1
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Mendez-Gomez HR, DeVries A, Castillo P, von Roemeling C, Qdaisat S, Stover BD, Xie C, Weidert F, Zhao C, Moor R, Liu R, Soni D, Ogando-Rivas E, Chardon-Robles J, McGuiness J, Zhang D, Chung MC, Marconi C, Michel S, Barpujari A, Jobin GW, Thomas N, Ma X, Campaneria Y, Grippin A, Karachi A, Li D, Sahay B, Elliott L, Foster TP, Coleman KE, Milner RJ, Sawyer WG, Ligon JA, Simon E, Cleaver B, Wynne K, Hodik M, Molinaro AM, Guan J, Kellish P, Doty A, Lee JH, Massini T, Kresak JL, Huang J, Hwang EI, Kline C, Carrera-Justiz S, Rahman M, Gatica S, Mueller S, Prados M, Ghiaseddin AP, Silver NL, Mitchell DA, Sayour EJ. RNA aggregates harness the danger response for potent cancer immunotherapy. Cell 2024; 187:2521-2535.e21. [PMID: 38697107 DOI: 10.1016/j.cell.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/09/2024] [Accepted: 04/03/2024] [Indexed: 05/04/2024]
Abstract
Cancer immunotherapy remains limited by poor antigenicity and a regulatory tumor microenvironment (TME). Here, we create "onion-like" multi-lamellar RNA lipid particle aggregates (LPAs) to substantially enhance the payload packaging and immunogenicity of tumor mRNA antigens. Unlike current mRNA vaccine designs that rely on payload packaging into nanoparticle cores for Toll-like receptor engagement in immune cells, systemically administered RNA-LPAs activate RIG-I in stromal cells, eliciting massive cytokine/chemokine response and dendritic cell/lymphocyte trafficking that provokes cancer immunogenicity and mediates rejection of both early- and late-stage murine tumor models. In client-owned canines with terminal gliomas, RNA-LPAs improved survivorship and reprogrammed the TME, which became "hot" within days of a single infusion. In a first-in-human trial, RNA-LPAs elicited rapid cytokine/chemokine release, immune activation/trafficking, tissue-confirmed pseudoprogression, and glioma-specific immune responses in glioblastoma patients. These data support RNA-LPAs as a new technology that simultaneously reprograms the TME while eliciting rapid and enduring cancer immunotherapy.
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Affiliation(s)
- Hector R Mendez-Gomez
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Anna DeVries
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Paul Castillo
- University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Christina von Roemeling
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Sadeem Qdaisat
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA; University of Florida Genetics Institute, Gainesville, FL 32610, USA
| | - Brian D Stover
- University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Chao Xie
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Frances Weidert
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Chong Zhao
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Rachel Moor
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Ruixuan Liu
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Dhruvkumar Soni
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Elizabeth Ogando-Rivas
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Jonathan Chardon-Robles
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - James McGuiness
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Dingpeng Zhang
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Michael C Chung
- University of Texas at Austin, College of Pharmacy, Division of Chemical Biology and Medicinal Chemistry, Austin TX 78712
| | - Christiano Marconi
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Stephen Michel
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Arnav Barpujari
- University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Gabriel W Jobin
- University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Nagheme Thomas
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Xiaojie Ma
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA; University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Yodarlynis Campaneria
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Adam Grippin
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Aida Karachi
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Derek Li
- University of Florida, Division of Quantitative Sciences, UF Health Cancer Center, Gainesville, FL 32610, USA
| | - Bikash Sahay
- University of Florida, College of Veterinary Medicine, Gainesville, FL 32610, USA
| | - Leighton Elliott
- University of Florida, Department of Medicine, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Timothy P Foster
- University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Kirsten E Coleman
- University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Rowan J Milner
- University of Florida, College of Veterinary Medicine, Gainesville, FL 32610, USA
| | - W Gregory Sawyer
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - John A Ligon
- University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA
| | - Eugenio Simon
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Brian Cleaver
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Kristine Wynne
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Marcia Hodik
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Annette M Molinaro
- University of California, San Francisco, Department of Neurological Surgery, San Francisco, CA 94158, USA
| | - Juan Guan
- University of Texas at Austin, College of Pharmacy, Division of Chemical Biology and Medicinal Chemistry, Austin TX 78712
| | - Patrick Kellish
- University of Florida Interdisciplinary Center for Biotechnology Research, Gainesville, FL 32610, USA
| | - Andria Doty
- University of Florida Interdisciplinary Center for Biotechnology Research, Gainesville, FL 32610, USA
| | - Ji-Hyun Lee
- University of Florida, Department of Biostatistics, Gainesville, FL 32610, USA
| | - Tara Massini
- University of Florida, Department of Radiology, Gainesville, FL 32610, USA
| | - Jesse L Kresak
- University of Florida, Department of Pathology, Gainesville, FL 32610, USA
| | - Jianping Huang
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Eugene I Hwang
- Children's National Hospital, Center for Cancer and Blood Disorders, Washington, DC 20010, USA
| | - Cassie Kline
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Department of Pediatrics, Division of Oncology, Philadelphia, PA 19104, USA
| | | | - Maryam Rahman
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Sebastian Gatica
- University of Florida, Department of Anesthesiology, Gainesville, FL 32610, USA
| | - Sabine Mueller
- University of California, San Francisco, Department of Neurology, Neurological Surgery, and Pediatrics, San Francisco, CA 94158, USA
| | - Michael Prados
- University of California, San Francisco, Department of Neurological Surgery, San Francisco, CA 94158, USA
| | - Ashley P Ghiaseddin
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Natalie L Silver
- Cleveland Clinic, Center of Immunotherapy and Precision Immuno-Oncology/Head and Neck Institute, Cleveland, OH 44106, USA
| | - Duane A Mitchell
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA
| | - Elias J Sayour
- University of Florida Lillian S. Wells Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL 32610, USA; University of Florida, Department of Pediatrics, Division of Hematology-Oncology, Gainesville, FL 32610, USA.
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2
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Crotty EE, Wilson AL, Davidson T, Tahiri S, Gust J, Griesinger AM, Venkataraman S, Park JR, Mueller S, Rood BR, Hwang EI, Wang LD, Vitanza NA. Cellular Therapy for Children with Central Nervous System Tumors: Mining and Mapping the Correlative Data. Curr Oncol Rep 2023; 25:847-855. [PMID: 37160547 PMCID: PMC10326126 DOI: 10.1007/s11912-023-01423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE OF REVIEW Correlative studies should leverage clinical trial frameworks to conduct biospecimen analyses that provide insight into the bioactivity of the intervention and facilitate iteration toward future trials that further improve patient outcomes. In pediatric cellular immunotherapy trials, correlative studies enable deeper understanding of T cell mobilization, durability of immune activation, patterns of toxicity, and early detection of treatment response. Here, we review the correlative science in adoptive cell therapy (ACT) for childhood central nervous system (CNS) tumors, with a focus on existing chimeric antigen receptor (CAR) and T cell receptor (TCR)-expressing T cell therapies. RECENT FINDINGS We highlight long-standing and more recently understood challenges for effective alignment of correlative data and offer practical considerations for current and future approaches to multi-omic analysis of serial tumor, serum, and cerebrospinal fluid (CSF) biospecimens. We highlight the preliminary success in collecting serial cytokine and proteomics from patients with CNS tumors on ACT clinical trials.
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Affiliation(s)
- Erin E Crotty
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, M/S JMB-8, 1900 9thAvenue, Seattle, WA, 98101, USA
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | - Tom Davidson
- Cancer and Blood Disease Institute, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Sophia Tahiri
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, M/S JMB-8, 1900 9thAvenue, Seattle, WA, 98101, USA
| | - Juliane Gust
- Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, WA, USA
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Andrea M Griesinger
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sujatha Venkataraman
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julie R Park
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, M/S JMB-8, 1900 9thAvenue, Seattle, WA, 98101, USA
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
- Seattle Children's Therapeutics, Seattle, WA, USA
| | - Sabine Mueller
- Department of Neurology, Neurosurgery, and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Brian R Rood
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
| | - Eugene I Hwang
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
| | - Leo D Wang
- Departments of Pediatrics and ImmunoOncology, City of Hope, Duarte, CA, USA
| | - Nicholas A Vitanza
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, M/S JMB-8, 1900 9thAvenue, Seattle, WA, 98101, USA.
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
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3
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Nazarian J, Mason GE, Ho CY, Panditharatna E, Kambhampati M, Vezina LG, Packer RJ, Hwang EI. Addendum: Histological and molecular analysis of a progressive diffuse intrinsic pontine glioma and synchronous metastatic lesions: a case report. Oncotarget 2023; 14:449. [PMID: 37171383 PMCID: PMC10178448 DOI: 10.18632/oncotarget.28286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
- Javad Nazarian
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA
- Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gary E Mason
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cheng Ying Ho
- Department of Pathology, Children's National Medical Center, Washington, DC, USA
| | - Eshini Panditharatna
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA
- Institute for Biomedical Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Madhuri Kambhampati
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA
| | - L Gilbert Vezina
- Division of Neuro-radiology, Children's National Medical Center, Washington, DC, USA
| | - Roger J Packer
- Brain Tumor Institute, Daniel and Jennifer Gilbert Neurofibromatosis Institute, Neuroscience and Behavioral Medicine, Children's National Medical Center, NW, Washington, DC, USA
| | - Eugene I Hwang
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
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4
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Hwang EI, Hanson D, Filbin MG, Mack SC. Why haven't we solved intracranial pediatric ependymoma? Current questions and barriers to treatment advances. Neoplasia 2023; 39:100895. [PMID: 36944298 PMCID: PMC10036929 DOI: 10.1016/j.neo.2023.100895] [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: 12/05/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/22/2023]
Abstract
Pediatric intracranial ependymoma has seen a recent exponential expansion of biological findings, rapidly dividing the diagnosis into several subgroups, each with specific molecular and clinical characteristics. While such subdivision may complicate clinical conclusions from historical trials, this knowledge also provides an opportunity for interrogating the major clinical and biological questions preventing near-term translation into effective therapy for children with ependymoma. In this article, we briefly review some of the most critical clinical questions facing both patient management and the construct of future trials in childhood ependymoma, as well as explore some of the current barriers to efficient translation of preclinical discovery to the clinic.
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Chaudhry K, Geiger A, Dowlati E, Lang H, Sohai DK, Hwang EI, Lazarski CA, Yvon E, Holdhoff M, Jones R, Savoldo B, Cruz CRY, Bollard CM. Co Transducing B7H3 CAR-NK cells with the DNR preserves their cytolytic function against GBM in the presence of exogenous TGF-β. Mol Ther Methods Clin Dev 2022; 27:415-430. [PMID: 36381305 PMCID: PMC9661497 DOI: 10.1016/j.omtm.2022.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 03/04/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
Cord blood (CB)-derived natural killer (NK) cells that are genetically engineered to express a chimeric antigen receptor (CAR) are an attractive off-the-shelf therapy for the treatment of cancer, demonstrating a robust safety profile in vivo. For poor prognosis brain tumors such as glioblastoma multiforme (GBM), novel therapies are urgently needed. Although CAR-T cells demonstrate efficacy in preclinical GBM models, an off-the-shelf product may exhibit unwanted side effects like graft-versus-host disease. Hence, we developed an off-the-shelf CAR-NK cell approach using a B7H3 CAR and showed that CAR-transduced NK cells have robust cytolytic activity against GBM cells in vitro. However, transforming growth factor (TGF)-β within the tumor microenvironment has devastating effects on the cytolytic activity of both unmodified and CAR-transduced NK cells. To overcome this potent immune suppression, we demonstrated that co-transducing NK cells with a B7H3 CAR and a TGF-β dominant negative receptor (DNR) preserves cytolytic function in the presence of exogenous TGF-β. This study demonstrates that a novel DNR and CAR co-expression strategy may be a promising therapeutic for recalcitrant CNS tumors like GBM.
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Affiliation(s)
- Kajal Chaudhry
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
| | - Ashley Geiger
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, Georgetown University Medical Center, Washington, DC, USA
| | - Haili Lang
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
| | - Danielle K. Sohai
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
| | - Eugene I. Hwang
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
| | - Christopher A. Lazarski
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
| | - Eric Yvon
- GW Cancer Center, George Washington University, Washington, DC, USA
| | - Matthias Holdhoff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Richard Jones
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Barbara Savoldo
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Conrad Russell Y. Cruz
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
- GW Cancer Center, George Washington University, Washington, DC, USA
- Corresponding author Conrad Russell Y. Cruz, Center for Cancer and Immunology Research, Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC 20010, USA.
| | - Catherine M. Bollard
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
- GW Cancer Center, George Washington University, Washington, DC, USA
- Corresponding author Catherine M. Bollard, Center for Cancer and Immunology Research, Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC 20010, USA.
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Goldman S, Margol A, Hwang EI, Tanaka K, Suchorska B, Crawford JR, Kesari S. Safety tumor treating fields (TTFields) therapy in pediatric patients with malignant brain tumors: Post-marketing surveillance data. Front Oncol 2022; 12:958637. [PMID: 36072789 PMCID: PMC9443515 DOI: 10.3389/fonc.2022.958637] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
There is an unmet need to develop effective and tolerable treatments for pediatric patients with malignant central nervous system tumors. This is especially essential for pediatric patients with aggressive brain tumors such as high-grade gliomas, which have a typical survival rate of under 2 years. Tumor Treating Fields (TTFields) are locoregional, noninvasive electric fields that produce an antimitotic effect on cancerous cells when applied to the skin via arrays. TTFields therapy (200 kHz) is currently approved in adult patients with newly diagnosed glioblastoma (GBM), with temozolomide, and recurrent GBM as monotherapy. Positive preclinical and clinical data have encouraged off-label use of TTFields therapy in pediatric patients with brain tumors, and this study aims to explore the safety of TTFields therapy in pediatric patients (0–18 years of age) based on data from an unsolicited post-marketing surveillance safety database. The real-world data reported here demonstrate that TTFields therapy has a favorable safety profile for pediatric patients with brain tumors, with no new safety signals observed. Findings from this study warrant further research into the efficacy of TTFields therapy, as well as its potential impact on the quality of life in pediatric patients.
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Affiliation(s)
- Stewart Goldman
- Phoenix Children’s Hospital, University of Arizona College of Medicine, Phoenix, AZ, United States
- *Correspondence: Stewart Goldman,
| | - Ashley Margol
- Children’s Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Eugene I. Hwang
- Department of Oncology, Children’s National Hospital, Washington, DC, United States
| | | | - Bogdana Suchorska
- Department of Neurosurgery, Sana Kliniken Duisburg, Duisburg, Germany
| | - John R. Crawford
- Department of Neurology, Children’s Health of Orange County, Orange County, CA, United States
| | - Santosh Kesari
- Providence Southern California Research Clinical Institute, Saint John’s Cancer Institute, Pacific Neuroscience Institute, Los Angeles, CA, United States
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Papusha L, Zaytseva M, Panferova A, Druy A, Valiakhmetova A, Artemov A, Salnikova E, Kislyakov A, Imyanitov E, Karachunsky A, Maschan A, Hwang EI, Novichkova G, Packer RJ. Two clinically distinct cases of infant hemispheric glioma carrying ZCCHC8:ROS1 fusion and responding to entrectinib. Neuro Oncol 2022; 24:1029-1031. [PMID: 35196386 PMCID: PMC9159448 DOI: 10.1093/neuonc/noac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ludmila Papusha
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Margarita Zaytseva
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Agnesa Panferova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexander Druy
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Andge Valiakhmetova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Anton Artemov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Ekaterina Salnikova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexey Kislyakov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
- Morozov City Children Hospital, Moscow, Russian Federation
| | - Evgeny Imyanitov
- St. Petersburg Pediatric Medical University, St. Petersburg, Russian Federation
- N.N. Petrov Institute of Oncology, St. Petersburg, Russian Federation
| | - Alexander Karachunsky
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexey Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Eugene I Hwang
- Division of Oncology, Children’s National Hospital, Washington, DC, USA
- Brain Tumor Institute, Washington, DC, USA
| | - Galina Novichkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Roger J Packer
- Division of Oncology, Children’s National Hospital, Washington, DC, USA
- Brain Tumor Institute, Washington, DC, USA
- Center for Neuroscience and Behavioral Medicine, Washington, DC, USA
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8
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Hwang EI, Sayour EJ, Flores CT, Grant G, Wechsler-Reya R, Hoang-Minh LB, Kieran MW, Salcido J, Prins RM, Figg JW, Platten M, Candelario KM, Hale PG, Blatt JE, Governale LS, Okada H, Mitchell DA, Pollack IF. The current landscape of immunotherapy for pediatric brain tumors. Nat Cancer 2022; 3:11-24. [PMID: 35121998 DOI: 10.1038/s43018-021-00319-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/24/2021] [Indexed: 02/06/2023]
Abstract
Pediatric central nervous system tumors are the most common solid malignancies in childhood, and aggressive therapy often leads to long-term sequelae in survivors, making these tumors challenging to treat. Immunotherapy has revolutionized prospects for many cancer types in adults, but the intrinsic complexity of treating pediatric patients and the scarcity of clinical studies of children to inform effective approaches have hampered the development of effective immunotherapies in pediatric settings. Here, we review recent advances and ongoing challenges in pediatric brain cancer immunotherapy, as well as considerations for efficient clinical translation of efficacious immunotherapies into pediatric settings.
