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Itenov TS, Murray DD, Jensen JUS. Sepsis: Personalized Medicine Utilizing 'Omic' Technologies-A Paradigm Shift? Healthcare (Basel) 2018; 6:healthcare6030111. [PMID: 30205441 PMCID: PMC6163606 DOI: 10.3390/healthcare6030111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 01/04/2023] Open
Abstract
Sepsis has over the years proven a considerable challenge to physicians and researchers. Numerous pharmacological and non-pharmacological interventions have been tested in trials, but have unfortunately failed to improve the general prognosis. This has led to the speculation that the sepsis population may be too heterogeneous to be targeted with the traditional one treatment suits all’ approach. Recent advances in genetic and biochemical analyses now allow genotyping and biochemical characterisation of large groups of patients via the ‘omics’ technologies. These new opportunities could lead to a paradigm shift in the approach to sepsis towards personalised treatments with interventions targeted towards specific pathophysiological mechanisms activated in the patient. In this article, we review the potentials and pitfalls of using new advanced technologies to deepen our understanding of the clinical syndrome of sepsis.
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Affiliation(s)
| | | | - Jens Ulrik Stæhr Jensen
- PERSIMUNE, Rigshospitalet, Copenhagen DK-2100, Denmark.
- Department of Internal Medicine C, Respiratory Medicine Section, Herlev-Gentofte Hospital, Hellerup DK-2900, Denmark.
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52
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Burdach SEG, Westhoff MA, Steinhauser MF, Debatin KM. Precision medicine in pediatric oncology. Mol Cell Pediatr 2018; 5:6. [PMID: 30171420 PMCID: PMC6119176 DOI: 10.1186/s40348-018-0084-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/01/2018] [Indexed: 01/06/2023] Open
Abstract
Outcome in treatment of childhood cancers has improved dramatically since the 1970s. This success was largely achieved by the implementation of cooperative clinical research trial groups that standardized and developed treatment of childhood cancer. Nevertheless, outcome in certain types of malignancies is still unfavorable. Intensification of conventional chemotherapy and radiotherapy improved outcome only marginally at the cost of acute and long-term side effects. Hence, it is necessary to develop targeted therapy strategies.Here, we review the developments and perspectives in precision medicine in pediatric oncology with a special focus on targeted drug therapies like kinase inhibitors and inducers of apoptosis, the impact of cancer genome sequencing and immunotherapy.
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Affiliation(s)
- Stefan E G Burdach
- Department of Pediatrics and Children's Cancer Research Center (CCRC), Technische Universität München, Koelner Platz 1, 80804, Munich, Germany. .,CCC München-Comprehensive Cancer Center and German Translational Cancer Research Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Mike-Andrew Westhoff
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Eythstr. 24, 89075, Ulm, Germany
| | - Maximilian Felix Steinhauser
- Department of Pediatrics and Children's Cancer Research Center (CCRC), Technische Universität München, Koelner Platz 1, 80804, Munich, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Eythstr. 24, 89075, Ulm, Germany
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53
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Cole BL, Pritchard CC, Anderson M, Leary SE. Targeted Sequencing of Malignant Supratentorial Pediatric Brain Tumors Demonstrates a High Frequency of Clinically Relevant Mutations. Pediatr Dev Pathol 2018; 21:380-388. [PMID: 29173061 DOI: 10.1177/1093526617743905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pediatric brain tumors cause more deaths than any other childhood malignancy, and the identification of potentially actionable genomic alterations in this rare heterogeneous group of tumors may improve treatment and outcome. The genetic landscape of common posterior fossa tumors has been described in the past several years, yet the classification of malignant pediatric supratentorial tumors remains controversial. Next-generation sequencing (NGS) is a promising tool to evaluate multiple genes concurrently. The clinical utility of NGS has not been proven in pediatric brain tumors. We identified patients diagnosed with high-grade supratentorial pediatric brain tumors resected between 2008 and 2012 at our institution. DNA from 12 formalin-fixed paraffin-embedded tumor samples from 9 patients was analyzed, including 3 paired samples from diagnosis and relapse. A panel of 194 cancer-related genes was sequenced using targeted next-generation deep sequencing. Genetic findings were correlated with histology, immunohistochemistry, treatment, and survival. We found one or more pathologic genetic change (mutation, amplification, or deletion) in 8 of 9 (89%) of patients studied. Epidermal Growth Factor Receptor ( EGFR) mutations were found in 3 patients, 2 of which had an exon 20 insertion not previously described in pediatric malignancy. Additional genetic changes were found in EGFR and Platelet-Derived Growth Factor Receptor Alpha ( PDGFRA) at relapse not present in the initial samples. Familial cancer predisposition syndromes were suggested by mutations found in 3 genes in 4 patients, including TP53, MSH2, and CHEK2. Seven of 9 patients in this study died of their disease. In summary, targeted deep sequencing may be used in rare pediatric brain tumors to identify driver mutations for targeted therapy, suggest constitutional and familial testing for cancer predisposition syndromes, and select molecular targets worthy of further study.
