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Zhaxi Q, Gesang L, Huang J, Suona Y, Ci B, Danzeng Z, Zhang R, Liu B. Hypermethylation of BMPR2 and TGF-β Promoter Regions in Tibetan Patients with High-Altitude Polycythemia at Extreme Altitude. Biochem Genet 2024:10.1007/s10528-024-10798-2. [PMID: 38787494 DOI: 10.1007/s10528-024-10798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/01/2024] [Indexed: 05/25/2024]
Abstract
Although the expression of many genes is associated with adaptation to high-altitude hypoxic environments, the role of epigenetics in the response to this harsh environmental stress is currently unclear. We explored whether abnormal DNA promoter methylation levels of six genes, namely, ABCA1, SOD2, AKT1, VEGFR2, TGF-β, and BMPR2, affect the occurrence and development of high-altitude polycythemia (HAPC) in Tibetans. The methylation levels of HAPC and the control group of 130 Tibetans from very high altitudes (> 4500 m) were examined using quantitative methylation-specific real-time PCR (QMSP). Depending on the type of data, the Pearson chi-square test, Wilcoxon rank-sum test, and Fisher exact test were used to assess the differences between the two groups. The correlation between the methylation levels of each gene and the hemoglobin content was explored using a linear mixed model. Our experiment revealed that the methylation levels of the TGF-β and BMPR2 genes differed significantly in the two groups (p < 0.05) and linear mixed model analysis showed that the correlation between the hemoglobin and methylation of ABCA1, TGF-β, and BMPR2 was statistically significant (p < 0.05). Our study suggests that levels of TGF-β and BMPR2 methylation are associated with the occurrence of HAPC in extreme-altitude Tibetan populations among 6 selected genes. Epigenetics may be involved in the pathogenesis of HAPC, and future experiments could combine gene and protein levels to verify the diagnostic value of TGF-β and BMPR2 methylation levels in HAPC.
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Affiliation(s)
- Quzong Zhaxi
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Luobu Gesang
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China.
| | - Ju Huang
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Yangzong Suona
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Bai Ci
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Zhuoga Danzeng
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Rui Zhang
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Binyun Liu
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
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Tasci E, Shah Y, Jagasia S, Zhuge Y, Shephard J, Johnson MO, Elemento O, Joyce T, Chappidi S, Cooley Zgela T, Sproull M, Mackey M, Camphausen K, Krauze AV. MGMT ProFWise: Unlocking a New Application for Combined Feature Selection and the Rank-Based Weighting Method to Link MGMT Methylation Status to Serum Protein Expression in Patients with Glioblastoma. Int J Mol Sci 2024; 25:4082. [PMID: 38612892 PMCID: PMC11012706 DOI: 10.3390/ijms25074082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Glioblastoma (GBM) is a fatal brain tumor with limited treatment options. O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status is the central molecular biomarker linked to both the response to temozolomide, the standard chemotherapy drug employed for GBM, and to patient survival. However, MGMT status is captured on tumor tissue which, given the difficulty in acquisition, limits the use of this molecular feature for treatment monitoring. MGMT protein expression levels may offer additional insights into the mechanistic understanding of MGMT but, currently, they correlate poorly to promoter methylation. The difficulty of acquiring tumor tissue for MGMT testing drives the need for non-invasive methods to predict MGMT status. Feature selection aims to identify the most informative features to build accurate and interpretable prediction models. This study explores the new application of a combined feature selection (i.e., LASSO and mRMR) and the rank-based weighting method (i.e., MGMT ProFWise) to non-invasively link MGMT promoter methylation status and serum protein expression in patients with GBM. Our method provides promising results, reducing dimensionality (by more than 95%) when employed on two large-scale proteomic datasets (7k SomaScan® panel and CPTAC) for all our analyses. The computational results indicate that the proposed approach provides 14 shared serum biomarkers that may be helpful for diagnostic, prognostic, and/or predictive operations for GBM-related processes, given further validation.
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Affiliation(s)
- Erdal Tasci
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Yajas Shah
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Sarisha Jagasia
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Ying Zhuge
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Jason Shephard
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Margaret O. Johnson
- Department of Neurosurgery, Duke University, Durham, NC 27710, USA
- National Tele-Oncology, Veterans Health Administration, Durham, NC 27710, USA
| | - Olivier Elemento
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Thomas Joyce
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Shreya Chappidi
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Theresa Cooley Zgela
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Mary Sproull
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Megan Mackey
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Kevin Camphausen
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Andra Valentina Krauze
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
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Barnett AE, Ozair A, Bamashmos AS, Li H, Bosler DS, Yeaney G, Ali A, Peereboom DM, Lathia JD, Ahluwalia MS. MGMT Methylation and Differential Survival Impact by Sex in Glioblastoma. Cancers (Basel) 2024; 16:1374. [PMID: 38611052 PMCID: PMC11011031 DOI: 10.3390/cancers16071374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: Sex differences in glioblastoma (GBM) have been observed in incidence, genetic and epigenetic alterations, and immune response. These differences have extended to the methylation of the MGMT promoter, which critically impacts temozolomide resistance. However, the association between sex, MGMT methylation, and survival is poorly understood, which this study sought to evaluate. Methods: A retrospective cohort study was conducted and reported following STROBE guidelines, based on adults with newly diagnosed GBM who received their first surgical intervention at Cleveland Clinic (Ohio, USA) between 2012 and 2018. Kaplan-Meier and multivariable Cox proportional hazards models were used to analyze the association between sex and MGMT promoter methylation status on overall survival (OS). MGMT was defined as methylated if the mean of CpG 1-5 ≥ 12. Propensity score matching was performed on a subset of patients to evaluate the effect of individual CpG site methylation. Results: A total of 464 patients had documented MGMT methylation status with a mean age of 63.4 (range 19-93) years. A total of 170 (36.6%) were female, and 133 (28.7%) received gross total resection as a first intervention. A total of 42.5% were MGMT methylated, with females more often having MGMT methylation than males (52.1% vs. 37.4%, p = 0.004). In univariable analysis, OS was significantly longer for MGMT promoter methylated than un-methylated groups for females (2 yr: 36.8% vs. 11.1%; median: 18.7 vs. 9.5 months; p = 0.001) but not for males (2 yr: 24.3% vs. 12.2%; median: 12.4 vs. 11.3 months; p = 0.22, p for MGMT-sex interaction = 0.02). In multivariable analysis, MGMT un-methylated versus methylated promoter females (2.07; 95% CI, 1.45-2.95; p < 0.0001) and males (1.51; 95% CI, 1.14-2.00; p = 0.004) had worse OS. Within the MGMT promoter methylated group, males had significantly worse OS than females (1.42; 95% CI: 1.01-1.99; p = 0.04). Amongst patients with data on MGMT CpG promoter site methylation values (n = 304), the median (IQR) of CpG mean methylation was 3.0% (2.0, 30.5). Females had greater mean CpG methylation than males (11.0 vs. 3.0, p < 0.002) and higher per-site CpG methylation with a significant difference at CPG 1, 2, and 4 (p < 0.008). After propensity score matching, females maintained a significant survival benefit (18.7 vs. 10.0 months, p = 0.004) compared to males (13.0 vs. 13.6 months, p = 0.76), and the pattern of difference was significant (P for CpG-sex interaction = 0.03). Conclusions: In this study, females had higher mean and individual CpG site methylation and received a greater PFS and OS benefit by MGMT methylation that was not seen in males despite equal degrees of CpG methylation.
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Affiliation(s)
- Addison E. Barnett
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH 44106, USA; (A.E.B.); (A.S.B.); (A.A.); (D.M.P.); (J.D.L.)
| | - Ahmad Ozair
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Anas S. Bamashmos
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH 44106, USA; (A.E.B.); (A.S.B.); (A.A.); (D.M.P.); (J.D.L.)
- NYU Langone Health, New York, NY 10016, USA
| | - Hong Li
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44106, USA;
| | - David S. Bosler
- Robert J. Tomisch Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (D.S.B.); (G.Y.)
| | - Gabrielle Yeaney
- Robert J. Tomisch Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (D.S.B.); (G.Y.)
| | - Assad Ali
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH 44106, USA; (A.E.B.); (A.S.B.); (A.A.); (D.M.P.); (J.D.L.)
| | - David M. Peereboom
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH 44106, USA; (A.E.B.); (A.S.B.); (A.A.); (D.M.P.); (J.D.L.)
| | - Justin D. Lathia
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH 44106, USA; (A.E.B.); (A.S.B.); (A.A.); (D.M.P.); (J.D.L.)
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Manmeet S. Ahluwalia
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH 44106, USA; (A.E.B.); (A.S.B.); (A.A.); (D.M.P.); (J.D.L.)
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
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McCord M, Jamshidi P, Thirunavu V, Santana-Santos L, Vormittag-Nocito E, Dittman D, Parker S, Baczkowski J, Jennings L, Walshon J, McCortney K, Galbraith K, Zhang H, Lukas RV, Stupp R, Dixit K, Kumthekar P, Heimberger AB, Snuderl M, Horbinski C. Variant allelic frequencies of driver mutations can identify gliomas with potentially false-negative MGMT promoter methylation results. Acta Neuropathol Commun 2023; 11:175. [PMID: 37919784 PMCID: PMC10623846 DOI: 10.1186/s40478-023-01680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
MGMT promoter methylation testing is required for prognosis and predicting temozolomide response in gliomas. Accurate results depend on sufficient tumor cellularity, but histologic estimates of cellularity are subjective. We sought to determine whether driver mutation variant allelic frequency (VAF) could serve as a more objective metric for cellularity and identify possible false-negative MGMT samples. Among 691 adult-type diffuse gliomas, MGMT promoter methylation was assessed by pyrosequencing (N = 445) or DNA methylation array (N = 246); VAFs of TERT and IDH driver mutations were assessed by next generation sequencing. MGMT results were analyzed in relation to VAF. By pyrosequencing, 56% of all gliomas with driver mutation VAF ≥ 0.325 had MGMT promoter methylation, versus only 37% with VAF < 0.325 (p < 0.0001). The mean MGMT promoter pyrosequencing score was 19.3% for samples with VAF VAF ≥ 0.325, versus 12.7% for samples with VAF < 0.325 (p < 0.0001). Optimal VAF cutoffs differed among glioma subtypes (IDH wildtype glioblastoma: 0.12-0.18, IDH mutant astrocytoma: ~0.33, IDH mutant and 1p/19q co-deleted oligodendroglioma: 0.3-0.4). Methylation array was more sensitive for MGMT promoter methylation at lower VAFs than pyrosequencing. Microscopic examination tended to overestimate tumor cellularity when VAF was low. Re-testing low-VAF cases with methylation array and droplet digital PCR (ddPCR) confirmed that a subset of them had originally been false-negative. We conclude that driver mutation VAF is a useful quality assurance metric when evaluating MGMT promoter methylation tests, as it can help identify possible false-negative cases.
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Affiliation(s)
- Matthew McCord
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Pouya Jamshidi
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Lucas Santana-Santos
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Erica Vormittag-Nocito
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - David Dittman
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Stephanie Parker
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Joseph Baczkowski
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Lawrence Jennings
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jordain Walshon
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Kathleen McCortney
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Kristyn Galbraith
- Department of Pathology, New York University Langone Health, New York, USA
| | - Hui Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Rimas V Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, USA
| | - Roger Stupp
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, USA
| | - Karan Dixit
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, USA
| | - Priya Kumthekar
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, USA
| | - Amy B Heimberger
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, USA
| | - Matija Snuderl
- Department of Pathology, New York University Langone Health, New York, USA
| | - Craig Horbinski
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA.
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA.
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, USA.
- Feinberg School of Medicine, Northwestern University, 303 E Superior Street, 6-518, Chicago, IL, 60611, USA.
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Buyuktepe M, Kaplan I, Bayatli E, Dogan H, Ugur HC. Significance of O6-methyl guanine methyltransferase promoter methylation in high grade glioma patients: optimal cutoff point, CpG locus, and genetic assay. J Neurooncol 2023; 164:171-177. [PMID: 37474746 DOI: 10.1007/s11060-023-04397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To evaluate O6-methyl guanine methyltransferase (MGMT) promoter methylation status in high grade glioma patients and to identify the best cutoff point as well as the most predictive CpG loci for patients survival. METHOD Consecutive high grade glioma patients treated with surgical gross total resection followed by concomitant radiochemotherapy and adjuvant chemotherapy were included in this retrospective observational study. Methylation status of MGMT promoter CpG island of resected tumor tissue were evaluated using next generation sequencing assay. The outcomes were grouped as CpG 70-78, CpG 79-83, CpG 84-87, CpG 70-87, and whole promoter. Quantitative analyses were dichotomized as methylated or unmethylated based on the cutoff points set to %10, and methylation was further graded as <%10 unmethylated, %10-30 low-methylated, and %30-100 high-methylated. RESULTS Total of 95 patients with the mean age of 51.50 ± 12.36 years were included in the study. Overall survival (OS) and progression free survival (PFS) were 14.53 ± 1.92 (95% CI 10.77-18.30) and 10.90 ± 2.05 (95% CI 6.89-14.92) months, respectively. MGMT promoter was methylated in 38.2% of cases and high-methylated in 10.5% of cases. Methylation status of MGMT promoter was recognized as a very powerful predictor of OS and PFS. In particular, high-methylation of CpG 79-83 and CpG 84-87 islands at promoter region were strongly associated with better survival outcomes (p < 0.05). CONCLUSION Our outcomes support the prognostic value of MGMT promoter methylation in patients with high grade glioma. Sequencing of whole promoter CpG islands demonstrated that methylation of particular CpG sites might predict clinical outcomes more precisely.