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Affiliation(s)
- Eugene I Hwang
- Division of Oncology, Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.
| | - Elias J Sayour
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Catherine T Flores
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Gerald Grant
- Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Robert Wechsler-Reya
- Tumor Initiation & Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Lan B Hoang-Minh
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | | | | | - Robert M Prins
- Departments of Neurosurgery and Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John W Figg
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University and CCU Brain Tumor Immunology, DKFZ, Heidelberg, Germany
| | - Kate M Candelario
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Paul G Hale
- Children's Brain Trust, Coral Springs, FL, USA
| | - Jason E Blatt
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Lance S Governale
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Hideho Okada
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Duane A Mitchell
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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9
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von Hoff K, Haberler C, Schmitt-Hoffner F, Schepke E, de Rojas T, Jacobs S, Zapotocky M, Sumerauer D, Perek-Polnik M, Dufour C, van Vuurden D, Slavc I, Gojo J, Pickles JC, Gerber NU, Massimino M, Gil-da-Costa MJ, Garami M, Kumirova E, Sehested A, Scheie D, Cruz O, Moreno L, Cho J, Zeller B, Bovenschen N, Grotzer M, Alderete D, Snuderl M, Zheludkova O, Golanov A, Okonechnikov K, Mynarek M, Juhnke BO, Rutkowski S, Schüller U, Pizer B, Zezschwitz BV, Kwiecien R, Wechsung M, Konietschke F, Hwang EI, Sturm D, Pfister SM, von Deimling A, Rushing EJ, Ryzhova M, Hauser P, Łastowska M, Wesseling P, Giangaspero F, Hawkins C, Figarella-Branger D, Eberhart C, Burger P, Gessi M, Korshunov A, Jacques TS, Capper D, Pietsch T, Kool M. Therapeutic implications of improved molecular diagnostics for rare CNS-embryonal tumor entities: results of an international, retrospective study. Neuro Oncol 2021; 23:1597-1611. [PMID: 34077956 DOI: 10.1093/neuonc/noab136] [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] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Only few data are available on treatment-associated behavior of distinct rare CNS-embryonal tumor entities previously treated as "CNS-primitive neuroectodermal tumors" (CNS-PNET). Respective data on specific entities, including CNS neuroblastoma, FOXR2 activated (CNS NB-FOXR2), and embryonal tumor with multi-layered rosettes (ETMR) are needed for development of differentiated treatment strategies. METHODS Within this retrospective, international study, tumor samples of clinically well-annotated patients with the original diagnosis of CNS-PNET were analyzed using DNA methylation arrays (n=307). Additional cases (n=66) with DNA methylation pattern of CNS NB-FOXR2 were included irrespective of initial histological diagnosis. Pooled clinical data (n=292) were descriptively analyzed. RESULTS DNA methylation profiling of "CNS-PNET" classified 58(19%) cases as ETMR, 57(19%) as HGG, 36(12%) as CNS NB-FOXR2, and 89(29%) cases were classified into 18 other entities. Sixty-seven (22%) cases did not show DNA methylation patterns similar to established CNS tumor reference classes. Best treatment results were achieved for CNS NB-FOXR2 patients (5-year PFS: 63%±7%, OS: 85%±5%, n=63), with 35/42 progression-free survivors after upfront craniospinal irradiation (CSI) and chemotherapy. The worst outcome was seen for ETMR and HGG patients with 5-year PFS of 18%±6% and 22%±7%, and 5-year OS of 24%±6% and 25%±7%, respectively. CONCLUSION The historically reported poor outcome of CNS-PNET patients becomes highly variable when tumors are molecularly classified based on DNA methylation profiling. Patients with CNS NB-FOXR2 responded well to current treatments and a standard-risk-CSI based regimen may be prospectively evaluated. The poor outcome of ETMR across applied treatment strategies substantiates the necessity for evaluation of novel treatments.
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Affiliation(s)
- Katja von Hoff
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Felix Schmitt-Hoffner
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Elizabeth Schepke
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Teresa de Rojas
- Pediatric OncoGenomics Unit, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Sandra Jacobs
- Department of Pediatrics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Michal Zapotocky
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - David Sumerauer
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, University of Warsaw, Warsaw, Poland
| | - Christelle Dufour
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Villejuif, France.,Paris-Saclay University, INSERM, Molecular predictors and New targets in Oncology, Villejuif, France
| | | | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Jessica C Pickles
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale die Tumori, Milan, Italy
| | | | - Miklos Garami
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Ella Kumirova
- Department of Neuro-Oncology, Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Astrid Sehested
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Frederik Vs vej 11, 2100 Copenhagen, Denmark
| | - Ofelia Cruz
- Pediatric Oncology Department. Hospital Sant Joan de Deu. Barcelona, Spain
| | - Lucas Moreno
- Paediatric Haematology & Oncology Division, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaeho Cho
- Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Bernward Zeller
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Niels Bovenschen
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michael Grotzer
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | - Daniel Alderete
- Service of Hematology/Oncology, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Olga Zheludkova
- Department of Neurooncology, Russian Scientific Center of Radiology, Moscow, Russia
| | - Andrey Golanov
- Department of Neuroradiology, Burdenko Neurosurgical Institute, Moscow, Russia
| | - Konstantin Okonechnikov
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - B Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Barry Pizer
- Institute of Translational Research, University of Liverpool, UK
| | - Barbara V Zezschwitz
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Maximilian Wechsung
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine and Berlin Institute of Health, Berlin, Germany
| | - Frank Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine and Berlin Institute of Health, Berlin, Germany
| | - Eugene I Hwang
- Department of Pediatric Hematology-Oncology, Center for Cancer and Immunology Research and Neuroscience Research, Children's National Medical Center, Washington DC, USA
| | - Dominik Sturm
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabeth J Rushing
- Institute of Neuropathology, University Medical Center Zurich, Zurich, Switzerland
| | - Marina Ryzhova
- Department of Neuropathology, Burdenko Neurosurgical Institute, Moscow, Russia
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Łastowska
- Department of Pathomorphology, Children's Memorial Health Institute, Warsaw, Poland
| | - Pieter Wesseling
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Amsterdam University Medical Center / VUmc, Amsterdam, The Netherlands
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
| | - Cynthia Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, Canada
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Charles Eberhart
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Burger
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Marco Gessi
- Neuropathology Unit, Division of Pathology, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica S.Cuore, Rome, Italy
| | - Andrey Korshunov
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tom S Jacques
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Capper
- Department of Neuropathology, Charité University Medicine, and Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn, DZNE German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Marcel Kool
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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10
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DeWire MD, Fuller C, Campagne O, Lin T, Pan H, Young Poussaint T, Baxter PA, Hwang EI, Bukowinski A, Dorris K, Hoffman L, Waanders AJ, Karajannis MA, Stewart CF, Onar-Thomas A, Fouladi M, Dunkel IJ. A Phase I and Surgical Study of Ribociclib and Everolimus in Children with Recurrent or Refractory Malignant Brain Tumors: A Pediatric Brain Tumor Consortium Study. Clin Cancer Res 2021; 27:2442-2451. [PMID: 33547201 PMCID: PMC8132306 DOI: 10.1158/1078-0432.ccr-20-4078] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/16/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Genomic aberrations in cell cycle and PI3K pathways are commonly observed in pediatric brain tumors. This study determined the MTD/recommended phase II dose (RP2D) of ribociclib and everolimus and characterized single-agent ribociclib concentrations in plasma and tumor in children undergoing resection. PATIENTS AND METHODS Patients were enrolled in the phase I study according to a rolling 6 design and received ribociclib and everolimus daily for 21 and 28 days, respectively. Surgical patients received ribociclib at the pediatric RP2D (350 mg/m2) for 7-10 days preoperatively followed by enrollment on the phase I study. Pharmacokinetics were analyzed for both cohorts. RESULTS Sixteen patients were enrolled on the phase I study (median age, 10.3 years; range, 3.9-20.4) and 6 patients in the surgical cohort (median age, 11.4 years; range: 7.2-17.1). Thirteen patients were enrolled at dose level 1 without dose-limiting toxicities (DLT). Two of the 3 patients at dose level 2 experienced DLTs (grade 3 hypertension and grade 4 alanine aminotransferase). The most common grade 3/4 toxicities were lymphopenia, neutropenia, and leukopenia. The RP2D of ribociclib and everolimus was 120 and 1.2 mg/m2 for 21 and 28 days, respectively. Steady-state everolimus exposures with ribociclib were 2.5-fold higher than everolimus administered alone. Ribociclib plasma, tumor concentrations, and cerebrospinal fluid (CSF) samples were collected. The mean tumor-to-plasma ratio of ribociclib was 19.8 (range, 2.22-53.4). CONCLUSIONS Ribociclib and everolimus were well-tolerated and demonstrated pharmacokinetic properties similar to those in adults. Potential therapeutic ribociclib concentrations could be achieved in CSF and tumor tissue, although interpatient variability was observed.
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Affiliation(s)
- Mariko D DeWire
- Department of Pediatrics College of Medicine, Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, University of Cincinnati, Cincinnati, Ohio
| | - Christine Fuller
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pathology, Upstate Medical University, Syracuse, New York
| | - Olivia Campagne
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tong Lin
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Patricia A Baxter
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Eugene I Hwang
- Division of Oncology, Children's National Medical Center, Washington, DC
| | - Andrew Bukowinski
- Division of Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen Dorris
- Division of Oncology, Denver Children's Hospital, Denver, Colorado
| | - Lindsey Hoffman
- Division of Oncology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Angela J Waanders
- Division of Hematology/Oncology, Ann & Robert H Lurie Children's Hospital, Chicago, Illinois
| | - Matthias A Karajannis
- Pediatric Neuro-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Clinton F Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Maryam Fouladi
- Department of Pediatrics College of Medicine, Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, University of Cincinnati, Cincinnati, Ohio
- Hematology/Oncology & BMT, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ira J Dunkel
- Pediatric Neuro-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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11
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Van Mater D, Gururangan S, Becher O, Campagne O, Leary S, Phillips JJ, Huang J, Lin T, Poussaint TY, Goldman S, Baxter P, Dhall G, Robinson G, DeWire-Schottmiller M, Hwang EI, Stewart CF, Onar-Thomas A, Dunkel IJ, Fouladi M. A phase I trial of the CDK 4/6 inhibitor palbociclib in pediatric patients with progressive brain tumors: A Pediatric Brain Tumor Consortium study (PBTC-042). Pediatr Blood Cancer 2021; 68:e28879. [PMID: 33405376 PMCID: PMC8414988 DOI: 10.1002/pbc.28879] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/06/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Disruption of cell-cycle regulators is a potential therapeutic target for brain tumors in children and adolescents. The aim of this study was to determine the maximum tolerated dose (MTD) and describe toxicities related to palbociclib, a selective cyclin-dependent kinase 4/6 (CDK4/6) inhibitor in pediatric patients with progressive/refractory brain tumors with intact retinoblastoma protein. METHODS Palbociclib was administered orally starting at 50 mg/m2 daily for the first 21 days of a 28-day course. Dose escalation was according to the Rolling-6 statistical design in less heavily (stratum I) and heavily pretreated (stratum II) patients, and MTD was determined separately for each group. Pharmacokinetic studies were performed during the first course, and pharmacodynamic studies were conducted to evaluate relationships between drug levels and toxicities. RESULTS A total of 21 patients were enrolled on stratum I and 14 patients on stratum II. The MTD for both strata was 75 mg/m2 . Palbociclib absorption (mean Tmax between 4.9 and 6.6 h) and elimination (mean half-life between 11.3 and 19.5 h) were assessed. The most common toxicity was myelosuppression. Higher palbociclib exposure was associated with grade 3/4 neutropenia and leukopenia. Dose limiting toxicities included grade 4 neutropenia and grade 3 thrombocytopenia and dehydration. No patients had an objective response to palbociclib therapy. CONCLUSIONS Palbociclib was safely administered to children and adolescents at a dosage of 75 mg/m2 for 21 consecutive days followed by seven days of rest in both strata. Future studies will establish its optimal utilization in pediatric patients with brain tumors.
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Affiliation(s)
- David Van Mater
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Sridharan Gururangan
- Preston A. Wells Center for Brain Tumor Therapy, McKnight Brain Institute, Department of Neurosurgery, University of Florida, Gainesville, FL
| | - Oren Becher
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Olivia Campagne
- Pharmaceutical Sciences Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sarah Leary
- Division of Pediatrics, Seattle Children’s Hospital, Seattle WA
| | - Joanna J. Phillips
- Departments of Neurological Surgery and Pathology, University of California San Francisco, San Francisco, CA
| | - Jie Huang
- Department of Biostatistics, St Jude Children’s Hospital, Memphis TN
| | - Tong Lin
- Department of Biostatistics, St Jude Children’s Hospital, Memphis TN
| | | | - Stewart Goldman
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Patricia Baxter
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
| | - Girish Dhall
- Division of Hematology and Oncology, Children’s of Alabama, Birmingham, AL
| | - Giles Robinson
- Division of Neuro-Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Eugene I. Hwang
- Children’s National Medical Center, Washington, District of Columbia
| | - Clinton F. Stewart
- Pharmaceutical Sciences Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Arzu Onar-Thomas
- Department of Biostatistics, St Jude Children’s Hospital, Memphis TN
| | - Ira J. Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maryam Fouladi
- Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH
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12
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Papusha L, Zaytseva M, Druy A, Valiakhmetova A, Yasko L, Salnikova E, Shekhtman A, Karachunsky A, Maschan A, Hwang EI, Novichkova G, Packer RJ. The experience of successful treatment of ETV6-NTRK3-positive infant glioblastoma with entrectinib. Neurooncol Adv 2021; 3:vdab022. [PMID: 33738452 PMCID: PMC7954097 DOI: 10.1093/noajnl/vdab022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ludmila Papusha
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Margarita Zaytseva
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexander Druy
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Andge Valiakhmetova
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Ludmila Yasko
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Ekaterina Salnikova
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Anastasia Shekhtman
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexander Karachunsky
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexey Maschan
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Eugene I Hwang
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, Washington, District of Columbia, USA.,Children's National Health System, Washington, District of Columbia, USA
| | - Galina Novichkova
- D. Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, Washington, District of Columbia, USA.,Children's National Health System, Washington, District of Columbia, USA
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13
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Fangusaro J, Mitchell DA, Kocak M, Robinson GW, Baxter PA, Hwang EI, Huang J, Onar-Thomas A, Dunkel IJ, Fouladi M, Warren KE. Phase 1 study of pomalidomide in children with recurrent, refractory, and progressive central nervous system tumors: A Pediatric Brain Tumor Consortium trial. Pediatr Blood Cancer 2021; 68:e28756. [PMID: 33025730 PMCID: PMC7757731 DOI: 10.1002/pbc.28756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/15/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Central nervous system (CNS) malignancies are the most common solid tumors among children, and novel therapies are needed to help improve survival. Pomalidomide is an immunomodulatory agent that displays antiangiogenic and cytotoxic activity, making it an appropriate candidate to explore in pediatric CNS tumors. METHODS A phase 1 first in pediatric trial of pomalidomide was conducted in children with recurrent, progressive, and refractory CNS tumors. The primary objective was to determine the maximum tolerated dose (MTD) and/or recommended phase 2 dose (RP2D) when given orally once daily for 21 consecutive days of a 28-day cycle. Once the MTD was established, 12 additional patients were enrolled on expansion cohorts based on age and steroid use. RESULTS Twenty-nine children were enrolled and 25 were evaluable for dose-limiting toxicity (DLT). The MTD was 2.6 mg/m2 (dose level 2). Four DLTs were observed in three patients at dose level 3 (3.4 mg/m2 ) includeding grade 3 diarrhea, grade 3 thrombocytopenia, grade 3 lung infection, and grade 4 neutropenia. The most common adverse events were grade 1 and 2 myelosuppression. One patient with an oligodendroglioma had stable disease for nine cycles, and a second patient with an anaplastic pleomorphic xanthoastrocytoma achieved a sustained partial response. Immunologic analyses suggested that pomalidomide triggers immunomodulation. CONCLUSIONS The MTD of pomalidomide is 2.6 mg/m2 . It was well tolerated, and immune correlates showed a serum immune response. These data led to an industry-sponsored phase 2 trial of pomalidomide monotherapy in children with recurrent brain tumors (NCT03257631).
