-MB successfully treated by incorporating marrow-ablative chemotherapy and autologous hematopoietic progenitor cell rescue (HDCx/AuHPCR). We also present a review of the literature for previously reported cases of relapsed Wnt-MB. We propose that patients with recurrent Wnt-MB may be treated using a multi-disciplinary approach that includes HDCx/AuHPCR with or without re-irradiation.
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Affiliation(s)
- Micah K Harris
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, 43205, USA
- The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Margaret Shatara
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, 43205, USA
- The Division of Pediatric Hematology and Oncology, Washington University School of Medicine, 1 Children's Pl, St. Louis, MO, 63011, USA
| | - Zachary Funk
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, 43205, USA
| | - Joseph Stanek
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, 43205, USA
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, 43210, USA
| | - Jeremy Jones
- The Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jonathan L Finlay
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, 43205, USA
| | - Mohamed S Abdelbaki
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, 43205, USA.
- The Division of Pediatric Hematology and Oncology, Washington University School of Medicine, 1 Children's Pl, St. Louis, MO, 63011, USA.
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17
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Melas M, Shatara M, Schieffer KM, Lee K, Varga EA, Leraas KM, Rodriguez DP, Abdelbaki MS, Osorio DS, Finlay JL, Boué DR, White P, Magrini V, Wilson RK, Mardis ER, Cottrell CE. 26. Co-occurrence of rosette-forming glioneuronal tumors with Noonan Syndrome. Cancer Genet 2022. [DOI: 10.1016/j.cancergen.2021.05.040] [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: 11/02/2022]
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18
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Abu-Arja MH, Osorio DS, Lassaletta A, Graham RT, Coven SL, Stanek JR, Bouffet E, Finlay JL, Abdelbaki MS. Prognostic factors for patients with relapsed central nervous system nongerminomatous germ cell tumors. Pediatr Blood Cancer 2022; 69:e29365. [PMID: 34558189 DOI: 10.1002/pbc.29365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/06/2022]
Abstract
We aimed toidentify prognostic factors that may help better understand the behavior of relapsed central nervous system nongerminomatous germ cell tumors. We identified nine studies, including 101 patients; 33 patients (33%) were alive 12 months post-initial relapse. Sixty percent of patients with serum/cerebrospinal fluid (CSF) alpha-fetoprotein (AFP) level ≤25 ng/mL at initial diagnosis were survivors compared with 28% among patients with serum/CSF AFP level >25 ng/mL (P = 0.01). Seventy-one percent of patients who achieved complete response/continued complete response (CR/CCR) by the end of therapy at relapse were survivors compared with 7% among patients who had less than CR/CCR (P < 0.0001). Forty-eight percent of patients who received marrow-ablative chemotherapy followed by autologous hematopoietic cell rescue (HDCx/AuHCR) following relapse were survivors compared with 12% among patients who did not receive HDCx/AuHCR (P = 0.0001). Local relapse site, gross total surgical resection, and radiotherapy at relapse were not associated with improved outcomes.
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Affiliation(s)
- Mohammad H Abu-Arja
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.,The Division of Hematology, Oncology and BMT, The Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Diana S Osorio
- The Division of Hematology, Oncology and BMT, The Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Alvaro Lassaletta
- The Department of Pediatric Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Richard T Graham
- The Division of Hematology, Oncology and BMT, The Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.,The Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Scott L Coven
- The Division of Hematology, Oncology and BMT, The Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.,The Division of Pediatric Hematology-Oncology, Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana
| | - Joseph R Stanek
- The Division of Hematology, Oncology and BMT, The Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Eric Bouffet
- The Division of Hematology, Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jonathan L Finlay
- The Division of Hematology, Oncology and BMT, The Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Mohamed S Abdelbaki
- The Division of Hematology, Oncology and BMT, The Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.,The Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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19
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Oigman G, Osorio DS, Ferman S, Stanek JR, Aversa do Souto A, Christiani MMC, Magalhaes DMA, Finlay JL, Vianna DA. Epidemiological characteristics and survival outcomes of children with medulloblastoma treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil. Pediatr Blood Cancer 2022; 69:e29274. [PMID: 34767315 DOI: 10.1002/pbc.29274] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Medulloblastoma (MB),the most common malignant brain tumor of childhood has survival outcomes exceeding 80% for standard-risk and 60% for high-risk patients in high-income countries (HICs). These results have not been replicated in low- and middle-income countries (LMICs), where 80% of children with cancer live. METHODS This is a retrospective review of 114 children aged 3-18 years diagnosed with MB from 1997 to 2016 at National Cancer Institute (INCA). Sociodemographic, clinical, and treatment data were extracted from the medical records and summarized descriptively. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. RESULTS The male-to-female ratio was 1.32 and the median age at diagnosis was 8.2 years. Headache (83%) and nausea/vomiting (78%) were the most common presenting symptoms. Five-year OS was 59.1% and PFS was 58.4%. The OS for standard-risk and high-risk patients was 69% and 53%, respectively. The median time to diagnosis interval was 50.5 days and the median time from surgery to radiation therapy initiation was 50.4 days. Patients who lived >40 km from INCA fared better (OS = 68.2% vs. 51.1%, p = .032). Almost 20% of families lived below the Brazilian minimum wage. Forty-five patients (35%) had metastatic disease at admission. Gross total resection was achieved in 57% of the patitents. CONCLUSIONS Although there are considerable barriers to deliver effective MB treatment in countries like Brazil, the OS seen in the present study demonstrates that good outcomes are not only feasible but can and should be increased with appropriate interventions.
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Affiliation(s)
- Gabriela Oigman
- Division of Pediatric Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diana S Osorio
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Sima Ferman
- Division of Pediatric Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joseph R Stanek
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Marcio M C Christiani
- Division of Neurosurgery, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denise M A Magalhaes
- Division of Radiation Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonathan L Finlay
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Denizar A Vianna
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Shatara M, Schieffer KM, Klawinski D, Thomas DL, Pierson CR, Sribnick EA, Jones J, Rodriguez DP, Deeg C, Hamelberg E, LaHaye S, Miller KE, Fitch J, Kelly B, Leraas K, Pfau R, White P, Magrini V, Wilson RK, Mardis ER, Abdelbaki MS, Finlay JL, Boué DR, Cottrell CE, Ghasemi DR, Pajtler KW, Osorio DS. Clinically aggressive pediatric spinal ependymoma with novel MYC amplification demonstrates molecular and histopathologic similarity to newly described MYCN-amplified spinal ependymomas. Acta Neuropathol Commun 2021; 9:192. [PMID: 34895332 PMCID: PMC8665631 DOI: 10.1186/s40478-021-01296-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/16/2021] [Accepted: 11/20/2021] [Indexed: 12/21/2022] Open
Abstract
Primary spinal cord tumors contribute to ≤ 10% of central nervous system tumors in individuals of pediatric or adolescent age. Among intramedullary tumors, spinal ependymomas make up ~ 30% of this rare tumor population. A twelve-year-old male presented with an intradural, extramedullary mass occupying the dorsal spinal canal from C6 through T2. Gross total resection and histopathology revealed a World Health Organization (WHO) grade 2 ependymoma. He recurred eleven months later with extension from C2 through T1-T2. Subtotal resection was achieved followed by focal proton beam irradiation and chemotherapy. Histopathology was consistent with WHO grade 3 ependymoma. Molecular profiling of the primary and recurrent tumors revealed a novel amplification of the MYC (8q24) gene, which was confirmed by fluorescence in situ hybridization studies. Although MYC amplification in spinal ependymoma is exceedingly rare, a newly described classification of spinal ependymoma harboring MYCN (2p24) amplification (SP-MYCN) has been defined by DNA methylation-array based profiling. These individuals typically present with a malignant progression and dismal outcomes, contrary to the universally excellent survival outcomes seen in other spinal ependymomas. DNA methylation array-based classification confidently classified this tumor as SP-MYCN ependymoma. Notably, among the cohort of 52 tumors comprising the SP-MYCN methylation class, none harbor MYC amplification, highlighting the rarity of this genomic amplification in spinal ependymoma. A literature review comparing our individual to reported SP-MYCN tumors (n = 26) revealed similarities in clinical, histopathologic, and molecular features. Thus, we provide evidence from a single case to support the inclusion of MYC amplified spinal ependymoma within the molecular subgroup of SP-MYCN.
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21
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LaHaye S, Fitch JR, Voytovich KJ, Herman AC, Kelly BJ, Lammi GE, Arbesfeld JA, Wijeratne S, Franklin SJ, Schieffer KM, Bir N, McGrath SD, Miller AR, Wetzel A, Miller KE, Bedrosian TA, Leraas K, Varga EA, Lee K, Gupta A, Setty B, Boué DR, Leonard JR, Finlay JL, Abdelbaki MS, Osorio DS, Koo SC, Koboldt DC, Wagner AH, Eisfeld AK, Mrózek K, Magrini V, Cottrell CE, Mardis ER, Wilson RK, White P. Discovery of clinically relevant fusions in pediatric cancer. BMC Genomics 2021; 22:872. [PMID: 34863095 PMCID: PMC8642973 DOI: 10.1186/s12864-021-08094-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background Pediatric cancers typically have a distinct genomic landscape when compared to adult cancers and frequently carry somatic gene fusion events that alter gene expression and drive tumorigenesis. Sensitive and specific detection of gene fusions through the analysis of next-generation-based RNA sequencing (RNA-Seq) data is computationally challenging and may be confounded by low tumor cellularity or underlying genomic complexity. Furthermore, numerous computational tools are available to identify fusions from supporting RNA-Seq reads, yet each algorithm demonstrates unique variability in sensitivity and precision, and no clearly superior approach currently exists. To overcome these challenges, we have developed an ensemble fusion calling approach to increase the accuracy of identifying fusions. Results Our Ensemble Fusion (EnFusion) approach utilizes seven fusion calling algorithms: Arriba, CICERO, FusionMap, FusionCatcher, JAFFA, MapSplice, and STAR-Fusion, which are packaged as a fully automated pipeline using Docker and Amazon Web Services (AWS) serverless technology. This method uses paired end RNA-Seq sequence reads as input, and the output from each algorithm is examined to identify fusions detected by a consensus of at least three algorithms. These consensus fusion results are filtered by comparison to an internal database to remove likely artifactual fusions occurring at high frequencies in our internal cohort, while a “known fusion list” prevents failure to report known pathogenic events. We have employed the EnFusion pipeline on RNA-Seq data from 229 patients with pediatric cancer or blood disorders studied under an IRB-approved protocol. The samples consist of 138 central nervous system tumors, 73 solid tumors, and 18 hematologic malignancies or disorders. The combination of an ensemble fusion-calling pipeline and a knowledge-based filtering strategy identified 67 clinically relevant fusions among our cohort (diagnostic yield of 29.3%), including RBPMS-MET, BCAN-NTRK1, and TRIM22-BRAF fusions. Following clinical confirmation and reporting in the patient’s medical record, both known and novel fusions provided medically meaningful information. Conclusions The EnFusion pipeline offers a streamlined approach to discover fusions in cancer, at higher levels of sensitivity and accuracy than single algorithm methods. Furthermore, this method accurately identifies driver fusions in pediatric cancer, providing clinical impact by contributing evidence to diagnosis and, when appropriate, indicating targeted therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-021-08094-z.