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Affiliation(s)
- Murat Buyuktepe
- Department of Neurosurgery, Unye State Hospital, Ordu, Turkey.
| | - Ibrahim Kaplan
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey
| | - Eyup Bayatli
- Departement of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Haldun Dogan
- INTERGEN Genetic Diagnosis and Research Center, Ankara, Turkey
| | - Hasan Caglar Ugur
- Departement of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
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Brighi N, Lamberti G, Andrini E, Mosconi C, Manuzzi L, Donati G, Lisotti A, Campana D. Prospective Evaluation of MGMT-Promoter Methylation Status and Correlations with Outcomes to Temozolomide-Based Chemotherapy in Well-Differentiated Neuroendocrine Tumors. Curr Oncol 2023; 30:1381-1394. [PMID: 36826067 PMCID: PMC9955977 DOI: 10.3390/curroncol30020106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Temozolomide (TEM) as a single agent or in combination with capecitabine (CAPTEM) is active in well-differentiated advanced neuroendocrine tumors (NETs) of gastro-entero-pancreatic and thoracic origin. The predictive role of MGMT-promoter methylation in this setting is controversial. We sought to prospectively evaluate the MGMT-promoter methylation status ability to predict outcomes to TEM-based chemotherapy in patients with NET. A single-center, prospective, observational study has been conducted at the ENETS Center-of-Excellence Outpatient Clinic of the IRCCS Policlinico Sant'Orsola-Malpighi in Bologna, Italy. Patients with advanced, gastro-entero-pancreatic or lung well-differentiated NETs candidate to TEM-based chemotherapy and with available tumor samples for MGMT-promoter methylation assessment were included. The MGMT-promoter methylation status was analyzed by using pyrosequencing. The primary endpoint was progression-free survival (PFS) by the MGMT-promoter methylation status. Secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety. Survival outcomes were compared by restricted mean survival time (RMST) difference. Of 26 screened patients, 22 were finally enrolled in the study. The most frequent NET primary sites were the pancreas (64%) and the lung (23%). MGMT promoter was methylated in five tumors (23%). At a median follow-up time of 47.2 months (95%CI 29.3-89.7), the median PFS was 32.8 months (95%CI 17.2-NA), while the median OS was not reached. Patients in the methylated MGMT group, when compared to those in the unmethylated MGMT group, had longer PFS (median not reached [95%CI NA-NA] vs. 30.2 months [95%CI 15.2-NA], respectively; RMST p = 0.005) and OS (median not reached [95%CI NA-NA] vs. not reached [40.1-NA], respectively; RMST p = 0.019). After adjusting for confounding factors, the MGMT-promoter methylation status was independently associated to the PFS. Numerically higher ORR (60% vs. 24%; p = 0.274) and DCR (100% vs. 88%; p = 1.00) were observed in the methylated vs. unmethylated MGMT group. TEM-based chemotherapy was well-tolerated (adverse events grade ≥3 < 10%). In this prospective study, MGMT-promoter methylation predicted better outcomes to TEM-based chemotherapy in patients with NET.
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Affiliation(s)
- Nicole Brighi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2142886
| | - Elisa Andrini
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lisa Manuzzi
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy
| | - Giada Donati
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Bologna, Italy
| | - Davide Campana
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
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MGMT Promoter Methylation as a Prognostic Factor in Primary Glioblastoma: A Single-Institution Observational Study. Biomedicines 2022; 10:biomedicines10082030. [PMID: 36009577 PMCID: PMC9405779 DOI: 10.3390/biomedicines10082030] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Glioblastoma is the most malignant central nervous system tumor, which represents 50% of all glial tumors. The understanding of glioma genesis, prognostic evaluation, and treatment planning has been significantly enhanced by the discovery of molecular genetic biomarkers. This study aimed to evaluate survival in patients with primary glioblastoma concerning O6-methylguanine–DNA methyltransferase (MGMT) promoter methylation and other clinical factors. The study included 41 newly diagnosed glioblastoma patients treated from 2011 to 2014 in the 10th Military Research Hospital and Polyclinic, Poland. All patients underwent surgical resection followed by radiation and chemotherapy with alkylating agents. The MGMT promoter methylation was evaluated in all patients, and 43% were found to be methylated. In 26 and 15 cases, gross total resection and subtotal resection were conducted, respectively. Patients with a methylated MGMT promoter had a median survival of 504 days, while those without methylation had a median survival of 329 days. The group that was examined had a median age of 53. In a patient group younger than 53 years, those with methylation had significantly longer overall survival (639 days), compared to 433.5 days for patients without methylation. The most prolonged survival (551 days) was in patients with MGMT promoter methylation after gross total resection. The value of MGMT promoter methylation as a predictive biomarker is widely acknowledged. However, its prognostic significance remains unclear. Our findings proved that MGMT promoter methylation is also an essential positive prognostic biomarker.
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Xing Z, Huang W, Su Y, Yang X, Zhou X, Cao D. Non-invasive prediction of p53 and Ki-67 labelling indices and O-6-methylguanine-DNA methyltransferase promoter methylation status in adult patients with isocitrate dehydrogenase wild-type glioblastomas using diffusion-weighted imaging and dynamic susceptibility contrast-enhanced perfusion-weighted imaging combined with conventional MRI. Clin Radiol 2022; 77:e576-e584. [PMID: 35469666 DOI: 10.1016/j.crad.2022.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/22/2022] [Indexed: 12/13/2022]
Abstract
AIM To assess whether conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) could non-invasively predict p53 and Ki-67 labelling index (LI) and O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status in adult isocitrate dehydrogenase (IDH) wild-type glioblastomas. METHODS The conventional MRI, DWI, and DSC-PWI results of 120 adult patients with IDH wild-type glioblastomas were reviewed retrospectively and their efficacy was analysed using chi-square tests or Fisher's exact test. Relative minimum apparent diffusion coefficient (rADCmin) and relative maximum cerebral blood volume (rCBVmax) values were compared between glioblastomas with different molecular statuses using the Mann-Whitney U-test. Receiver operating characteristic (ROC) curves and logistic regression were used to evaluate predictive performance. RESULTS Glioblastomas with a high p53 LI were more likely to show a well-defined enhancement margin (p=0.047). Glioblastomas in the high-Ki-67-LI group demonstrated significantly lower rADCmin (p<0.001) and higher rCBVmax (p=0.001) values than those in the low-Ki-67-LI group. Tumours without MGMT promoter methylation showed lower rADCmin (p<0.001) and higher rCBVmax (p<0.001) values than those with it. The rCBVmax value exhibited a greater efficacy in predicting the MGMT promoter methylation status of adult IDH wild-type glioblastomas than the rADCmin value (p=0.001). CONCLUSIONS The present results suggest that conventional and DWI and DSC-PWI results are influenced by the molecular status of the glioblastoma and indicate that DWI and DSC-PWI may help to identify regions of high invasiveness within heterogeneous glioblastomas.
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Affiliation(s)
- Z Xing
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - W Huang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China; Department of Radiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361000, China
| | - Y Su
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - X Yang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - X Zhou
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - D Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China; Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, China.
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Quantitative Analysis of the MGMT Methylation Status of Glioblastomas in Light of the 2021 WHO Classification. Cancers (Basel) 2022; 14:cancers14133149. [PMID: 35804921 PMCID: PMC9264886 DOI: 10.3390/cancers14133149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Glioblastomas with methylation of the promoter region of the O(6)-methylguanine-DNA methyltransferase (MGMT) gene exhibit increased sensitivity to alkylating chemotherapy. Quantitative assessment of the MGMT promoter methylation status might provide additional prognostic information. The aim of our study was to determine a quantitative methylation threshold for better survival among patients with glioblastomas. Methods: We included consecutive patients ≥18 years treated at our department between 11/2010 and 08/2018 for a glioblastoma, IDH wildtype, undergoing quantitative MGMT promoter methylation analysis. The primary endpoint was overall survival. Results: A total of 321 patients were included. Median overall survival was 12.6 months. Kaplan−Meier and adjusted Cox regression analysis showed better survival for the groups with 16−30%, 31−60%, and 61−100% methylation. In contrast, survival in the group with 1−15% methylation was similar to those with unmethylated promoter regions. A secondary analysis confirmed this threshold. Conclusions: Better survival is observed in patients with glioblastomas with ≥16% methylation of the MGMT promoter region than with <16% methylation. Survival with tumors with 1−15% methylation is similar to with unmethylated tumors. Above 16% methylation, we found no additional benefit with increasing methylation.
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MGMT and Whole-Genome DNA Methylation Impacts on Diagnosis, Prognosis and Therapy of Glioblastoma Multiforme. Int J Mol Sci 2022; 23:ijms23137148. [PMID: 35806153 PMCID: PMC9266959 DOI: 10.3390/ijms23137148] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Abstract
Epigenetic changes in DNA methylation contribute to the development of many diseases, including cancer. In glioblastoma multiforme, the most prevalent primary brain cancer and an incurable tumor with a median survival time of 15 months, a single epigenetic modification, the methylation of the O6-Methylguanine-DNA Methyltransferase (MGMT) gene, is a valid biomarker for predicting response to therapy with alkylating agents and also, independently, prognosis. More recently, the progress from single gene to whole-genome analysis of DNA methylation has allowed a better subclassification of glioblastomas. Here, we review the clinically relevant information that can be obtained by studying MGMT gene and whole-genome DNA methylation changes in glioblastomas, also highlighting benefits, including those of liquid biopsy, and pitfalls of the different detection methods. Finally, we discuss how changes in DNA methylation, especially in glioblastomas bearing mutations in the Isocitrate Dehydrogenase (IDH) 1 and 2 genes, can be exploited as targets for tailoring therapy.
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11
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Feng Z, Oberije CJG, van de Wetering AJP, Koch A, Wouters KAD, Vaes N, Masclee AAM, Carvalho B, Meijer GA, Zeegers MP, Herman JG, Melotte V, van Engeland M, Smits KM. Lessons From a Systematic Literature Search on Diagnostic DNA Methylation Biomarkers for Colorectal Cancer: How to Increase Research Value and Decrease Research Waste? Clin Transl Gastroenterol 2022; 13:e00499. [PMID: 35584320 PMCID: PMC9236597 DOI: 10.14309/ctg.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/22/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To improve colorectal cancer (CRC) survival and lower incidence rates, colonoscopy and/or fecal immunochemical test screening are widely implemented. Although candidate DNA methylation biomarkers have been published to improve or complement the fecal immunochemical test, clinical translation is limited. We describe technical and methodological problems encountered after a systematic literature search and provide recommendations to increase (clinical) value and decrease research waste in biomarker research. In addition, we present current evidence for diagnostic CRC DNA methylation biomarkers. METHODS A systematic literature search identified 331 diagnostic DNA methylation marker studies published before November 2020 in PubMed, EMBASE, Cochrane Library, and Google Scholar. For 136 bodily fluid studies, extended data extraction was performed. STARD criteria and level of evidence were registered to assess reporting quality and strength for clinical translation. RESULTS Our systematic literature search revealed multiple issues that hamper the development of DNA methylation biomarkers for CRC diagnosis, including methodological and technical heterogeneity and lack of validation or clinical translation. For example, clinical translation and independent validation were limited, with 100 of 434 markers (23%) studied in bodily fluids, 3 of 434 markers (0.7%) translated into clinical tests, and independent validation for 92 of 411 tissue markers (22%) and 59 of 100 bodily fluids markers (59%). DISCUSSION This systematic literature search revealed that major requirements to develop clinically relevant diagnostic CRC DNA methylation markers are often lacking. To avoid the resulting research waste, clinical needs, intended biomarker use, and independent validation should be better considered before study design. In addition, improved reporting quality would facilitate meta-analysis, thereby increasing the level of evidence and enabling clinical translation.
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Affiliation(s)
- Zheng Feng
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
| | - Cary J. G. Oberije
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands;
| | - Alouisa J. P. van de Wetering
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands;
| | - Alexander Koch
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
| | - Kim. A. D. Wouters
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
| | - Nathalie Vaes
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
| | - Ad A. M. Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands;
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands;
| | - Beatriz Carvalho
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands;
| | - Gerrit A. Meijer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands;
| | - Maurice P. Zeegers
- Department of Complex Genetics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands;
- Department of Complex Genetics, CAPHRI – Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands;
| | - James G. Herman
- Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Veerle Melotte
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
- Department of Clinical Genetics, Erasmus University Medical Center, University of Rotterdam, Rotterdam, the Netherlands;
| | - Manon van Engeland
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
| | - Kim M. Smits
- Department of Pathology, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands;
- Division of Medical Oncology, Department of Internal Medicine, GROW – School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands.
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12
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Caccese M, Simonelli M, Villani V, Rizzato S, Ius T, Pasqualetti F, Russo M, Rudà R, Amoroso R, Bellu L, Bertorelle R, Cavallin F, Dipasquale A, Carosi M, Pizzolitto S, Cesselli D, Persico P, Casini B, Fassan M, Zagonel V, Lombardi G. Definition of the Prognostic Role of MGMT Promoter Methylation Value by Pyrosequencing in Newly Diagnosed IDH Wild-Type Glioblastoma Patients Treated with Radiochemotherapy: A Large Multicenter Study. Cancers (Basel) 2022; 14:cancers14102425. [PMID: 35626029 PMCID: PMC9139569 DOI: 10.3390/cancers14102425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background. O6-methylguanine (O6-MeG)-DNA methyltransferase (MGMT) methylation status is a predictive factor for alkylating treatment efficacy in glioblastoma patients, but its prognostic role is still unclear. We performed a large, multicenter study to evaluate the association between MGMT methylation value and survival. Methods. We evaluated glioblastoma patients with an assessment of MGMT methylation status by pyrosequencing from nine Italian centers. The inclusion criteria were histological diagnosis of IDH wild-type glioblastoma, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ≤2, and radio-chemotherapy treatment with temozolomide. The relationship between OS and MGMT was investigated with a time-dependent Receiver Operating Characteristics (ROC) curve and Cox regression models. Results. In total, 591 newly diagnosed glioblastoma patients were analyzed. The median OS was 16.2 months. The ROC analysis suggested a cut-off of 15% for MGMT methylation. The 2-year Overall Survival (OS) was 18.3% and 51.8% for MGMT methylation <15% and ≥15% (p < 0.0001). In the multivariable analysis, MGMT methylation <15% was associated with impaired survival (p < 0.00001). However, we also found a non-linear association between MGMT methylation and OS (p = 0.002): median OS was 14.8 months for MGMT in 0−4%, 18.9 months for MGMT in 4−40%, and 29.9 months for MGMT in 40−100%. Conclusions. Our findings suggested a non-linear relationship between OS and MGMT promoter methylation, which implies a varying magnitude of prognostic effect across values of MGMT promoter methylation by pyrosequencing in newly diagnosed IDH wild-type glioblastoma patients treated with chemoradiotherapy.
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Affiliation(s)
- Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (V.Z.); (G.L.)
- Correspondence: ; Tel.: +39-(0)4-9821-5888
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (A.D.); (P.P.)
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Veronica Villani
- Neuro-Oncology Unit, Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Simona Rizzato
- Department of Oncology, Central Friuli University Health Authority, 33100 Udine, Italy;
| | - Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Francesco Pasqualetti
- Radiation Oncology Unit, Pisa University Hospital, 56121 Pisa, Italy;
- Department of Oncology, University of Oxford, Oxford OX1 4BH, UK
| | - Marco Russo
- Neurology Unit, Neuromotor Department, Azienda USL-IRCCS Reggio Emilia, 42121 Emilia, Italy;
| | - Roberta Rudà
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, 10094 Torino, Italy;
- Neurology Unit, Hospital of Castelfranco Veneto, 31033 Castelfranco Veneto, Italy
| | - Rosina Amoroso
- Neurosurgery Unit, Department of Surgery, Hospital of Livorno, Azienda Asl Toscana Nord Ovest, 57100 Livorno, Italy;
| | - Luisa Bellu
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
| | - Roberta Bertorelle
- Immunology and Molecular Oncology Unit, Department of Oncology, Veneto Institute of Oncology IOV IRCCS, 35128 Padua, Italy;
| | | | - Angelo Dipasquale
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (A.D.); (P.P.)