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Affiliation(s)
- Jason Fangusaro
- Children’s Healthcare of Atlanta and Emory University Medical School, Atlanta, GA
| | - Duane A. Mitchell
- University of Florida Brain Tumor Immunotherapy Program, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL
| | - Mehmet Kocak
- University of Tennessee Health Science Center, Memphis, TN
| | | | | | | | - Jianping Huang
- University of Florida Brain Tumor Immunotherapy Program, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL
| | | | - Ira J. Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maryam Fouladi
- Nationwide Children’s Hospital, Columbus, OH (work was done when author was at Cincinnati Children’s Hospital, Cincinnati, OH)
| | - Katherine E. Warren
- Dana Farber Cancer Institute and Harvard Medical School, Boston, MA (work was done when author was at the National Cancer Institute, Bethesda, MD)
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14
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Crotty EE, Downey KM, Ferrerosa LM, Flores CT, Hegde B, Raskin S, Hwang EI, Vitanza NA, Okada H. Considerations when treating high-grade pediatric glioma patients with immunotherapy. Expert Rev Neurother 2021; 21:205-219. [PMID: 33225764 PMCID: PMC7880880 DOI: 10.1080/14737175.2020.1855144] [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] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Children with high-grade gliomas (pHGGs) represent a clinical population in substantial need of new therapeutic options given the inefficacy and toxicity of current standard-of-care modalities. Although immunotherapy has emerged as a promising modality, it has yet to elicit a significant survival benefit for pHGG patients. While preclinical studies address a variety of underlying challenges, translational clinical trial design and management also need to reflect the most updated progress and lessons from the field. AREAS COVERED The authors will focus our discussion on the design of clinical trials, the management of potential toxicities, immune monitoring, and novel biomarkers. Clinical trial design should integrate appropriate patient populations, novel, and preclinically optimized trial design, and logical treatment combinations, particularly those which synergize with standard of care modalities. However, there are caveats due to the nature of immunotherapy trials, such as patient selection bias, evidenced by the frequent exclusion of patients on high-dose corticosteroids. Robust immune-modulating effects of modern immunotherapy can have toxicities. As such, it is important to understand and manage these, especially in pHGG patients. EXPERT OPINION Adequate integration of these considerations should allow us to effectively gain insights on biological activity, safety, and biomarkers associated with benefits for patients.
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Affiliation(s)
- Erin E. Crotty
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
| | - Kira M. Downey
- Department of Neurological Surgery, Helen Diller Family Comprehensive Cancer Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Lauren M. Ferrerosa
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, 747 52nd Street, Oakland, CA, USA
| | | | - Bindu Hegde
- Department of Neurological Surgery, Helen Diller Family Comprehensive Cancer Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Scott Raskin
- Children’s National Hospital, Washington, DC, USA
| | | | - Nicholas A. Vitanza
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Hideho Okada
- Department of Neurological Surgery, Helen Diller Family Comprehensive Cancer Research Center, University of California San Francisco, San Francisco, CA, USA
- The Parker Institute for Cancer Immunotherapy, University of California, San Francisco, San Francisco, CA, USA
- Cancer Immunotherapy Program, University of California, San Francisco, San Francisco, CA, USA
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15
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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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16
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Valiakhmetova A, Papusha L, Yasko L, Druy A, Karachunsky A, Novichkova G, Hwang EI, Packer RJ. LGG-26. DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMOR (DLGNT) IN CHILDREN: DIFFERENT CLINICAL PRESENTATIONS AND OUTCOMES. Neuro Oncol 2020. [PMCID: PMC7715974 DOI: 10.1093/neuonc/noaa222.408] [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: 11/28/2022] Open
Abstract
Diffuse leptomeningeal glioneuronal tumor (DLGNT) is an extremely rare disease, newly recognized in the 2016 WHO classification of tumors of the CNS. Most DLGNTs are low-grade neuroepithelial tumors with variable elements of neuronal/neurocytic and glial differentiation, have diffuse leptomeningeal enhancement on MRI, and typically harbor KIAA1549-BRAF fusions. Other alterations, such as the BRAF V600E substitution, are less common. Here, we present three cases of DLGNT with different presentations and outcomes. The first patient is a 2yr-old male with KIAA1549-BRAF fusion, and was treated with Carbo/VCR chemotherapy after a biopsy, with resultant ongoing stable disease for 3.5 years. The second patient, an 8yr-old male had the BRAF V600E point mutation and was treated with conventional chemotherapy (VCR/carboplatin). On progression, he received the BRAF inhibitor vemurafenib, achieving a complete response which last 14 month. The third patient, a 27 month old male, harbored a KIAA1549-BRAF fusion and was treated at diagnosis with the MEK inhibitor trametinib. The tumor has been radiographically stable in the context of clinical improvement for 21 months since the treatment initiation, ongoing 24 month. In summary, we present further evidence of MAPK pathway alterations in children with DLGNT. We describe a range of molecular presentations and clinical outcomes, including one patient treated with conventional chemotherapy with further stabilization of disease during 3.5 years and two patients who were successfully treated with targeted therapy.
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Affiliation(s)
- Andge Valiakhmetova
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
- D. Rogachev NMRC of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Ludmila Papusha
- D. Rogachev NMRC of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Ludmila Yasko
- D. Rogachev NMRC of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexander Druy
- D. Rogachev NMRC of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexander Karachunsky
- D. Rogachev NMRC of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Galina Novichkova
- D. Rogachev NMRC of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Eugene I Hwang
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, Children’s National Health System, Washington, DC, USA
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, Children’s National Health System, Washington, DC, USA
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17
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Valiakhmetova A, Papusha L, Druy A, Yasko L, Ektova A, Karachunsky A, Maschan A, Hwang EI, Novichkova G, Packer RJ. Pediatric diffuse leptomeningeal glioneuronal tumor: Two clinical cases of successful targeted therapy. Pediatr Blood Cancer 2020; 67:e28478. [PMID: 32841504 DOI: 10.1002/pbc.28478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/19/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Andge Valiakhmetova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia.,N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Ludmila Papusha
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alexander Druy
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Ludmila Yasko
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Anastasia Ektova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia.,N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Alexander Karachunsky
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alexei Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Eugene I Hwang
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, Washington, District of Columbia.,Children's National Health System, Washington, District of Columbia
| | - Galina Novichkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, Washington, District of Columbia.,Children's National Health System, Washington, District of Columbia
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18
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Kambhampati M, Panditharatna E, Yadavilli S, Saoud K, Lee S, Eze A, Almira-Suarez MI, Hancock L, Bonner ER, Gittens J, Stampar M, Gaonkar K, Resnick AC, Kline C, Ho CY, Waanders AJ, Georgescu MM, Rance NE, Kim Y, Johnson C, Rood BR, Kilburn LB, Hwang EI, Mueller S, Packer RJ, Bornhorst M, Nazarian J. Harmonization of postmortem donations for pediatric brain tumors and molecular characterization of diffuse midline gliomas. Sci Rep 2020; 10:10954. [PMID: 32616776 PMCID: PMC7331588 DOI: 10.1038/s41598-020-67764-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/07/2020] [Accepted: 06/11/2020] [Indexed: 01/23/2023] Open
Abstract
Children diagnosed with brain tumors have the lowest overall survival of all pediatric cancers. Recent molecular studies have resulted in the discovery of recurrent driver mutations in many pediatric brain tumors. However, despite these molecular advances, the clinical outcomes of high grade tumors, including H3K27M diffuse midline glioma (H3K27M DMG), remain poor. To address the paucity of tissue for biological studies, we have established a comprehensive protocol for the coordination and processing of donated specimens at postmortem. Since 2010, 60 postmortem pediatric brain tumor donations from 26 institutions were coordinated and collected. Patient derived xenograft models and cell cultures were successfully created (76% and 44% of attempts respectively), irrespective of postmortem processing time. Histological analysis of mid-sagittal whole brain sections revealed evidence of treatment response, immune cell infiltration and the migratory path of infiltrating H3K27M DMG cells into other midline structures and cerebral lobes. Sequencing of primary and disseminated tumors confirmed the presence of oncogenic driver mutations and their obligate partners. Our findings highlight the importance of postmortem tissue donations as an invaluable resource to accelerate research, potentially leading to improved outcomes for children with aggressive brain tumors.
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Affiliation(s)
- Madhuri Kambhampati
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.,Brain Tumor Institute, Children's National Hospital, Washington, DC, USA
| | - Eshini Panditharatna
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.,Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sridevi Yadavilli
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.,Brain Tumor Institute, Children's National Hospital, Washington, DC, USA
| | - Karim Saoud
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.,Brain Tumor Institute, Children's National Hospital, Washington, DC, USA
| | - Sulgi Lee
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.,Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Augustine Eze
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.,Brain Tumor Institute, Children's National Hospital, Washington, DC, USA
| | - M I Almira-Suarez
- Department of Pathology, Children's National Hospital, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Lauren Hancock
- Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.,Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, USA
| | - Erin R Bonner
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.,Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jamila Gittens
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.,PTC Therapeutics, South Plainfield, NJ, USA
| | - Mojca Stampar
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA
| | - Krutika Gaonkar
- Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam C Resnick
- Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cassie Kline
- Pediatric Hematology-Oncology and Neurology, UCSF Benioff Children's Hospital, San Francisco, CA, USA.,Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Cheng-Ying Ho
- Department of Pathology and Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Angela J Waanders
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Naomi E Rance
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Yong Kim
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Courtney Johnson
- Brain Tumor Institute, Children's National Hospital, Washington, DC, USA
| | - Brian R Rood
- Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.,Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, USA
| | - Lindsay B Kilburn
- Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.,Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, USA
| | - Eugene I Hwang
- Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.,Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, USA
| | - Sabine Mueller
- Pediatric Hematology-Oncology and Neurology, UCSF Benioff Children's Hospital, San Francisco, CA, USA.,Department of Oncology, Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
| | - Roger J Packer
- Brain Tumor Institute, Children's National Hospital, Washington, DC, USA
| | - Miriam Bornhorst
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA. .,Brain Tumor Institute, Children's National Hospital, Washington, DC, USA. .,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Javad Nazarian
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA. .,Department of Oncology, Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland. .,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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19
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Lee S, Kambhampati M, Yadavilli S, Gordish-Dressman H, Santi M, Cruz CR, Packer RJ, Almira-Suarez MI, Hwang EI, Nazarian J. Differential Expression of Wilms' Tumor Protein in Diffuse Intrinsic Pontine Glioma. J Neuropathol Exp Neurol 2020; 78:380-388. [PMID: 30990879 PMCID: PMC6467196 DOI: 10.1093/jnen/nlz021] [Citation(s) in RCA: 5] [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] [Indexed: 12/16/2022] Open
Abstract
Diffuse intrinsic pontine gliomas (DIPGs) are deadly tumors comprising 10%–15% of all childhood CNS cancers. Standard treatment is considered palliative and prognosis is near universal mortality. DIPGs have been classified into genomic subtypes based on histone variants with the lysine to methionine mutation on position 27 of histone tails (K27M). Given the increasing promise of immunotherapy, there have been ongoing efforts to identify tumor-specific antigens to serve as immunologic targets. We evaluated a large cohort of CNS specimens for Wilms’ tumor protein (WT1) expression. These specimens include primary pediatric CNS tumors (n = 38 midline gliomas and n = 3 non-midline gliomas; n = 23 DIPG, n = 10 low-grade gliomas, n = 8 high-grade gliomas), and DIPG primary cells. Here, we report the validation of WT1 as a tumor-associated antigen in DIPGs. We further report that WT1 expression is significantly correlated with specific oncohistone variants, with the highest expression detected in the H3.3K27M subgroup. WT1 expression was absent in all control specimens (n = 21). Western blot assays using DIPG primary cells (n = 6) showed a trend of higher WT1 expression in H3.3K27M cells when compared with H3.1 K27M cells and H3 wildtype cells. Our data are the first indication of the association between WT1 and DIPG, with specific upregulation in those harboring oncohistone H3.3K27M.