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Affiliation(s)
- Stephanie LaHaye
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - James R Fitch
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kyle J Voytovich
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Adam C Herman
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Benjamin J Kelly
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Grant E Lammi
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeremy A Arbesfeld
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Saranga Wijeratne
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Samuel J Franklin
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathleen M Schieffer
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Natalie Bir
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sean D McGrath
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anthony R Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy Wetzel
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine E Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tracy A Bedrosian
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kristen Leraas
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth A Varga
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kristy Lee
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ajay Gupta
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA
| | - Bhuvana Setty
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Daniel R Boué
- Department of Pathology, The Ohio State University, Columbus, OH, USA.,Department of Pathology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeffrey R Leonard
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Section of Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jonathan L Finlay
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Mohamed S Abdelbaki
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Diana S Osorio
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Selene C Koo
- Department of Pathology, The Ohio State University, Columbus, OH, USA.,Department of Pathology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel C Koboldt
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alex H Wagner
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Ann-Kathrin Eisfeld
- Division of Hematology, The Ohio State University, Columbus, OH, USA.,Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University, Columbus, OH, USA.,The Ohio State Comprehensive Cancer Center, Columbus, OH, USA
| | - Krzysztof Mrózek
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University, Columbus, OH, USA.,The Ohio State Comprehensive Cancer Center, Columbus, OH, USA
| | - Vincent Magrini
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Catherine E Cottrell
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Elaine R Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Richard K Wilson
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Peter White
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
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22
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Graham RT, Bell EH, Webb A, Zhao Y, Timmers C, Fleming JL, Sells BE, Robison NJ, Palmer JD, Finlay JL, Chakravarti A. Pediatric Gliosarcoma With and Without Neurofibromatosis Type 1: A Whole-exome Comparison of 2 Patients. J Pediatr Hematol Oncol 2021; 43:e1201-e1204. [PMID: 33235140 DOI: 10.1097/mph.0000000000002020] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022]
Abstract
Gliosarcoma is rare among pediatric patients and among individuals with Neurofibromatosis Type 1 (NF1). Here we compare 2 pediatric gliosarcoma patients, one of whom has NF1. We performed whole-exome sequencing, methylation, and copy number analysis on tumor and blood for both patients. Whole-exome sequencing showed higher mutational burden in the tumor of the patient without NF1. Copy number analysis showed differences in chromosomal losses/gains between the tumors. Neither tumor showed O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation. The NF1 patient survived without progression while the other expired. This is the first reported case of gliosarcoma in a child with NF1.
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Affiliation(s)
- Richard T Graham
- Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Erica H Bell
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Amy Webb
- Center for Biostatistics, The Ohio State University
| | - Yue Zhao
- Center for Biostatistics, The Ohio State University
| | | | - Jessica L Fleming
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Blake E Sells
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Nathan J Robison
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Jonathan L Finlay
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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23
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Levitch CF, Malkin B, Latella L, Guerry W, Gardner SL, Finlay JL, Sands SA. Long-term neuropsychological outcomes of survivors of young childhood brain tumors treated on the Head Start II protocol. Neurooncol Pract 2021; 8:609-619. [PMID: 34594573 DOI: 10.1093/nop/npab028] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The Head Start treatment protocols have focused on curing young children with brain tumors while avoiding or delaying radiotherapy through using a combination of high-dose, marrow-ablative chemotherapy and autologous hematopoietic cell transplantation (AuHCT). Late effects data from treatment on the Head Start II (HS II) protocol have previously been published for short-term follow-up (STF) at a mean of 39.7 months post-diagnosis. The current study examines long-term follow-up (LTF) outcomes from the same cohort. Methods Eighteen HS II patients diagnosed with malignant brain tumors <10 years of age at diagnosis completed a neurocognitive battery and parents completed psychological questionnaires at a mean of 104.7 months' post-diagnosis. Results There was no significant change in Full Scale IQ at LTF compared to baseline or STF. Similarly, most domains had no significant change from STF, including verbal IQ, performance IQ, academics, receptive language, learning/memory, visual-motor integration, and externalizing behaviors. Internalizing behaviors increased slightly at LTF. Clinically, most domains were within the average range, except for low average mathematics and receptive language. Additionally, performance did not significantly differ by age at diagnosis or time since diagnosis. Of note, children treated with high-dose methotrexate for disseminated disease or atypical teratoid/rhabdoid tumor displayed worse neurocognitive outcomes. Conclusions These results extend prior findings of relative stability in intellectual functioning for a LTF period. Ultimately, this study supports that treatment strategies for avoiding or delaying radiotherapy using high-dose, marrow-ablative chemotherapy and AuHCT may decrease the risk of neurocognitive and social-emotional declines in young pediatric brain tumor survivors.
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Affiliation(s)
- Cara F Levitch
- Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin Malkin
- Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lauren Latella
- Graduate School of Education, Fordham University, Bronx, New York, USA
| | - Whitney Guerry
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sharon L Gardner
- Department of Pediatrics, NYU Langone Health, New York, New York, USA
| | - Jonathan L Finlay
- Department of Pediatrics and Division of Hematology, Oncology, and Blood & Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Stephen A Sands
- Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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24
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Graham RT, Abu-Arja MH, Stanek JR, Cappellano A, Coleman C, Chi S, Cooney T, Dhall G, Ellen JG, Finlay JL, Fisher MJ, Friedman GK, Gajjar A, Gauvain K, Hoffman LM, Hukin J, Lucas JT, Mueller S, Navalkele P, Ronsley R, Tinkle C, Villeneuve S, Yeo KK, Su JM, Margol A, Gottardo NG, Allen J, Packer R, Bartels U, Abdelbaki MS. Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma. Pediatr Blood Cancer 2021; 68:e29172. [PMID: 34125480 PMCID: PMC9639702 DOI: 10.1002/pbc.29172] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Central nervous system (CNS) germinomas are treatment-sensitive tumors with excellent survival outcomes. Current treatment strategies combine chemotherapy with radiotherapy (RT) in order to reduce the field and dose of RT. Germinomas originating in the basal ganglia/thalamus (BGTGs) have proven challenging to treat given their rarity and poorly defined imaging characteristics. Craniospinal (CSI), whole brain (WBI), whole ventricle (WVI), and focal RT have all been utilized; however, the best treatment strategy remains unclear. METHODS Retrospective multi-institutional analysis has been conducted across 18 institutions in four countries. RESULTS For 43 cases of nonmetastatic BGTGs, the 5- and 10-year event-free survivals (EFS) were 85.8% and 81.0%, respectively, while the 5- and 10-year overall survivals (OS) were 100% and 95.5%, respectively (one patient fatality from unrelated cause). Median RT doses were as follows: CSI: 2250 cGy/cGy(RBE) (1980-2400); WBI: 2340 cGy/cGy(RBE) (1800-3000); WVI: 2340 cGy/cGy(RBE) (1800-2550); focal: 3600 cGy (3060-5400). Thirty-eight patients (90.5%) received chemotherapy. There was no statistically significant difference in the EFS based on initial field extent (p = .84). Nevertheless, no relapses were reported in patients who received CSI or WBI. Chemotherapy alone had significantly inferior EFS compared to combined therapy (p = .0092), but patients were salvageable with RT. CONCLUSION Patients with BGTGs have excellent outcomes and RT proved to be an integral component of the treatment plan. This group of patients should be included in future prospective clinical trials and the best RT field should be investigated further.
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Affiliation(s)
- Richard T. Graham
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA.,Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA.,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Mohammad H. Abu-Arja
- The Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, Weill-Cornell College of Medicine, Brooklyn, NY, USA.,Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Joseph R. Stanek
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children’s Hospital Columbus, OH, USA
| | - Andrea Cappellano
- Instituto de Oncologia Pediátrica GRAACC/UNIFESP, Division of Neuroncology, Sao Paulo, Brazil
| | - Christina Coleman
- Departments of Pediatrics, Neurology, and Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Susan Chi
- Dana Farber/Boston Children’s Cancer and Blood Disorder Center, Pediatric Neuro-Oncology, Boston MA, USA
| | - Tabitha Cooney
- Dana Farber/Boston Children’s Cancer and Blood Disorder Center, Pediatric Neuro-Oncology, Boston MA, USA
| | - Girish Dhall
- Division of Hematology and Oncology, Department of Pediatrics University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob G. Ellen
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan L. Finlay
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Michael J. Fisher
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory K. Friedman
- Division of Hematology and Oncology, Department of Pediatrics University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Karen Gauvain
- Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, USA
| | - Lindsey M. Hoffman
- Division of Hematology/Oncology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Juliette Hukin
- Division of Hematology and Oncology, Children’s and Women’s Health Centre of B.C., University of British Columbia, Vancouver, BC, Canada
| | - John T. Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sabine Mueller
- Departments of Pediatrics, Neurology, and Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Pournima Navalkele
- Department of Pediatrics, SSM Cardinal Glennon Children’s Hospital, Saint Louis University, Saint Louis, MO, USA
| | - Rebecca Ronsley
- Division of Hematology and Oncology, Children’s and Women’s Health Centre of B.C., University of British Columbia, Vancouver, BC, Canada
| | - Christopher Tinkle
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Stephanie Villeneuve
- Division of Hematology/Oncology, Izaak Walton Killam Hospital for Children, Nova Scotia, Canada
| | - Kee Kiat Yeo
- Dana Farber/Boston Children’s Cancer and Blood Disorder Center, Pediatric Neuro-Oncology, Boston MA, USA
| | - Jack M. Su
- Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ashley Margol
- Cancer and Blood Disease Institute and Division of Hematology-Oncology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nicholas G. Gottardo
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Jeffrey Allen
- Department of Pediatrics, NYU Langone Health, New York, NY, USA
| | - Roger Packer
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, Children’s National Health System, Washington, DC, USA
| | - Ute Bartels
- Division of Hematology/Oncology, Pediatric Neuro-Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mohamed S. Abdelbaki
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA.,Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, USA
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25
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Rosabal-Obando M, Osorio DS, Lassaletta A, La Madrid AM, Bartels U, Finlay JL, Qaddoumi I, Rutkowski S, Mynarek M. Follow-up evaluation of a web-based pediatric brain tumor board in Latin America. Pediatr Blood Cancer 2021; 68:e29073. [PMID: 34003601 DOI: 10.1002/pbc.29073] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since 2013, pediatric oncologists from Central and South America discuss neuro-oncology cases with experts from North America and Europe in a web-based "Latin American Tumor Board" (LATB). Here, we evaluate the feasibility of recommendations rendered by the Board. METHODS An electronic questionnaire was distributed to physicians who had received recommendations between October 2017 and October 2018. Physicians were asked regarding the feasibility of each recommendation given during the LATB discussion. Baseline case characteristics of all presented cases were obtained from anonymized minutes. RESULTS Of the 142 patients discussed, data on 103 patients from 15 countries were available, corresponding to 283 recommendations. Physicians followed 60% of diagnostic procedural recommendations and 69% of therapeutic recommendations. The most difficult recommendations to follow were genetic and molecular testing, pathology review, chemotherapy, surgery, and molecular targeted therapies. Histological diagnoses changed in eight of 18 cases in which a pathology review was undertaken. Fifty-four percent of the recommendations that could not be implemented were considered not feasible in the specific context of the patient, while 31% were not implemented due to a decision of the medical staff or the parents (15% not specified). However, 96% of respondents considered the recommendations useful. CONCLUSION Recommendations were frequently perceived as useful, and were applicable in the participating institutions. Nevertheless, limitations in availability of diagnostic procedures and treatment modalities affected the feasibility of some recommendations. Tele-oncology tumor boards offer physicians from low- and middle-income countries access to real-time, high-level subspecialist expertise and provide a valuable platform for worldwide information exchange.