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Affiliation(s)
- Bonnie L Cole
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,2 Department of Anatomic Pathology, University of Washington, Seattle, Washington
| | - Colin C Pritchard
- 3 Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Maia Anderson
- 4 Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington
| | - Sarah Es Leary
- 4 Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington.,5 Department of Pediatrics, University of Washington, Seattle, Washington.,6 Fred Hutchinson Cancer Research Center, Seattle, Washington
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54
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Newton Y, Rassekh SR, Deyell RJ, Shen Y, Jones MR, Dunham C, Yip S, Leelakumari S, Zhu J, McColl D, Swatloski T, Salama SR, Ng T, Hendson G, Lee AF, Ma Y, Moore R, Mungall AJ, Haussler D, Stuart JM, Jantzen C, Laskin J, Jones SJM, Marra MA, Morozova O. Comparative RNA-Sequencing Analysis Benefits a Pediatric Patient With Relapsed Cancer. JCO Precis Oncol 2018; 2. [PMID: 31372595 PMCID: PMC6675034 DOI: 10.1200/po.17.00198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical detection of sequence and structural variants in known cancer genes points to viable treatment options for a minority of children with cancer.1 To increase the number of children who benefit from genomic profiling, gene expression information must be considered alongside mutations.2,3 Although high expression has been used to nominate drug targets for pediatric cancers,4,5 its utility has not been evaluated in a systematic way.6 We describe a child with a rare sarcoma that was profiled with whole-genome and RNA sequencing (RNA-Seq) techniques. Although the tumor did not harbor DNA mutations targetable by available therapies, incorporation of gene expression information derived from RNA-Seq analysis led to a therapy that produced a significant clinical response. We use this case to describe a framework for inclusion of gene expression into the clinical genomic evaluation of pediatric tumors.