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Affiliation(s)
- Sulgi Lee
- Children's National Health System, Center for Genetic Medicine Research, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Institute for Biomedical Sciences, Washington
| | - Madhuri Kambhampati
- Children's National Health System, Center for Genetic Medicine Research, Washington, District of Columbia
| | - Sridevi Yadavilli
- Children's National Health System, Center for Genetic Medicine Research, Washington, District of Columbia
| | - Heather Gordish-Dressman
- Children's National Health System, Center for Genetic Medicine Research, Washington, District of Columbia
| | - Mariarita Santi
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Conrad R Cruz
- Children's National Health System, Center for Cancer and Immunology Research, Washington, District of Columbia
| | - Roger J Packer
- Children's National Health System, Brain Tumor Institute, Washington, District of Columbia
| | - M Isabel Almira-Suarez
- Department of Pathology and Laboratory Medicine, Children's National Health System, Washington, District of Columbia (MIA-S)
| | - Eugene I Hwang
- Children's National Health System, Brain Tumor Institute, Washington, District of Columbia
| | - Javad Nazarian
- Children's National Health System, Center for Genetic Medicine Research, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Institute for Biomedical Sciences, Washington.,Children's National Health System, Brain Tumor Institute, Washington, District of Columbia.,Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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20
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Abounader R, Wright K, Purow B, Hansford JR, Hwang EI, Gottardo NG. Highlights from the Literature. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Li BK, Vasiljevic A, Dufour C, Yao F, Ho BLB, Lu M, Hwang EI, Gururangan S, Hansford JR, Fouladi M, Nobusawa S, Laquerriere A, Delisle MB, Fangusaro J, Forest F, Toledano H, Solano-Paez P, Leary S, Birks D, Hoffman LM, Szathmari A, Faure-Conter C, Fan X, Catchpoole D, Zhou L, Schultz KAP, Ichimura K, Gauchotte G, Jabado N, Jones C, Loussouarn D, Mokhtari K, Rousseau A, Ziegler DS, Tanaka S, Pomeroy SL, Gajjar A, Ramaswamy V, Hawkins C, Grundy RG, Hill DA, Bouffet E, Huang A, Jouvet A. Pineoblastoma segregates into molecular sub-groups with distinct clinico-pathologic features: a Rare Brain Tumor Consortium registry study. Acta Neuropathol 2020; 139:223-241. [PMID: 31820118 DOI: 10.1007/s00401-019-02111-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022]
Abstract
Pineoblastomas (PBs) are rare, aggressive pediatric brain tumors of the pineal gland with modest overall survival despite intensive therapy. We sought to define the clinical and molecular spectra of PB to inform new treatment approaches for this orphan cancer. Tumor, blood, and clinical data from 91 patients with PB or supratentorial primitive neuroectodermal tumor (sPNETs/CNS-PNETs), and 2 pineal parenchymal tumors of intermediate differentiation (PPTIDs) were collected from 29 centres in the Rare Brain Tumor Consortium. We used global DNA methylation profiling to define a core group of PB from 72/93 cases, which were delineated into five molecular sub-groups. Copy number, whole exome and targeted sequencing, and miRNA expression analyses were used to evaluate the clinico-pathologic significance of each sub-group. Tumors designated as group 1 and 2 almost exclusively exhibited deleterious homozygous loss-of-function alterations in miRNA biogenesis genes (DICER1, DROSHA, and DGCR8) in 62 and 100% of group 1 and 2 tumors, respectively. Recurrent alterations of the oncogenic MYC-miR-17/92-RB1 pathway were observed in the RB and MYC sub-group, respectively, characterized by RB1 loss with gain of miR-17/92, and recurrent gain or amplification of MYC. PB sub-groups exhibited distinct clinical features: group 1-3 arose in older children (median ages 5.2-14.0 years) and had intermediate to excellent survival (5-year OS of 68.0-100%), while Group RB and MYC PB patients were much younger (median age 1.3-1.4 years) with dismal survival (5-year OS 37.5% and 28.6%, respectively). We identified age < 3 years at diagnosis, metastatic disease, omission of upfront radiation, and chr 16q loss as significant negative prognostic factors across all PBs. Our findings demonstrate that PB exhibits substantial molecular heterogeneity with sub-group-associated clinical phenotypes and survival. In addition to revealing novel biology and therapeutics, molecular sub-grouping of PB can be exploited to reduce treatment intensity for patients with favorable biology tumors.
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Affiliation(s)
- Bryan K Li
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., 10421B, Black, Toronto, ON, M5G 1X8, Canada
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandre Vasiljevic
- Faculté de Médecine, Université de Lyon, Lyon, France
- Service d'Anatomie et Cytologie Pathologiques, CHU de Lyon, Lyon, France
| | - Christelle Dufour
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Villejuif, Paris, France
| | - Fupan Yao
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ben L B Ho
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Mei Lu
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Eugene I Hwang
- Department of Oncology, Children's National Medical Center, Washington, DC, USA
| | - Sridharan Gururangan
- Department of Pediatrics, Preston A. Wells Jr. Center for Brain Tumor Therapy, UF Health Shands Hospital, University of Florida, Gainesville, FL, USA
| | - Jordan R Hansford
- Children's Cancer Centre, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Maryam Fouladi
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Annie Laquerriere
- Department of Pathology, Normandy Center for Genomic and Personalized Medicine, Rouen University Hospital, Normandie University, UNIROUEN, Inserm U1245, F 76000, Rouen, France
| | | | - Jason Fangusaro
- Department of Pediatric Hematology and Oncology, Children's Healthcare of Atlanta and the Emory University School of Medicine, Atlanta, GA, USA
| | - Fabien Forest
- Department of Pathology, CHU St. Etienne, Saint-Étienne, France
| | - Helen Toledano
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Palma Solano-Paez
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Hospital Infantil Virgen del Rocio, Seville, Spain
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children's, Seattle, WA, USA
| | - Diane Birks
- Department of Pediatrics, University of Colorado Denver, Denver, CO, USA
| | - Lindsey M Hoffman
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Alexandru Szathmari
- Département de Neurochirurgie Adulte et Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Xing Fan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Catchpoole
- Children's Cancer Research Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Li Zhou
- Children's Cancer Research Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Kris Ann P Schultz
- Cancer and Blood Disorder, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | | | - Nada Jabado
- Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Chris Jones
- The Institute of Cancer Research, London, UK
| | - Delphine Loussouarn
- Service d'Anatomie et de Cytologie pathologiques, CHU Nantes, Nantes, France
| | - Karima Mokhtari
- Département de Neuropathologie, Hôpital Universitaire Pitie-Salpetriere, Paris, France
| | - Audrey Rousseau
- Département de Pathologie Cellulaire et Tissulaire, CHU d'Angers, Angers, France
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Children's Cancer Institute, Lowy Cancer Centre, University of New South Wales, Sydney, NSW, Australia
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Scott L Pomeroy
- Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Amar Gajjar
- Department of Oncology, Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., 10421B, Black, Toronto, ON, M5G 1X8, Canada
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cynthia Hawkins
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Richard G Grundy
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - D Ashley Hill
- Division of Pathology, Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC, USA
| | - Eric Bouffet
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., 10421B, Black, Toronto, ON, M5G 1X8, Canada
| | - Annie Huang
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., 10421B, Black, Toronto, ON, M5G 1X8, Canada.
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada.
- Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Anne Jouvet
- Service d'Anatomie et Cytologie Pathologiques, CHU de Lyon, Lyon, France
- Pathology and Molecular Biology, SFCE, Bordeaux, France
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22
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Abstract
Pediatric brain tumors are the leading cause of cancer-related death in children. Recent advances in sequencing techniques, and collaborative efforts to encode the mutational landscape of various tumor subtypes, have resulted in the identification of recurrent mutations that may present as actionable targets in these tumors. A number of molecularly targeted agents are approved or in development for the treatment of various tumor types in adult patients. Similarly, these agents are increasingly being incorporated into pediatric clinical trials, allowing for a targeted approach to treatment. However, due to the genetic heterogeneity of these tumors, focused clinical trials in pediatric patients are challenging and regulatory hurdles may delay access to therapeutic compounds that are in regular use in adult patients. The tumor site-agnostic clinical development of TRK inhibitors for pediatric solid tumors is a current example of how the combination of genetic testing and innovative clinical trial design can accelerate the clinical development of targeted agents for pediatric patients.
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Affiliation(s)
- Miriam Bornhorst
- Department of Pediatric Hematology-Oncology, Center for Cancer and Immunology Research and Neuroscience Research, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.,Center for Cancer and Immunology Research and Neuroscience Research, The Brain Tumor Institute, Children's National Medical Center, Washington, DC, USA.,Center for Cancer and Immunology Research and Neuroscience Research, Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, Washington, DC, USA
| | - Eugene I Hwang
- Department of Pediatric Hematology-Oncology, Center for Cancer and Immunology Research and Neuroscience Research, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA. .,Center for Cancer and Immunology Research and Neuroscience Research, The Brain Tumor Institute, Children's National Medical Center, Washington, DC, USA.
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23
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Jaju A, Hwang EI, Kool M, Capper D, Chavez L, Brabetz S, Billups C, Li Y, Fouladi M, Packer RJ, Pfister SM, Olson JM, Heier LA. MRI Features of Histologically Diagnosed Supratentorial Primitive Neuroectodermal Tumors and Pineoblastomas in Correlation with Molecular Diagnoses and Outcomes: A Report from the Children's Oncology Group ACNS0332 Trial. AJNR Am J Neuroradiol 2019; 40:1796-1803. [PMID: 31601576 DOI: 10.3174/ajnr.a6253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Supratentorial primitive neuroectodermal tumors and pineoblastomas have traditionally been grouped together for treatment purposes. Molecular profiling of these tumors has revealed a number of distinct entities and has led to the term "CNS-primitive neuroectodermal tumors" being removed from the 2016 World Health Organization classification. The purpose of this study was to describe the MR imaging findings of histologically diagnosed primitive neuroectodermal tumors and pineoblastomas and correlate them with molecular diagnoses and outcomes. MATERIALS AND METHODS Histologically diagnosed primitive neuroectodermal tumors and pineoblastomas were enrolled in this Children's Oncology Group Phase III trial, and molecular classification was retrospectively completed using DNA methylation profiling. MR imaging features were systematically studied and correlated with molecular diagnoses and survival. RESULTS Of the 85 patients enrolled, 56 met the inclusion criteria, in whom 28 tumors were in pineal and 28 in nonpineal locations. Methylation profiling revealed a variety of diagnoses, including pineoblastomas (n = 27), high-grade gliomas (n = 17), embryonal tumors (n = 7), atypical teratoid/rhabdoid tumors (n = 3), and ependymomas (n = 2). Thus, 39% overall and 71% of nonpineal tumor diagnoses were discrepant with histopathology. Tumor location, size, margins, and edema were predictors of embryonal-versus-nonembryonal tumors. Larger size and ill-defined margins correlated with poor event-free survival, while metastatic disease by MR imaging did not. CONCLUSIONS In nonpineal locations, only a minority of histologically diagnosed primitive neuroectodermal tumors are embryonal tumors; therefore, high-grade glioma or ependymoma should be high on the radiographic differential. An understanding of molecularly defined tumor entities and their relative frequencies and locations will help the radiologist make more accurate predictions of the tumor types.
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Affiliation(s)
- A Jaju
- From the Department of Radiology (A.J.), Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois .,Northwestern University Feinberg School of Medicine (A.J.), Chicago, Illinois
| | - E I Hwang
- Brain Tumor Institute (E.I.H., R.J.P.), Children's National Health System, Washington, DC
| | - M Kool
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - D Capper
- Department of Pediatric Neuropathology (D.C.), University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - L Chavez
- Department of Medicine (L.C.), University of California San Diego, La Jolla, California
| | - S Brabetz
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - C Billups
- Department of Biostatistics (C.B., Y.L.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Y Li
- Department of Biostatistics (C.B., Y.L.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - M Fouladi
- Brain Tumor Center (M.F.), Cincinnati Children's Hospital, Cincinnati, Ohio
| | - R J Packer
- Brain Tumor Institute (E.I.H., R.J.P.), Children's National Health System, Washington, DC
| | - S M Pfister
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - J M Olson
- Fred Hurtchinson Cancer Research Center (J.M.O.), Seattle Children's Hospital, Seattle, Washington
| | - L A Heier
- Department of Radiology (L.A.H.), New York Presbyterian Hospital, New York, New York
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24
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Powell AB, Yadavilli S, Saunders D, Van Pelt S, Chorvinsky E, Burga RA, Albihani S, Hanley PJ, Xu Z, Pei Y, Yvon ES, Hwang EI, Bollard CM, Nazarian J, Cruz CRY. Medulloblastoma rendered susceptible to NK-cell attack by TGFβ neutralization. J Transl Med 2019; 17:321. [PMID: 31547819 PMCID: PMC6757414 DOI: 10.1186/s12967-019-2055-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 04/12/2019] [Accepted: 08/31/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medulloblastoma (MB), the most common pediatric brain cancer, presents with a poor prognosis in a subset of patients with high risk disease, or at recurrence, where current therapies are ineffective. Cord blood (CB) natural killer (NK) cells may be promising off-the-shelf effector cells for immunotherapy due to their recognition of malignant cells without the need for a known target, ready availability from multiple banks, and their potential to expand exponentially. However, they are currently limited by immune suppressive cytokines secreted in the MB tumor microenvironment including Transforming Growth Factor β (TGF-β). Here, we address this challenge in in vitro models of MB. METHODS CB-derived NK cells were modified to express a dominant negative TGF-β receptor II (DNRII) using retroviral transduction. The ability of transduced CB cells to maintain function in the presence of medulloblastoma-conditioned media was then assessed. RESULTS We observed that the cytotoxic ability of nontransduced CB-NK cells was reduced in the presence of TGF-β-rich, medulloblastoma-conditioned media (21.21 ± 1.19% killing at E:T 5:1 in the absence vs. 14.98 ± 2.11% in the presence of medulloblastoma-conditioned media, n = 8, p = 0.02), but was unaffected in CB-derived DNRII-transduced NK cells (21.11 ± 1.84% killing at E:T 5:1 in the absence vs. 21.81 ± 3.37 in the presence of medulloblastoma-conditioned media, n = 8, p = 0.85. We also observed decreased expression of CCR2 in untransduced NK cells (mean CCR2 MFI 826 ± 117 in untransduced NK + MB supernatant from mean CCR2 MFI 1639.29 ± 215 in no MB supernatant, n = 7, p = 0.0156), but not in the transduced cells. Finally, we observed that CB-derived DNRII-transduced NK cells may protect surrounding immune cells by providing a cytokine sink for TGF-β (decreased TGF-β levels of 610 ± 265 pg/mL in CB-derived DNRII-transduced NK cells vs. 1817 ± 342 pg/mL in untransduced cells; p = 0.008). CONCLUSIONS CB NK cells expressing a TGF-β DNRII may have a functional advantage over unmodified NK cells in the presence of TGF-β-rich MB, warranting further investigation on its potential applications for patients with medulloblastoma.
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Affiliation(s)
- Allison B Powell
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Sridevi Yadavilli
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA
| | - Devin Saunders
- Center for Cancer and Immunology Research, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Stacey Van Pelt
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Elizabeth Chorvinsky
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA
| | - Rachel A Burga
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Shuroug Albihani
- Center for Cancer and Immunology Research, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Patrick J Hanley
- Center for Cancer and Immunology Research, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Zhenhua Xu
- Center for Cancer and Immunology Research, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Yanxin Pei
- Center for Cancer and Immunology Research, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Eric S Yvon
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Eugene I Hwang
- Center for Cancer and Immunology Research, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Catherine M Bollard
- George Washington University Cancer Center, George Washington University, Washington, DC, USA.,Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA
| | - Javad Nazarian
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA
| | - Conrad Russell Y Cruz
- George Washington University Cancer Center, George Washington University, Washington, DC, USA. .,Center for Cancer and Immunology Research, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
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25
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Sin-Chan P, Mumal I, Suwal T, Ho B, Fan X, Singh I, Du Y, Lu M, Patel N, Torchia J, Popovski D, Fouladi M, Guilhamon P, Hansford JR, Leary S, Hoffman LM, Mulcahy Levy JM, Lassaletta A, Solano-Paez P, Rivas E, Reddy A, Gillespie GY, Gupta N, Van Meter TE, Nakamura H, Wong TT, Ra YS, Kim SK, Massimi L, Grundy RG, Fangusaro J, Johnston D, Chan J, Lafay-Cousin L, Hwang EI, Wang Y, Catchpoole D, Michaud J, Ellezam B, Ramanujachar R, Lindsay H, Taylor MD, Hawkins CE, Bouffet E, Jabado N, Singh SK, Kleinman CL, Barsyte-Lovejoy D, Li XN, Dirks PB, Lin CY, Mack SC, Rich JN, Huang A. A C19MC-LIN28A-MYCN Oncogenic Circuit Driven by Hijacked Super-enhancers Is a Distinct Therapeutic Vulnerability in ETMRs: A Lethal Brain Tumor. Cancer Cell 2019; 36:51-67.e7. [PMID: 31287992 DOI: 10.1016/j.ccell.2019.06.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 02/11/2019] [Revised: 04/26/2019] [Accepted: 06/03/2019] [Indexed: 12/26/2022]
Abstract
Embryonal tumors with multilayered rosettes (ETMRs) are highly lethal infant brain cancers with characteristic amplification of Chr19q13.41 miRNA cluster (C19MC) and enrichment of pluripotency factor LIN28A. Here we investigated C19MC oncogenic mechanisms and discovered a C19MC-LIN28A-MYCN circuit fueled by multiple complex regulatory loops including an MYCN core transcriptional network and super-enhancers resulting from long-range MYCN DNA interactions and C19MC gene fusions. Our data show that this powerful oncogenic circuit, which entraps an early neural lineage network, is potently abrogated by bromodomain inhibitor JQ1, leading to ETMR cell death.