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Affiliation(s)
- Mariel Rosabal-Obando
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Diana S Osorio
- Neuro-Oncology Program, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Alvaro Lassaletta
- Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Ute Bartels
- Neuro-Oncology, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan L Finlay
- Neuro-Oncology Program, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Ibrahim Qaddoumi
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Abu-Arja MH, Rojas Del Río N, Morales La Madrid A, Lassaletta A, Coven SL, Moreno R, Valero M, Perez V, Espinoza F, Fernandez E, Santander J, Tordecilla J, Oyarce V, Kopp K, Bartels U, Qaddoumi I, Finlay JL, Cáceres A, Reyes M, Espinoza X, Osorio DS. Evaluation of the Pediatric Neuro-Oncology Resources Available in Chile. JCO Glob Oncol 2021; 7:425-434. [PMID: 33788596 PMCID: PMC8081533 DOI: 10.1200/go.20.00430] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pediatric neuro-oncology resources are mostly unknown in Chile. We report the human and material resources available in Chilean hospitals providing pediatric neuro-oncology services. METHODS A cross-sectional survey was distributed to 17 hospitals providing pediatric neuro-oncology services (Programa Infantil Nacional de Drogas Antineoplásicas [PINDA] hospitals, 11; private, 6). RESULTS Response rate was 71% (PINDA, 8; private, 4). Pediatric neuro-oncology services were mainly provided within general hospitals (67%). Registries for pediatric CNS tumors and chemotherapy-related toxicities were available in 100% and 67% of hospitals, respectively. CNS tumors were treated by pediatric oncologists in 92% of hospitals; none were formally trained in neuro-oncology. The most used treatment protocols were the national PINDA protocols. All WHO essential medicines for childhood cancer were available in more than 80% of the hospitals except for gemcitabine, oxaliplatin, paclitaxel, and procarbazine. The median number of pediatric neurosurgeons per hospital was two (range, 2-6). General neuroradiologists were available in 83% of the centers. Pathology specimens were sent to neuropathologists (58%), adult pathologists (25%), and pediatric pathologists (17%). Intensity-modulated radiotherapy, conformal radiotherapy, and cobalt radiotherapy were used by 67%, 58%, and 42% of hospitals, respectively. Only one private hospital performed autologous hematopoietic cell transplant for children with CNS tumors. CONCLUSION A wide range of up-to-date treatment modalities are available for children with CNS tumors. Our survey highlights future directions to improve the pediatric neuro-oncology services available in Chile such as the expansion of multidisciplinary clinics, palliative care services, long-term cancer survivorship programs, dedicated clinical research support teams, establishing standardized mechanism for sending pathologic specimen for second opinion to international specialized centers, and establishing specialized neuro-oncology training program.
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Affiliation(s)
- Mohammad H Abu-Arja
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Nicolás Rojas Del Río
- Department of Pediatrics, Division of Hematology Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Alvaro Lassaletta
- The Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Scott L Coven
- Division of Pediatric Hematology-Oncology, Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, IN
| | - Rosa Moreno
- Department of Pediatrics, Pediatría Hospital Dr. Sótero del Río, Puente Alto, Chile
| | - Miguel Valero
- Department of Pediatrics, Hospital Carlos van Buren, Valparaíso, Chile
| | - Veronica Perez
- Department of Pediatrics, Hospital San Juan de Dios, Santiago, Chile
| | - Felipe Espinoza
- Department of Pediatrics, San Borja Arriaran Clinic Hospital, Santiago, Chile.,Department of Pediatrics, Clínica Bicentenario, Santiago, Chile
| | - Eduardo Fernandez
- Department of Pediatrics, Hospital Clínico Regional Dr. Guillermo Grant Benavente de Concepción, Concepción, Chile
| | - José Santander
- Department of Pediatrics, Clinica Davila, Recoleta, Chile
| | - Juan Tordecilla
- Department of Pediatrics, Clinica Santa Maria, Providencia, Chile
| | - Veronica Oyarce
- Department of Pediatrics, Dr. Exequiel González Cortés Hospital, San Miguel, Chile
| | - Katherine Kopp
- Department of Pediatrics, Dr. Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Ute Bartels
- Department of Hematology Oncology, Hospital for Sick Children, Toronto, Canada
| | - Ibrahim Qaddoumi
- Global Pediatric Medicine Department, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jonathan L Finlay
- Division of Hematology, Oncology, Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Adrián Cáceres
- Neurosurgery Unit, Hospital Nacional de Niños Carlos Sáenz Herrera, San José, Costa Rica
| | - Mauricio Reyes
- Department of Radiation Oncology, Instituto Nacional del Cáncer, Santiago, Chile
| | - Ximena Espinoza
- Department of Pediatrics, The Hematology Oncology Unit, Hospital de Niños Dr. Roberto del Río, Santiago, Chile
| | - Diana S Osorio
- Division of Hematology, Oncology, Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
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Pan L, Zhang R, Ma L, Pierson CR, Finlay JL, Li C, Lin J. STAT3 inhibitor in combination with irradiation significantly inhibits cell viability, cell migration, invasion and tumorsphere growth of human medulloblastoma cells. Cancer Biol Ther 2021; 22:430-439. [PMID: 34254873 DOI: 10.1080/15384047.2021.1951573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/21/2022] Open
Abstract
Persistent activation of signal transducer and activator of transcription 3 (STAT3) is frequently reported in cancers and plays important roles in tumor progression. Therefore, directly targeting persistent STAT3 signaling is an attractive cancer therapeutic strategy. The aim of this study is to test the inhibitory efficacy of novel STAT3 small molecule inhibitors, LLY17 and LLL12B, in combination with irradiation in human medulloblastoma cells. Both LLY17 and LLL12B inhibit the IL-6-induced and persistent STAT3 phosphorylation in human medulloblastoma cells. Irradiation using 4 Gy alone exhibits some inhibitory effects on medulloblastoma cell viability, and these effects are further enhanced by combining with either STAT3 inhibitor. Irradiation alone also shows certain inhibitory effects on medulloblastoma cell migration and invasion and the combination of LLY17 or LLL12B with irradiation further demonstrates greater inhibitory effects than monotherapy. STAT3 inhibitor alone or irradiation alone exhibits some suppression of medulloblastoma tumorsphere growth, and the combination of LLY17 or LLL12B and irradiation exhibits greater suppression of tumorsphere growth than monotherapy. Combining either STAT3 inhibitor with irradiation reduces the expression of STAT3 downstream targets, Cyclin D1 and Survivin, and induces apoptosis in medulloblastoma cells. These results support that combination of a potent STAT3 inhibitor such as LLY17 or LLL12B with irradiation is an effective and novel therapeutic approach for medulloblastoma.
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Affiliation(s)
- Li Pan
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ruijie Zhang
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ling Ma
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher R Pierson
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Department of Pathology and Department of Biomedical Education & Anatomy, College of Medicine, The Ohio State University, Columbus, OH USA
| | - Jonathan L Finlay
- Division of Hematology, Oncology and BMT, the Research Institute at Nationwide Children's Hospital, Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH USA
| | - Chenglong Li
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL USA
| | - Jiayuh Lin
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, USA
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28
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Fischer AN, Roecker R, Saba da Silva N, Cavalheiro S, Finlay JL, Cappellano A, Osorio DS. Validated quantitative needs assessment differences in the management of children with central nervous system cancer between Brazil, an upper middle-income country, and the United States of America, a high income country. Pediatr Blood Cancer 2021; 68:e28958. [PMID: 33760367 DOI: 10.1002/pbc.28958] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric cancer cure rates differ among high-income countries (HIC) and upper middle-income countries (UMIC). We have compared individual capacities of two major referral pediatric centers from a HIC and an UMIC caring for children with central nervous system (CNS) cancer. METHODS A quantitative needs assessment questionnaire and key informant interviews, distributed in March of 2017, were used to evaluate the treatment of children with CNS cancer at Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) children's cancer center in São Paulo, Brazil and Nationwide Children's Hospital (NCH) in Columbus, Ohio, United States of America (USA). RESULTS Both hospitals had 24-hour pediatric oncology, nursing and intensivist coverage. Supportive care available at both institutions included social workers, psychologists, child life specialists, and physical/occupational/speech therapists. Differences included two part-time neuroradiologists and one pathologist specializing in neuropathology at IOP/GRAACC/UNIFESP, whereas eight full-time neuroradiologists and two neuropathologists at NCH/OSU. There were four pediatric neurosurgeons on staff at each hospital; however, there were only 2 operative days per week at IOP/GRAACC/UNIFESP, compared with 7 days at NCH/OSU. Additionally, time to initiation of radiation therapy at IOP/GRAACC/UNIFESP extended 2-4 weeks compared with less than 1 week at NCH/OSU. CONCLUSIONS Center-specific differences in resources exist in highly specialized hospitals caring for children with CNS cancer in HIC and UMIC. This quantitative needs assessment may facilitate the development of targeted strategies for effective interventions to improve on the management of children with CNS cancers.
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Affiliation(s)
- Allison N Fischer
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Roberto Roecker
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | | | - Sergio Cavalheiro
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | - Jonathan L Finlay
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Andrea Cappellano
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | - Diana S Osorio
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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29
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Miller KE, Schieffer KM, Grischow O, Rodriguez DP, Cottrell CE, Leonard JR, Finlay JL, Mardis ER. Clinical response to dabrafenib plus trametinib in a pediatric ganglioglioma with BRAF p.T599dup mutation. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006023. [PMID: 33637608 PMCID: PMC8040738 DOI: 10.1101/mcs.a006023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/21/2020] [Accepted: 02/22/2021] [Indexed: 12/31/2022] Open
Abstract
In this follow-up report, we present updated information regarding a previously reported pediatric patient with a World Health Organization grade I ganglioglioma harboring a BRAF p.T599dup mutation (Cold Spring Harb Mol Case Stud 4: a002618). This patient, based on our initial finding, is receiving combination targeted therapy with a selective BRAF inhibitor (dabrafenib) plus MEK inhibitor (trametinib). The combination therapy was started after the patient experienced progressive tumor growth and worsening neurological symptoms, including visual changes, headaches, and peripheral neuropathy, despite 9 months of treatment with adjuvant chemotherapy (vinblastine). The patient has been receiving dabrafenib plus trametinib for 15 months and continues to have stable disease as well as improved neurological symptoms. Although combinatorial therapy targeting BRAF and MEK using dabrafenib and trametinib, respectively, is indicated for tumors harboring a BRAF p.V600E/K mutation, our report demonstrates efficacy of this combination in a non-V600E BRAF-mutated tumor. The identification of BRAF alterations may assist clinicians in determining alternative targeted treatment strategies, especially considering the paucity of effective treatments for primary brain tumors and the poor prognosis associated with many central nervous system (CNS) diagnoses. Additional case studies or larger cohort reports will continue to clarify the efficacy of BRAF and/or MEK inhibitors in patients whose tumors harbor a BRAF alteration.
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Affiliation(s)
- Katherine E Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43215, USA
| | - Kathleen M Schieffer
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43215, USA
| | - Olivia Grischow
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43215, USA
| | - Diana P Rodriguez
- Department of Radiology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
| | - Catherine E Cottrell
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43215, USA.,Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
| | - Jeffrey R Leonard
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.,Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.,Department of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Jonathan L Finlay
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.,Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Elaine R Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43215, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.,Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
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30
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Schieffer KM, Feldman AZ, Kautto EA, McGrath S, Miller AR, Hernandez-Gonzalez ME, LaHaye S, Miller KE, Koboldt DC, Brennan P, Kelly B, Wetzel A, Agarwal V, Shatara M, Conley S, Rodriguez DP, Abu-Arja R, Shaikhkhalil A, Snuderl M, Orr BA, Finlay JL, Osorio DS, Drapeau AI, Leonard JR, Pierson CR, White P, Magrini V, Mardis ER, Wilson RK, Cottrell CE, Boué DR. Molecular classification of a complex structural rearrangement of the RB1 locus in an infant with sporadic, isolated, intracranial, sellar region retinoblastoma. Acta Neuropathol Commun 2021; 9:61. [PMID: 33827698 PMCID: PMC8025529 DOI: 10.1186/s40478-021-01164-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/05/2021] [Accepted: 03/19/2021] [Indexed: 12/15/2022] Open
Abstract
Retinoblastoma is a childhood cancer of the retina involving germline or somatic alterations of the RB Transcriptional Corepressor 1 gene, RB1. Rare cases of sellar-suprasellar region retinoblastoma without evidence of ocular or pineal tumors have been described. A nine-month-old male presented with a sellar-suprasellar region mass. Histopathology showed an embryonal tumor with focal Flexner-Wintersteiner-like rosettes and loss of retinoblastoma protein (RB1) expression by immunohistochemistry. DNA array-based methylation profiling confidently classified the tumor as pineoblastoma group A/intracranial retinoblastoma. The patient was subsequently enrolled on an institutional translational cancer research protocol and underwent comprehensive molecular profiling, including paired tumor/normal exome and genome sequencing and RNA-sequencing of the tumor. Additionally, Pacific Biosciences (PacBio) Single Molecule Real Time (SMRT) sequencing was performed from comparator normal and disease-involved tissue to resolve complex structural variations. RNA-sequencing revealed multiple fusions clustered within 13q14.1-q21.3, including a novel in-frame fusion of RB1-SIAH3 predicted to prematurely truncate the RB1 protein. SMRT sequencing revealed a complex structural rearrangement spanning 13q14.11-q31.3, including two somatic structural variants within intron 17 of RB1. These events corresponded to the RB1-SIAH3 fusion and a novel RB1 rearrangement expected to correlate with the complete absence of RB1 protein expression. Comprehensive molecular analysis, including DNA array-based methylation profiling and sequencing-based methodologies, were critical for classification and understanding the complex mechanism of RB1 inactivation in this diagnostically challenging tumor.