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Affiliation(s)
- Yulia Newton
- University of California Santa Cruz Genomics Institute, Mailstop CBSE, 1156 High St, Santa Cruz, CA 95064
| | - S Rod Rassekh
- British Columbia Children's Hospital and British Columbia Children's Hospital Research Institute
| | - Rebecca J Deyell
- British Columbia Children's Hospital and British Columbia Children's Hospital Research Institute
| | - Yaoqing Shen
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Martin R Jones
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Chris Dunham
- British Columbia Children's Hospital and British Columbia Children's Hospital Research Institute
| | | | - Sreeja Leelakumari
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Jingchun Zhu
- University of California Santa Cruz Genomics Institute, Mailstop CBSE, 1156 High St, Santa Cruz, CA 95064
| | - Duncan McColl
- University of California Santa Cruz Genomics Institute, Mailstop CBSE, 1156 High St, Santa Cruz, CA 95064
| | - Teresa Swatloski
- University of California Santa Cruz Genomics Institute, Mailstop CBSE, 1156 High St, Santa Cruz, CA 95064
| | - Sofie R Salama
- University of California Santa Cruz Genomics Institute, Mailstop CBSE, 1156 High St, Santa Cruz, CA 95064
| | | | - Glenda Hendson
- British Columbia Children's Hospital and British Columbia Children's Hospital Research Institute
| | - Anna F Lee
- British Columbia Children's Hospital and British Columbia Children's Hospital Research Institute
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Richard Moore
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - David Haussler
- University of California Santa Cruz Genomics Institute, Mailstop CBSE, 1156 High St, Santa Cruz, CA 95064
| | - Joshua M Stuart
- University of California Santa Cruz Genomics Institute, Mailstop CBSE, 1156 High St, Santa Cruz, CA 95064
| | - Colleen Jantzen
- British Columbia Children's Hospital and British Columbia Children's Hospital Research Institute
| | | | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Olena Morozova
- University of California Santa Cruz Genomics Institute, Mailstop CBSE, 1156 High St, Santa Cruz, CA 95064
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55
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Abstract
PURPOSE OF REVIEW The current review describes recent advances and unique challenges in precision medicine for pediatric cancers and highlights clinical trials assessing the clinical impact of targeted therapy matched to molecular alterations identified by tumor profiling. RECENT FINDINGS Multiple prospective clinical sequencing studies in pediatric oncology have been reported in the last 2 years. These studies demonstrated feasibility of sequencing in the clinic and revealed a rate of actionable variants that justifies the development of precision trials for childhood cancer. A number of precision medicine trials are recently completed, underway or in development and these will be reviewed herein, with a focus on highlighting aspects of precision medicine trial design relevant to pediatric oncology. SUMMARY The primary results of the first round of pediatric precision oncology clinical trials will provide us with a greater understanding of the clinical impact of linking tumor profiling to selection of targeted therapies. The aggregation of sequencing and clinical data from these trials and the results of biologic investigations linked to these trials will drive further discoveries and broaden opportunities for precision medicine for children with cancer.
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56
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Abstract
Any therapy that aims at eradicating a cancerous growth will have at its core a cell death-inducing component. Here we argue that paediatric oncology presents with its unique set of considerations and problems, which—while taking the lead from oncological research experiences obtained from the adult population—need to be clinically evaluated independently. This is particularly true when considering long-term side effects. Precision medicine offers a promising new approach in therapy, but given as a monotherapy and in a limited combination, as found in an apoptosis inducer/sensitiser combination, it will most likely lead to mutation escape of the target cell population and the emergence of resistance. However, using the increasing amount of the molecular data as the basis for a complex combination therapy combining several key components such as cell death-inducing agents, kinase inhibitors and BH3 mimetics, holds great promise.
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Mochizuki AY, Frost IM, Mastrodimos MB, Plant AS, Wang AC, Moore TB, Prins RM, Weiss PS, Jonas SJ. Precision Medicine in Pediatric Neurooncology: A Review. ACS Chem Neurosci 2018; 9:11-28. [PMID: 29199818 PMCID: PMC6656379 DOI: 10.1021/acschemneuro.7b00388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Central nervous system tumors are the leading cause of cancer related death in children. Despite much progress in the field of pediatric neurooncology, modern combination treatment regimens often result in significant late effects, such as neurocognitive deficits, endocrine dysfunction, secondary malignancies, and a host of other chronic health problems. Precision medicine strategies applied to pediatric neurooncology target specific characteristics of individual patients' tumors to achieve maximal killing of neoplastic cells while minimizing unwanted adverse effects. Here, we review emerging trends and the current literature that have guided the development of new molecularly based classification schemas, promising diagnostic techniques, targeted therapies, and delivery platforms for the treatment of pediatric central nervous system tumors.