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Mariantonia Carosi
- Pathology Unit, Regina Elena National Cancer Institute, 00161 Rome, Italy; (M.C.); (B.C.)
| | - Stefano Pizzolitto
- Department of Surgical Pathology, Central Friuli University Health Authority, 33100 Udine, Italy;
| | - Daniela Cesselli
- Department of Laboratory Medicine, Institute of Pathology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (M.S.); (A.D.); (P.P.)
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Beatrice Casini
- Pathology Unit, Regina Elena National Cancer Institute, 00161 Rome, Italy; (M.C.); (B.C.)
| | - Matteo Fassan
- Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, 35128 Padua, Italy;
- Cytopathology Unit, Department of Medicine (DIMED), Surgical Pathology & AMP, University of Padua, 35128 Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (V.Z.); (G.L.)
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (V.Z.); (G.L.)
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13
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Brat DJ, Aldape K, Bridge JA, Canoll P, Colman H, Hameed MR, Harris BT, Hattab EM, Huse JT, Jenkins RB, Lopez-Terrada DH, McDonald WC, Rodriguez FJ, Souter LH, Colasacco C, Thomas NE, Yount MH, van den Bent MJ, Perry A. Molecular Biomarker Testing for the Diagnosis of Diffuse Gliomas. Arch Pathol Lab Med 2022; 146:547-574. [PMID: 35175291 PMCID: PMC9311267 DOI: 10.5858/arpa.2021-0295-cp] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The diagnosis and clinical management of patients with diffuse gliomas (DGs) have evolved rapidly over the past decade with the emergence of molecular biomarkers that are used to classify, stratify risk, and predict treatment response for optimal clinical care. OBJECTIVE.— To develop evidence-based recommendations for informing molecular biomarker testing for pediatric and adult patients with DGs and provide guidance for appropriate laboratory test and biomarker selection for optimal diagnosis, risk stratification, and prediction. DESIGN.— The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. A systematic review of literature was conducted to address the overarching question, "What ancillary tests are needed to classify DGs and sufficiently inform the clinical management of patients?" Recommendations were derived from quality of evidence, open comment feedback, and expert panel consensus. RESULTS.— Thirteen recommendations and 3 good practice statements were established to guide pathologists and treating physicians on the most appropriate methods and molecular biomarkers to include in laboratory testing to inform clinical management of patients with DGs. CONCLUSIONS.— Evidence-based incorporation of laboratory results from molecular biomarker testing into integrated diagnoses of DGs provides reproducible and clinically meaningful information for patient management.
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Affiliation(s)
- Daniel J. Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Julia A. Bridge
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE; Cytogenetics, ProPath, Dallas, TX
| | - Peter Canoll
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Howard Colman
- Department of Neurosurgery and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Meera R. Hameed
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Brent T. Harris
- Department of Neurology and Pathology, MedStar Georgetown University Hospital, Washington, DC
| | - Eyas M. Hattab
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY
| | - Jason T. Huse
- Departments of Pathology and Translational Molecular Pathology, University of Texas MD, Anderson Cancer Center, Houston, TX
| | - Robert B. Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Dolores H. Lopez-Terrada
- Departments of Pathology and Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | | | | | | | | | | | | | - Martin J. van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arie Perry
- Departments of Pathology and Neurological Surgery University of California San Francisco School of Medicine, San Francisco, CA
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14
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MGMT gene promoter methylation by pyrosequencing method correlates volumetric response and neurological status in IDH wild-type glioblastomas. J Neurooncol 2022; 157:561-571. [PMID: 35397757 PMCID: PMC9072488 DOI: 10.1007/s11060-022-03999-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/24/2022] [Indexed: 01/03/2023]
Abstract
Purpose Although the usefulness of O6-methylguanine DNA methyltransferase (MGMT) promoter methylation analysis for predicting response to chemoradiotherapy and the prognosis of patients with glioblastoma has been widely reported, there is still no consensus regarding how to define MGMT promoter methylation percentage (MGMTpm%) cutoffs by pyrosequencing method. The aim of this study was to determine the optimal cutoff value of MGMT promoter methylation status using volumetric analysis focused on the tumor volume ratio (TVR) measured by MRI. Methods This retrospective study included newly diagnosed IDH wild-type glioblastoma patients with residual tumor after surgery, followed by local radiotherapy with temozolomide. TVR was defined as the tumor volume at 6 months after the initial chemoradiotherapy administration divided by the tumor volume before the start of therapy. The mean MGMTpm% of 16 CpG islands (74–89) was analyzed using pyrosequencing. We statistically analyzed the correlation between MGMTpm%, TVR, and change in Karnofsky performance status. Results The study included 44 patients with residual tumors. Thirteen (92.9%) of 14 patients with MGMTpm% ≥ 23.9% showed 50% or more volumetric response, leading to prolonged survival, and 17 (70.8%) of 24 patients with MGMTpm% < 8.2% had progressive disease after initial chemoradiotherapy administration. Three (50.0%) of six patients with MGMTpm% 8.2% to < 23.9% had stable disease or partial response. Conclusion Evaluation of MGMTpm% by pyrosequencing is important in predicting the volumetric response and prognosis of glioblastoma patients with residual tumors.
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Ji H, Li K, Jiang W, Li J, Zhang JA, Zhu X. MRVI1 and NTRK3 Are Potential Tumor Suppressor Genes Commonly Inactivated by DNA Methylation in Cervical Cancer. Front Oncol 2022; 11:802068. [PMID: 35141152 PMCID: PMC8818726 DOI: 10.3389/fonc.2021.802068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
The abnormally methylated tumor suppressor genes (TSGs) associated with cervical cancer are unclear. DNA methylation data, RNA-seq expression profiles, and overall survival data were downloaded from TCGA CESC database. DMGs and DEGs were obtained through CHAMP and DESeq packages, respectively. TSGs were downloaded from TSGene 2.0. Candidate hypermethylated/down-regulated TSGs were further evaluated and pyrosequencing was used to confirm their difference in methylation levels of selected TSGs in cervical cancer patients. A total of 25946 differentially methylated CpGs corresponding to 2686 hypermethylated genes and 4898 hypomethylated genes between cervical cancer and adjacent normal cervical tissues were found in this study. Besides, 693 DEGs (109 up-regulated and 584 down-regulated) were discovered in cervical cancer tissues. Then, 192 hypermethylated/down-regulated genes were obtained in cervical cancer compared to adjacent tissues. Interestingly, 26 TSGs were found in hypermethylated/down-regulated genes. Among these genes, low expression of MRVI1 and NTRK3 was associated with poor overall survival in cervical cancer. Moreover, GEO data showed that MRVI1 and NTRK3 were significantly decreased in cervical cancer tissues. The expression levels of MRVI1 and NTRK3 were negatively correlated with the methylation levels of their promoter CpG sites. Additionally, elevated methylation levels of MRVI1 and NTRK3 promoter were further verified in cervical cancer tissues by pyrosequencing experiments. Finally, the ROC results showed that the promoter methylation levels of MRVI1 and NTRK3 had the ability to discriminate cervical cancer from healthy samples. The study contributes to our understanding of the roles of MRVI1 and NTRK3 in cervical cancer.
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Affiliation(s)
- Huihui Ji
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kehan Li
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenxiao Jiang
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingwei Li
- Department of Obstetrics and Gynecology, Taizhou Woman and Children’s Hospital of Wenzhou Medical University, Taizhou, China
| | - Jian-an Zhang
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqiong Zhu
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, Taizhou Woman and Children’s Hospital of Wenzhou Medical University, Taizhou, China
- *Correspondence: Xueqiong Zhu,
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16
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Liu D, Yang T, Ma W, Wang Y. Clinical strategies to manage adult glioblastoma patients without MGMT hypermethylation. J Cancer 2022; 13:354-363. [PMID: 34976195 PMCID: PMC8692679 DOI: 10.7150/jca.63595] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/21/2021] [Indexed: 01/11/2023] Open
Abstract
Glioblastoma (GBM) is a highly malignant brain tumor with a dismal prognosis. Standard therapy for GBM comprises surgical resection, followed by radiotherapy plus concomitant and adjuvant temozolomide (TMZ) therapy. The methylation status of the O6-methylguanine DNA methyltransferase (MGMT) promoter is one of the most essential predictive biomarkers for patients with GBM treated with TMZ. Patients with an unmethylated MGMT promoter (umMGMT), who comprise 60% of patients with GBM, present an even worse prognosis because of TMZ resistance. Radiotherapy with various fractionation, chemotherapy compensating for TMZ, targeted therapy against diverse oncogenic pathways, immunotherapy of vaccine or immune checkpoint inhibitor, and tumor treating fields have been studied in umMGMT GBM patients. However, most efforts have yielded negative results or merely minimal improvements. Therefore, effective patient subgroup selection concerning precision medicine has become the focus. By assigning different treatments to the corresponding patient subgroups, a better curative effect and subsequently prolonged survival can be achieved. In this review, we re-evaluate the value of standard TMZ therapy and summarize the new clinical strategies and attempts to treat patients with umMGMT, which yielded positive and negative results, to provide alternative treatment options and discuss future directions of umMGMT GBM treatment.
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Affiliation(s)
- Delin Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Tianrui Yang
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Yu Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
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Alizadeh-Sedigh M, Fazeli MS, Mahmoodzadeh H, Sharif SB, Teimoori-Toolabi L. Methylation of FBN1, SPG20, ITF2, RUNX3, SNCA, MLH1, and SEPT9 genes in circulating cell-free DNA as biomarkers of colorectal cancer. Cancer Biomark 2021; 34:221-250. [PMID: 34957998 DOI: 10.3233/cbm-210315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Investigating aberrant tumor-specific methylation in plasma cell-free DNA provides a promising and noninvasive biomarker for cancer detection. OBJECTIVE We aimed to investigate methylation status of some promoter regions in the plasma and tumor tissues to find biomarkers for early detection of colorectal cancer. METHODS This case-control study on seventy colorectal cancer patients and fifty matched healthy controls used Methylation-Specific High-Resolution Melting Curve analysis to evaluate the methylation of the selected promoter regions in converted genomic tissue DNA and plasma cfDNA. RESULTS The methylation levels in selected regions of SPG20 (+24375 to +24680, +24209 to +24399, and +23625 to +23883), SNCA (+807 to +1013, +7 to +162, and -180 to +7), FBN1 (+223 to +429, +1 to +245, and -18 to -175), ITF2 (+296 to +436 and -180 to +55), SEPT9 (-914412 to -91590 and -99083 to -92264), and MLH1 (-13 to +22) were significantly higher in tumor tissues compared with normal adjacent tissues. The methylation levels of FBN1, ITF2, SNCA, and SPG20 promoters were significantly higher in the patient's plasma compared to patient's normal tissue and plasma of healthy control subjects. FBN1, SPG20, and SEPT9 promoter methylation had a good diagnostic performance for discriminating CRC tissues from normal adjacent tissues (AUC > 0.8). A panel of SPG20, FBN1, and SEPT9 methylation had a higher diagnostic value than that of any single biomarker and other panels in tissue-based assay (AUC > 0.9). The methylation of FBN1(a) and SPG20(a) regions, as the closest region to the first coding sequence (CDS), had a good diagnostic performance in plasma cfDNA (AUC > 0.8) while a panel consisted of FBN1(a) and SPG20(a) regions showed excellent diagnostic performance for CRC detection in plasma cfDNA (AUC > 0.9). CONCLUSION Methylation of FBN1(a) and SPG20(a) promoter regions in the plasma cfDNA can be an excellent simple, non-invasive blood-based test for early detection of CRC.
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Affiliation(s)
- Maryam Alizadeh-Sedigh
- Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Sadegh Fazeli
- Department of Surgery, Division of Colorectal Surgery, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibollah Mahmoodzadeh
- Cancer Institute of Iran, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Behrouz Sharif
- Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Ladan Teimoori-Toolabi
- Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
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18
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Nguyen N, Redfield J, Ballo M, Michael M, Sorenson J, Dibaba D, Wan J, Ramos GD, Pandey M. Identifying the optimal cutoff point for MGMT promoter methylation status in glioblastoma. CNS Oncol 2021; 10:CNS74. [PMID: 34486380 PMCID: PMC8461752 DOI: 10.2217/cns-2021-0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: To define the optimal cutoff point for determining methylation status of O6-methylguanine-DNA methyltransferase (MGMT) by pyrosequencing in glioblastoma. Patients & methods: A retrospective study of 109 glioblastoma patients was performed to determine the optimal cutoff point for MGMT methylation status. Results: Receiver operating characteristic (ROC) analysis revealed 21% as the optimal cutoff (sensitivity: 68%; specificity: 59%) for MGMT methylation corresponding with the highest likelihood ratio of 1.66 and accuracy of 0.65. Methylation status (hazard ratio: 0.453; 95% CI: 0.279-0.735; p = 0.001) was associated with better overall survival. The crude model indicated linearity between methylation percent and survival rate; an increase of 10% of methylation resulted in a reduction of risk of death by 20% (p = 0.004). Conclusion: ROC analysis determined 21% as the optimal cutoff point for MGMT methylation status by pyrosequencing.