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MESH Headings
- Biomarkers, Tumor
- Brain Neoplasms/diagnosis
- Brain Neoplasms/etiology
- Brain Neoplasms/therapy
- Cell Cycle/genetics
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/genetics
- Chromosomes, Human, Pair 19
- Chromosomes, Human, Pair 2
- DNA Copy Number Variations
- Enhancer Elements, Genetic
- Epigenesis, Genetic
- Gene Expression Regulation
- Gene Regulatory Networks
- Genetic Association Studies
- Genetic Predisposition to Disease
- Humans
- MicroRNAs/genetics
- Models, Biological
- Multigene Family
- N-Myc Proto-Oncogene Protein/genetics
- Neoplasms, Germ Cell and Embryonal/diagnosis
- Neoplasms, Germ Cell and Embryonal/etiology
- Neoplasms, Germ Cell and Embryonal/therapy
- Oncogenes
- RNA-Binding Proteins/genetics
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Affiliation(s)
- Patrick Sin-Chan
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Iqra Mumal
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada
| | - Tannu Suwal
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada
| | - Ben Ho
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Xiaolian Fan
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Irtisha Singh
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yuchen Du
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Mei Lu
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Neilket Patel
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Jonathon Torchia
- Princess Margaret Cancer Center-OICR Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, ON M5G0A3, Canada
| | - Dean Popovski
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Maryam Fouladi
- Division of Oncology, Department of Cancer and Blood Diseases, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Paul Guilhamon
- Developmental and Stem Cell Biology Program and Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, Murdoch Children's Research Institute, Department of Pediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Sarah Leary
- Department of Hematology-Oncology, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Lindsey M Hoffman
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA
| | - Jean M Mulcahy Levy
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA
| | - Alvaro Lassaletta
- Pediatric Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid 28009, Spain
| | - Palma Solano-Paez
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Seville 41013, Spain
| | - Eloy Rivas
- Department of Pathology, Neuropathology Division, Hospital Universitario Virgen del Rocio, Seville 41013, Spain
| | - Alyssa Reddy
- University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - G Yancey Gillespie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham AL 35294, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA
| | - Timothy E Van Meter
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298-0631, USA
| | - Hideo Nakamura
- Department of Neurosurgery, Kurume University, Fukuoka 830-0011, Japan
| | - Tai-Tong Wong
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei 11031, Taiwan
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Seoul 138-736, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Luca Massimi
- Department of Neurosurgery, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Richard G Grundy
- Children's Brain Tumor Research Centre, Queen's Medical Centre University of Nottingham, Nottingham NG72UH, UK
| | - Jason Fangusaro
- Department of Pediatric Hematology and Oncology at Children's Healthcare of Atlanta and the Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Donna Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON K1H8L1, Canada
| | - Jennifer Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N1N4, Canada
| | - Lucie Lafay-Cousin
- Department of Pediatric Oncology, Alberta Children's Hospital, Calgary, AB T3B6A8, Canada
| | - Eugene I Hwang
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC 20010, USA
| | - Yin Wang
- Department of Neuropathology Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Daniel Catchpoole
- The Tumor Bank, Children's Cancer Research Unit, Kids Research, the Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Jean Michaud
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON K1H8M5, Canada
| | - Benjamin Ellezam
- Department of Pathology, CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC H3T1C5, Canada
| | - Ramya Ramanujachar
- Paediatric Haematology and Oncology, Southampton Children's Hospital, Southampton SO166YD, UK
| | - Holly Lindsay
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Michael D Taylor
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada; Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Cynthia E Hawkins
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada; Department of Pathology, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Eric Bouffet
- Division of Hematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Nada Jabado
- Departments of Pediatrics and Human Genetics, McGill University, Montréal, QC H3A0C7, Canada
| | - Sheila K Singh
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Claudia L Kleinman
- Departments of Pediatrics and Human Genetics, McGill University, Montréal, QC H3A0C7, Canada
| | | | - Xiao-Nan Li
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Peter B Dirks
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada; Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Charles Y Lin
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stephen C Mack
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Jeremy N Rich
- Department of Medicine, Division of Regenerative Medicine, University of California, San Diego, CA 92093, USA
| | - Annie Huang
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada; Division of Hematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON M5G1L7, Canada.
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26
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Hwang EI, Kool M, Burger PC, Capper D, Chavez L, Brabetz S, Williams-Hughes C, Billups C, Heier L, Jaju A, Michalski J, Li Y, Leary S, Zhou T, von Deimling A, Jones DT, Fouladi M, Pollack IF, Gajjar A, Packer RJ, Pfister SM, Olson JM. Extensive Molecular and Clinical Heterogeneity in Patients With Histologically Diagnosed CNS-PNET Treated as a Single Entity: A Report From the Children's Oncology Group Randomized ACNS0332 Trial. J Clin Oncol 2018; 36:JCO2017764720. [PMID: 30332335 PMCID: PMC9153369 DOI: 10.1200/jco.2017.76.4720] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Children with histologically diagnosed high-risk medulloblastoma, supratentorial primitive neuroectodermal tumor of the CNS (CNS-PNET), and pineoblastoma (PBL) have had poor survival despite intensive treatment. We included these patients in this Children's Oncology Group trial. Molecular profiling later revealed tumor heterogeneity that was not detectable at protocol inception. Enrollment of patients with CNS-PNET/PBL was subsequently discontinued, and outcomes for this part of the study are reported here. PATIENTS AND METHODS In this phase III, four-arm prospective trial, consenting children age 3-22 years with newly diagnosed CNS-PNET were randomly assigned (1:1) to receive carboplatin during radiation and/or adjuvant isotretinoin after standard intensive therapy. Primary outcome measure was event-free survival (EFS) in the intent-to-treat population. Molecular tumor classification was retrospectively completed using DNA methylation profiling. RESULTS Eighty-five participants with institutionally diagnosed CNS-PNETs/PBLs were enrolled. Of 60 patients with sufficient tissue, 31 were nonpineal in location, of which 22 (71%) represented tumors that were not intended for trial inclusion, including 18 high-grade gliomas (HGGs), two atypical teratoid rhabdoid tumors, and two ependymomas. Outcomes across tumor types were strikingly different. Patients with supratentorial embryonal tumors/PBLs exhibited 5-year EFS and overall survival of 62.8% (95% CI, 43.4% to 82.2%) and 78.5% (95% CI, 62.2% to 94.8%), respectively, whereas patients with molecularly classified HGG had EFS and overall survival of 5.6% (95% CI, 0% to 13.0%) and 12.0% (95% CI, 0% to 24.7%), respectively. Neither carboplatin, nor isotretinoin significantly altered outcomes for all patients. Survival for patients with HGG was similar to that of historic studies that avoid craniospinal irradiation and intensive chemotherapy. CONCLUSION For patients with CNS-PNET/PBL, prognosis is considerably better than previously assumed when molecularly confirmed HGGs are removed. Identification of molecular HGGs may spare affected children from unhelpful intensive treatment. This trial highlights the challenges of a histology-based diagnosis for pediatric brain tumors and indicates that molecular profiling should become a standard component of initial diagnosis.
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Affiliation(s)
- Eugene I. Hwang
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Marcel Kool
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Peter C. Burger
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - David Capper
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Lukas Chavez
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Sebastian Brabetz
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Chris Williams-Hughes
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Catherine Billups
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Linda Heier
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Alok Jaju
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Jeff Michalski
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Yimei Li
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Sarah Leary
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Tianni Zhou
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Andreas von Deimling
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - David T.W. Jones
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Maryam Fouladi
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Ian F. Pollack
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Amar Gajjar
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Roger J. Packer
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Stefan M. Pfister
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - James M. Olson
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
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Panditharatna E, Kilburn LB, Aboian MS, Kambhampati M, Gordish-Dressman H, Magge SN, Gupta N, Myseros JS, Hwang EI, Kline C, Crawford JR, Warren KE, Cha S, Liang WS, Berens ME, Packer RJ, Resnick AC, Prados M, Mueller S, Nazarian J. Clinically Relevant and Minimally Invasive Tumor Surveillance of Pediatric Diffuse Midline Gliomas Using Patient-Derived Liquid Biopsy. Clin Cancer Res 2018; 24:5850-5859. [PMID: 30322880 DOI: 10.1158/1078-0432.ccr-18-1345] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/27/2018] [Accepted: 08/30/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Pediatric diffuse midline glioma (DMG) are highly malignant tumors with poor clinical outcomes. Over 70% of patients with DMG harbor the histone 3 p.K27M (H3K27M) mutation, which correlates with a poorer clinical outcome, and is also used as a criterion for enrollment in clinical trials. Because complete surgical resection of DMG is not an option, biopsy at presentation is feasible, but rebiopsy at time of progression is rare. While imaging and clinical-based disease monitoring is the standard of care, molecular-based longitudinal characterization of these tumors is almost nonexistent. To overcome these hurdles, we examined whether liquid biopsy allows measurement of disease response to precision therapy. EXPERIMENTAL DESIGN We established a sensitive and specific methodology that detects major driver mutations associated with pediatric DMGs using droplet digital PCR (n = 48 subjects, n = 110 specimens). Quantification of circulating tumor DNA (ctDNA) for H3K27M was used for longitudinal assessment of disease response compared with centrally reviewed MRI data. RESULTS H3K27M was identified in cerebrospinal fluid (CSF) and plasma in 88% of patients with DMG, with CSF being the most enriched for ctDNA. We demonstrated the feasibility of multiplexing for detection of H3K27M, and additional driver mutations in patient's tumor and matched CSF, maximizing the utility of a single source of liquid biome. A significant decrease in H3K27M plasma ctDNA agreed with MRI assessment of tumor response to radiotherapy in 83% (10/12) of patients. CONCLUSIONS Our liquid biopsy approach provides a molecularly based tool for tumor characterization, and is the first to indicate clinical utility of ctDNA for longitudinal surveillance of DMGs.
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Affiliation(s)
- Eshini Panditharatna
- Rese arch Center for Genetic Medicine, Children's National Health System, Washington, D.C.,Institute for Biomedical Sciences, George Washington University School of Medicine and Health Sciences, Washington, D.C
| | - Lindsay B Kilburn
- Center for Cancer and Blood Disorders, Children's National Health System, Washington D.C.,Brain Tumor Institute, Children's National Health System, Washington, D.C
| | - Mariam S Aboian
- Departments of Neurology, Pediatrics and Neurosurgery, University of California, San Francisco School of Medicine, San Francisco, California
| | - Madhuri Kambhampati
- Rese arch Center for Genetic Medicine, Children's National Health System, Washington, D.C
| | | | - Suresh N Magge
- Division of Neurosurgery, Children's National Health System, Washington, D.C
| | - Nalin Gupta
- Department of Neurological Surgery and Pediatrics, University of California San Francisco, San Francisco, California
| | - John S Myseros
- Division of Neurosurgery, Children's National Health System, Washington, D.C
| | - Eugene I Hwang
- Center for Cancer and Blood Disorders, Children's National Health System, Washington D.C.,Brain Tumor Institute, Children's National Health System, Washington, D.C
| | - Cassie Kline
- Pediatric Hematology-Oncology and Neurology, UCSF Benioff Children's Hospital, San Francisco, California
| | - John R Crawford
- Department of Neurosciences, UC San Diego School of Medicine, La Jolla, California
| | | | - Soonmee Cha
- Department of Radiology, University of California, San Francisco School of Medicine, San Francisco, California
| | - Winnie S Liang
- Translational Genomics Research Institute, Phoenix, Arizona
| | | | - Roger J Packer
- Brain Tumor Institute, Children's National Health System, Washington, D.C
| | - Adam C Resnick
- Center for Data-Driven Discovery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael Prados
- Departments of Neurology, Pediatrics and Neurosurgery, University of California, San Francisco School of Medicine, San Francisco, California
| | - Sabine Mueller
- Departments of Neurology, Pediatrics and Neurosurgery, University of California, San Francisco School of Medicine, San Francisco, California
| | - Javad Nazarian
- Rese arch Center for Genetic Medicine, Children's National Health System, Washington, D.C. .,Center for Cancer and Blood Disorders, Children's National Health System, Washington D.C.,Brain Tumor Institute, Children's National Health System, Washington, D.C.,Department of Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, D.C
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28
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Li BK, Vasiljevic A, Ho B, Jouvet A, Hwang EI, Hansford JR, Laquerriere A, Delisle MB, Gururangan S, Fangusaro JR, Forest F, Sumihito N, Toledano H, Fouladi M, Gauchotte G, Ziegler DS, Bouffet E, Grundy RG, Dufour C, Huang AA. Genomic landscape of pineoblastoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ben Ho
- Hospital for Sick Children, Toronto, ON, Canada
| | - Anne Jouvet
- Hopital Pierre Wertheimer, CHU Lyon, France, Lyon, France
| | | | - Jordan R. Hansford
- Children's Cancer Centre, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | - Sridharan Gururangan
- Preston Wells Center for Brain Tumor therapy, McKnight Brain Institute, University of Florida, Gainesville, FL
| | | | - Fabien Forest
- Department of Pathology, CHU St. Etienne, France, Saint-Etienne, France
| | - Nobusawa Sumihito
- Department of Human Pathology, Gunma University, Maebashi City, Japan
| | - Helen Toledano
- Department of Pediatric Hematology Oncology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Maryam Fouladi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Christelle Dufour
- Institut Gustave Roussy - Paediatric and Adolescent Oncology Department, Villejuif, France
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29
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Kilburn LB, Kocak M, Baxter P, Poussaint TY, Paulino AC, McIntyre C, Lemenuel-Diot A, Lopez-Diaz C, Kun L, Chintagumpala M, Su JM, Broniscer A, Baker JN, Hwang EI, Fouladi M, Boyett JM, Blaney SM. A pediatric brain tumor consortium phase II trial of capecitabine rapidly disintegrating tablets with concomitant radiation therapy in children with newly diagnosed diffuse intrinsic pontine gliomas. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26832. [PMID: 29090526 PMCID: PMC5774861 DOI: 10.1002/pbc.26832] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND We conducted a phase II study of oral capecitabine rapidly disintegrating tablets given concurrently with radiation therapy (RT) to assess progression-free survival (PFS) in children with newly diagnosed diffuse intrinsic pontine gliomas (DIPG). PATIENTS AND METHODS Children 3-17 years with newly diagnosed DIPG were eligible. Capecitabine, 650 mg/m2 /dose BID (maximum tolerated dose [MTD] in children with concurrent radiation), was administered for 9 weeks starting the first day of RT. Following a 2-week break, three courses of capecitabine, 1,250 mg/m2 /dose BID for 14 days followed by a 7-day rest, were administered. As prospectively designed, 10 evaluable patients treated at the MTD on the phase I trial were included in the phase II analyses. The design was based on comparison of the PFS distribution to a contemporary historical control (n = 140) with 90% power to detect a 15% absolute improvement in the 1-year PFS with a type-1 error rate, α = 0.10. RESULTS Forty-four patients were evaluable for the phase II objectives. Capecitabine and RT was well tolerated with low-grade palmar plantar erythrodyesthesia, increased alanine aminotransferase, cytopenias, and vomiting the most commonly reported toxicities. Findings were significant for earlier progression with 1-year PFS of 7.21% (SE = 3.47%) in the capecitabine-treated cohort versus 15.59% (SE = 3.05%) in the historical control (P = 0.007), but there was no difference for overall survival (OS) distributions (P = 0.30). Tumor enhancement at diagnosis was associated with shorter PFS and OS. Capecitabine was rapidly absorbed and converted to its metabolites. CONCLUSION Capecitabine did not improve the outcome for children with newly diagnosed DIPG.