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31
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Schieffer KM, Agarwal V, LaHaye S, Miller KE, Koboldt DC, Lichtenberg T, Leraas K, Brennan P, Kelly BJ, Crist E, Rusin J, Finlay JL, Osorio DS, Sribnick EA, Leonard JR, Feldman A, Orr BA, Serrano J, Vasudevaraja V, Snuderl M, White P, Magrini V, Wilson RK, Mardis ER, Boué DR, Cottrell CE. YAP1-FAM118B Fusion Defines a Rare Subset of Childhood and Young Adulthood Meningiomas. Am J Surg Pathol 2021; 45:329-340. [PMID: 33074854 DOI: 10.1097/pas.0000000000001597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Meningiomas are a central nervous system tumor primarily afflicting adults, with <1% of cases diagnosed during childhood or adolescence. Somatic variation in NF2 may be found in ∼50% of meningiomas, with other genetic drivers (eg, SMO, AKT1, TRAF7) contributing to NF2 wild-type tumors. NF2 is an upstream negative regulator of YAP signaling and loss of the NF2 protein product, Merlin, results in YAP overexpression and target gene transcription. This mechanism of dysregulation is described in NF2-driven meningiomas, but further work is necessary to understand the NF2-independent mechanism of tumorigenesis. Amid our institutional patient-centric comprehensive molecular profiling study, we identified an individual with meningioma harboring a YAP1-FAM118B fusion, previously reported only in supratentorial ependymoma. The tumor histopathology was remarkable, characterized by prominent islands of calcifying fibrous nodules within an overall collagen-rich matrix. To gain insight into this finding, we subsequently evaluated the genetic landscape of 11 additional pediatric and adolescent/young adulthood meningioma patients within the Children's Brain Tumor Tissue Consortium. A second individual harboring a YAP1-FAM118B gene fusion was identified within this database. Transcriptomic profiling suggested that YAP1-fusion meningiomas are biologically distinct from NF2-driven meningiomas. Similar to other meningiomas, however, YAP1-fusion meningiomas demonstrated overexpression of EGFR and MET. DNA methylation profiling further distinguished YAP1-fusion meningiomas from those observed in ependymomas. In summary, we expand the genetic spectrum of somatic alteration associated with NF2 wild-type meningioma to include the YAP1-FAM118B fusion and provide support for aberrant signaling pathways potentially targetable by therapeutic intervention.
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Affiliation(s)
| | - Vibhuti Agarwal
- Division of Hematology, Oncology, and Bone Marrow Transplant
| | | | | | - Daniel C Koboldt
- The Steve and Cindy Rasmussen Institute for Genomic Medicine.,Departments of Pediatrics
| | | | - Kristen Leraas
- The Steve and Cindy Rasmussen Institute for Genomic Medicine
| | - Patrick Brennan
- The Steve and Cindy Rasmussen Institute for Genomic Medicine
| | | | - Erin Crist
- The Steve and Cindy Rasmussen Institute for Genomic Medicine
| | | | - Jonathan L Finlay
- Division of Hematology, Oncology, and Bone Marrow Transplant.,Departments of Pediatrics.,Division of Hematology and Oncology, The Ohio State University College of Medicine, Columbus, OH
| | - Diana S Osorio
- Division of Hematology, Oncology, and Bone Marrow Transplant.,Departments of Pediatrics.,Division of Hematology and Oncology, The Ohio State University College of Medicine, Columbus, OH
| | | | | | | | - Brent A Orr
- St. Jude Children's Research Hospital, Memphis, TN
| | - Jonathan Serrano
- Department of Pathology, New York University Langone Health, New York City, NY
| | | | - Matija Snuderl
- Department of Pathology, New York University Langone Health, New York City, NY
| | - Peter White
- The Steve and Cindy Rasmussen Institute for Genomic Medicine.,Departments of Pediatrics
| | - Vincent Magrini
- The Steve and Cindy Rasmussen Institute for Genomic Medicine.,Departments of Pediatrics
| | - Richard K Wilson
- The Steve and Cindy Rasmussen Institute for Genomic Medicine.,Departments of Pediatrics
| | - Elaine R Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine.,Departments of Pediatrics
| | - Daniel R Boué
- Pathology and Laboratory Medicine, Nationwide Children's Hospital.,Pathology
| | - Catherine E Cottrell
- The Steve and Cindy Rasmussen Institute for Genomic Medicine.,Departments of Pediatrics.,Pathology
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32
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Dhall G, O'Neil SH, Ji L, Haley K, Whitaker AM, Nelson MD, Gilles F, Gardner SL, Allen JC, Cornelius AS, Pradhan K, Garvin JH, Olshefski RS, Hukin J, Comito M, Goldman S, Atlas MP, Walter AW, Sands S, Sposto R, Finlay JL. Excellent outcome of young children with nodular desmoplastic medulloblastoma treated on "Head Start" III: a multi-institutional, prospective clinical trial. Neuro Oncol 2021; 22:1862-1872. [PMID: 32304218 DOI: 10.1093/neuonc/noaa102] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND "Head Start" III, was a prospective clinical trial using intensive induction followed by myeloablative chemotherapy and autologous hematopoietic cell rescue (AuHCR) to either avoid or reduce the dose/volume of irradiation in young children with medulloblastoma. METHODS Following surgery, patients received 5 cycles of induction followed by myeloablative chemotherapy using carboplatin, thiotepa, and etoposide with AuHCR. Irradiation was reserved for children >6 years old at diagnosis or with residual tumor post-induction. RESULTS Between 2003 and 2009, 92 children <10 years old with medulloblastoma were enrolled. Five-year event-free survival (EFS) and overall survival (OS) rates (±SE) were 46 ± 5% and 62 ± 5% for all patients, 61 ± 8% and 77 ± 7% for localized medulloblastoma, and 35 ± 7% and 52 ± 7% for disseminated patients. Nodular/desmoplastic (ND) medulloblastoma patients had 5-year EFS and OS (±SE) rates of 89 ± 6% and 89 ± 6% compared with 26 ± 6% and 53 ± 7% for classic and 38 ± 13% and 46 ± 14% for large-cell/anaplastic (LCA) medulloblastoma, respectively. In multivariate Cox regression analysis, histology was the only significant independent predictor of EFS after adjusting for stage, extent of resection, regimen, age, and sex (P <0.0001). Five-year irradiation-free EFS was 78 ± 8% for ND and 21 ± 5% for classic/LCA medulloblastoma patients. Myelosuppression was the most common toxicity, with 2 toxic deaths. Twenty-four survivors completed neurocognitive evaluation at a mean of 4.9 years post-diagnosis. IQ and memory scores were within average range overall, whereas processing speed and adaptive functioning were low-average. CONCLUSION We report excellent survival and preservation of mean IQ and memory for young children with ND medulloblastoma using high-dose chemotherapy, with most patients surviving without irradiation.
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Affiliation(s)
- Girish Dhall
- Division of Pediatric Hematology-Oncology, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Sharon H O'Neil
- Division of Neurology and The Saban Research Institute, Children's Hospital Los Angeles (CHLA), Los Angeles, California, USA
| | - Lingyun Ji
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
| | - Kelley Haley
- Division of Hematology-Oncology CHLA, Los Angeles, California, USA
| | | | | | - Floyd Gilles
- Department of Pathology CHLA, Los Angeles, California, USA
| | - Sharon L Gardner
- Division of Pediatric Hematology-Oncology, NYU Medical Center, New York, New York, USA
| | - Jeffrey C Allen
- Division of Pediatric Hematology-Oncology, NYU Medical Center, New York, New York, USA
| | - Albert S Cornelius
- Division of Pediatric Hematology-Oncology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Kamnesh Pradhan
- Division of Pediatric Hematology-Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - James H Garvin
- Division of Pediatric Hematology-Oncology, New York Presbyterian Hospital, New York, New York, USA
| | - Randal S Olshefski
- Division of Pediatric Hematology-Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Juliette Hukin
- Division of Pediatric Hematology-Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Melanie Comito
- Division of Pediatric Hematology-Oncology, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Stewart Goldman
- Division of Pediatric Hematology-Oncology, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Mark P Atlas
- Division of Pediatric Hematology-Oncology, Children's Medical Center of New York, New York, New York, USA
| | - Andrew W Walter
- Division of Pediatric Hematology-Oncology, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Stephen Sands
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Sposto
- Division of Hematology-Oncology CHLA, Los Angeles, California, USA
| | - Jonathan L Finlay
- Division of Pediatric Hematology-Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
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33
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Chen X, Pan L, Wei J, Zhang R, Yang X, Song J, Bai RY, Fu S, Pierson CR, Finlay JL, Li C, Lin J. LLL12B, a small molecule STAT3 inhibitor, induces growth arrest, apoptosis, and enhances cisplatin-mediated cytotoxicity in medulloblastoma cells. Sci Rep 2021; 11:6517. [PMID: 33753770 PMCID: PMC7985203 DOI: 10.1038/s41598-021-85888-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/01/2021] [Indexed: 12/13/2022] Open
Abstract
Signal Transducer and Activator of Transcription 3 (STAT3) is a transcription factor and an oncogene product, which plays a pivotal role in tumor progression. Therefore, targeting persistent STAT3 signaling directly is an attractive anticancer strategy. The aim of this study is to test the efficacy of a novel STAT3 small molecule inhibitor, LLL12B, in suppressing medulloblastoma cells in vitro and tumor growth in vivo. LLL12B selectively inhibited the induction of STAT3 phosphorylation by interleukin-6 but not induction of STAT1 phosphorylation by INF-γ. LLL12B also induced apoptosis in human medulloblastoma cells. In addition, LLL12B exhibited good oral bioavailability in vivo and potent suppressive activity in tumor growth of medulloblastoma cells in vivo. Besides, combining LLL12B with cisplatin showed greater inhibition of cell viability and tumorsphere formation as well as induction of apoptosis comparing to single agent treatment in medulloblastoma cells. Furthermore, LLL12B and cisplatin combination exhibited greater suppression of medulloblastoma tumor growth than monotherapy in vivo. The present study supported that LLL12B is a novel therapeutic agent for medulloblastoma and the combination of LLL12B with a chemotherapeutic agent cisplatin may be an effective approach for medulloblastoma therapy.