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Affiliation(s)
- Ngan Nguyen
- University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jordan Redfield
- University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Matthew Ballo
- Deparment of Radiation Oncology, West Cancer Center & Research Institute, Memphis, TN 38138, USA
| | - Madison Michael
- Department of Neurosurgery at University of Tennessee Health Science Center & Semmes Murphey Clinic, Memphis, TN 38163, USA
| | - Jeffrey Sorenson
- Department of Neurosurgery at University of Tennessee Health Science Center & Semmes Murphey Clinic, Memphis, TN 38163, USA
| | - Daniel Dibaba
- University of Tennessee Health Science Center, Tennessee Clinical & Translational Science Institute, Memphis, TN 38163, USA
| | - Jim Wan
- University of Tennessee Health Science Center, Tennessee Clinical & Translational Science Institute, Memphis, TN 38163, USA
| | | | - Manjari Pandey
- Department of Hematology and Oncology, University of Tennessee Health Science Center & West Cancer Center & Research Institute, Memphis, TN 38138, USA
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19
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Brandner S, McAleenan A, Kelly C, Spiga F, Cheng HY, Dawson S, Schmidt L, Faulkner CL, Wragg C, Jefferies S, Higgins JPT, Kurian KM. MGMT promoter methylation testing to predict overall survival in people with glioblastoma treated with temozolomide: a comprehensive meta-analysis based on a Cochrane Systematic Review. Neuro Oncol 2021; 23:1457-1469. [PMID: 34467991 PMCID: PMC8408882 DOI: 10.1093/neuonc/noab105] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The DNA repair protein O6-methylguanine-DNA methyltransferase (MGMT) causes resistance of tumor cells to alkylating agents. It is a predictive biomarker in high-grade gliomas treated with temozolomide, however, there is no consensus on which test method, methylation sites, and cutoff values to use. METHODS We performed a Cochrane Review to examine studies using different techniques to measure MGMT and predict survival in glioblastoma patients treated with temozolomide. Eligible longitudinal studies included (i) adults with glioblastoma treated with temozolomide with or without radiotherapy, or surgery; (ii) where MGMT status was determined in tumor tissue, and assessed by 1 or more technique; and (iii) where overall survival was an outcome parameter, with sufficient information to estimate hazard ratios (HRs). Two or more methods were compared in 32 independent cohorts with 3474 patients. RESULTS Methylation-specific PCR (MSP) and pyrosequencing (PSQ) techniques were more prognostic than immunohistochemistry for MGMT protein, and PSQ is a slightly better predictor than MSP. CONCLUSIONS We cannot draw strong conclusions about use of frozen tissue vs formalin-fixed paraffin-embedded in MSP and PSQ. Also, our meta-analysis does not provide strong evidence about the best CpG sites or threshold. MSP has been studied mainly for CpG sites 76-80 and 84-87 and PSQ at CpG sites ranging from 72 to 95. A cutoff threshold of 9% for CpG sites 74-78 performed better than higher thresholds of 28% or 29% in 2 of the 3 good-quality studies. About 190 studies were identified presenting HRs from survival analysis in patients in which MGMT methylation was measured by 1 technique only.
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Affiliation(s)
- Sebastian Brandner
- Division of Neuropathology and Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire Kelly
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hung-Yuan Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire L Faulkner
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Christopher Wragg
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Sarah Jefferies
- Department of Oncology, Addenbrooke’s Hospital, Cambridge, UK
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kathreena M Kurian
- Bristol Medical School, Brain Tumour Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
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20
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Osawa T, Tosaka M, Horiguchi K, Sugawara K, Yokoo H, Yoshimoto Y. Elderly patients aged over 75 years with glioblastoma: Preoperative status and surgical strategies. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Li M, Dong G, Zhang W, Ren X, Jiang H, Yang C, Zhao X, Zhu Q, Li M, Chen H, Yu K, Cui Y, Song L. Combining MGMT promoter pyrosequencing and protein expression to optimize prognosis stratification in glioblastoma. Cancer Sci 2021; 112:3699-3710. [PMID: 34115910 PMCID: PMC8409410 DOI: 10.1111/cas.15024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/16/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
Pyrosequencing (PSQ) represents the golden standard for MGMT promoter status determination. Binary interpretation of results based on the threshold from the average of several CpGs tested would neglect the existence of the “gray zone”. How to define the gray zone and reclassify patients in this subgroup remains to be elucidated. A consecutive cohort of 312 primary glioblastoma patients were enrolled. CpGs 74‐81 in the promoter region of MGMT were tested by PSQ and the protein expression was assessed by immunohistochemistry (IHC). Receiver operating characteristic curves were constructed to calculate the area under the curves (AUC). Kaplan‐Meier plots were used to estimate the survival rate of patients compared by the log‐rank test. The optimal threshold of each individual CpG differed from 5% to 11%. Patients could be separated into the hypomethylated subgroup (all CpGs tested below the corresponding optimal thresholds, n = 126, 40.4%), hypermethylated subgroup (all CpGs tested above the corresponding optimal thresholds, n = 108, 34.6%), and the gray zone subgroup (remaining patients, n = 78, 25.0%). Patients in the gray zone harbored an intermediate prognosis. The IHC score instead of the average methylation levels could successfully predict the prognosis for the gray zone (AUC for overall survival, 0.653 and 0.519, respectively). Combining PSQ and IHC significantly improved the efficiency of survival prediction (AUC: 0.662, 0.648, and 0.720 for PSQ, IHC, and combined, respectively). Immunohistochemistry is a robust method to predict prognosis for patients in the gray zone defined by PSQ. Combining PSQ and IHC could significantly improve the predictive ability for clinical outcomes.
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Affiliation(s)
- Mingxiao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gehong Dong
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiwei Zhang
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haihui Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuanwei Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuzhe Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qinghui Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongyan Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kefu Yu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Cui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Brain Tumor, Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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22
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Berzero G, Bellu L, Baldini C, Ducray F, Guyon D, Eoli M, Silvani A, Dehais C, Idbaih A, Younan N, Nguyen-Them L, Gaillard S, Pasqualetti F, Lepage-Seydoux C, Sekkate S, Tresca P, Kas A, Gratieux J, Ammari S, Saragoussi E, Savatovsky J, Delattre JY, Hoang-Xuan K, Meyronet D, Villa C, Bielle F, Sanson M, Touat M, Di Stefano AL. Sustained Tumor Control With MAPK Inhibition in BRAF V600-Mutant Adult Glial and Glioneuronal Tumors. Neurology 2021; 97:e673-e683. [PMID: 34088874 DOI: 10.1212/wnl.0000000000012330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/11/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess whether RAF and MEK inhibitors (RAFi/MEKi) can provide long-term clinical benefit in adult patients with BRAF V600-mutant glial and glioneuronal tumors (GGNTs), we analyzed tumor response and long-term outcome in a retrospective cohort. METHODS We performed a retrospective search in the institutional databases of 6 neuro-oncology departments for adult patients with recurrent or disseminated BRAF V600-mutant GGNTs treated with RAFi/MEKi. RESULTS Twenty-eight adults with recurrent or disseminated BRAF V600-mutant gangliogliomas (n = 9), pleomorphic xanthoastrocytomas (n = 9), and diffuse gliomas (n = 10) were included in the study. At the time that treatment with RAFi/MEKi was started, all tumors displayed radiologic features of high-grade neoplasms. Thirteen patients received RAFi as single agents (vemurafenib [n = 11], dabrafenib [n = 2]), and 15 received combinations of RAFi/MEKi (vemurafenib + cobimetinib [n = 5], dabrafenib + trametinib [n = 10]). Eleven patients achieved a partial or complete response (11 of 28, 39%), with a median reduction of -78% in their tumor burden. Responders experienced a median increase of 10 points in their Karnofsky Performance Status (KPS) score and a median progression-free survival of 18 months, which was longer than achieved with first-line treatment (i.e., 7 months, p = 0.047). Responders had better KPS score (p = 0.018) and tended to be younger (p = 0.061) and to be treated earlier (p = 0.099) compared to nonresponders. Five patients were rechallenged with RAFi/MEKi at progression, with novel tumor responses in 2. On univariate and multivariate analyses, response to RAFi/MEKi was an independent predictor of overall survival. CONCLUSIONS Our study highlights the long-term clinical benefits of RAFi/MEKi in adult patients with BRAF V600-mutant GGNTs and encourages rechallenge in responders. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that, for adult patients with BRAF V600-mutant GGNT, RAFi/MEKi can reduce tumor burden and provide clinical benefit.
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Affiliation(s)
- Giulia Berzero
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Luisa Bellu
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Capucine Baldini
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - François Ducray
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - David Guyon
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Marica Eoli
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Antonio Silvani
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Caroline Dehais
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Ahmed Idbaih
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Nadia Younan
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Ludovic Nguyen-Them
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Stephan Gaillard
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Francesco Pasqualetti
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Coralie Lepage-Seydoux
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Sakina Sekkate
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Patricia Tresca
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Aurélie Kas
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Julie Gratieux
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Samy Ammari
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Edouard Saragoussi
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Julien Savatovsky
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Jean-Yves Delattre
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Khê Hoang-Xuan
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - David Meyronet
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Chiara Villa
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Franck Bielle
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Marc Sanson
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Mehdi Touat
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris
| | - Anna Luisa Di Stefano
- From Sorbonne Université (G.B., L.B., C.D., A.I., J.-Y.D., K.H.-X., F.B., M.S., M.T., A.L.D.S.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, and AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France; Radiation Therapy Unit (L.B.), Imaging and Medical Physics Department, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy; Drug Development Department (C.B.), Institut Gustave Roussy and Université Paris-Saclay, Villejuif; Department of Neuroncology (F.D.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Department of Neurology (D.G., N.Y., A.L.D.S.), Department of Neurosurgery (S.G.), Service de Pharmacie (C.L.-S.), Department of Oncology (S.S.), Department of Neuroradiology (J.G.), and Department of Pathology (C.V.), Hôpital Foch, Suresnes, France; Neuro-oncology Unit (M.E., A.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Service de Neurologie (L.N.T.), Centre Hospitalier Perpignan, France; Radiation Oncology (F.P.), Department of Medicine and Oncology, University Hospital, Pisa, Italy; Clinical Research Unit (P.T.), Institut Curie, Paris; Department of Nuclear Medicine (A.K.), AP-HP GH Pitié-Salpêtrière, Paris; Department of Diagnostic Radiology (S.A.), Institut Gustave Roussy, Villejuif, France; Neuroradiology Unit (E.S., J.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris; Department of Pathology (D.M.), Eastern Hospital Group, Lyon Civil Hospices; Department of Neuropathology (F.B.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Onconeurotek Tumor Bank (F.B., M.S.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France. Dr. Berzero is currently at Neurology Unit (G.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Dr. Gaillard is currently at the Department of Neurosurgery, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris.
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23
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Spada F, Maisonneuve P, Fumagalli C, Marconcini R, Gelsomino F, Antonuzzo L, Campana D, Puliafito I, Rossi G, Faviana P, Messerini L, Barberis M, Fazio N. Temozolomide alone or in combination with capecitabine in patients with advanced neuroendocrine neoplasms: an Italian multicenter real-world analysis. Endocrine 2021; 72:268-278. [PMID: 32700133 DOI: 10.1007/s12020-020-02421-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/09/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Temozolomide (TEM) has been reported to be active alone or in combination with capecitabine (CAP) in patients with neuroendocrine neoplasms (NENs). We retrospectively evaluated activity and toxicity of TEM-based chemotherapy in patients with advanced NENs and explored the potential correlation with clinical/biological factors. METHODS Patients received oral TEM alone or in combination with CAP. Objective response rate (ORR) [complete response + partial response (PR)], median progression-free survival (mPFS), and toxicity were calculated. The O6-methylguanine-DNA-methyltransferase (MGMT) gene inactivation status in tumor tissue was evaluated by pyrosequencing. RESULTS From September 2008 to April 2020, 170 patients (84% progressive on different therapies) were consecutively treated, 114 (67%) patients received TEM-CAP and 56 (33%) TEM alone. Primary tumor sites were: pancreas 98 (58%), gastrointestinal tract 21 (12%), lung 35 (21%), and unknown 16 (9%). The ORR was 28% for the whole population (33% for TEM-CAP and 18% for TEM as single agent). The median OS (mOS) and mPFS of the whole population were 35.6 months (32.6-48.7) and 14.7 months (10.1-18.3), respectively. There were 48% PR in the MGMT hypermethylated, mainly in pancreatic NENs. Vomiting and leukopenia were the most frequent grade 3/4 toxicity. CONCLUSIONS This large retrospective analysis suggested that a TEM-based chemotherapy is active in advanced, pretreated NEN patients. It generated solid hypotheses that warrant a future prospective study in a biological homogeneous NEN population and clinical setting.
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Affiliation(s)
- Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Caterina Fumagalli
- Histopathology and Molecular Diagnostics Unit, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Riccardo Marconcini
- Department of Oncology 2, Santa Chiara Hospital, Via Roma 67, 56100, Pisa, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital, Via del Pozzo 70, 41100, Modena, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology 1, AOU Careggi Hospital, Viale Pieraccini 17, 50139, Firenze, Italy
| | - Davide Campana
- Scienze Mediche e Chirurgiche, Azienda Ospedaliero-Universitaria, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Ivana Puliafito
- Oncologia Medica, Istituto Oncologico del Mediterraneo (IOM), Via Penninazzo 7, 95029, Viagrande, Italy
| | - Giulio Rossi
- Anatomia Patologica, Azienda USL Romagna, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Pinuccia Faviana
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Via Paradisa 2, 56126, Pisa, Italy
| | - Luca Messerini
- Division of Human Pathology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Firenze, Italy
| | - Massimo Barberis
- Histopathology and Molecular Diagnostics Unit, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
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24
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Di Stefano AL, Picca A, Saragoussi E, Bielle F, Ducray F, Villa C, Eoli M, Paterra R, Bellu L, Mathon B, Capelle L, Bourg V, Gloaguen A, Philippe C, Frouin V, Schmitt Y, Lerond J, Leclerc J, Lasorella A, Iavarone A, Mokhtari K, Savatovsky J, Alentorn A, Sanson M. Clinical, molecular, and radiomic profile of gliomas with FGFR3-TACC3 fusions. Neuro Oncol 2021; 22:1614-1624. [PMID: 32413119 DOI: 10.1093/neuonc/noaa121] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Actionable fibroblast growth factor receptor 3 (FGFR3)-transforming acidic coiled-coil protein 3 fusions (F3T3) are found in approximately 3% of gliomas, but their characteristics and prognostic significance are still poorly defined. Our goal was to characterize the clinical, radiological, and molecular profile of F3T3 positive diffuse gliomas. METHODS We screened F3T3 fusion by real-time (RT)-PCR and FGFR3 immunohistochemistry in a large series of gliomas, characterized for main genetic alterations, histology, and clinical evolution. We performed a radiological and radiomic case control study, using an exploratory and a validation cohort. RESULTS We screened 1162 diffuse gliomas (951 unselected cases and 211 preselected for FGFR3 protein immunopositivity), identifying 80 F3T3 positive gliomas. F3T3 was mutually exclusive with IDH mutation (P < 0.001) and EGFR amplification (P = 0.01), defining a distinct molecular cluster associated with CDK4 (P = 0.04) and MDM2 amplification (P = 0.03). F3T3 fusion was associated with longer survival for the whole series and for glioblastomas (median overall survival was 31.1 vs 19.9 mo, P = 0.02) and was an independent predictor of better outcome on multivariate analysis.F3T3 positive gliomas had specific MRI features, affecting preferentially insula and temporal lobe, and with poorly defined tumor margins. F3T3 fusion was correctly predicted by radiomics analysis on both the exploratory (area under the curve [AUC] = 0.87) and the validation MRI (AUC = 0.75) cohort. Using Cox proportional hazards models, radiomics predicted survival with a high C-index (0.75, SD 0.04), while the model combining clinical, genetic, and radiomic data showed the highest C-index (0.81, SD 0.04). CONCLUSION F3T3 positive gliomas have distinct molecular and radiological features, and better outcome.