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Affiliation(s)
- Lindsay B. Kilburn
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington, DC
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Patricia Baxter
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston TX
| | - Tina Young Poussaint
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston MA
| | - Arnold C. Paulino
- Department of Radiation Oncology MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Larry Kun
- Department of Radiological Sciences, St. Jude Children’s Research Hospital Memphis, TN
| | | | - Jack M Su
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston TX
| | - Alberto Broniscer
- Department of Oncology St. Jude Children’s Research Hospital, Memphis, TN,Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
| | - Justin N. Baker
- Department of Oncology St. Jude Children’s Research Hospital, Memphis, TN
| | - Eugene I. Hwang
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington, DC
| | - Maryam Fouladi
- Division of Hematology/Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - James M. Boyett
- Department of Biostatistics, Operations and Biostatistics Center for PBTC St. Jude Children’s Research Hospital, Memphis, TN
| | - Susan M. Blaney
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston TX
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30
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Nazarian J, Mason GE, Ho CY, Panditharatna E, Kambhampati M, Vezina LG, Packer RJ, Hwang EI. Histological and molecular analysis of a progressive diffuse intrinsic pontine glioma and synchronous metastatic lesions: a case report. Oncotarget 2018; 7:42837-42842. [PMID: 27329600 PMCID: PMC5173175 DOI: 10.18632/oncotarget.10034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/01/2015] [Accepted: 05/25/2016] [Indexed: 11/25/2022] Open
Abstract
There is no curative treatment for patients with diffuse intrinsic pontine glioma (DIPG). However, with the recent availability of biopsy and autopsy tissue, new data regarding the biologic behavior of this tumor have emerged, allowing greater molecular characterization and leading to investigations which may result in improved therapeutic options. Treatment strategies must address both primary disease sites as well as any metastatic deposits, which may be variably sensitive to a particular approach. In this case report, we present a patient with DIPG treated with irradiation and serial investigational agents. The clinical, pathological and molecular phenotypes of both the progressive primary tumor as well as concomitant metastatic deposits obtained at autopsy are discussed. While some mRNA differences were demonstrated, all analyzed sites of disease shared similar mutational arrangements, suggesting that targeting the mutations of the primary tumor may be effective for all sites of disease.
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Affiliation(s)
- Javad Nazarian
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA.,Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gary E Mason
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cheng Ying Ho
- Department of Pathology, Children's National Medical Center, Washington, DC, USA
| | - Eshini Panditharatna
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA.,Institute for Biomedical Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Madhuri Kambhampati
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, USA
| | - L Gilbert Vezina
- Division of Neuro-radiology, Children's National Medical Center, Washington, DC, USA
| | - Roger J Packer
- Brain Tumor Institute, Daniel and Jennifer Gilbert Neurofibromatosis Institute, Neuroscience and Behavioral Medicine, Children's National Medical Center, NW, Washington, DC, USA
| | - Eugene I Hwang
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
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31
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Kline CN, Packer RJ, Hwang EI, Raleigh DR, Braunstein S, Raffel C, Bandopadhayay P, Solomon DA, Aboian M, Cha S, Mueller S. Case-based review: pediatric medulloblastoma. Neurooncol Pract 2017; 4:138-150. [PMID: 29692919 DOI: 10.1093/nop/npx011] [Citation(s) in RCA: 16] [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] [Indexed: 11/14/2022] Open
Abstract
Medulloblastoma is the most common malignant brain tumor affecting children. These tumors are high grade with propensity to metastasize within the central nervous system and, less frequently, outside the neuraxis. Recent advancements in molecular subgrouping of medulloblastoma refine diagnosis and improve counseling in regards to overall prognosis. Both are predicated on the molecular drivers of each subgroup-WNT-activated, SHH-activated, group 3, and group 4. The traditional therapeutic mainstay for medulloblastoma includes a multimodal approach with surgery, radiation, and multiagent chemotherapy. As we discover more about the molecular basis of medulloblastoma, efforts to adjust treatment approaches based on molecular risk stratification are under active investigation. Certainly, the known neurological, developmental, endocrine, and psychosocial injury related to medulloblastoma and its associated therapies motivate ongoing research towards improving treatment for this life-threatening tumor while at the same time minimizing long-term side effects.
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Affiliation(s)
- Cassie N Kline
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Roger J Packer
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Eugene I Hwang
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - David R Raleigh
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Steve Braunstein
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Corey Raffel
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Pratiti Bandopadhayay
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - David A Solomon
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Mariam Aboian
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Soonmee Cha
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Sabine Mueller
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
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Fangusaro JR, Mitchell DA, Kocak M, Onar-Thomas A, Sadighi ZS, Baxter PA, Hwang EI, Huang J, Dunkel IJ, Fouladi M, Warren KE. A phase I trial of pomalidomide for children with recurrent, progressive/refractory central nervous system (CNS) tumors: A Pediatric Brain Tumor Consortium (PBTC) study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10543 Background: CNS malignancies are the most common solid tumors among children. Novel therapies are needed to help improve the survival outcomes in children with recurrent disease. Pomalidomide is an immunomodulatory agent thought to also function through a combination of anti-angiogenic, anti-inflammatory and cytotoixic activity making it a good candidate to explore in pediatric CNS tumors. Methods: A Phase I trial of pomalidomide was conducted among children ≥ 3 to < 21 years old with recurrent, progressive/refractory CNS tumors using the “rolling 6” dose escalation design. The primary objective was to determine the maximum tolerated dose (MTD) and/or recommended Phase II dose (RP2D) when given orally once daily for 21 consecutive days of a 28-day course. Once the MTD was established, 12 additional patients were enrolled on expansion cohorts based on age and steroid use. Results: 29 children were enrolled and 25 were evaluable for dose limiting toxicity (DLT) evaluation. The MTD was 2.6 mg/m2 (Dose level 2). DLTs observed at dose level 3 (3.4 mg/m2) included diarrhea (n = 1), thrombocytopenia (n = 1) and lung infection (n = 1), all grade 3. The most common toxicities were grade 1 lymphopenia (55%), leukopenia (62%) and thrombocytopenia (38%). There were no obvious differences in tolerability based on age or steroid use. Pharmacokinetics were similar to those observed in adults and increased in a dose-dependent manner. At the RP2D of 2.6 mg/m2, the Cmax was 97.4 ng/mL and the t½ was 4.1 hours. The median number of treatment cycles was 1.6 (0.2-12.3). Two patients, one with an oligodendroglioma and one with anaplastic pleomorphic xanthoastrocytoma, had long term stable disease for 9 and 18+ cycles. No objective responses were observed. Twelve month progression-free and overall-survivals were 5.2+/-3.6% and 12.8+/-8.5%, respectively. Immunologic correlate analyses are ongoing. Conclusions: The RP2D of pomalidomide is 2.6 mg/m2 in children with recurrent brain tumors. Further prospective evaluation of this agent alone or in combination will be necessary to better understand its efficacy in specific pediatric CNS tumor populations. Clinical trial information: NCT02415153.
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Affiliation(s)
| | - Duane Anthony Mitchell
- University of Florida Brain Tumor Immunotherapy Program, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Gainesville, FL
| | - Mehmet Kocak
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | - Jianping Huang
- University of Florida Brain Tumor Immunotherapy Program, Preston A. Wells, Jr. Center for Brain Tumor Therapy, Department of Neurosurgery, Gainesville, FL
| | - Ira J. Dunkel
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Maryam Fouladi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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33
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Tavasoli A, Armangue T, Ho CY, Whitehead M, Bornhorst M, Rhee J, Hwang EI, Wells EM, Packer R, van der Knaap MS, Bugiani M, Vanderver A. Alexander Disease. J Child Neurol 2017; 32:184-187. [PMID: 28112050 DOI: 10.1177/0883073816673263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alexander disease is a leukodystrophy caused by dominant missense mutations in the gene encoding the glial fibrillary acidic protein. Individuals with this disorder often present with a typical neuroradiologic pattern including white matter abnormalities with brainstem involvement, selective contrast enhancement, and structural changes to the basal ganglia/thalamus. In rare cases, focal lesions have been seen and cause concern for primary malignancies. Here the authors present an infant initially diagnosed with a chiasmatic astrocytoma that was later identified as having glial fibrillary acidic protein mutation-confirmed Alexander disease. Pathologic and radiologic considerations that were helpful in arriving at the correct diagnosis are discussed.
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Affiliation(s)
- Ali Tavasoli
- 1 Division of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA.,2 Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Thais Armangue
- 1 Division of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA.,3 IDIBAPS-Hospital Clinic, University of Barcelona, Barcelona, Spain.,4 Sant Joan de Deu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Cheng-Ying Ho
- 5 Department of Pathology, Children's National Health System, Washington, DC, USA
| | - Matthew Whitehead
- 6 Department of Radiology, Children's National Health System, Washington, DC, USA
| | - Miriam Bornhorst
- 7 Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC, USA
| | - Jullie Rhee
- 1 Division of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
| | - Eugene I Hwang
- 7 Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC, USA
| | - Elizabeth M Wells
- 1 Division of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
| | - Roger Packer
- 1 Division of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
| | - Marjo S van der Knaap
- 8 Department of Pediatric Neurology, Center for White Matter Disorders, VUMC of Amsterdam, Amsterdam, Netherlands
| | - Marianna Bugiani
- 8 Department of Pediatric Neurology, Center for White Matter Disorders, VUMC of Amsterdam, Amsterdam, Netherlands
| | - Adeline Vanderver
- 1 Division of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
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34
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Torchia J, Golbourn B, Feng S, Ho KC, Sin-Chan P, Vasiljevic A, Norman JD, Guilhamon P, Garzia L, Agamez NR, Lu M, Chan TS, Picard D, de Antonellis P, Khuong-Quang DA, Planello AC, Zeller C, Barsyte-Lovejoy D, Lafay-Cousin L, Letourneau L, Bourgey M, Yu M, Gendoo DMA, Dzamba M, Barszczyk M, Medina T, Riemenschneider AN, Morrissy AS, Ra YS, Ramaswamy V, Remke M, Dunham CP, Yip S, Ng HK, Lu JQ, Mehta V, Albrecht S, Pimentel J, Chan JA, Somers GR, Faria CC, Roque L, Fouladi M, Hoffman LM, Moore AS, Wang Y, Choi SA, Hansford JR, Catchpoole D, Birks DK, Foreman NK, Strother D, Klekner A, Bognár L, Garami M, Hauser P, Hortobágyi T, Wilson B, Hukin J, Carret AS, Van Meter TE, Hwang EI, Gajjar A, Chiou SH, Nakamura H, Toledano H, Fried I, Fults D, Wataya T, Fryer C, Eisenstat DD, Scheinemann K, Fleming AJ, Johnston DL, Michaud J, Zelcer S, Hammond R, Afzal S, Ramsay DA, Sirachainan N, Hongeng S, Larbcharoensub N, Grundy RG, Lulla RR, Fangusaro JR, Druker H, Bartels U, Grant R, Malkin D, McGlade CJ, Nicolaides T, Tihan T, Phillips J, Majewski J, Montpetit A, Bourque G, Bader GD, Reddy AT, Gillespie GY, Warmuth-Metz M, Rutkowski S, Tabori U, Lupien M, Brudno M, Schüller U, Pietsch T, Judkins AR, Hawkins CE, Bouffet E, Kim SK, Dirks PB, Taylor MD, Erdreich-Epstein A, Arrowsmith CH, De Carvalho DD, Rutka JT, Jabado N, Huang A. Integrated (epi)-Genomic Analyses Identify Subgroup-Specific Therapeutic Targets in CNS Rhabdoid Tumors. Cancer Cell 2016; 30:891-908. [PMID: 27960086 PMCID: PMC5500911 DOI: 10.1016/j.ccell.2016.11.003] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [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: 01/06/2016] [Revised: 09/19/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
We recently reported that atypical teratoid rhabdoid tumors (ATRTs) comprise at least two transcriptional subtypes with different clinical outcomes; however, the mechanisms underlying therapeutic heterogeneity remained unclear. In this study, we analyzed 191 primary ATRTs and 10 ATRT cell lines to define the genomic and epigenomic landscape of ATRTs and identify subgroup-specific therapeutic targets. We found ATRTs segregated into three epigenetic subgroups with distinct genomic profiles, SMARCB1 genotypes, and chromatin landscape that correlated with differential cellular responses to a panel of signaling and epigenetic inhibitors. Significantly, we discovered that differential methylation of a PDGFRB-associated enhancer confers specific sensitivity of group 2 ATRT cells to dasatinib and nilotinib, and suggest that these are promising therapies for this highly lethal ATRT subtype.
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Affiliation(s)
- Jonathon Torchia
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Brian Golbourn
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Shengrui Feng
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - King Ching Ho
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Patrick Sin-Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Alexandre Vasiljevic
- Department of Pathology, Groupement Hospitalier Est, CHU de Lyon, Lyon-Bron 69677, France
| | - Joseph D Norman
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Paul Guilhamon
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Livia Garzia
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Natalia R Agamez
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Mei Lu
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Tiffany S Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Daniel Picard
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Pasqualino de Antonellis
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Dong-Anh Khuong-Quang
- Department of Pediatrics, McGill University, Montreal, QC H3Z2Z3, Canada; Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada
| | - Aline C Planello
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Constanze Zeller
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Dalia Barsyte-Lovejoy
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Lucie Lafay-Cousin
- Division of Pediatric Hematology/Oncology, Alberta Children's Hospital, AB T3B6A8, Canada
| | - Louis Letourneau
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Mathieu Bourgey
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Man Yu
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Deena M A Gendoo
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Misko Dzamba
- Department of Computer Science, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Mark Barszczyk
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Tiago Medina
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Alexandra N Riemenschneider
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - A Sorana Morrissy
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Seoul 138-736, Korea
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Marc Remke
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Christopher P Dunham
- Division of Anatomic Pathology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, University of British Columbia, V6T1Z3, Canada
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Qiang Lu
- Laboratory Medicine and Pathology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Vivek Mehta
- Division of Neurosurgery, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Steffen Albrecht
- Department of Pathology, McGill University, Montreal, QC H3Z2Z3, Canada
| | - Jose Pimentel
- Divison of Pathology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon 1649-035, Portugal
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N1N4, Canada
| | - Gino R Somers
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Claudia C Faria
- Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon 1649-035, Portugal
| | - Lucia Roque
- Cytometry and Cytogenetic Laboratory, CIPM, Portuguese Cancer Institute, Lisbon 1099-023, Portugal
| | - Maryam Fouladi
- Division of Oncology, Department of Cancer and Blood Diseases, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Lindsey M Hoffman
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | - Andrew S Moore
- Oncology Service, Children's Health Queensland Hospital; University of Queensland Diamantina Institute, Brisbane, QLD 4102, Australia
| | - Yin Wang
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China
| | - Seung Ah Choi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Jordan R Hansford
- Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Daniel Catchpoole
- Children's Cancer Research Unit, Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Diane K Birks
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | | | - Doug Strother
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Almos Klekner
- Department of Neurosurgery, University of Debrecen, Debrecen 4032, Hungary
| | - Laszló Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen 4032, Hungary
| | - Miklós Garami
- Second Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Péter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Tibor Hortobágyi
- Department of Histopathology, University of Szeged, Szeged 6720, Hungary
| | - Beverly Wilson
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Juliette Hukin
- Division of Hematology and Oncology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Anne-Sophie Carret
- Department of Pediatrics, Division of Hematology-Oncology, Université de Montréal/CHU Sainte-Justine, Montreal, QC H3T1C5, Canada
| | - Timothy E Van Meter
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA 23298-0631, USA
| | - Eugene I Hwang
- Department of Oncology, Children's National Medical Center, Washington, DC 20010, USA
| | - Amar Gajjar
- Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Shih-Hwa Chiou
- Department of Medical Research, Taipei Veterans General Hospital and National Yang-Ming University, Taipei 112, Taiwan
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University, Kumamoto 860-8556, Japan
| | - Helen Toledano
- Department of Pediatric Hematology Oncology, Children's Medical Center of Israel, Petach Tikva 49202, Isreal
| | - Iris Fried
- Department of Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Daniel Fults
- Department of Neurosurgery, University of Utah, School of Medicine, Salt Lake City, UT 84132, USA
| | - Takafumi Wataya
- Department of Neurosurgery, Shizuoka Children's Hospital, Shizuoka 420-8660, Japan
| | - Chris Fryer
- Division of Hematology and Oncology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - David D Eisenstat
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Katrin Scheinemann
- Department of Pediatrics, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Adam J Fleming
- Department of Pediatrics, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Donna L Johnston
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H8L1, Canada
| | - Jean Michaud
- Pathology and Laboratory Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H8L1, Canada
| | - Shayna Zelcer
- Division of Pediatric Hematology/Oncology, Children's Hospital, London Health Sciences Center, London, ON N6A5A5, Canada
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, Children's Hospital of Western Ontario, University of Western Ontario, London, ON N6A5W9, Canada
| | - Samina Afzal
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H4R2, Canada
| | - David A Ramsay
- Department of Pathology and Laboratory Medicine, Children's Hospital of Western Ontario, University of Western Ontario, London, ON N6A5W9, Canada
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10300, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10300, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham NG72RD, England
| | - Rishi R Lulla
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Jason R Fangusaro
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Harriet Druker
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ronald Grant
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - David Malkin
- Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - C Jane McGlade
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Theodore Nicolaides
- Department of Pediatrics (Hematology/Oncology), University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Tarik Tihan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Joanna Phillips
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada; Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Alexandre Montpetit
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Guillaume Bourque
- Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada; Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Gary D Bader
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Alyssa T Reddy
- Department of Pediatric Hematology and Oncology, University of Alabama, Birmingham, AL 35233, USA
| | - G Yancey Gillespie
- Department of Neurosurgery, University of Alabama, Birmingham, AL 35233, USA
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University of Würzburg, Würzburg 97070, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Uri Tabori
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Mathieu Lupien
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, Toronto, ON M5G0A4, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ulrich Schüller
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Torsten Pietsch
- Institute for Neuropathology, University of Bonn Medical Center, Bonn 53105, Germany
| | - Alexander R Judkins
- Department of Pathology & Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA
| | - Cynthia E Hawkins
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Pathology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Peter B Dirks
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Anat Erdreich-Epstein
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Cheryl H Arrowsmith
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Daniel D De Carvalho
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada.