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Affiliation(s)
- Xiang Chen
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Li Pan
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jia Wei
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ruijie Zhang
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Xiaozhi Yang
- Department of Medicinal Chemistry, College of Pharmacy, The University of Florida, Gainesville, FL, 32610, USA
| | - Jinhua Song
- Department of Medicinal Chemistry, College of Pharmacy, The University of Florida, Gainesville, FL, 32610, USA
| | - Ren-Yuan Bai
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Shengling Fu
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Christopher R Pierson
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, The Department of Pathology and Department of Biomedical Education and Anatomy, The College of Medicine, The Ohio State University, Columbus, OH, 43205, USA
| | - Jonathan L Finlay
- Division of Hematology, Oncology and BMT, Department of Pediatrics, College of Medicine, The Research Institute At Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43205, USA
| | - Chenglong Li
- Department of Medicinal Chemistry, College of Pharmacy, The University of Florida, Gainesville, FL, 32610, USA.
| | - Jiayuh Lin
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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34
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Graham RT, Coven SL, Stanek JR, Folta A, Hollingsworth EW, Finlay JL, Kumar R. Venous thromboembolism in children with central nervous system tumors: Comparison of an institutional cohort to a national administrative database. Pediatr Blood Cancer 2021; 68:e28846. [PMID: 33340265 DOI: 10.1002/pbc.28846] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Central nervous system (CNS) tumors are the second most common malignancy of childhood, and published data on venous thromboembolism (VTE) rate and risk factors for these patients are outdated or incomplete. Here, we determine the cumulative incidence and risk factors for VTE in this population. PROCEDURE VTE diagnosis and associated clinical risk factors were abstracted and analyzed for two cohorts of children (0-21 years) diagnosed with CNS tumors between January 1, 2010 to September 30, 2018. The first study was a retrospective single institution cohort study. The initial observations were confirmed across multiple pediatric hospitals using the Pediatric Health Information System (PHIS) administrative database. RESULTS The single-institution cohort included 338 patients aged 3 days to 20.9 years (median age, 8.6 years); VTE developed in eight (2.4%) patients. The PHIS cohort included 17 634 patients aged from 0 to 21.9 years (median: 9.5 years); VTE developed in 354 (2.0%) patients. Univariate analysis for the single-institution cohort identified central venous catheter (CVC) placement as a risk factor for VTE (odds ratio [OR] 8.40, 95% confidence interval [CI] 1.43-49.41, P = .0186). Multivariable analysis of the PHIS dataset identified CVC placement (OR 1.97, 95% CI 1.57-2.46; P < .0001), obesity (OR 2.96, 95% CI 1.21-7.26; P = .0177), and more than one hospital admission (OR 3.54, 95% CI 2.69-4.64; P < .0001) as significant predictors of VTE. VTE diagnosis was not associated with increased mortality in either cohort. CONCLUSIONS The VTE rate in children with CNS tumors is low (2%). CVC placement was identified as a modifiable risk factor in both cohorts.
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Affiliation(s)
- Richard T Graham
- Division of Neuro-Oncology, Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Scott L Coven
- Department of Pediatrics, Indiana University, Riley Children's Hospital, Indianapolis, Indiana
| | - Joseph R Stanek
- Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Ashley Folta
- Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Ethan W Hollingsworth
- Medical Scientist Training Program, University of California, Irvine, California
- Department of Anatomy and Neurobiology, University of California, Irvine, California
| | - Jonathan L Finlay
- Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Riten Kumar
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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35
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Tang K, Kurland D, Vasudevaraja V, Serrano J, Delorenzo M, Radmanesh A, Thomas C, Spino M, Gardner S, Allen JC, Nicolaides T, Osorio DS, Finlay JL, Boué DR, Snuderl M. Exploring DNA Methylation for Prognosis and Analyzing the Tumor Microenvironment in Pleomorphic Xanthoastrocytoma. J Neuropathol Exp Neurol 2021; 79:880-890. [PMID: 32594172 DOI: 10.1093/jnen/nlaa051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022] Open
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a rare type of brain tumor that affects children and young adults. Molecular prognostic markers of PXAs remain poorly established. Similar to gangliogliomas, PXAs show prominent immune cell infiltrate, but its composition also remains unknown. In this study, we correlated DNA methylation and BRAF status with clinical outcome and explored the tumor microenvironment. We performed DNA methylation in 21 tumor samples from 18 subjects with a histological diagnosis of PXA. MethylCIBERSORT was used to deconvolute the PXA microenvironment by analyzing the associated immune cell-types. Median age at diagnosis was 16 years (range 7-32). At median follow-up of 30 months, 3-year and 5-year overall survival was 73% and 71%, respectively. Overall survival ranged from 1 to 139 months. Eleven out of 18 subjects (61%) showed disease progression. Progression-free survival ranged from 1 to 89 months. Trisomy 7 and CDKN2A/B (p16) homozygous deletion did not show any association with overall survival (p = 0.67 and p = 0.74, respectively). Decreased overall survival was observed for subjects with tumors lacking the BRAF V600E mutation (p = 0.02). PXAs had significantly increased CD8 T-cell epigenetic signatures compared with previously profiled gangliogliomas (p = 0.0019). The characterization of immune cell-types in PXAs may have implications for future development of immunotherapy.
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Affiliation(s)
- Karen Tang
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York.,Clinical and Translational Science Institute, New York University Langone Health, New York, New York
| | - David Kurland
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Varshini Vasudevaraja
- Department of Biomedical Informatics, New York University Langone Health, New York, New York
| | - Jonathan Serrano
- Department of Biomedical Informatics, New York University Langone Health, New York, New York
| | - Michael Delorenzo
- Department of Neuropathology, New York University Langone Health, New York, New York
| | - Alireza Radmanesh
- Department of Neuroradiology, New York University Langone Health, New York, New York
| | - Cheddhi Thomas
- Department of Neuropathology, New York University Langone Health, New York, New York.,Department of Neuropathology, Incyte Diagnostics, Spokane Valley, Washington
| | - Marissa Spino
- Department of Neuropathology, New York University Langone Health, New York, New York
| | - Sharon Gardner
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Jeffrey C Allen
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Theodore Nicolaides
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Diana S Osorio
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant
| | - Jonathan L Finlay
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, and the Ohio State University, Columbus, Ohio
| | - Matija Snuderl
- Department of Neuropathology, New York University Langone Health, New York, New York
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36
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Yankelevich M, Finlay JL, Gorsi H, Kupsky W, Boue DR, Koschmann CJ, Kumar-Sinha C, Mody R. Molecular insights into malignant progression of atypical choroid plexus papilloma. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a005272. [PMID: 33608379 PMCID: PMC7903885 DOI: 10.1101/mcs.a005272] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
Choroid plexus tumors are rare pediatric neoplasms ranging from low-grade papillomas to overtly malignant carcinomas. They are commonly associated with Li–Fraumeni syndrome and germline TP53 mutations. Choroid plexus carcinomas associated with Li–Fraumeni syndrome are less responsive to chemotherapy, and there is a need to avoid radiation therapy leading to poorer outcomes and survival. Malignant progression from choroid plexus papillomas to carcinomas is exceedingly rare with only a handful of cases reported, and the molecular mechanisms of this progression remain elusive. We report a case of malignant transformation of choroid plexus papilloma to carcinoma in a 7-yr-old male with a germline TP53 mutation in which we present an analysis of molecular changes that might have led to the progression based on the next-generation genetic sequencing of both the original choroid plexus papilloma and the subsequent choroid plexus carcinoma. Chromosomal aneuploidy was significant in both lesions with mostly gains present in the papilloma and additional significant losses in the carcinoma. The chromosomal loss that occurred, in particular loss of Chromosome 13, resulted in the losses of two critical tumor suppressor genes, RB1 and BRCA2, which might play a possible role in the observed malignant transformation.
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Affiliation(s)
- Maxim Yankelevich
- Pediatric Hematology/Oncology Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey 08901, USA.,Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - Jonathan L Finlay
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, Ohio 43205, USA
| | - Hamza Gorsi
- Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - William Kupsky
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - Daniel R Boue
- Department of Pathology, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, Ohio 43205, USA
| | - Carl J Koschmann
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Chandan Kumar-Sinha
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109, USA.,Michigan Center for Translational Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Rajen Mody
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109, USA
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37
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Baron Nelson MC, O'Neil SH, Tanedo J, Dhanani S, Malvar J, Nuñez C, Nelson MD, Tamrazi B, Finlay JL, Rajagopalan V, Lepore N. Brain biomarkers and neuropsychological outcomes of pediatric posterior fossa brain tumor survivors treated with surgical resection with or without adjuvant chemotherapy. Pediatr Blood Cancer 2021; 68:e28817. [PMID: 33251768 PMCID: PMC7755691 DOI: 10.1002/pbc.28817] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/30/2020] [Accepted: 10/31/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Children with brain tumors experience cognitive late effects, often related to cranial radiation. We sought to determine differential effects of surgery and chemotherapy on brain structure and neuropsychological outcomes in children who did not receive cranial radiation therapy (CRT). METHODS Twenty-eight children with a history of posterior fossa tumor (17 treated with surgery, 11 treated with surgery and chemotherapy) underwent neuroimaging and neuropsychological assessment a mean of 4.5 years (surgery group) to 9 years (surgery + chemotherapy group) posttreatment, along with 18 healthy sibling controls. Psychometric measures assessed IQ, language, executive functions, processing speed, memory, and social-emotional functioning. Group differences and correlations between diffusion tensor imaging findings and psychometric scores were examined. RESULTS The z-score mapping demonstrated fractional anisotropy (FA) values were ≥2 standard deviations lower in white matter tracts, prefrontal cortex gray matter, hippocampus, thalamus, basal ganglia, and pons between patient groups, indicating microstructural damage associated with chemotherapy. Patients scored lower than controls on visuoconstructional reasoning and memory (P ≤ .02). Lower FA in the uncinate fasciculus (R = -0.82 to -0.91) and higher FA in the thalamus (R = 0.73-0.91) associated with higher IQ scores, and higher FA in the thalamus associated with higher scores on spatial working memory (R = 0.82). CONCLUSIONS Posterior fossa brain tumor treatment with surgery and chemotherapy affects brain microstructure and neuropsychological functioning years into survivorship, with spatial processes the most vulnerable. Biomarkers indicating cellular changes in the thalamus, hippocampus, pons, prefrontal cortex, and white matter tracts associate with lower psychometric scores.
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Affiliation(s)
- Mary C Baron Nelson
- Departments of Medical Education and Pediatrics, Keck School of Medicine of USC, Los Angeles, California
- Radiology Department, CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California
| | - Sharon H O'Neil
- Radiology Department, CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey Tanedo
- Radiology Department, CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California
- USC Viterbi School of Engineering, Los Angeles, California
| | - Sofia Dhanani
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of USC, Los Angeles, California
| | - Jemily Malvar
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | | | - Marvin D Nelson
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, California
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Benita Tamrazi
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, California
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan L Finlay
- The Ohio State University College of Medicine, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | - Vidya Rajagopalan
- Radiology Department, CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Natasha Lepore
- Radiology Department, CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California
- USC Viterbi School of Engineering, Los Angeles, California
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
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38
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Cam M, Charan M, Welker AM, Dravid P, Studebaker AW, Leonard JR, Pierson CR, Nakano I, Beattie CE, Hwang EI, Kambhampati M, Nazarian J, Finlay JL, Cam H. ΔNp73/ETS2 complex drives glioblastoma pathogenesis- targeting downstream mediators by rebastinib prolongs survival in preclinical models of glioblastoma. Neuro Oncol 2021; 22:345-356. [PMID: 31763674 DOI: 10.1093/neuonc/noz190] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/03/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) remains one of the least successfully treated cancers. It is essential to understand the basic biology of this lethal disease and investigate novel pharmacological targets to treat GBM. The aims of this study were to determine the biological consequences of elevated expression of ΔNp73, an N-terminal truncated isoform of TP73, and to evaluate targeting of its downstream mediators, the angiopoietin 1 (ANGPT1)/tunica interna endothelial cell kinase 2 (Tie2) axis, by using a highly potent, orally available small-molecule inhibitor (rebastinib) in GBM. METHODS ΔNp73 expression was assessed in glioma sphere cultures, xenograft glioblastoma tumors, and glioblastoma patients by western blot, quantitative reverse transcription PCR, and immunohistochemistry. Immunoprecipitation, chromatin immunoprecipitation (ChiP) and sequential ChIP were performed to determine the interaction between ΔNp73 and E26 transformation-specific (ETS) proto-oncogene 2 (ETS2) proteins. The oncogenic consequences of ΔNp73 expression in glioblastomas were examined by in vitro and in vivo experiments, including orthotopic zebrafish and mouse intracranial-injection models. Effects of rebastinib on growth of established tumors and survival were examined in an intracranial-injection mouse model. RESULTS ΔNp73 upregulates both ANGPT1 and Tie2 transcriptionally through ETS conserved binding sites on the promoters by interacting with ETS2. Elevated expression of ΔNp73 promotes tumor progression by mediating angiogenesis and survival. Therapeutic targeting of downstream ΔNp73 signaling pathways by rebastinib inhibits growth of established tumors and extends survival in preclinical models of glioblastoma. CONCLUSION Aberrant expression of ΔNp73 in GBM promotes tumor progression through autocrine and paracrine signaling dependent on Tie2 activation by ANGPT1. Disruption of this signaling by rebastinib improves tumor response to treatment in glioblastoma.