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Affiliation(s)
- Anna Luisa Di Stefano
- Inserm Unit 1127, Sorbonne University, Institute of the Brain and Spinal Cord, Paris, France.,SiRIC CURAMUS, LNCC (équipe labellisée).,Department of Neuropathology 2, Pitié-Salpêtrière Hospital,Paris, France.,Department of Neurology, Foch Hospital, Suresnes, France
| | - Alberto Picca
- C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Edouard Saragoussi
- Department of Radiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Franck Bielle
- Department of Neuropathology, Pitié Salpêtrière-Charles Foix, Paris, France
| | - Francois Ducray
- Department of Neuro-Oncology, Civil Hospice of Lyon, University Claude Bernard Lyon 1, Department of Cancer Cell Plasticity, Cancer Research Center of Lyon, Lyon, France.,POLA Network
| | - Chiara Villa
- Department of Pathology, Foch Hospital, Suresnes, France
| | - Marica Eoli
- Unit of Molecular Neuro-Oncology, Carlo Besta Neurological Institute, Milan, Italy
| | - Rosina Paterra
- Unit of Molecular Neuro-Oncology, Carlo Besta Neurological Institute, Milan, Italy
| | - Luisa Bellu
- Department of Neuropathology 2, Pitié-Salpêtrière Hospital,Paris, France
| | - Bertrand Mathon
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Laurent Capelle
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Véronique Bourg
- Department of Neurology, Pasteur 2 Hospital, Nice Côte D'Azur University, Nice, France
| | - Arnaud Gloaguen
- Signals and Systems Laboratory, Paris-Saclay University, Gif-sur-Yvette, France.,Neurospin, French Atomic Energy Commission, Paris-Saclay University, Gif-sur-Yvette, France
| | - Cathy Philippe
- Neurospin, French Atomic Energy Commission, Paris-Saclay University, Gif-sur-Yvette, France
| | - Vincent Frouin
- Neurospin, French Atomic Energy Commission, Paris-Saclay University, Gif-sur-Yvette, France
| | - Yohann Schmitt
- Inserm Unit 1127, Sorbonne University, Institute of the Brain and Spinal Cord, Paris, France.,SiRIC CURAMUS, LNCC (équipe labellisée)
| | - Julie Lerond
- Inserm Unit 1127, Sorbonne University, Institute of the Brain and Spinal Cord, Paris, France.,SiRIC CURAMUS, LNCC (équipe labellisée).,Department of Neuropathology, Pitié Salpêtrière-Charles Foix, Paris, France
| | - Julie Leclerc
- Inserm Unit 1127, Sorbonne University, Institute of the Brain and Spinal Cord, Paris, France.,SiRIC CURAMUS, LNCC (équipe labellisée).,Department of Neuropathology, Pitié Salpêtrière-Charles Foix, Paris, France
| | - Anna Lasorella
- Institute for Cancer Genetics, Columbia University, New York, New York, USA.,Department of Pathology and Cell Biology, Columbia University, New York, New York, USA.,Department of Pediatrics, Columbia University, New York, New York, USA
| | - Antonio Iavarone
- Institute for Cancer Genetics, Columbia University, New York, New York, USA.,Department of Pathology and Cell Biology, Columbia University, New York, New York, USA.,Department of Neurology, Columbia University, New York, New York, USA
| | - Karima Mokhtari
- Department of Neuropathology, Pitié Salpêtrière-Charles Foix, Paris, France
| | - Julien Savatovsky
- Department of Radiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Agusti Alentorn
- Inserm Unit 1127, Sorbonne University, Institute of the Brain and Spinal Cord, Paris, France.,SiRIC CURAMUS, LNCC (équipe labellisée).,Department of Neuropathology 2, Pitié-Salpêtrière Hospital,Paris, France
| | - Marc Sanson
- Inserm Unit 1127, Sorbonne University, Institute of the Brain and Spinal Cord, Paris, France.,SiRIC CURAMUS, LNCC (équipe labellisée).,Department of Neuropathology 2, Pitié-Salpêtrière Hospital,Paris, France.,OncoNeuroTek, Institute of the Brain and Spinal Cord, Paris, France
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25
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McAleenan A, Kelly C, Spiga F, Kernohan A, Cheng HY, Dawson S, Schmidt L, Robinson T, Brandner S, Faulkner CL, Wragg C, Jefferies S, Howell A, Vale L, Higgins JPT, Kurian KM. Prognostic value of test(s) for O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation for predicting overall survival in people with glioblastoma treated with temozolomide. Cochrane Database Syst Rev 2021; 3:CD013316. [PMID: 33710615 PMCID: PMC8078495 DOI: 10.1002/14651858.cd013316.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Glioblastoma is an aggressive form of brain cancer. Approximately five in 100 people with glioblastoma survive for five years past diagnosis. Glioblastomas that have a particular modification to their DNA (called methylation) in a particular region (the O6-methylguanine-DNA methyltransferase (MGMT) promoter) respond better to treatment with chemotherapy using a drug called temozolomide. OBJECTIVES To determine which method for assessing MGMT methylation status best predicts overall survival in people diagnosed with glioblastoma who are treated with temozolomide. SEARCH METHODS We searched MEDLINE, Embase, BIOSIS, Web of Science Conference Proceedings Citation Index to December 2018, and examined reference lists. For economic evaluation studies, we additionally searched NHS Economic Evaluation Database (EED) up to December 2014. SELECTION CRITERIA Eligible studies were longitudinal (cohort) studies of adults with diagnosed glioblastoma treated with temozolomide with/without radiotherapy/surgery. Studies had to have related MGMT status in tumour tissue (assessed by one or more method) with overall survival and presented results as hazard ratios or with sufficient information (e.g. Kaplan-Meier curves) for us to estimate hazard ratios. We focused mainly on studies comparing two or more methods, and listed brief details of articles that examined a single method of measuring MGMT promoter methylation. We also sought economic evaluations conducted alongside trials, modelling studies and cost analysis. DATA COLLECTION AND ANALYSIS Two review authors independently undertook all steps of the identification and data extraction process for multiple-method studies. We assessed risk of bias and applicability using our own modified and extended version of the QUality In Prognosis Studies (QUIPS) tool. We compared different techniques, exact promoter regions (5'-cytosine-phosphate-guanine-3' (CpG) sites) and thresholds for interpretation within studies by examining hazard ratios. We performed meta-analyses for comparisons of the three most commonly examined methods (immunohistochemistry (IHC), methylation-specific polymerase chain reaction (MSP) and pyrosequencing (PSQ)), with ratios of hazard ratios (RHR), using an imputed value of the correlation between results based on the same individuals. MAIN RESULTS We included 32 independent cohorts involving 3474 people that compared two or more methods. We found evidence that MSP (CpG sites 76 to 80 and 84 to 87) is more prognostic than IHC for MGMT protein at varying thresholds (RHR 1.31, 95% confidence interval (CI) 1.01 to 1.71). We also found evidence that PSQ is more prognostic than IHC for MGMT protein at various thresholds (RHR 1.36, 95% CI 1.01 to 1.84). The data suggest that PSQ (mainly at CpG sites 74 to 78, using various thresholds) is slightly more prognostic than MSP at sites 76 to 80 and 84 to 87 (RHR 1.14, 95% CI 0.87 to 1.48). Many variants of PSQ have been compared, although we did not see any strong and consistent messages from the results. Targeting multiple CpG sites is likely to be more prognostic than targeting just one. In addition, we identified and summarised 190 articles describing a single method for measuring MGMT promoter methylation status. AUTHORS' CONCLUSIONS PSQ and MSP appear more prognostic for overall survival than IHC. Strong evidence is not available to draw conclusions with confidence about the best CpG sites or thresholds for quantitative methods. MSP has been studied mainly for CpG sites 76 to 80 and 84 to 87 and PSQ at CpG sites ranging from 72 to 95. A threshold of 9% for CpG sites 74 to 78 performed better than higher thresholds of 28% or 29% in two of three good-quality studies making such comparisons.
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Affiliation(s)
- Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire Kelly
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hung-Yuan Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) , University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire L Faulkner
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Christopher Wragg
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Sarah Jefferies
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Amy Howell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) , University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kathreena M Kurian
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Medical School: Brain Tumour Research Centre, Public Health Sciences, University of Bristol, Bristol, UK
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26
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Rosas-Alonso R, Colmenarejo-Fernandez J, Pernia O, Rodriguez-Antolín C, Esteban I, Ghanem I, Sanchez-Cabrero D, Losantos-Garcia I, Palacios-Zambrano S, Moreno-Bueno G, de Castro J, Martinez-Marin V, Ibanez-de-Caceres I. Clinical validation of a novel quantitative assay for the detection of MGMT methylation in glioblastoma patients. Clin Epigenetics 2021; 13:52. [PMID: 33750464 PMCID: PMC7941980 DOI: 10.1186/s13148-021-01044-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background The promoter hypermethylation of the methylguanine-DNA methyltransferase gene is a frequently used biomarker in daily clinical practice as it is associated with a favorable prognosis in glioblastoma patients treated with temozolamide. Due to the absence of adequately standardized techniques, international harmonization of the MGMT methylation biomarker is still an unmet clinical need for the diagnosis and treatment of glioblastoma patients. Results In this study we carried out a clinical validation of a quantitative assay for MGMT methylation detection by comparing a novel quantitative MSP using double-probe (dp_qMSP) with the conventional MSP in 100 FFPE glioblastoma samples. We performed both technologies and established the best cutoff for the identification of positive-methylated samples using the quantitative data obtained from dp_qMSP. Kaplan–Meier curves and ROC time dependent curves were employed for the comparison of both methodologies. Conclusions We obtained similar results using both assays in the same cohort of patients, in terms of progression free survival and overall survival according to Kaplan–Meier curves. In addition, the results of ROC(t) curves showed that dp_qMSP increases the area under curve time-dependent in comparison with MSP for predicting progression free survival and overall survival over time. We concluded that dp_qMSP is an alternative methodology compatible with the results obtained with the conventional MSP. Our assay will improve the therapeutic management of glioblastoma patients, being a more sensitive and competitive alternative methodology that ensures the standardization of the MGMT-biomarker making it reliable and suitable for clinical use. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-021-01044-2.
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Affiliation(s)
- Rocio Rosas-Alonso
- Epigenetics Laboratory. INGEMM, Paseo La Castellana 261. Edificio Bloque Quirúrgico Planta -2. University Hospital La Paz, 28046, Madrid, Spain. .,Experimental Therapies and Novel Biomarkers in Cancer. IdiPAZ, Madrid, Spain.
| | - Julian Colmenarejo-Fernandez
- Epigenetics Laboratory. INGEMM, Paseo La Castellana 261. Edificio Bloque Quirúrgico Planta -2. University Hospital La Paz, 28046, Madrid, Spain.,Experimental Therapies and Novel Biomarkers in Cancer. IdiPAZ, Madrid, Spain
| | - Olga Pernia
- Epigenetics Laboratory. INGEMM, Paseo La Castellana 261. Edificio Bloque Quirúrgico Planta -2. University Hospital La Paz, 28046, Madrid, Spain.,Experimental Therapies and Novel Biomarkers in Cancer. IdiPAZ, Madrid, Spain
| | - Carlos Rodriguez-Antolín
- Epigenetics Laboratory. INGEMM, Paseo La Castellana 261. Edificio Bloque Quirúrgico Planta -2. University Hospital La Paz, 28046, Madrid, Spain.,Experimental Therapies and Novel Biomarkers in Cancer. IdiPAZ, Madrid, Spain
| | - Isabel Esteban
- Experimental Therapies and Novel Biomarkers in Cancer. IdiPAZ, Madrid, Spain.,Pathology Department, La Paz University Hospital, Madrid, Spain
| | - Ismael Ghanem
- Medical Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | | | | | - Gema Moreno-Bueno
- MD Anderson Cancer Center, Madrid, Spain.,Biochemistry Department, UAM/ IIBm (CSIC-UAM), IdiPaz, Fundación MD Anderson Internacional, Madrid, Spain.,CIBERONC, Madrid, Spain
| | - Javier de Castro
- Experimental Therapies and Novel Biomarkers in Cancer. IdiPAZ, Madrid, Spain.,Medical Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | - Inmaculada Ibanez-de-Caceres
- Epigenetics Laboratory. INGEMM, Paseo La Castellana 261. Edificio Bloque Quirúrgico Planta -2. University Hospital La Paz, 28046, Madrid, Spain. .,Experimental Therapies and Novel Biomarkers in Cancer. IdiPAZ, Madrid, Spain.
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27
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Tumor cell plasticity, heterogeneity, and resistance in crucial microenvironmental niches in glioma. Nat Commun 2021; 12:1014. [PMID: 33579922 PMCID: PMC7881116 DOI: 10.1038/s41467-021-21117-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
Both the perivascular niche (PVN) and the integration into multicellular networks by tumor microtubes (TMs) have been associated with progression and resistance to therapies in glioblastoma, but their specific contribution remained unknown. By long-term tracking of tumor cell fate and dynamics in the live mouse brain, differential therapeutic responses in both niches are determined. Both the PVN, a preferential location of long-term quiescent glioma cells, and network integration facilitate resistance against cytotoxic effects of radiotherapy and chemotherapy—independently of each other, but with additive effects. Perivascular glioblastoma cells are particularly able to actively repair damage to tumor regions. Population of the PVN and resistance in it depend on proficient NOTCH1 expression. In turn, NOTCH1 downregulation induces resistant multicellular networks by TM extension. Our findings identify NOTCH1 as a central switch between the PVN and network niche in glioma, and demonstrate robust cross-compensation when only one niche is targeted. Whether the perivascular niche (PVN) and the integration into multicellular networks by tumor microtubes (TMs) have a different role in glioblastoma progression and resistance to therapies is currently unclear. Here, the authors, by long-term tracking of individual glioma, demonstrate that both niches can partially compensate for each other and that glioma cells localized in both niches are resistant to radio- and chemotherapy.