| | - James T Rutka
- Department of Surgery, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
| | - Nada Jabado
- Department of Pediatrics, McGill University, Montreal, QC H3Z2Z3, Canada; Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada.
| | - Annie Huang
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
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35
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Pecker LH, Timsar A, Pary PP, Denomme GA, Criss VR, Luban NLC, Hwang EI, Wong ECC. Unusual serological findings associated with ceftriaxone-induced immune hemolytic anemia in a child with disseminated low-grade glioma. Pediatr Blood Cancer 2016; 63:1852-5. [PMID: 27304608 DOI: 10.1002/pbc.26101] [Citation(s) in RCA: 2] [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: 03/22/2016] [Revised: 04/30/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022]
Abstract
Ceftriaxone-induced immune hemolytic anemia (CIHA) is the second most common cause of drug-induced hemolytic anemia. Prompt recognition of this drug reaction is essential because brisk hemolysis can be deadly. The extent to which ceftriaxone antibodies persist after CIHA is unknown; rechallenging patients who have experienced CIHA is not recommended. We report a case of CIHA in a neurooncology patient, which is the first to show anticeftriaxone antibodies with Rh specificity and persisted for 8 months after the drug reaction. These findings have implications for understanding the mechanism of CIHA.
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Affiliation(s)
- L H Pecker
- Children's National Health System, Washington, District of Columbia.,Center for Cancer and Blood Disorders, Washington, District of Columbia.,Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - A Timsar
- Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, District of Columbia.,Department of Pathology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - P P Pary
- Children's National Health System, Washington, District of Columbia
| | - G A Denomme
- Diagnostic Laboratories, Blood Center of Wisconsin, Wisconsin
| | - V R Criss
- Children's National Health System, Washington, District of Columbia
| | - N L C Luban
- Children's National Health System, Washington, District of Columbia.,Center for Cancer and Blood Disorders, Washington, District of Columbia.,Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, District of Columbia.,Department of Pathology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - E I Hwang
- Children's National Health System, Washington, District of Columbia.,Center for Cancer and Blood Disorders, Washington, District of Columbia.,Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - E C C Wong
- Children's National Health System, Washington, District of Columbia.,Center for Cancer and Blood Disorders, Washington, District of Columbia.,Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, District of Columbia.,Department of Pathology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia
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36
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Bornhorst M, Hwang EI. Experimental Therapeutic Trial Design for Pediatric Brain Tumors. J Child Neurol 2016; 31:1421-32. [PMID: 26353880 DOI: 10.1177/0883073815604221] [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: 03/18/2015] [Accepted: 08/11/2015] [Indexed: 11/17/2022]
Abstract
Pediatric brain tumors are the leading cause of cancer-related death during childhood. Since the first pediatric brain tumor clinical trials, the field has seen improved outcomes in some, but not all tumor types. In the past few decades, a number of promising new therapeutic agents have emerged, yet only a few of these agents have been incorporated into clinical trials for pediatric brain tumors. In this review, the authors discuss the process of and challenges in pediatric clinical trial design; this will allow for highly efficient and effective clinical trials with appropriate endpoints to ensure rapid and safe investigation of novel therapeutics for children with brain tumors.
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Affiliation(s)
- Miriam Bornhorst
- Department of Pediatric Hematology-Oncology, Children's National Medical Center, Washington, DC, USA Brain Tumor Institute, Washington, DC, USA
| | - Eugene I Hwang
- Department of Pediatric Hematology-Oncology, Children's National Medical Center, Washington, DC, USA Gilbert Family Neurofibromatosis Institute, Centers for Cancer and Immunology Research & Neuroscience Research, Children's National Medical Center, Washington, DC, USA
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37
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Panditharatna E, Nikbakht H, Mikael L, Li R, Gayden T, Osmand M, Ho CY, Kambhampati M, Hwang EI, Faury D, Siu A, Papillon-Cavanagh S, Bechet D, Ligon KL, Ellezam B, Ingram WJ, Stinson C, Moore AS, Warren KE, Karamchandani J, Packer RJ, Jabado N, Majewski J, Nazarian J. HG-76SPATIAL AND TEMPORAL HOMOGENEITY OF DRIVER MUTATIONS IN DIFFUSE INTRINSIC PONTINE GLIOMA. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now073.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Kambhampati M, Gittens J, Ho CY, Yadavilli S, Panditharatna E, Stampar M, Kilburn L, Hwang EI, Rood B, Packer RJ, Nazarian J. HG-62NEEDS AND MEANS OF POSTMORTEM BRAIN TUMOR DONATION AND COORDINATION: ONE CENTER'S EXPERIENCE. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now073.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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39
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Nikbakht H, Panditharatna E, Mikael LG, Li R, Gayden T, Osmond M, Ho CY, Kambhampati M, Hwang EI, Faury D, Siu A, Papillon-Cavanagh S, Bechet D, Ligon KL, Ellezam B, Ingram WJ, Stinson C, Moore AS, Warren KE, Karamchandani J, Packer RJ, Jabado N, Majewski J, Nazarian J. Spatial and temporal homogeneity of driver mutations in diffuse intrinsic pontine glioma. Nat Commun 2016; 7:11185. [PMID: 27048880 PMCID: PMC4823825 DOI: 10.1038/ncomms11185] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/29/2016] [Indexed: 12/28/2022] Open
Abstract
Diffuse Intrinsic Pontine Gliomas (DIPGs) are deadly paediatric brain tumours where needle biopsies help guide diagnosis and targeted therapies. To address spatial heterogeneity, here we analyse 134 specimens from various neuroanatomical structures of whole autopsy brains from nine DIPG patients. Evolutionary reconstruction indicates histone 3 (H3) K27M--including H3.2K27M--mutations potentially arise first and are invariably associated with specific, high-fidelity obligate partners throughout the tumour and its spread, from diagnosis to end-stage disease, suggesting mutual need for tumorigenesis. These H3K27M ubiquitously-associated mutations involve alterations in TP53 cell-cycle (TP53/PPM1D) or specific growth factor pathways (ACVR1/PIK3R1). Later oncogenic alterations arise in sub-clones and often affect the PI3K pathway. Our findings are consistent with early tumour spread outside the brainstem including the cerebrum. The spatial and temporal homogeneity of main driver mutations in DIPG implies they will be captured by limited biopsies and emphasizes the need to develop therapies specifically targeting obligate oncohistone partnerships.
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Affiliation(s)
- Hamid Nikbakht
- Department of Human Genetics, McGill University, Montreal, Québec, Canada H3A 1B1.,McGill University and Génome Québec Innovation Centre, Montreal, Québec, Canada H3A 0G1
| | - Eshini Panditharatna
- Research Center for Genetic Medicine, Children's National Health System, Washington, District Of Columbia 20010, USA.,Institute for Biomedical Sciences, George Washington University School of Medicine and Health Sciences, Washington, District Of Columbia 20052, USA
| | - Leonie G Mikael
- Department of Pediatrics, McGill University and McGill University Heath Centre Research Institute, Montreal, Québec, Canada H4A 3J1
| | - Rui Li
- Department of Human Genetics, McGill University, Montreal, Québec, Canada H3A 1B1.,McGill University and Génome Québec Innovation Centre, Montreal, Québec, Canada H3A 0G1
| | - Tenzin Gayden
- Department of Human Genetics, McGill University, Montreal, Québec, Canada H3A 1B1
| | - Matthew Osmond
- Department of Human Genetics, McGill University, Montreal, Québec, Canada H3A 1B1.,McGill University and Génome Québec Innovation Centre, Montreal, Québec, Canada H3A 0G1
| | - Cheng-Ying Ho
- Division of Pathology, Children's National Health System, Washington, District Of Columbia 20010, USA
| | - Madhuri Kambhampati
- Research Center for Genetic Medicine, Children's National Health System, Washington, District Of Columbia 20010, USA
| | - Eugene I Hwang
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District Of Columbia 20010, USA
| | - Damien Faury
- Department of Pediatrics, McGill University and McGill University Heath Centre Research Institute, Montreal, Québec, Canada H4A 3J1
| | - Alan Siu
- The Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, District Of Columbia 20052, USA
| | - Simon Papillon-Cavanagh
- Department of Human Genetics, McGill University, Montreal, Québec, Canada H3A 1B1.,McGill University and Génome Québec Innovation Centre, Montreal, Québec, Canada H3A 0G1
| | - Denise Bechet
- Department of Human Genetics, McGill University, Montreal, Québec, Canada H3A 1B1
| | - Keith L Ligon
- Center for Molecular Oncologic Pathology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusett 02115, USA
| | - Benjamin Ellezam
- Department of Pathology, CHU Ste-Justine, Université de Montréal, Montreal, Québec, Canada H3T 1C5
| | - Wendy J Ingram
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland 4101, Australia
| | - Caedyn Stinson
- University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland 4102, Australia
| | - Andrew S Moore
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland 4101, Australia.,University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland 4102, Australia.,Oncology Service, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland 4101, Australia
| | - Katherine E Warren
- National Cancer Institute, National Institute of Health, Bethesda, Maryland 20892, USA
| | - Jason Karamchandani
- Department of Pathology, Montreal Neurological Hospital, McGill University, Montreal, Québec, Canada H3A 2B4
| | - Roger J Packer
- Brain Tumour Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, District Of Columbia, 20010, USA
| | - Nada Jabado
- Department of Human Genetics, McGill University, Montreal, Québec, Canada H3A 1B1.,Department of Pediatrics, McGill University and McGill University Heath Centre Research Institute, Montreal, Québec, Canada H4A 3J1
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, Québec, Canada H3A 1B1.,McGill University and Génome Québec Innovation Centre, Montreal, Québec, Canada H3A 0G1
| | - Javad Nazarian
- Research Center for Genetic Medicine, Children's National Health System, Washington, District Of Columbia 20010, USA.,Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, District Of Columbia 20052, USA
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Abstract
Neuron glia antigen-2 ((NG2), also known as chondroitin sulphate proteoglycan 4, or melanoma-associated chondroitin sulfate proteoglycan) is a type-1 membrane protein expressed by many central nervous system (CNS) cells during development and differentiation and plays a critical role in proliferation and angiogenesis. ‘NG2’ often references either the protein itself or the highly proliferative and undifferentiated glial cells expressing high levels of NG2 protein. NG2 glia represent the fourth major type of neuroglia in the mammalian nervous system and are classified as oligodendrocyte progenitor cells by virtue of their committed oligodendrocyte generation in developing and adult brain. Here, we discuss NG2 glial cells as well as NG2 protein and its expression and role with regards to CNS neoplasms as well as its potential as a therapeutic target for treating childhood CNS cancers.
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Affiliation(s)
- Sridevi Yadavilli
- Research Center for Genetic Medicine, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
| | - Eugene I Hwang
- Division of Oncology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
| | - Roger J Packer
- Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC 20010, USA
| | - Javad Nazarian
- Research Center for Genetic Medicine, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA; Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA.
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Crotty EE, Meier ER, Wells EM, Hwang EI, Packer RJ. Anaplastic Ependymoma in a Child With Sickle Cell Anemia: A Case Report Highlighting Treatment Challenges for Young Children With Central Nervous System Tumors and Underlying Vasculopathy. Pediatr Blood Cancer 2016; 63:547-50. [PMID: 26488903 DOI: 10.1002/pbc.25809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/27/2015] [Indexed: 11/11/2022]
Abstract
A 3-year-old boy with sickle cell anemia (SCA) presented with progressive daily emesis and was found to have an anaplastic ependymoma. Radiation therapy and chemotherapy are usually employed after subtotal resections of anaplastic ependymomas, although the benefits from chemotherapy are unclear. To mitigate the risks of adjuvant treatment in this patient at risk for SCA-associated vasculopathy, renal impairment, and other end-organ damage, proton beam irradiation without chemotherapy was chosen. Scheduled packed red blood cell transfusions were instituted to maintain sickle hemoglobin levels less than 30%. This case highlights treatment complexities for malignant brain tumors in patients predisposed to treatment-related adverse effects.