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Affiliation(s)
- Maren Cam
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Manish Charan
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Alessandra M Welker
- Cancer Center and Regenerative Medicine, Massachusetts General Hospital, Boston
| | - Piyush Dravid
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Adam W Studebaker
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey R Leonard
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Christopher R Pierson
- Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Ichiro Nakano
- Comprehensive Cancer Center, University of Alabama, Birmingham, Alabama
| | - Christine E Beattie
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Eugene I Hwang
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC
| | - Madhuri Kambhampati
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC
| | - Javad Nazarian
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC
| | - Jonathan L Finlay
- Neuro-oncology Program, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Hakan Cam
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
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39
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Shatara M, Blue M, Stanek JR, Liu AY, Osorio DS, AbdelBaki MS, Prevedello D, Puduvalli V, Giglio P, Gardner S, Allen J, Wong KE, Dhall G, Finlay JL. GCT-66. FINAL REPORT OF THE PROSPECTIVE NEXT/CNS-GCT-4 CONSORTIUM TRIAL (GemPOx FOLLOWED BY MARROW-ABLATIVE CHEMOTHERAPY) IN PATIENTS WITH REFRACTORY/RECURRENT CNS GERM CELL TUMORS. Neuro Oncol 2020. [PMCID: PMC7715238 DOI: 10.1093/neuonc/noaa222.283] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We report the responses, toxicities and long-term outcomes of gemcitabine, paclitaxel and oxaliplatin (GemPOx) regimen administered, in responsive patients, prior to single cycle marrow-ablative chemotherapy (thiotepa, etoposide and carboplatin) with autologous hematopoietic progenitor cell rescue (HDCx+AuHPCR). METHODS Since December 2009, 11 recurrent/refractory patients (10 MMGCT, 1 germinoma; 10 males; mean age 16.5 years, range 7–46 years) have been treated with up to four cycles of gemcitabine (800mg/M2), paclitaxel (170mg/M2) and oxaliplatin (100mg/M2) administered on one day at 14 days intervals. RESULTS All 11 patients were enrolled on a prospective multi-center trial, which was closed in October 2019. Three patients achieved complete remissions (tumor marker and/or imaging studies), five achieved partial remissions, two developed disease progression (PD), and one was withdrawn after one cycle for severe paclitaxel neurotoxicity followed by rapid tumor progression and death. One patient with PD after one cycle had pathologically-confirmed metastatic transformation to pure embryonal rhabdomyosarcoma, and rapidly expired. A second patient, with pure pineal choriocarcinoma, progressed after the second GemPOx cycle, ultimately died of tumor progression. Eight of the 11 responsive patients subsequently underwent HDCx+AuHPCR; five of these received some form of radiotherapy. Seven patients (six MMGCT, one germinoma) are alive and disease-free without recurrence for a mean of 94 months (range 74–118 months) since completion of therapy. CONCLUSION GemPOx is an effective re-induction regimen for patient with recurrent CNS germ cell tumors, with acceptable toxicities; when followed by marrow-ablative chemotherapy and subsequent irradiation/re-irradiation, the regimen produces encouraging long-term disease-free survival.
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Affiliation(s)
- Margaret Shatara
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Megan Blue
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Joseph R Stanek
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Allison Y Liu
- University of California-Davis Health, Sacramento, CA, USA
| | - Diana S Osorio
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Mohamed S AbdelBaki
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | | | | | | | - Sharon Gardner
- New York University School of Medicine, New York, New York, USA
| | - Jeffrey Allen
- New York University School of Medicine, New York, New York, USA
| | | | - Girish Dhall
- The University of Alabama at Birmingham, Birmingham, AL, USA
- Children’s Hospital of Alabama, Birmingham, AL, USA
| | - Jonathan L Finlay
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
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40
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Finlay JL, Mynarek M, Dhall G, Lafay-Cousin L, Mazewski C, Ashley D, Leary S, Cohen BH, Robinson G, Geyer JR, Tait D, Stanek J, Gajjar A, Rutkowski S. MBCL-19. CHEMOTHERAPY STRATEGIES FOR YOUNG CHILDREN NEWLY DIAGNOSED WITH DESMOPLASTIC/EXTENSIVE NODULAR MEDULLOBLASTOMA UP TO THE ERA OF MOLECULAR PROFILING – A COMPARATIVE OUTCOMES ANALYSIS OF PROSPECTIVE MULTI-CENTER EUROPEAN AND NORTH AMERICAN TRIALS. Neuro Oncol 2020. [PMCID: PMC7715954 DOI: 10.1093/neuonc/noaa222.495] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND/OBJECTIVE
Survival has been poor in several multi-center/national trials since the 1980s, either delaying, avoiding or minimizing brain irradiation in young children with medulloblastoma. The introduction of German regimens incorporating both intravenous high-dose (HD-MTX) and intraventricular (IVENT-MTX) methotrexate, and North American regimens utilizing marrow-ablative chemotherapy with autologous hematopoietic cell rescue (HDCx+AuHCR), have reported encouraging outcomes. We performed a comparative outcomes analysis of these strategies for young children with desmoplastic/extensive nodular medulloblastoma (D/ENMB).
DESIGN/METHODS
Data from 12 trials reported between 2005 and 2019 for children <six-years-old with D/ENMB were reviewed; event-free (EFS) with standard errors were compared.
RESULTS
The German HIT-SKK’92 and HIT-SKK’00 trials incorporating HD-MTX and IVENT-MTX reported 85+/-8% and 95+/-5% 5-10-year EFS respectively; a third trial (ACNS1221) incorporating HIT-SKK therapy but without IVENT-MTX reported 49+/-10% EFS. Three trials (Head Start I/II combined and CCG-99703) employing induction chemotherapy without HD-MTX, followed by 1/3 HDCx+AuHCR cycles, reported 3-5-year EFS of 67+/-16% and 79+/-11%. Two trials employing HD-MTX-containing induction chemotherapy (Head Start III and ACNS0334), followed by 1/3 HDCx+AuHCR cycles, reported 3-5-year EFS of 89+/-6% and 100%, respectively. Finally, four trials utilizing neither IVENT-MTX nor HDCx+AuHCR (UK-CNS-9204, CCG-9921, COG-P9934 and SJYC07) reported 2-5-year EFS of 35+/-11%, 77+/-9%, 58+/-8% and 53+/-9%.
CONCLUSIONS
A trend towards better EFS for young children with D/ENMB is observed in trials including either HD-MTX as well as IVENT-MTX or including HD-MTX-containing induction chemotherapy and HDCx+AuHCR. Trials excluding HD-MTX, IVENT-MTX and HDCx+AuHCR have poorer outcomes.
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Affiliation(s)
- Jonathan L Finlay
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Martin Mynarek
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Girish Dhall
- Children’s Hospital of Alabama, Birmingham, Alabama, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lucie Lafay-Cousin
- Alberta Children’s Hospital, Calgary, Alberta, USA
- University of Calgary, Calgary, Alberta, USA
| | - Claire Mazewski
- Aflac Cancer and Blood Disorders Institute-Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Emory University School of Medicine-Winship Cancer Institute, Atlanta, Georgia, USA
| | - David Ashley
- Duke University School of Medicine, Durham, North Carolina, USA
- Preston Robert Tisch Brain Tumor Institute, Durham, North Carolina, USA
| | - Sarah Leary
- Seattle Children’s Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Giles Robinson
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - J Russell Geyer
- Seattle Children’s Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Diana Tait
- The Royal Marsden Hospital, London, United Kingdom
| | | | - Amar Gajjar
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
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41
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Erker C, Larouche V, Margol A, Cacciotti C, Perreault S, Cohen KJ, AbdelBaki MS, Hukin J, Rassekh SR, Eisenstat DD, Wilson B, Knipstein J, Hoppmann AL, Sandler ES, Dorris K, Fay-McClymont TB, Salloum R, Harrod VL, Crooks B, Finlay JL, Bouffet E, Lafay-Cousin L. MBCL-24. CAN YOUNG CHILDREN WITH RELAPSED MEDULLOBLASTOMA BE SALVAGED AFTER INITIAL IRRADIATION-SPARING APPROACHES? Neuro Oncol 2020. [PMCID: PMC7715107 DOI: 10.1093/neuonc/noaa222.500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Irradiation-sparing approaches are used in young children with medulloblastoma (MB) given the vulnerability of the developing brain to neurocognitive impairment. Limited data are available following relapse for these patients. We aimed to describe the management and outcomes of young children with MB who relapsed after initial treatment without craniospinal irradiation (CSI). METHODS International retrospective study including patients with MB diagnosed between 1995–2017, ≤ 72 months old, initially treated without CSI, who subsequently relapsed. RESULTS Data are available for 52 patients (32 male). Median age at initial diagnosis was 27 months (range, 6–72) with 24 being metastatic. Initial therapy included conventional chemotherapy alone or high-dose chemotherapy (HDC) in 21 and 31 subjects, respectively. Three received upfront focal irradiation. Molecular subgrouping, available for 24 tumors, included 9 SHH and 15 non-WNT/non-SHH. Median time to relapse was 13 months (range, 3–63). Relapse was local, disseminated or combined in 20, 15, and 16, respectively. Salvage therapy with curative intent was given in 42/52 patients, including CSI in 28 subjects (median dose 36Gy, 18–41.4) or focal irradiation in 5 others. Three received HDC only. At a median follow-up time of 46 months (range, 4–255), 25 (48%) were alive, including 7/9 SHH and 7/15 non-WNT/non-SHH. The 2- and 5-year OS was 67% and 56% (SE, 7%), respectively. Two of 3 patients with SHH who did not receive salvage radiotherapy are survivors. CONCLUSION A substantial proportion of young children who relapse following irradiation-sparing strategies can be salvaged. Neurocognitive and ototoxicity outcomes are being evaluated.
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Affiliation(s)
- Craig Erker
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Ashley Margol
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Chantel Cacciotti
- Dana-Farber/ Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Sébastien Perreault
- Université de Montréal, Montreal, Québec, Canada
- CHU Sainte-Justine, Montreal, Québec, Canada
| | - Kenneth J Cohen
- The Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamed S AbdelBaki
- Ohio State University, Columbus, Ohio, USA
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Juliette Hukin
- University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Shahrad Rod Rassekh
- University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - David D Eisenstat
- University of Alberta, Edmonton, Alberta, Canada
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Beverly Wilson
- University of Alberta, Edmonton, Alberta, Canada
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Jeffrey Knipstein
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna L Hoppmann
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eric S Sandler
- Nemours Children’s Specialty Care, Jacksonville, Florida, USA
- Wolfson Children’s Hospital, Jacksonville, Florida, USA
| | - Kathleen Dorris
- University of Colorado School of Medicine, Aurora, Colorado, USA
- Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Taryn B Fay-McClymont
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Ralph Salloum
- University of Cincinnati, Cincinnati, Ohio, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Virginia L Harrod
- University of Texas, Dell Medical School, Austin, Texas, USA
- Dell Children’s Medical Center of Central Texas, Austin, Texas, USA
| | - Bruce Crooks
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jonathan L Finlay
- Ohio State University, Columbus, Ohio, USA
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Eric Bouffet
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lucie Lafay-Cousin
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital, Calgary, Alberta, Canada
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Obando MR, Osorio DS, Lassaletta A, Madrid AML, Bartels U, Finlay JL, Qaddoumi I, Rutkowski S, Mynarek M. LINC-18. FOLLOW-UP EVALUATION OF A WEB-BASED PEDIATRIC BRAIN TUMOR BOARD IN LATIN AMERICA. Neuro Oncol 2020. [PMCID: PMC7715704 DOI: 10.1093/neuonc/noaa222.453] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2013, pediatric oncologists from Latin America have discussed neuro-oncology cases with experts from North America and Europe in a web-based “Latin American Tumor Board” (LATB). This descriptive study evaluates the feasibility of the recommendations rendered during the Board. METHODS An electronic questionnaire was distributed to physicians who received recommendations between October 2017 and October 2018, two months after their case presentation on the LATB. Physicians were asked regarding the feasibility of each recommendation given during the Board. Baseline case characteristics of all presented cases were obtained from anonymized minutes prepared after the presentations. RESULTS 36 physicians from 15 countries answered 103 of 142 questionnaires (72.5%), containing 283 recommendations. Physicians followed 60% of diagnostic procedural recommendations and 70% of therapeutic recommendations. Overall, 96% of respondents considered the recommendations applicable and useful. The most difficult recommendations to follow were genetic and molecular testing, pathology review, locally adapted chemotherapy protocols administration, neurosurgical interventions and access to molecular targeted therapies. The most cited reasons for not implementing the recommendations were lack of resources, inapplicable recommendations to that low-to-middle income country (LMIC) setting, and lack of parental consent. CONCLUSION The recommendations given on the LATB are frequently applicable and helpful for physicians in LMIC. Nevertheless, limitations in availability of both diagnostic procedures and treatment modalities affected the feasibility of some recommendations. Virtual tumor boards offer physicians from LMIC access to real time, high-level subspecialist expertise and provide a valuable platform for information exchange among physicians worldwide.