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Saito T, Muragaki Y, Maruyama T, Abe K, Komori T, Amano K, Eguchi S, Nitta M, Tsuzuki S, Fukui A, Kawamata T. Mucosal thickening of the maxillary sinus is frequently associated with diffuse glioma patients and correlates with poor survival prognosis of GBM patients: comparative analysis to meningioma patients. Neurosurg Rev 2021; 44:3249-3258. [PMID: 33537891 DOI: 10.1007/s10143-021-01490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 11/24/2022]
Abstract
Glioma patients were frequently associated with mucosal thickening of the maxillary sinus (MTMS), which reflects mucosal inflammation. We suspected that MTMS is associated with impaired mucosal immune response and correlated with dysfunction in the anti-tumor immune response in diffuse glioma patients. Therefore, the aim of this study was to determine whether the occurrence of diffuse glioma is correlated with MTMS compared to meningioma and control groups. Furthermore, we investigated whether MTMS is associated with overall survival (OS) in glioblastoma (GBM) patients. This study included 343 patients with newly diagnosed diffuse gliomas and 218 patients with meningioma treated at our institution between 2015 and 2018. As control, 201 patients with headache who did not have an intracranial organic lesion were included. Using three-axis MR images, we evaluated the incidence of MTMS in all patients. Additionally, we investigated the relationship between MTMS and OS. The incidence of MTMS in patients with diffuse glioma was significantly higher than that in the meningioma (p < .0001) and control groups (p < .0001). In 128 patients with GBM, MTMS status correlated significantly with OS (p = .0064). We revealed that the incidence of MTMS is significantly associated with patients with diffuse glioma. This suggests that MTMS is indirectly involved in the occurrence of diffuse gliomas. Furthermore, the presence of MTMS correlated significantly with shorter OS in GBM patients, indicating that MTMS is involved in suppression of anti-tumor immune response. Preoperative recognition of MTMS might be useful for improving the clinical management of GBM patients.
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Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kayoko Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Kosaku Amano
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Seiichiro Eguchi
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shunsuke Tsuzuki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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29
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De Chiara L, Leiro-Fernandez V, Rodríguez-Girondo M, Valverde D, Botana-Rial MI, Fernández-Villar A. Comparison of Bisulfite Pyrosequencing and Methylation-Specific qPCR for Methylation Assessment. Int J Mol Sci 2020; 21:ijms21239242. [PMID: 33287451 PMCID: PMC7730915 DOI: 10.3390/ijms21239242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022] Open
Abstract
Different methodological approaches are available to assess DNA methylation biomarkers. In this study, we evaluated two sodium bisulfite conversion-dependent methods, namely pyrosequencing and methylation-specific qPCR (MS-qPCR), with the aim of measuring the closeness of agreement of methylation values between these two methods and its effect when setting a cut-off. Methylation of tumor suppressor gene p16/INK4A was evaluated in 80 lung cancer patients from which cytological lymph node samples were obtained. Cluster analyses were used to establish methylated and unmethylated groups for each method. Agreement and concordance between pyrosequencing and MS-qPCR was evaluated with Pearson’s correlation, Bland–Altman, Cohen’s kappa index and ROC curve analyses. Based on these analyses, cut-offs were derived for MS-qPCR. An acceptable correlation (Pearson’s R2 = 0.738) was found between pyrosequencing (PYRmean) and MS-qPCR (NMP; normalized methylation percentage), providing similar clinical results when categorizing data as binary using cluster analysis. Compared to pyrosequencing, MS-qPCR tended to underestimate methylation for values between 0 and 15%, while for methylation >30% overestimation was observed. The estimated cut-off for MS-qPCR data based on cluster analysis, kappa-index agreement and ROC curve analysis were much lower than that derived from pyrosequencing. In conclusion, our results indicate that independently of the approach used for estimating the cut-off, the methylation percentage obtained through MS-qPCR is lower than that calculated for pyrosequencing. These differences in data and therefore in the cut-off should be examined when using methylation biomarkers in the clinical practice.
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Affiliation(s)
- Loretta De Chiara
- Department of Biochemistry, Genetics and Immunology, University of Vigo, 36310 Vigo, Spain;
- Centro de Investigaciones Biomédicas (CINBIO), Centro Singular de Investigación de Galicia, Universidad de Vigo, 36310 Vigo, Spain
- Correspondence: ; Tel.: +34-986-813-841
| | - Virginia Leiro-Fernandez
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo, 36213 Vigo, Spain; (V.L.-F.); (M.I.B.-R.); (A.F.-V.)
- PneumoVigo I +i Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), 36213 Vigo, Spain
| | - Mar Rodríguez-Girondo
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, 2300RC Leiden, The Netherlands;
| | - Diana Valverde
- Department of Biochemistry, Genetics and Immunology, University of Vigo, 36310 Vigo, Spain;
- Centro de Investigaciones Biomédicas (CINBIO), Centro Singular de Investigación de Galicia, Universidad de Vigo, 36310 Vigo, Spain
| | - María Isabel Botana-Rial
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo, 36213 Vigo, Spain; (V.L.-F.); (M.I.B.-R.); (A.F.-V.)
- PneumoVigo I +i Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), 36213 Vigo, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo, 36213 Vigo, Spain; (V.L.-F.); (M.I.B.-R.); (A.F.-V.)
- PneumoVigo I +i Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), 36213 Vigo, Spain
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30
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Hanihara M, Miyake K, Watanabe A, Yamada Y, Oishi N, Kawataki T, Inukai T, Kondo T, Kinouchi H. Assessment of MGMT methylation status using high-performance liquid chromatography in newly diagnosed glioblastoma. Clin Epigenetics 2020; 12:174. [PMID: 33203454 PMCID: PMC7672949 DOI: 10.1186/s13148-020-00968-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The utility of O6-methylguanine-DNA methyltransferase (MGMT) gene promoter methylation status as a prognostic marker in patients with glioblastoma (GBM) has been established. However, the number of CpG sites that must be methylated to cause transcriptional silencing remains unclear, and no significant consensus exists on the optimal method of assessing MGMT methylation. We developed a new high-performance liquid chromatography (HPLC) method that enables accurate analysis of DNA methylation levels using long PCR products. In the present study, we analyzed the MGMT methylation status of 28 isocitrate dehydrogenase-wild-type GBMs treated with temozolomide using ion-exchange HPLC and set the optimal cutoff values. RESULTS We designed three primers for separate regions (regions 1-3) that had 21 to 38 CpGs for PCR and validated the MGMT promoter methylation status using frozen samples. There was a strong correlation between HPLC and bisulfite sequencing results (R = 0.794). The optimal cutoff values for MGMT methylation in HPLC were determined to allow differentiation of patient prognosis by receiver operating characteristic curve analysis. The cutoff values were 34.15% for region 1, 8.84% for region 2, and 36.72% for region 3. Kaplan-Meyer curve analysis estimated that the most differentiated prognosis was enabled in the setting of 8.84% methylation of MGMT in region 2. Progression-free survival and overall survival were significantly longer for patients in this setting of region 2 methylation (p = 0.00365 and p = 0.00258, respectively). CONCLUSIONS The combination of our HPLC method and the original primer setting provides a new standard method for determination of MGMT methylation status in patients with GBM and is useful for refining MGMT-based drug selection.
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Affiliation(s)
- Mitsuto Hanihara
- Departments of Neurosurgery, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kunio Miyake
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
| | - Atsushi Watanabe
- Department of Pediatrics, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yuriko Yamada
- Tsukuba Research Institute, Research and Development Division, Sekisui Medical Co., Ltd., Ryugasaki, Japan
| | - Naoki Oishi
- Department of Pathology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tomoyuki Kawataki
- Departments of Neurosurgery, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Takeshi Inukai
- Tsukuba Research Institute, Research and Development Division, Sekisui Medical Co., Ltd., Ryugasaki, Japan
| | - Tetsuo Kondo
- Department of Pathology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroyuki Kinouchi
- Departments of Neurosurgery, University of Yamanashi, Chuo, Yamanashi, Japan
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31
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Karschnia P, Teske N, Dorostkar MM, Siller S, Weller J, Baehring JM, Dietrich J, von Baumgarten L, Herms J, Tonn JC, Thon N. Extent and prognostic value of MGMT promotor methylation in glioma WHO grade II. Sci Rep 2020; 10:19758. [PMID: 33184319 PMCID: PMC7661705 DOI: 10.1038/s41598-020-76312-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022] Open
Abstract
MGMT promotor methylation is associated with favourable outcome in high-grade glioma. In glioma WHO grade II, it is unclear whether the extent of MGMT promotor methylation and its prognostic role is independent from other molecular markers. We performed a retrospective analysis of 155 patients with glioma WHO grade II. First, all 155 patients were assigned to three molecular groups according to the 2016 WHO classification system: (1) oligodendroglioma, IDH-mutant and 1p19q co-deleted (n = 81); (2) astrocytoma, IDH-mutant and 1p19q non-codeleted (n = 54); (3) astrocytoma, IDH-wildtype (n = 20). MGMT promotor methylation was quantified using Sanger sequencing of the CpG sites 74–98 within the MGMT promotor region. Highest numbers of methylated CpG sites were found for oligodendroglioma, IDH-mutant and 1p19q co-deleted. When 1p19q co-deletion was absent, numbers of methylated CpG sites were higher in the presence of IDH-mutation. Accordingly, lowest numbers were seen in the IDH-wildtype subpopulation. In the entire cohort, larger numbers of methylated CpG sites were associated with favourable outcome. When analysed separately for the three WHO subgroups, a similar association was only retained in astrocytoma, IDH-wildtype. Collectively, extent of MGMT promotor methylation was strongly associated with other molecular markers and added prognostic information in astrocytoma, IDH-wildtype. Evaluation in prospective cohorts is warranted.
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Affiliation(s)
- Philipp Karschnia
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site, Munich, Germany. .,Division of Neuro-Oncology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA. .,Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Nico Teske
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Mario M Dorostkar
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Sebastian Siller
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Jonathan Weller
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Joachim M Baehring
- Division of Neuro-Oncology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Jorg Dietrich
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Louisa von Baumgarten
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Jochen Herms
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Joerg-Christian Tonn
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Niklas Thon
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site, Munich, Germany.
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32
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den Helder RV, Wever BM, van Trommel JA, Ket JC, Bleeker MC, Steenbergen RD, van Trommel NE. DNA methylation markers for endometrial cancer detection in minimally invasive samples: a systematic review. Epigenomics 2020; 12:1661-1672. [PMID: 32938224 DOI: 10.2217/epi-2020-0164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aim: DNA methylation testing for endometrial cancer detection in minimally invasive specimens is a promising tool to improve screening and diagnostic procedures. Available literature was systematically reviewed to assess the potential of this approach and define methylation markers deserving further development. Methods: A systematic search up to March 31 2020 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: 15 methylation markers with an area under the curve value of ≥ 0.80 for endometrial cancer detection in cytological specimens were selected from nine studies. Conclusion: Detection of methylation markers in cytological samples indicate the feasibility of minimally invasive testing methods, potentially guiding diagnosis and detection of endometrial cancer in high-risk women and in cancer screening programs.
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Affiliation(s)
- Rianne van den Helder
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.,Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynecologic Oncology, Centre of Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Birgit Mm Wever
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jip A van Trommel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | | | - Maaike Cg Bleeker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Renske Dm Steenbergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Nienke E van Trommel
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynecologic Oncology, Centre of Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
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33
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Wen PY, Weller M, Lee EQ, Alexander BM, Barnholtz-Sloan JS, Barthel FP, Batchelor TT, Bindra RS, Chang SM, Chiocca EA, Cloughesy TF, DeGroot JF, Galanis E, Gilbert MR, Hegi ME, Horbinski C, Huang RY, Lassman AB, Le Rhun E, Lim M, Mehta MP, Mellinghoff IK, Minniti G, Nathanson D, Platten M, Preusser M, Roth P, Sanson M, Schiff D, Short SC, Taphoorn MJB, Tonn JC, Tsang J, Verhaak RGW, von Deimling A, Wick W, Zadeh G, Reardon DA, Aldape KD, van den Bent MJ. Glioblastoma in adults: a Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol 2020; 22:1073-1113. [PMID: 32328653 PMCID: PMC7594557 DOI: 10.1093/neuonc/noaa106] [Citation(s) in RCA: 552] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Glioblastomas are the most common form of malignant primary brain tumor and an important cause of morbidity and mortality. In recent years there have been important advances in understanding the molecular pathogenesis and biology of these tumors, but this has not translated into significantly improved outcomes for patients. In this consensus review from the Society for Neuro-Oncology (SNO) and the European Association of Neuro-Oncology (EANO), the current management of isocitrate dehydrogenase wildtype (IDHwt) glioblastomas will be discussed. In addition, novel therapies such as targeted molecular therapies, agents targeting DNA damage response and metabolism, immunotherapies, and viral therapies will be reviewed, as well as the current challenges and future directions for research.
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Affiliation(s)
- Patrick Y Wen
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Eudocia Quant Lee
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian M Alexander
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jill S Barnholtz-Sloan
- Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Floris P Barthel
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School
| | - Ranjit S Bindra
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan M Chang
- University of California San Francisco, San Francisco, California, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy F Cloughesy
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - John F DeGroot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Monika E Hegi
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Craig Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew B Lassman
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Emilie Le Rhun
- University of Lille, Inserm, Neuro-oncology, General and Stereotaxic Neurosurgery service, University Hospital of Lille, Lille, France; Breast Cancer Department, Oscar Lambret Center, Lille, France and Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Ingo K Mellinghoff
- Department of Neurology and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - David Nathanson
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University, Heidelberg, Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marc Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière – Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - David Schiff
- University of Virginia School of Medicine, Division of Neuro-Oncology, Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Susan C Short
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Martin J B Taphoorn
- Department of Neurology, Medical Center Haaglanden, The Hague and Department of Neurology, Leiden University Medical Center, the Netherlands
| | | | - Jonathan Tsang
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Roel G W Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Andreas von Deimling
- Neuropathology and Clinical Cooperation Unit Neuropathology, University Heidelberg and German Cancer Center, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology and Neuro-oncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Gelareh Zadeh
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Canada
| | - David A Reardon
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth D Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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Richard S, Tachon G, Milin S, Wager M, Karayan-Tapon L. Dual MGMT inactivation by promoter hypermethylation and loss of the long arm of chromosome 10 in glioblastoma. Cancer Med 2020; 9:6344-6353. [PMID: 32666673 PMCID: PMC7476845 DOI: 10.1002/cam4.3217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/27/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background Epigenetic inactivation of O6‐methylguanine‐methyltransferase (MGMT) gene by methylation of its promoter is predictive of Temozolomid (TMZ) response in glioblastoma (GBM). MGMT is located on chromosome 10q26 and the loss of chromosome 10q is observed in 70% of GBMs. In this study, we assessed the hypothesis that the dual inactivation of MGMT, by hypermethylation of MGMT promoter and by loss the long arm of chromosome 10 (10q), may confer greater sensitivity to TMZ. Methods A total of 149 tumor samples from patients diagnosed with GBM based on the WHO 2016 classification were included in this retrospective study between November 2016 and December 2018. Methylation status of MGMT promoter was evaluated by pyrosequencing and status of chromosome 10q was assessed by array comparative genomic hybridization. Results Glioblastoma patients with chromosome 10q loss associated with hypermethylation of MGMT promoter had significantly longer overall survival (OS) (P = .0024) and progression‐free survival (PFS) (P = .031). Indeed, median OS of patients with dual inactivation of MGMT was 21.5 months compared to 12 months and 8.1 months for groups with single MGMT inactivation by hypermethylation and by 10q loss, respectively. The group with no MGMT inactivation had 9.5 months OS. Moreover, all long‐term survivors with persistent response to TMZ treatment (OS ≥ 30 months) displayed dual inactivation of MGMT. Conclusions Our data suggest that the molecular subgroup characterized by the dual inactivation of MGMT receives greater benefit from TMZ treatment. The results of our study may be of immediate clinical interest since chromosome 10q status and methylation of MGMT promoter are commonly determined in routine practice.