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Affiliation(s)
- Erin E Crotty
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia
| | - Emily R Meier
- Division of Hematology, Children's National Health System, Washington, District of Columbia
| | - Elizabeth M Wells
- Brain Tumor Institute, Children's National Health System, Washington, District of Columbia.,Division of Neurology, Children's National Health System, Washington, District of Columbia
| | - Eugene I Hwang
- Brain Tumor Institute, Children's National Health System, Washington, District of Columbia.,Division of Oncology, Children's National Health System, Washington, District of Columbia
| | - Roger J Packer
- Brain Tumor Institute, Children's National Health System, Washington, District of Columbia.,Division of Neurology, Children's National Health System, Washington, District of Columbia
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Merino DM, Shlien A, Villani A, Pienkowska M, Mack S, Ramaswamy V, Shih D, Tatevossian R, Novokmet A, Choufani S, Dvir R, Ben-Arush M, Harris BT, Hwang EI, Lulla R, Pfister SM, Achatz MI, Jabado N, Finlay JL, Weksberg R, Bouffet E, Hawkins C, Taylor MD, Tabori U, Ellison DW, Gilbertson RJ, Malkin D. Molecular characterization of choroid plexus tumors reveals novel clinically relevant subgroups. Clin Cancer Res 2014; 21:184-92. [PMID: 25336695 DOI: 10.1158/1078-0432.ccr-14-1324] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate molecular alterations in choroid plexus tumors (CPT) using a genome-wide high-throughput approach to identify diagnostic and prognostic signatures that will refine tumor stratification and guide therapeutic options. EXPERIMENTAL DESIGN One hundred CPTs were obtained from a multi-institutional tissue and clinical database. Copy-number (CN), DNA methylation, and gene expression signatures were assessed for 74, 36, and 40 samples, respectively. Molecular subgroups were correlated with clinical parameters and outcomes. RESULTS Unique molecular signatures distinguished choroid plexus carcinomas (CPC) from choroid plexus papillomas (CPP) and atypical choroid plexus papillomas (aCPP); however, no significantly distinct molecular alterations between CPPs and aCPPs were observed. Allele-specific CN analysis of CPCs revealed two novel subgroups according to DNA content: hypodiploid and hyperdiploid CPCs. Hyperdiploid CPCs exhibited recurrent acquired uniparental disomy events. Somatic mutations in TP53 were observed in 60% of CPCs. Investigating the number of mutated copies of p53 per sample revealed a high-risk group of patients with CPC carrying two copies of mutant p53, who exhibited poor 5-year event-free (EFS) and overall survival (OS) compared with patients with CPC carrying one copy of mutant p53 (OS: 14.3%, 95% confidence interval, 0.71%-46.5% vs. 66.7%, 28.2%-87.8%, respectively, P = 0.04; EFS: 0% vs. 44.4%, 13.6%-71.9%, respectively, P = 0.03). CPPs and aCPPs exhibited favorable survival. DISCUSSION Our data demonstrate that differences in CN, gene expression, and DNA methylation signatures distinguish CPCs from CPPs and aCPPs; however, molecular similarities among the papillomas suggest that these two histologic subgroups are indeed a single molecular entity. A greater number of copies of mutated TP53 were significantly associated to increased tumor aggressiveness and a worse survival outcome in CPCs. Collectively, these findings will facilitate stratified approaches to the clinical management of CPTs.
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Affiliation(s)
- Diana M Merino
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Shlien
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anita Villani
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Stephen Mack
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - David Shih
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ana Novokmet
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sanaa Choufani
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rina Dvir
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Rishi Lulla
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | - Nada Jabado
- Montreal Children's Hospital, Montreal, Québec, Canada
| | | | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Uri Tabori
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - David Malkin
- The Hospital for Sick Children, Toronto, Ontario, Canada.
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Avery RA, Hwang EI, Ishikawa H, Acosta MT, Hutcheson KA, Santos D, Zand DJ, Kilburn LB, Rosenbaum KN, Rood BR, Schuman JS, Packer RJ. Handheld optical coherence tomography during sedation in young children with optic pathway gliomas. JAMA Ophthalmol 2014; 132:265-71. [PMID: 24435762 DOI: 10.1001/jamaophthalmol.2013.7649] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Monitoring young children with optic pathway gliomas (OPGs) for visual deterioration can be difficult owing to age-related noncompliance. Optical coherence tomography (OCT) measures of retinal nerve fiber layer (RNFL) thickness have been proposed as a surrogate marker of vision but this technique is also limited by patient cooperation. OBJECTIVE To determine whether measures of circumpapillary RNFL thickness, acquired with handheld OCT (HH-OCT) during sedation, can differentiate between young children with and without vision loss from OPGs. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of a prospective observational study was conducted at a tertiary-care children's hospital. Children with an OPG (sporadic or secondary to neurofibromatosis type 1) who were cooperative for visual acuity testing, but required sedation to complete magnetic resonance imaging, underwent HH-OCT imaging of the circumpapillary RNFL while sedated. MAIN OUTCOMES AND MEASURES Area under the curve of the receiver operating characteristic, sensitivity, specificity, positive predictive value, and negative predictive value of the average and quadrant-specific RNFL thicknesses. RESULTS Thirty-three children (64 eyes) met inclusion criteria (median age, 4.8 years; range, 1.8-12.6 years). In children with vision loss (abnormal visual acuity and/or visual field), RNFL thickness was decreased in all quadrants compared with the normal-vision group (P < .001 for all comparisons). Using abnormal criteria of less than 5% and less than 1%, the area under the curve was highest for the average RNFL thickness (0.96 and 0.97, respectively) compared with specific anatomic quadrants. The highest discrimination and predictive values were demonstrated for participants with 2 or more quadrants meeting less than 5% (sensitivity = 93.3; specificity = 97.9; positive predictive value = 93.3; and negative predictive value = 97.9) and less than 1% (sensitivity = 93.3; specificity = 100; positive predictive value = 100; and negative predictive value = 98.0) criteria. CONCLUSIONS AND RELEVANCE Measures of RNFL thickness acquired with HH-OCT during sedation can differentiate between young children with and without vision loss from OPGs. For young children who do not cooperate with vision testing, HH-OCT measures may be a surrogate marker of vision. Longitudinal studies are needed to delineate the temporal relationship between RNFL decline and vision loss.
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Affiliation(s)
- Robert A Avery
- The Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, Washington, DC2Department of Neurology, Children's National Medical Center, Washington, DC3Department of Ophthalmology, Children's National Medical Center, Washington, DC7
| | - Eugene I Hwang
- Department of Oncology, Children's National Medical Center, Washington, DC7The Brain Tumor Institute, Children's National Medical Center, Washington, DC
| | - Hiroshi Ishikawa
- University of Pittsburgh Medical Center Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania10Department of Bioengineering
| | - Maria T Acosta
- The Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, Washington, DC2Department of Neurology, Children's National Medical Center, Washington, DC8Center for Neuroscience and Behavior, Children's National Medical Center, Washin
| | - Kelly A Hutcheson
- Department of Ophthalmology, Children's National Medical Center, Washington, DC
| | - Domiciano Santos
- Department of Anesthesiology, Children's National Medical Center, Washington, DC
| | - Dina J Zand
- Department of Genetics, Children's National Medical Center, Washington, DC
| | - Lindsay B Kilburn
- Department of Oncology, Children's National Medical Center, Washington, DC7The Brain Tumor Institute, Children's National Medical Center, Washington, DC
| | | | - Brian R Rood
- Department of Oncology, Children's National Medical Center, Washington, DC7The Brain Tumor Institute, Children's National Medical Center, Washington, DC
| | - Joel S Schuman
- University of Pittsburgh Medical Center Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania10Department of Bioengineering
| | - Roger J Packer
- The Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, Washington, DC2Department of Neurology, Children's National Medical Center, Washington, DC6Department of Oncology, Children's National Medical Center, Washington, DC7The B
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Abstract
IMPORTANCE Children with optic pathway gliomas (OPGs) frequently experience vision loss from their tumors. Standard front-line treatment using carboplatin-based chemotherapy typically produces only a modest benefit (eg, stabilization or 0.2 logMAR improvement) in visual acuity (VA). Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor and acts primarily as an anti-angiogenic agent. Recent reports suggest a qualitative improvement in vision after bevacizumab-based treatment in children with OPGs. OBSERVATIONS We report 4 cases of pediatric OPGs (2 neurofibromatosis type 1-related and 2 sporadic cases) that received treatment with bevacizumab due to progressive VA or visual field (VF) loss despite prior treatment with chemotherapy or proton-beam radiation. All 4 subjects demonstrated a marked improvement in their VA, VF, or both while receiving bevacizumab-based therapy. Three patients had complete resolution of their VA or VF loss in at least 1 eye-2 of whom had previously received bevacizumab therapy. CONCLUSIONS AND RELEVANCE Given that most patients with OPG-related visual impairment will show modest or no visual improvement with standard treatment, the incorporation of bevacizumab in these cases may greatly improve visual outcomes and should be considered in appropriate clinical situations.
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Affiliation(s)
- Robert A Avery
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC2The Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, Washington, DC3Division of Neurology, Children's National Medical Cente
| | - Eugene I Hwang
- The Brain Tumor Institute, Children's National Medical Center, Washington, DC7Division of Hematology-Oncology, Children's National Medical Center, Washington, DC
| | - Regina I Jakacki
- Division of Hematology-Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC2The Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, Washington, DC3Division of Neurology, Children's National Medical Cente
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Willard VW, Hardy KK, Allen TM, Hwang EI, Gururangan S, Hostetter SA, Bonner MJ. Sluggish cognitive tempo in survivors of pediatric brain tumors. J Neurooncol 2013; 114:71-8. [DOI: 10.1007/s11060-013-1149-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/06/2013] [Indexed: 11/24/2022]
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46
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Hwang EI, Jakacki RI, Fisher MJ, Kilburn LB, Horn M, Vezina G, Rood BR, Packer RJ. Long-term efficacy and toxicity of bevacizumab-based therapy in children with recurrent low-grade gliomas. Pediatr Blood Cancer 2013; 60:776-82. [PMID: 22976922 DOI: 10.1002/pbc.24297] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/02/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Because definitive resection or radiotherapy for pediatric low-grade gliomas (LGGs) may be associated with severe and permanent adverse effects, medical management has taken a significant role. Bevacizumab-based therapy has demonstrated encouraging responses; however, longer-term toxicity, response durability and alternative dosing regimens have not been evaluated. PROCEDURE This was a retrospective review of children with multiply recurrent, progressive LGGs treated with bevacizumab-based therapy and followed for at least 12 months after treatment completion. Toxicity was uniformly graded and imaging was centrally reviewed. RESULTS All fourteen patients had failed at least two prior treatment regimens; six had dissemination. Patients received initial bevacizumab-based therapy at a median age of 5.3 years (range, 1-12 years). Median treatment duration was 12 months (range, 1-24 months). 12 patients had an objective response; 2 had stable disease. Median time to maximum response was 9 weeks (range, 7-17 weeks). No patients progressed on therapy, although 13/14 progressed after stopping bevacizumab at a median of 5 months. Four patients were re-treated with bevacizumab and all again responded or stabilized. Alternative dosing strategies were effective, including bevacizumab monotherapy and prolonging the dosing interval to 3 weeks. High-grade bevacizumab-related toxicities consisted of grade 3 proteinuria (n = 2), primary inflammatory arthritis (n = 1), and somnolence (n = 1). Toxicities resolved within 6 months of treatment cessation except one case of hypertension. CONCLUSIONS Bevacizumab-based therapy is successful at inducing rapid LGG response. Patients progressing off-therapy may be successfully re-treated with bevacizumab. Nearly all tumors progress once treatment is discontinued. Toxicities are not insignificant but usually reversible.
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Affiliation(s)
- Eugene I Hwang
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, District of Columbia, USA.
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Hwang EI, Ahn BT, Lee HB, Kim YK, Lee KS, Bok SH, Kim YT, Kim SU. Inhibitory activity for chitin synthase II from Saccharomyces cerevisiae by tannins and related compounds. Planta Med 2001; 67:501-504. [PMID: 11509967 DOI: 10.1055/s-2001-16487-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In the course of search for potent inhibitors of chitin synthase II from natural resources, seven tannins and related compounds were isolated from the aerial part of Euphorbia pekinensis and identified as gallic acid (1), methyl gallate (2), 3-O-galloyl-(-)-shikimic acid (3), corilagin (4), geraniin (5), quercetin-3-O-(2"-O-galloyl)-beta-D-glucoside (6), and kaempferol-3-O-(2"-O-galloyl)-beta-D-glucoside (7). These and nine related compounds, (-)-quinic acid (8), (-)-shikimic acid (9), ellagic acid (10), kaempferol (11), quercetin (12), quercitrin (13), rutin (14), quercetin-3-O-(2"-O-galloyl)-beta-D-rutinoside (15) and 1,3,4,6-tetra-O-galloyl-beta-D-glucose (16), were evaluated for the inhibitory activity against chitin synthase II and III. They inhibited chitin synthase II with IC(50) values of 18-206 microM, except for two organic acids, (-)-quinic acid (8) and (-)-shikimic acid (9). Among them, 3-O-galloyl-(-)-shikimic acid (3) was the most potent inhibitor against chitin synthase II of Saccharomyces cerevisiae with an IC(50) value of 18 microM. The inhibition appears to be selective for chitin synthase II, as they did not appreciably inhibit chitin synthase III.
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Affiliation(s)
- E I Hwang
- Antibiotics Research Laboratory, Korea Research Institute of Bioscience and Biotechnology, Yusung, Taejon, Korea
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Hwang EI, Yun BS, Kim YK, Kwon BM, Kim HG, Lee HB, Jeong WJ, Kim SU. Phellinsin A, a novel chitin synthases inhibitor produced by Phellinus sp. PL3. J Antibiot (Tokyo) 2000; 53:903-11. [PMID: 11099223 DOI: 10.7164/antibiotics.53.903] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Phellinsin A, a novel chitin synthases inhibitor was isolated from the cultured broth of fungus PL3, which was identified as Phellinus sp. PL3. Phellinsin A was purified by solvent partition, silica gel, ODS column chromatographies, and preparative HPLC, consecutively. The structure of phellinsin A was assigned as a phenolic compound on the basis of various spectroscopic analyses including UV, IR, Mass, and NMR. Its molecular weight and formula were found to be 358 and C18H14O8, respectively. Phellinsin A selectively inhibited chitin synthase I and II of Saccharomyces cerevisiae with an IC50 value of 76 and 28 microg/ml, respectively, in our cell free assay system. This compound showed antifungal activity against Colletotrichum lagenarium, Pyricularia oryzae, Rhizoctonia solani, Aspergillus fumigatus, and Trichophyton mentagrophytes.
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Affiliation(s)
- E I Hwang
- Antibiotics Research Lab, Korea Research Institute of Bioscience & Biotechnology, Yusung, Taejon
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Hwang EI, Yun BS, Kim YK, Kwon BM, Kim HG, Lee HB, Bae KS, Kim SU. Chaetoatrosin A, a novel chitin synthase II inhibitor produced by Chaetomium atrobrunneum F449. J Antibiot (Tokyo) 2000; 53:248-55. [PMID: 10819295 DOI: 10.7164/antibiotics.53.248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chaetoatrosin A, a novel chitin synthase II inhibitor, was isolated from the culture broth of fungus F449, which was identified as Chaetomium atrobrunneum F449. Chaetoatrosin A was purified by solvent partition, silica gel, ODS, preparative TLC, and Sephadex LH-20 column chromatographies, consecutively. The structure of chaetoatrosin A was assigned as 1,8-dihydroxy-3(2-hydroxypropionyl)-6-methoxynaphthalene on the basis of various spectroscopic analyses including UV, IR, mass spectral, and NMR. Its molecular weight and formula were found to be 262 and C14H14O5, respectively. ,Chaetoatrosin A inhibited chitin synthase II by 50% at the concentration of 104 microg/ml in an enzyme assay system. This compound showed antifungal activities against Rhizoctonia solani, Pyricularia oryzae, Botrytis cinerea, Cryptococcus neoformans and Trichophyton mentagrophytes.
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Affiliation(s)
- E I Hwang
- Antibiotics Research Lab, Korea Research Institute of Bioscience and Biotechnology, Yusung, Taejon, Korea
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Jeong TS, Hwang EI, Lee HB, Lee ES, Kim YK, Min BS, Bae KH, Bok SH, Kim SU. Chitin synthase II inhibitory activity of ursolic acid, isolated from Crataegus pinnatifida. Planta Med 1999; 65:261-3. [PMID: 10232075 DOI: 10.1055/s-2006-960474] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Two triterpenoid compounds, ursolic acid and uvaol, were isolated from Crataegus pinnatifida Bunge leaves. Ursolic acid inhibits chitin synthase II from S. cerevisiae with an IC50 value of 0.84 microgram/ml and the inhibition appears to be selective for chitin synthase II, whereas uvaol has no inhibitory activity up to 280 micrograms/ml. Oleanolic acid, alpha-hederin hydrate, and betulic acid inhibited the chitin synthase II activity under the same conditions with an IC50 of 5.6, 64.3, and 98.7 micrograms/ml, respectively.
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