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Affiliation(s)
| | - Diana S Osorio
- Nationwide Children′s Hospital and the Ohio State University, Columbus, Ohio, USA
| | | | | | | | - Jonathan L Finlay
- Nationwide Children′s Hospital and the Ohio State University, Columbus, Ohio, USA
| | | | | | - Martin Mynarek
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abu-Arja MH, Osorio DS, Stanek JR, Finlay JL, AbdelBaki MS. GCT-40. PROGNOSTIC FACTORS FOR PATIENTS WITH RELAPSED CENTRAL NERVOUS SYSTEM (CNS) NON-GERMINOMATOUS GERM CELL TUMORS (NGGCTs). Neuro Oncol 2020. [PMCID: PMC7715477 DOI: 10.1093/neuonc/noaa222.258] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with relapsed CNS NGGCTs experience poor outcomes. Our aim to explore prognostic factors that may guide future clinical trials. METHODS A review of clinical trials that included patients with relapsed CNS NGGCTs was performed. RESULTS Seventy-four patients were identified; only 14 patients (19%) were long-term survivors. Patients who relapsed >24 months after initial diagnosis had a survival rate of 47% compared with 15% of patients who relapsed in <24 months after initial diagnosis (p= 0.015). Patient with serum/cerebrospinal fluid (CSF) alpha-fetoprotein (AFP) level <25 ng/ml at relapse had a survival rate of 40% compared with 0% among patients with serum/CSF AFP level >25 ng/ml at relapse (p= 0.0015). Patients who achieved complete response/continued complete response (CR/CCR) by the end of therapy had a survival rate of 59% compared with 3% among patients who had less than CR/CCR by the end of therapy (p= 0.0001). Patients who received marrow-ablative chemotherapy followed by autologous hematopoietic cell rescue (HDCx/AuHCR) at relapse had a survival rate of 33% compared with 9% of patients who did not receive HDCx/AuHCR at relapse (p=0.056). The extent of surgical resection, receiving radiotherapy, and beta-human chorionic gonadotropin levels at relapse were not statistically associated with improved outcomes. CONCLUSION Timing of relapse (>24 months after initial diagnosis), serum/CSF AFP <25 ng/ml at relapse, achieving CR/CCR after treatment were associated with a positive impact on survival. Receiving HDCx/AuHCR at relapse was associated with an improved outcome trend among the patients.
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Finlay JL, Abu-Arja MH, Abu-Arja R, Auletta J, AbdelBaki MS, Osorio DS, Conley S, Shatara M, Boué DR, Pierson CR, Rusin J, Martin L, Jones J, Palmer JD, Vatner R, Drapeau A, Sribnick E, Leonard JR. GCT-25. INNOVATIVE, INTENSIVE IRRADIATION-AVOIDING/MINIMIZING CHEMOTHERAPY FOR HIGH-RISK PRIMARY CENTRAL NERVOUS SYSTEM (CNS) MIXED MALIGNANT GERM CELL TUMORS (HR-MMGCT): A PILOT STUDY AND PROPOSED MULTI-NATIONAL PROSPECTIVE TRIAL. Neuro Oncol 2020. [PMCID: PMC7715075 DOI: 10.1093/neuonc/noaa222.245] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND About one-third of children with primary CNS MMGCT experience incomplete responses to initial induction chemotherapy prior to irradiation, many of whom will subsequently relapse. Such high-risk patients are variably defined as having initial alpha-fetoprotein (AFP) elevations exceeding 1,000ng/mL, predominant histopathologies of malignant non-germinomatous GCT and incomplete responses to induction chemotherapy. Drugs targeting GCT-specific molecular markers have been identified for non-germinomatous GCT elements but have yet to be incorporated into prospective clinical trials. Four children with clearly identified HR-MMGCT characteristics have been treated on an innovative pilot regimen incorporating intensified chemotherapy and molecularly targeted agents, with avoidance or minimization of irradiation. METHODS Four children (two with pure suprasellar embryonal carcinoma (EC) - one with Down syndrome and the other with pre-diagnosis cognitive dysfunction; one with initial serum AFP exceeding 7,000ng/mL and yolk sac tumor (YST)+EC+Teratoma pathology; one with initial serum AFP exceeding 1,000ng/mL) were treated with 3 cycles of “standard” induction chemotherapy (ACNS1123), followed by 1–3 transplant cycles (thiotepa/carboplatin) each with complete radiographic and tumor marker responses. Two children with pure EC subsequently received six cycles of brentuximab-vedotin without irradiation and remain disease-free off therapy for 2–4 years. One child with YST+EC+Teratoma has subsequently received reduced dose craniospinal irradiation and pineal region boost, and will receive oral everolimus, erlotinib, palbocyclib and intravenous brentuximab-vedotin. The fourth child with YST+MT will commence everolimus, erlotinib and palbocyclib without irradiation. CONCLUSION This treatment strategy for HR-MMGCT patients provides preliminary tolerance and response data justifying extension to a multi-center trial.
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Affiliation(s)
- Jonathan L Finlay
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Mohammad H Abu-Arja
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
- Weill-Cornell College of Medicine, New York, NY, USA
| | - Rolla Abu-Arja
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Jeffery Auletta
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Mohamed S AbdelBaki
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Diana S Osorio
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | | | | | - Daniel R Boué
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Christopher R Pierson
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Jerome Rusin
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Lisa Martin
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Jeremy Jones
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Joshua D Palmer
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Ralph Vatner
- Cincinnati Children’s Hospital, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - Annie Drapeau
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Eric Sribnick
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Jeffrey R Leonard
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
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Nobre L, Zapotocky M, Ramaswamy V, Ryall S, Bennet J, Alderete D, Guill JB, Baroni L, Bartels U, Bavle A, Bornhorst M, Boue’ DR, Canete A, Chintagumpala M, Coven SL, Cruz O, Dahiya S, Dirks P, Dunkel IJ, Eisenstat D, Conter CF, Finch E, Finlay JL, Frappaz D, Garre ML, Gauvain K, Bechensteen AG, Hansford JR, Harting I, Hauser P, Hazrati LN, Huang A, Injac SG, Iurilli V, Karajannis M, Kaur G, Kyncl M, Krskova L, Laperriere N, Larouche V, Lassaletta A, Leary S, Lin F, Mascelli S, McKeown T, Milde T, Madrid AML, Morana G, Morse H, Mushtaq N, Osorio DS, Packer R, Pavelka Z, Quiroga-Cantero E, Rutka J, Sabel M, Salgado D, Solano P, Sterba J, Su J, Sumerauer D, Taylor MD, Toledano H, Tsang DS, Fernandes MV, van Landeghem F, van Tilburg CM, Wilson B, Witt O, Zamecbik J, Bouffet E, Hawkins C, Tabori U. LGG-55. OUTCOME OF BRAF V600E PEDIATRIC GLIOMAS TREATED WITH TARGETED BRAF INHIBITION. Neuro Oncol 2020. [PMCID: PMC7715492 DOI: 10.1093/neuonc/noaa222.433] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with pediatric gliomas harboring BRAF V600E mutation have a poor outcome with current chemoradiation strategies. Our aim was to study the role of targeted BRAF inhibition in these tumors. We collected clinical, imaging, molecular and outcome information from BRAF V600E glioma patients treated with BRAFi across 29 centers from multiple countries. Sixty-seven patients were treated with BRAFi (56 pediatric low grade gliomas, PLGG and 11 pediatric high grade gliomas, PHGG) for up to 5.6 years. Objective responses were observed in 80% of PLGGs compared to 28% with conventional chemotherapy (p<0.001). These responses were rapid (median, 4 months), and sustained in 86% of tumors up to 5 years while on therapy. PLGG which discontinued BRAFi, 76.5% (13/17) progressed rapidly after discontinuation (median 2.3 months). However, upon re-challenge with BRAFi therapy, 90% achieved an objective response. Poor prognostic factors to conventional therapies, such as concomitant homozygous deletion of CDKN2A, were not associated with a lack of response to BRAFi. In contrast, only 36% of PHGG responded to BRAFi with all but one tumor progressing within 18 months. In PLGG, responses translated to 3-year progression-free survival of 49.6% (95%CI, 35.3% to 69.5%) vs 29.8% (95% CI, 20% to 44.4%) for BRAFi vs chemotherapy respectively (p=0.02). The use of BRAFi results in robust and durable responses while on therapy in BRAF V600E PLGG. Prospective studies are required to determine long-term survival and functional outcomes with BRAFi therapy in childhood gliomas.
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Affiliation(s)
- Liana Nobre
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | | | - Scott Ryall
- The Hospital For Sick Children, Toronto, ON, Canada
| | - Julie Bennet
- The Hospital For Sick Children, Toronto, ON, Canada
| | - Daniel Alderete
- Hospital of Pediatrics S,A,M,I,C, Prof, Dr, Juan P, Garrahan, Buenos Aires, Argentina
| | | | - Lorena Baroni
- Hospital of Pediatrics S,A,M,I,C, Prof, Dr, Juan P, Garrahan, Buenos Aires, Argentina
| | - Ute Bartels
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | | | | | - Adela Canete
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Ofelia Cruz
- 4Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sonika Dahiya
- Washington University School of Medicine, St Louis, MO, USA
| | - Peter Dirks
- The Hospital For Sick Children, Toronto, ON, Canada
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | - Inga Harting
- Hopp Children’s Cancer Center, Heidelberg, Germany
| | | | | | - Annie Huang
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Martin Kyncl
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | | | - Sarah Leary
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Frank Lin
- Texas Children’s Cancer Center, Houston, TX, USA
| | | | - Tara McKeown
- The Hospital For Sick Children, Toronto, ON, Canada
| | - Till Milde
- Hopp Children’s Cancer Center, Heidelberg, Germany
| | | | | | | | | | | | - Roger Packer
- Children’s National Health System, Washington, DC, USA
| | | | | | - James Rutka
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | | | - Palma Solano
- Hospital Infantil Virgen del Rocío, Sevilla, Spain
| | | | - Jack Su
- Texas Children’s Cancer Center, Houston, TX, USA
| | | | | | - Helen Toledano
- Schneiders Children’s Medical Center Of Israel, Petah Tikva, Israel
| | | | | | | | | | - Bev Wilson
- Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Olaf Witt
- Hopp Children’s Cancer Center, Heidelberg, Germany
| | | | - Eric Bouffet
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | - Uri Tabori
- The Hospital For Sick Children, Toronto, ON, Canada
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Yankelevich M, Finlay JL, Gorsi H, Kupsky W, Boue DR, Koschmann CJ, Kumar C, Mody R. RARE-51. MOLECULAR INSIGHTS INTO MALIGNANT PROGRESSION OF CHOROID PLEXUS PAPILLOMA (CPP). Neuro Oncol 2020. [PMCID: PMC7715816 DOI: 10.1093/neuonc/noaa222.761] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Malignant transformation of CPP is rare and the mechanisms remain elusive. We report a case of progression of papilloma into carcinoma where we performed molecular sequencing of both samples. A boy was found to have a brain mass soon after birth. The gross total resection (GTR) was diagnostic of CPP. Six years later he developed a recurrent mass that demonstrated progression to a choroid plexus carcinoma (CPC). The patient received chemotherapy according to a “HeadStartII” protocol. He is 2.5 years off therapy and disease-free. A sequencing study consisting of 1700 genes and tumor transcriptome was done. The analysis of both samples revealed a germline variant of TP53(R248W) with LOH and an allele frequency of 39% in the germline sample, suggesting a mosaicism. Analysis of both samples identified extensive aneuploidy and similar pattern of gains in chromosomes 7/8/12/20/21/X. Copy number aberrations newly acquired in the carcinoma included copy gain of chromosomes 5q/12/15q/20, and copy loss of chromosomes 5q/13/22. The papilloma was found to harbor 3 somatic mutations with 4% to 21% allelic fractions, all lost in the carcinoma. These mutations were of unknown significance and with too low allelic fractions to be responsible for the transformation. More pertinently, chromosomal aneuploidy was significant with additional losses in the carcinoma. This resulted in the losses of two critical tumor suppressor genes, RB and BRCA2, playing a possible role in the observed transformation. The “HeadStart” experience suggested that the prognosis of TP53 mutant CPC may be improved in the absence of radiation therapy.