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Affiliation(s)
- Sophie Richard
- Faculté de Médecine, Université de Poitiers, Poitiers, France.,Laboratoire de cancérologie biologique, CHU de Poitiers, Poitiers, France
| | - Gaëlle Tachon
- Faculté de Médecine, Université de Poitiers, Poitiers, France.,Laboratoire de cancérologie biologique, CHU de Poitiers, Poitiers, France.,Laboratoire des Neurosciences Expérimentales et Cliniques, INSERM 1084, Poitiers, France
| | - Serge Milin
- Laboratoire d'anatomopathologie, CHU de Poitiers, Poitiers, France
| | - Michel Wager
- Laboratoire de cancérologie biologique, CHU de Poitiers, Poitiers, France.,Laboratoire des Neurosciences Expérimentales et Cliniques, INSERM 1084, Poitiers, France.,CHU de Poitiers, Poitiers, France
| | - Lucie Karayan-Tapon
- Faculté de Médecine, Université de Poitiers, Poitiers, France.,Laboratoire de cancérologie biologique, CHU de Poitiers, Poitiers, France.,Laboratoire des Neurosciences Expérimentales et Cliniques, INSERM 1084, Poitiers, France
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The Essentials of Molecular Testing in CNS Tumors: What to Order and How to Integrate Results. Curr Neurol Neurosci Rep 2020; 20:23. [PMID: 32445025 DOI: 10.1007/s11910-020-01041-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Molecular testing has become essential for the optimal workup of central nervous system (CNS) tumors. There is a vast array of testing from which to choose, and it can sometimes be challenging to appropriately incorporate findings into an integrated report. This article reviews various molecular tests and provides a concise overview of the most important molecular findings in the most commonly encountered CNS tumors. RECENT FINDINGS Many molecular alterations in CNS tumors have been identified over recent years, some of which are incorporated into the 2016 World Health Organization (WHO) classification and the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official WHO (cIMPACT-NOW) updates. Array-based methylation profiling has emerged over the past couple of years and will likely replace much of currently used ancillary testing for diagnostic purposes. A combination of next-generation sequencing (NGS) panel and copy number array is ideal for diffuse gliomas and embryonal tumors, with a low threshold to employ in other tumor types. With the recent advances in molecular diagnostics, it will be ever more important for the pathologist to recognize the molecular testing available, which tests to perform, and to appropriately integrate results in light of clinical, radiologic, and histologic findings.
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Mansouri A, Hachem LD, Mansouri S, Nassiri F, Laperriere NJ, Xia D, Lindeman NI, Wen PY, Chakravarti A, Mehta MP, Hegi ME, Stupp R, Aldape KD, Zadeh G. MGMT promoter methylation status testing to guide therapy for glioblastoma: refining the approach based on emerging evidence and current challenges. Neuro Oncol 2020; 21:167-178. [PMID: 30189035 DOI: 10.1093/neuonc/noy132] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/11/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor, with a universally poor prognosis. The emergence of molecular biomarkers has had a significant impact on histological typing and diagnosis, as well as predicting patient survival and response to treatment. The methylation status of the O6-methylguanine-DNA methyl-transferase (MGMT) gene promoter is one such molecular biomarker. Despite the strong evidence supporting the role of MGMT methylation status in prognostication, its routine implementation in clinical practice has been challenging. The methods and optimal cutoff definitions for MGMT status determination remain controversial. Variation in detection methods between laboratories presents a major challenge for consensus. Moreover, consideration of other clinical and genetic/epigenetic factors must also be incorporated into treatment decision making. In this review, we distill the available evidence to summarize our position on the optimal use of available assays, and propose strategies for resolving cases with equivocal methylation status and a framework for incorporating this important assay into research and clinical practice.
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Affiliation(s)
- Alireza Mansouri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Laureen D Hachem
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sheila Mansouri
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Normand J Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Daniel Xia
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Arnab Chakravarti
- Radiation Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - Monika E Hegi
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Roger Stupp
- Malnati Brain Tumor Institute of the Lurie Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kenneth D Aldape
- Department of Laboratory Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Singh A, Gupta S, Badarukhiya JA, Sachan M. Detection of aberrant methylation of HOXA9 and HIC1 through multiplex MethyLight assay in serum DNA for the early detection of epithelial ovarian cancer. Int J Cancer 2020; 147:1740-1752. [PMID: 32191343 DOI: 10.1002/ijc.32984] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/22/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
Accumulated evidence revealed that aberrant CpG island hypermethylation plays an important role in carcinogenesis which can serve as a promising target for molecular detection in body fluids. Despite a myriad of attempts to diagnose ovarian cancer (OC) at an early stage, this clinical aim remains a major challenge. To date, no single biomarker is able to accurately detect early OC in either tissue or body fluid. Aberrant DNA methylation patterns in circulating DNA provide highly specific cancer signals. In our study, we establish a novel panel of methylation-specific genes for the development of a TaqMan based qPCR assay to quantify methylation levels. We analyzed promoter methylation of homeobox A9 (HOXA9) and hypermethylated in cancer 1 (HIC1) quantitatively in 120 tissue samples and in 70 matched serum cell-free DNA (CFDNA) of cancerous and noncancerous samples by MethyLight assay. HOXA9 and HIC1 methylation occurred in 82.3 and 80.0% of OC tissue samples in singleplex assay, thereby confirming that methylation was highly cancer-specific. When either or both gene promoter showed methylation, the sensitivity was 88.2% with a specificity of 88.6% in tissue samples. The combined sensitivity for this novel marker panel in serum CFDNA was 88.9% (area under the curve [AUC] = 0.95). In contrast, no hypermethylation was observed in serum from matched cancer-free control women. Our results confirm the elevated performance of novel epigenetic marker panel (HOXA9 and HIC1) when analyzed in tissue and matched serum samples. Our findings reveal the potential of this biomarker panel as a suitable diagnostic serum biomarker for early screening of OC.
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Affiliation(s)
- Alka Singh
- Department of Biotechnology, Motilal Nehru National Institute of Technology, Allahabad, India
| | - Sameer Gupta
- Department of Surgical Oncology, King George Medical University, Lucknow, India
| | | | - Manisha Sachan
- Department of Biotechnology, Motilal Nehru National Institute of Technology, Allahabad, India
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Khatami F, Larijani B, Heshmat R, Nasiri S, Haddadi-Aghdam M, Teimoori-Toolabi L, Tavangar SM. Hypermethylated RASSF1 and SLC5A8 promoters alongside BRAF V600E mutation as biomarkers for papillary thyroid carcinoma. J Cell Physiol 2020; 235:6954-6968. [PMID: 32017063 DOI: 10.1002/jcp.29591] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Circulating cell-free DNA (cfDNA) has been considered as a diagnostic source to track genetic and epigenetic alterations in cancer. We aimed to study mutation in addition to the methylation status in the promoter regions of RASSF1 and SLC5A8 genes in tissues and circulating free DNA samples of patients affected with papillary thyroid carcinoma (PTC) and thyroid nodules as controls. BRAFV600E mutation was studied by ARMS-scorpion real-time polymerase chain reaction method in 57 PTC and 45 thyroid nodule cases. Methylation status of RASSF1 and SLC5A8 promoter regions was analyzed by methylation-specific high-resolution melting curve analysis. BRAFV600E mutation was found in 39 (68.4%) out of 57 PTC tissue samples, while in 33 (49.1%) cases of cfDNA, this mutation was detected. The frequency of BRAFV600E mutation in cfDNA was significantly different between metastatic and nonmetastatic PTC cases (22 of 33 PTC cases vs. 5 of 34 thyroid nodule samples). Methylation levels of three promoter regions of SLC5A8 and proximal promoter region of RASSF1 was significantly different between PTC and thyroid nodule cases in both cfDNA and tissue DNA. In addition, the methylation status of these two genes in tissue DNA was reflected in methylation status observed in cfDNA. This study confirmed that BRAFV600E mutation is better for discrimination between papillary thyroid carcinoma and thyroid nodules. On the other hand, hypermethylation in the more proximal promoter regions to RASSF1 and SLC5A8 genes showed higher sensitivity and more acceptable specificity for this discrimination.
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Affiliation(s)
- Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirzad Nasiri
- Departments of Surgery, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Haddadi-Aghdam
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Ladan Teimoori-Toolabi
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed M Tavangar
- Department of Pathology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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de Ruijter TC, van der Heide F, Smits KM, Aarts MJ, van Engeland M, Heijnen VCG. Prognostic DNA methylation markers for hormone receptor breast cancer: a systematic review. Breast Cancer Res 2020; 22:13. [PMID: 32005275 PMCID: PMC6993426 DOI: 10.1186/s13058-020-1250-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/15/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In patients with hormone receptor-positive breast cancer, differentiating between patients with a low and a high risk of recurrence is an ongoing challenge. In current practice, prognostic clinical parameters are used for risk prediction. DNA methylation markers have been proven to be of additional prognostic value in several cancer types. Numerous prognostic DNA methylation markers for breast cancer have been published in the literature. However, to date, none of these markers are used in clinical practice. METHODS We conducted a systematic review of PubMed and EMBASE to assess the number and level of evidence of published DNA methylation markers for hormone receptor-positive breast cancer. To obtain an overview of the reporting quality of the included studies, all were scored according to the REMARK criteria that were established as reporting guidelines for prognostic biomarker studies. RESULTS A total of 74 studies were identified reporting on 87 different DNA methylation markers. Assessment of the REMARK criteria showed variation in reporting quality of the studies. Eighteen single markers and one marker panel were studied in multiple independent populations. Hypermethylation of the markers RASSF1, BRCA, PITX2, CDH1, RARB, PCDH10 and PGR, and the marker panel GSTP1, RASSF1 and RARB showed a statistically significant correlation with poor disease outcome that was confirmed in at least one other, independent study. CONCLUSION This systematic review provides an overview on published prognostic DNA methylation markers for hormone receptor-positive breast cancer and identifies eight markers that have been independently validated. Analysis of the reporting quality of included studies suggests that future research on this topic would benefit from standardised reporting guidelines.
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Affiliation(s)
- Tim C. de Ruijter
- Division of Medical Oncology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
| | - Frank van der Heide
- Division of Medical Oncology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Kim M. Smits
- Division of Medical Oncology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Maureen J. Aarts
- Division of Medical Oncology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
| | - Manon van Engeland
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Vivianne C. G. Heijnen
- Division of Medical Oncology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
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Saito T, Muragaki Y, Shioyama T, Komori T, Maruyama T, Nitta M, Yasuda T, Hosono J, Okamoto S, Kawamata T. Malignancy Index Using Intraoperative Flow Cytometry is a Valuable Prognostic Factor for Glioblastoma Treated With Radiotherapy and Concomitant Temozolomide. Neurosurgery 2020; 84:662-672. [PMID: 29618055 DOI: 10.1093/neuros/nyy089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 02/22/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Intraoperative prediction of radiochemosensitivity is desirable for improving the clinical management of glioblastoma (GBM) patients. We have previously developed an original technique for intraoperative flow cytometry (iFC) and defined a malignancy index (MI). OBJECTIVE To determine whether MI correlates with prognosis in GBM patients who underwent the standard treatment protocol of radiotherapy and temozolomide administration. METHODS The current study included 102 patients with GBM that had been newly diagnosed from 2010 to 2015 who underwent our iFC analysis and received the standard treatment protocol. We evaluated MI values in each patient, then statistically analyzed the relationship between MI and prognosis using survival analysis that include other clinicopathological factors (age, sex, Karnofsky performance status [KPS], extent of resection, second-line bevacizumab, O6-methylguanine-DNA methyltransferase [MGMT] status, MIB-1 labeling index, and mutation of the isocitrate dehydrogenase 1 gene [IDH1]). RESULTS Log-rank test revealed that age, KPS, extent of resection, MGMT status, IDH1 mutation, and high MI (≥26.3%) significantly correlated with overall survival. Multivariate analysis with Cox regression modeling identified MI as the most significant prognostic factor (hazard ratio = 2.246; 95% confidence interval = 1.347-3.800; P = .0019). MI showed strong correlation with IDH1 mutation status in chi-square test (P = .0023). In addition, log-rank test revealed that MI affects overall survival more strongly in patients with IDH1 wildtype than those with IDH1 mutant. CONCLUSION MI from an iFC study may help predict the prognosis in patients with GBM who receive the standard treatment. Survival can be related to sensitivity to radio-chemotherapy.
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Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takayuki Yasuda
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Junji Hosono
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Saori Okamoto
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Schaff LR, Yan D, Thyparambil S, Tian Y, Cecchi F, Rosenblum M, Reiner AS, Panageas KS, Hembrough T, Lin AL. Characterization of MGMT and EGFR protein expression in glioblastoma and association with survival. J Neurooncol 2019; 146:163-170. [PMID: 31823165 DOI: 10.1007/s11060-019-03358-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Understanding the molecular landscape of glioblastoma (GBM) is increasingly important in the age of targeted therapy. O-6-Methylguanine-DNA methyltransferase (MGMT) promoter methylation and EGFR amplification are markers that may play a role in prognostication, treatment, and/or clinical trial eligibility. Quantification of MGMT and EGFR protein expression may offer an alternative strategy towards understanding GBM. Here, we quantify baseline expression of MGMT and EGFR protein in newly diagnosed GBM samples using mass spectrometry. We correlate findings with MGMT methylation and EGFR amplification statuses and survival. METHODS We retrospectively identified adult patients with newly diagnosed resected GBM. MGMT and EGFR protein expression were quantified using a selected reaction monitoring mass spectrometry assay. Protein levels were correlated with MGMT methylation and EGFR amplification and survival data. RESULTS We found a statistically significant association between MGMT protein expression and promoter methylation status (p = 0.02) as well as between EGFR protein expression and EGFR amplification (p < 0.0001). EGFR protein expression and amplification were more tightly associated than MGMT protein expression and methylation. Only MGMT promoter methylation was statistically significantly associated with progression-free and overall survival. CONCLUSIONS Unlike EGFR protein expression and EGFR amplification which are strongly associated, only a weak association was seen between MGMT protein expression and promoter methylation. Quantification of MGMT protein expression was inferior to MGMT methylation for prognostication in GBM. Discordance was observed between EGFR amplification and EGFR protein expression; additional study is warranted to determine whether EGFR protein expression is a better biomarker than EGFR amplification for clinical decisions and trial enrollment.
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Affiliation(s)
- Lauren R Schaff
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | | | | | - Yuan Tian
- NantOmics, Culver City, CA, 90230, USA
| | | | - Marc Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Anne S Reiner
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Katherine S Panageas
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Andrew L Lin
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Abstract
Gliomas, that do not respond to alkylating agent chemotherapy, can be made more sensitive to chemotherapy through promotor mediated epigenetic silencing of the MGMT gene. MGMT is one of the important markers in glioblastomas as it not only predicts response to therapy but may also be used as an independent prognostic marker. As such, MGMT is gaining increasing traction in diagnosis, prognostication, and therapeutic decision-making for these highly malignant gliomas. Although, MGMT promotor methylation status is becoming more commonly used in neuro-oncology; this test remains imperfect. Because of its increasing use in clinical practice and research, it is integral that we are aware of its pitfalls and complications. Currently, there are many ways to detect a patient's MGMT promotor methylation status, including: quantitative PCR, methylation-specific PCR, pyrosequencing, real time PCR with high resolution melt, and the infinitum methylation EPIC beadChip. The technical aspects, shortcomings, and optimal approach to interpreting the results of each method will be discussed. Furthermore, given that none of these methods have been prospectively validated, the challenge of equivocal cases will be discussed, and technical and logistic strategies for overcoming these challenges will be proposed. Finally, the difficulty in validating these methods, establishing standardized practice, and considerations of the cost of these competing methods will be explored.
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Saito T, Muragaki Y, Maruyama T, Komori T, Nitta M, Tsuzuki S, Fukui A, Kawamata T. Influence of wide opening of the lateral ventricle on survival for supratentorial glioblastoma patients with radiotherapy and concomitant temozolomide-based chemotherapy. Neurosurg Rev 2019; 43:1583-1593. [PMID: 31705405 DOI: 10.1007/s10143-019-01185-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/04/2023]
Abstract
The prognosis for glioblastoma (GBM) varies among patients. Ventricular opening during surgery has been reported as a prognostic factor for GBM patients, but the influence of ventricular opening itself on patient prognosis remains controversial. We presumed that the degree of ventricular opening would correlate with the degree of subventricular zone (SVZ) resection and with prognosis in GBM patients. This study therefore investigated whether the degree of ventricular opening correlates with prognosis in GBM patients treated with the standard protocol of chemo-radiotherapy. Participants comprised 111 patients with newly diagnosed GBM who underwent surgery and received postoperative radiotherapy and temozolomide-based chemotherapy from 2005 to 2018. We classified 111 patients into "No ventricular opening (NVO)", "Ventricular opening, small (VOS; distance < 23.2 mm)", and "Ventricular opening, wide (VOW; distance ≥ 23.2 mm)" groups. We evaluated the relationship between degree of ventricular opening and prognosis using survival analyses that included other clinicopathological factors. Log-rank testing revealed age, Karnofsky performance status (KPS), extent of resection, O6-methylguanine-DNA methyltransferase (MGMT) status, isocitrate dehydrogenase (IDH)1 mutation, and degree of ventricular opening correlated significantly with overall survival. Multivariate analysis identified the degree of ventricular opening (small vs. wide) as the most significant prognostic factor (hazard ratio = 3.674; p < 0.0001). We demonstrated that wide opening of the lateral ventricle (LV) contributes to longer survival compared with small opening among GBM patients. Our results indicate that wide opening of the LV may correlate with the removal of a larger proportion of tumor stem cells from the SVZ.
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Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shunsuke Tsuzuki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Weak MGMT gene promoter methylation confers a clinically significant survival benefit in patients with newly diagnosed glioblastoma: a retrospective cohort study. J Neurooncol 2019; 146:55-62. [DOI: 10.1007/s11060-019-03334-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/03/2019] [Indexed: 12/25/2022]
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Malmström A, Łysiak M, Kristensen BW, Hovey E, Henriksson R, Söderkvist P. Do we really know who has an MGMT methylated glioma? Results of an international survey regarding use of MGMT analyses for glioma. Neurooncol Pract 2019; 7:68-76. [PMID: 32025325 PMCID: PMC6993038 DOI: 10.1093/nop/npz039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Glioma O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status informs clinical decision making. Worldwide different methods and cutoff levels are used, which can lead to discordant methylation results. Methods We conducted an international survey to clarify which methods are regularly used and why. We also explored opinions regarding international consensus on methods and cutoff. Results The survey had 152 respondents from 25 countries. MGMT methylation status is determined for all glioblastomas in 37% of laboratories. The most common methods are methylation-specific polymerase chain reaction (msPCR) (37%) and pyrosequencing (34%). A method is selected for simplicity (56%), cost-effectiveness (50%), and reproducibility of results (52%). For sequencing, the number of CpG sites analyzed varies from 1–3 up to more than 16. For 50% of laboratories, the company producing the kit determines which CpG sites are examined, whereas 33% select the sites themselves. Selection of cutoff is equally distributed among a cutoff defined in the literature, by the local laboratory, or by the outside laboratory performing the analysis. This cutoff varies, reported from 1% to 30%, and in 1 laboratory tumor is determined as methylated in case of 1 methylated CpG site of 17 analyzed. Some report tumors as unmethylated or weakly vs highly methylated. An international consensus on MGMT methylation method and cutoff is warranted by 66% and 76% of respondents, respectively. The method preferred would be msPCR (45%) or pyrosequencing (42%), whereas 18% suggest next-generation sequencing. Conclusion Although analysis of MGMT methylation status is routine, there is controversy regarding laboratory methods and cutoff level. Most respondents favor development of international consensus guidelines.
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Affiliation(s)
- Annika Malmström
- Department of Advanced Home Care, Linköping University, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Małgorzata Łysiak
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Bjarne Winther Kristensen
- Department of Pathology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark
| | - Elizabeth Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia.,University of New South Wales, Sydney, Australia
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Khatami F, Larijani B, Heshmat R, Nasiri S, Saffar H, Shafiee G, Mossafa A, Tavangar SM. Promoter Methylation of Four Tumor Suppressor Genes in Human Papillary Thyroid Carcinoma. IRANIAN JOURNAL OF PATHOLOGY 2019; 14:290-298. [PMID: 31754358 PMCID: PMC6824767 DOI: 10.30699/ijp.2019.94401.1922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 07/27/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND & OBJECTIVE Papillary thyroid cancer (PTC) is considered to be the most common type of thyroid malignancies. Epigenetic alteration, in which the chromatin conformation and gene expression change without changing the sequence of DNA, can occur in some tumor suppressor genes and oncogenes. Methylation is the most common type of epigenetic alterations that can be an excellent indicator of PTC invasive behavior. METHODS In this research, we determined the promoter methylation status of four tumor suppressor genes (SLC5A8, RASSF1, MGMT, and DNMT1) and compared the results of 55 PTC cases with 40 goiter patients. For methylation, we used the methylation-sensitive high resolution melting (MS-HRM) assay technique. The resulting graphs of each run were compared with those of 0%, 50%, and 100% methylated controls. RESULTS Our data showed that the promoter methylation of SLC5A8, Ras association domain family member 1(RASSF1), and MGMT were significantly different between PTC tissue and goiter with P-value less than 0.05. The most significant differences were observed in RASSF1; 77.2% of hyper-methylated PTC patients versus 15.6% hyper-methylated goiter samples (P<0.001). CONCLUSION RASSF1 promoter methylation can be a PTC genetic marker. RASSF1 promoter methylation is under the impact of the methyltransferase genes (DNMT1 and MGMT), protein expression, and promoter methylation.
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Affiliation(s)
- Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirzad Nasiri
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Mossafa
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Cytosolic Hsp70 as a biomarker to predict clinical outcome in patients with glioblastoma. PLoS One 2019; 14:e0221502. [PMID: 31430337 PMCID: PMC6701831 DOI: 10.1371/journal.pone.0221502] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The major stress-inducible heat shock protein 70 (Hsp70) is induced after different stress stimuli. In tumors, elevated intracellular Hsp70 levels were associated on the one hand with radio- and chemotherapy resistance and on the other hand with a favorable outcome for patients. This study was undertaken to investigate cytosolic Hsp70 (cHsp70) as a potential biomarker for progression free (PFS) and overall survival (OS) in patients with primary glioblastomas (GBM). METHODS The cHsp70 expression in tumor tissue of 60 patients diagnosed with primary GBM was analyzed by immunohistochemistry. The cHsp70 expression was correlated to the PFS and OS of the patients. RESULTS A high cHsp70 expression was associated with a prolonged PFS (hazard ratio = 0.374, p = 0.001) and OS (hazard ratio = 0.416, p = 0.014) in GBM patients treated according to the standard Stupp protocol with surgery, radiotherapy and temozolomide. CONCLUSIONS These data suggest that the intracellular Hsp70 expression might serve as a prognostic marker in patients with primary GBM.
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Pyrosequencing versus methylation-specific PCR for assessment of MGMT methylation in tumor and blood samples of glioblastoma patients. Sci Rep 2019; 9:11125. [PMID: 31366977 PMCID: PMC6668570 DOI: 10.1038/s41598-019-47642-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Circulating biomarkers in blood may provide an interesting alternative to risky tissue biopsies in the diagnosis and follow-up of glioblastoma patients. We have assessed MGMT methylation status in blood and tissue samples from unresected glioblastoma patients who had been included in the randomized GENOM-009 trial. Paired blood and tissue samples were assessed by methylation-specific PCR (MSP) and pyrosequencing (PYR). After establishing the minimum PYR cut-off that could yield a significant difference in overall survival, we assessed the sensitivity, specificity, positive predictive value and negative predictive value (NPV) of the analyses. Methylation could be detected in cfDNA by both MSP and PYR but with low concordance with results in tissue. Sensitivity was low for both methods (31% and 38%, respectively), while specificity was higher for MSP in blood than for PYR in plasma (96% vs 76%) and NPV was similar (56 vs 57%). Concordance of results in tissue by MSP and PYR was 84.3% (P < 0.001) and correlated with outcome. We conclude that detection of cfDNA in the blood of glioblastoma patients can be an alternative when tumor tissue is not available but methods for the detection of cfDNA in blood must improve before it can replace analysis in tumor tissue.
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Extent of Resection, MGMT Promoter Methylation Status and Tumor Location Independently Predict Progression-Free Survival in Adult Sporadic Pilocytic Astrocytoma. Cancers (Basel) 2019; 11:cancers11081072. [PMID: 31362435 PMCID: PMC6721291 DOI: 10.3390/cancers11081072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 12/16/2022] Open
Abstract
In adults, pilocytic astrocytomas (PA) account for less than 2% of gliomas, resulting in uncertainty regarding the clinical course and optimal treatment, particularly in cases where gross total resection (GTR) could not be achieved. Moreover, information on molecular markers and their prognostic impact is sparse. In order to improve risk stratification, we analyzed our institutional series of 58 patients aged 17 years and older with histology-proven intracranial PA World Health Organization grade I for clinical and molecular prognosticators. Anaplastic and NF1-associated tumors were excluded. O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status was determined by pyrosequencing or 450k/850k DNA methylation array. A univariate log-rank test and multivariate StepAIC were applied to identify prognostic factors. The median age was 30 years (range 17–66). Tumors were located in the cerebral/cerebellar hemispheres, midline structures and cerebello-pontine angle in 53%, 38% and 9%. MGMT promoter methylation was present in eight patients (14%). GTR (39/58 patients) significantly reduced the likelihood of tumor recurrence (p = 0.0001). Tumor relapse occurred in 16 patients (28%) after a median progression-free survival (PFS) of 135 months (range 6–153 months); there was one tumor-related death. PFS at 5 and 10 years was 67% and 53%. In multivariate analysis, PFS was significantly prolonged in patients with GTR (HR 0.1; CI 0.03–0.37; p < 0.001), unmethylated MGMT promoter (HR 0.18; CI 0.05–0.64; p = 0.009) and midline tumors (HR 0.21; CI 0.06–0.78; p = 0.02). In conclusion, MGMT promoter methylation status and tumor location were identified as novel prognostic factors in adult PAs, pointing at distinct molecular subtypes and detecting patients in need of close observance and intensified treatment.
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Beltrán-García J, Osca-Verdegal R, Mena-Mollá S, García-Giménez JL. Epigenetic IVD Tests for Personalized Precision Medicine in Cancer. Front Genet 2019; 10:621. [PMID: 31316555 PMCID: PMC6611494 DOI: 10.3389/fgene.2019.00621] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
Epigenetic alterations play a key role in the initiation and progression of cancer. Therefore, it is possible to use epigenetic marks as biomarkers for predictive and precision medicine in cancer. Precision medicine is poised to impact clinical practice, patients, and healthcare systems. The objective of this review is to provide an overview of the epigenetic testing landscape in cancer by examining commercially available epigenetic-based in vitro diagnostic tests for colon, breast, cervical, glioblastoma, lung cancers, and for cancers of unknown origin. We compile current commercial epigenetic tests based on epigenetic biomarkers (i.e., DNA methylation, miRNAs, and histones) that can actually be implemented into clinical practice.
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Affiliation(s)
- Jesús Beltrán-García
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,Department of Physiology, School of Medicine and Dentistry, Universitat de València (UV), Valencia, Spain
| | - Rebeca Osca-Verdegal
- INCLIVA Biomedical Research Institute, Valencia, Spain.,Department of Physiology, School of Medicine and Dentistry, Universitat de València (UV), Valencia, Spain
| | - Salvador Mena-Mollá
- Department of Physiology, School of Medicine and Dentistry, Universitat de València (UV), Valencia, Spain.,EpiDisease S.L. Spin-Off of CIBERER (ISCIII), Valencia, Spain
| | - José Luis García-Giménez
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,Department of Physiology, School of Medicine and Dentistry, Universitat de València (UV), Valencia, Spain.,EpiDisease S.L. Spin-Off of CIBERER (ISCIII), Valencia, Spain
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