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Affiliation(s)
| | - Jonathan L Finlay
- Division of Hematology, Oncology, and BMT, Nationwide Children’s Hospital and The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Hamza Gorsi
- Division of Pediatric Hematology/Oncology, Children’s Hospital of Michigan and Wayne State University School of Medicine, Detroit, MI, USA
| | - William Kupsky
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Daniel R Boue
- Department of Pathology, Nationwide Children’s Hospital and The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Carl J Koschmann
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chandan Kumar
- Michigan Center for Translational Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rajen Mody
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Lazow MA, Schafer A, DeWire-Schottmiller MD, Lane A, Boué DR, Osorio DS, Finlay JL, Wright E, Rush S, Hoffman LM, Reuss J, Hummel TR, Salloum R, de Blank PM, Smiley NP, Sutton ME, Asher A, Stevenson CB, Drissi R, Fouladi M, Fuller C. LGG-31. CHARACTERIZING TEMPORAL GENOMIC HETEROGENEITY IN PEDIATRIC LOW GRADE GLIOMAS: ANALYSIS OF AN EXPANDED MULTI-INSTITUTIONAL COHORT WITH 101 PAIRED TUMOR SAMPLES. Neuro Oncol 2020. [PMCID: PMC7715389 DOI: 10.1093/neuonc/noaa222.413] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Recent discoveries have provided valuable insight into the genomic landscape of pediatric low grade gliomas (LGGs) at diagnosis, facilitating molecularly targeted treatment. However, little is known about their temporal and therapy-related genomic heterogeneity. An adequate understanding of the evolution of pediatric LGGs’ genomic profiles over time is critically important in guiding decisions about targeted therapeutics and diagnostic biopsy at recurrence.
METHODS
Fluorescence in situ hybridization, mutation-specific immunohistochemistry, and exome analyses were performed on paired tumor samples from primary diagnostic and subsequent surgeries.
RESULTS
101 tumor samples from 48 patients (43 with 2 specimens, 5 with 3 specimens) from 3 institutions underwent testing. BRAF fusion and BRAFV600E status were conserved in 100% and 97% of paired specimens, respectively. No loss or gain of IDH1 mutations or FGFR1, NTRK2, MYB, or MYBL1 rearrangements were detected over time. Histologic diagnosis remained the same in all tumors, with no acquired H3K27M mutations or malignant transformation. CDKN2A deletions were acquired in 7 patients (including 3 who received chemotherapy [2 with temozolomide] and 1 who received radiation), and were associated with a trend toward shorter time to progression (median: 5.5 vs. 13.0 months [p=0.08]).
CONCLUSIONS
Most targetable genetic alterations in pediatric LGGs, including BRAF alterations, are conserved at recurrence and following chemotherapy or radiation. However, CDKN2A deletion acquisition was demonstrated and may define a higher risk group. Given potential for targeted therapies for tumors acquiring CDKN2A deletions, performing a biopsy at recurrence may be indicated in certain patients, especially those with rapid progression.
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Affiliation(s)
- Margot A Lazow
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Austin Schafer
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Adam Lane
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | | | - Sarah Rush
- Akron Children’s Hospital, Akron, OH, USA
| | | | - Jamie Reuss
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Trent R Hummel
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Ralph Salloum
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Peter M de Blank
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Mary E Sutton
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anthony Asher
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Rachid Drissi
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Maryam Fouladi
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine Fuller
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Cappellano AM, Silva NS, Mançano B, Almeida DB, Cavalheiro S, Dastoli PA, Silva FA, Epelman S, Aguiar SS, Finlay JL. GCT-58. BRAZILIAN CENTRAL NERVOUS SYSTEM GERM CELL TUMOR CONSORTIUM PROTOCOL. Neuro Oncol 2020. [PMCID: PMC7715565 DOI: 10.1093/neuonc/noaa222.275] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Primary central nervous system (CNS) germ cell tumors (GCT) account for 2–3% brain tumors children/adolescents in Western hemisphere. The report aim is to present the results of a Brazilian CNSGCT consortium protocol. METHODS Since 2013, 45 patients with histologic and/or tumor marker (TM) diagnosis of germinoma with/without HCGβ levels≤200mIU/ml (n=33), four between 100-200mIU/ml and NGGCT (n=12), received carboplatin/etoposide/cyclophosphamide (4–6 cycles), followed by 18Gy ventricular field irradiation and primary site(s) boost. Autologous bone marrow transplant (ABMT) was conducted for NGGCT low responders. RESULTS Mean age 12.9 years (4.7-20y), 34 males. Diagnosis was made by TM (n=9), surgery (n=19), both (n=15). Two bifocal cases, (-)TM were treated as germinoma. Primary tumor location was pineal (n=20), suprasellar (n=13), bifocal (n=11) and basal ganglia/thalamus (n=1). Fourteen had ventricular/spinal spread. Second-look surgery occurred in 5 patients. For the germinoma group, 26 achieved complete response (CR) after chemotherapy, seven showed residual teratoma/scar. For the NGGCT after 2/4 cycles, four patients showed CR, 2 failure/progression and 6 partial response (4 (-)TM). Two were submitted to ABMT. Radiotherapy was performed as described, except in three. One recurrence to date. Two patients died (endocrinologic complications/progression). Toxicity was mostly grade ¾ neutropenia/thrombocytopenia during chemotherapy. At a median follow-up of 38 months, OS was 100% for Germinoma and 85% NGGCT. CONCLUSION The treatment is tolerable and VFI dose reduction to 18Gy seems to preserve efficacy. Further follow-up is warranted to assess the NG group and the slow-responder patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Sidnei Epelman
- Hospital Santa Marcelina/TUCCA, São Paulo, São Paulo, Brazil
| | - Simone S Aguiar
- Hospital Santa Marcelina/TUCCA, São Paulo, São Paulo, Brazil
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Osorio DS, Abu-Arja R, Abdel-Baki MS, Leonard JR, Sribnick EA, Finlay JL, Ellison DW, Picarsic J, Kahwash S, Boue’ DR. RARE-40. CASE REPORT: LONG-TERM SURVIVOR OF A RARE, PEDIATRIC PRIMARY HISTIOCYTIC SARCOMA (HS) OF THE CENTRAL NERVOUS SYSTEM (CNS) FOLLOWING COMPLETE RESECTION, CHEMOTHERAPY AND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION (ALLO-HCT). Neuro Oncol 2020. [PMCID: PMC7715933 DOI: 10.1093/neuonc/noaa222.750] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report an unusual case of a patient with primary CNS-HS a very rare neoplasm of histiocytic lineage with usually poor prognosis. An 8 year old boy presented with a one month history of headaches, nausea and vomiting. Physical examination revealed nystagmus and dysmetria. Brain MRI revealed a localized 2.4 cm posterior fossa (cerebellar) mass with restricted diffusion. The patient underwent a gross total resection of the mass. Initial post-operative lumbar puncture was positive for rare malignant cells. Pathology showed a focally necrotic neoplasm, composed of nests and cords of large relatively uniform cells with abundant eosinophilic cytoplasm, moderately pleomorphic nuclei and numerous mitotic figures, consistent with CNS-HS with juvenile xanthogranuloma phenotype, as supported by positive IHC expression of CD163, CD68, CD14, fascin, and Factor XIIIa, while negative for CD1a, Lymphoid and Myeloid markers, and BRAFv600e mutation. He was treated with two cycles of clofarabine and cytarabine and triple intrathecal (IT) chemotherapy. He developed generalized seizures and MRI showed demyelination consistent with IT methotrexate toxicity; MTX was then discontinued. He was then given two additional cycles of cladribine and weekly intrathecal therapy prior to consolidation with an Allo-HCT using a 10/10 HLA allelic-matched unrelated donor. His conditioning regimen included total body irradiation and cyclophosphamide. He did well post-transplant with peripheral blood chimerism at 1 year showing > 95% donor cells. He remains disease-free with an excellent quality of life since August 2016. We report one of the few known survivors of this unusual and highly malignant entity.
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Affiliation(s)
- Diana S Osorio
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Rolla Abu-Arja
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Mohamed S Abdel-Baki
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Jeffrey R Leonard
- Department of Pediatric Neurosurgery, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Eric A Sribnick
- Department of Pediatric Neurosurgery, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Jonathan L Finlay
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - David W Ellison
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jennifer Picarsic
- Department of Pathology, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - Samir Kahwash
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Daniel R Boue’
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
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Harris MK, Lamb M, Stanek JR, Finlay JL, AbdelBaki MS. GCT-74. RETROSPECTIVE LITERATURE REVIEW OF CENTRAL NERVOUS SYSTEM (CNS) GERM CELL TUMORS (GCTs) IN PATIENTS WITH DOWN SYNDROME (DS). Neuro Oncol 2020. [PMCID: PMC7715102 DOI: 10.1093/neuonc/noaa222.290] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
A standard-of-care has not been established for the management of DS patients who develop primary CNS GCTs – the most common CNS neoplasm in DS – despite being more susceptible to treatment-related adverse events.
METHODS
A review of the English-language medical literature between 1960 and 2020 was conducted.
RESULTS
Thirty-one cases of CNS GCTs in DS patients (median nine-years-old; 21 males) were reported; the majority (23/31) originated from East Asia. Twelve had germinomas (39%), 12 had non-germinomatous germ cell tumors (NGGCTs) (39%), and seven had teratomas (22%). Four patients (13%) died from tumor progression (one germinoma versus three teratoma). Seven patients (23%) died from treatment-related complications (four germinoma versus three NGGCT). Of the germinoma patients, two died from chemotherapy-related sepsis, one from post-surgery cardiopulmonary failure, and one from Moyamoya following radiation-therapy (RT) only. Of the NGGCT patients, one died from chemotherapy-related sepsis, one from post-surgical infection, and one from pneumonia following surgery/chemotherapy/RT. Three-year overall survival (OS) was 58.1% for all patients, 52.5% for germinoma, 64.8% for NGGCT, and 60% for teratoma. Three-year OS for patients who received RT or chemotherapy was 63.6% and 59.6% respectively. Twenty patients (65%) remain alive (seven germinoma versus nine NGCCT versus four teratoma). Ten patients (32%) experienced serious treatment-related complications (five germinoma versus five NGGCT).
CONCLUSIONS
Patients with DS and CNS GCTs are at an increased risk of treatment-related complications. Therefore, a different therapeutic approach may need to be considered for this patient population in order to mitigate the treatment-related complications and long-term neurocognitive sequelae.
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Affiliation(s)
- Micah K Harris
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Margaret Lamb
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Joseph R Stanek
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Jonathan L Finlay
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Mohamed S AbdelBaki
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
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