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Affiliation(s)
- Aaron Y. Mochizuki
- Department
of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Isaura M. Frost
- Department
of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Melina B. Mastrodimos
- Department
of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Ashley S. Plant
- Division
of Pediatric Oncology, Children’s Hospital of Orange County, Orange, California 92868, United States
| | - Anthony C. Wang
- Department
of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Theodore B. Moore
- Department
of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Robert M. Prins
- Department
of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
- Jonsson
Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
- Department
of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, California 90095, United States
| | - Paul S. Weiss
- California
NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
- Department
of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
- Department
of Materials Science and Engineering, University of California, Los Angeles, Los
Angeles, California 90095, United States
- Jonsson
Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Steven J. Jonas
- California
NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
- Department
of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, United States
- Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, Los Angeles, California 90095, United States
- Children’s
Discovery and Innovation Institute, University of California, Los Angeles, Los
Angeles, California 90095, United States
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58
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Lalonde E, Wertheim G, Li MM. Clinical Impact of Genomic Information in Pediatric Leukemia. Front Pediatr 2017; 5:263. [PMID: 29312903 PMCID: PMC5735078 DOI: 10.3389/fped.2017.00263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/24/2017] [Indexed: 12/21/2022] Open
Abstract
Pediatric leukemia remains a significant contributor to childhood lethality rates. However, recent development of new technologies including next-generation sequencing (NGS) has increased our understanding of the biological and genetic underpinnings of leukemia, resulting in novel diagnostic and treatment paradigms. The most prevalent pediatric leukemias include B-cell acute lymphoblastic leukemia (B-ALL) and acute myeloid leukemia (AML). These leukemias are highly heterogeneous, both clinically and genetically. There are multiple genetic subgroups defined by the World Health Organization, each with distinct clinical management. Clinical laboratories have started adopting genomic testing strategies to include high-throughput sequencing assays which, together with conventional cytogenetic techniques, enable optimal patient care. This review summarizes genetic and genomic techniques used in clinical laboratories to support management of pediatric leukemia, highlighting technical, biological, and clinical advances. We illustrate clinical utilities of comprehensive genomic evaluation of leukemia genomes through clinical case examples, which includes the interrogations of hundreds of genes and multiple mutation mechanisms using NGS technologies. Finally, we provide a future perspective on clinical genomics and precision medicine.
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Affiliation(s)
- Emilie Lalonde
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Gerald Wertheim
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Marilyn M. Li
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Childhood Cancer Research, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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59
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Okur V, Chung WK. The impact of hereditary cancer gene panels on clinical care and lessons learned. Cold Spring Harb Mol Case Stud 2017; 3:mcs.a002154. [PMID: 29162654 PMCID: PMC5701305 DOI: 10.1101/mcs.a002154] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mutations in hereditary cancer syndromes account for a modest fraction of all cancers; however, identifying patients with these germline mutations offers tremendous health benefits to both patients and their family members. There are about 60 genes that confer a high lifetime risk of specific cancers, and this information can be used to tailor prevention, surveillance, and treatment. With advances in next-generation sequencing technologies and the elimination of gene patents for evaluating genetic information, we are now able to analyze multiple genes simultaneously, leading to the widespread clinical use of gene panels for germline cancer testing. Over the last 4 years since these panels were introduced, we have learned about the diagnostic yield of testing, the expanded phenotypes of the patients with mutations, and the clinical utility of genetic testing in patients with cancer and/or without cancer but with a family history of cancer. We have also experienced challenges including the large number of variants of unknown significance (VUSs), identification of somatic mutations and need to differentiate these from germline mutations, technical issues with particular genes and mutations, insurance coverage and reimbursement issues, lack of access to data, and lack of clinical management guidelines for newer and, especially, moderate and low-penetrance genes. The lessons learned from cancer genetic testing panels are applicable to other clinical areas as well and highlight the problems to be solved as we advance genomic medicine.
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Affiliation(s)
- Volkan Okur
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York 10032, USA
| | - Wendy K Chung
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York 10032, USA; .,Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA
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60
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Rosenberg AR, Wolfe J. Approaching the third decade of paediatric palliative oncology investigation: historical progress and future directions. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:56-67. [PMID: 29333484 DOI: 10.1016/s2352-4642(17)30014-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Paediatric palliative care (PPC) endeavours to alleviate the suffering and improve the quality of life of children with serious illnesses and their families. In the past two decades since WHO defined PPC and called for its inclusion in paediatric oncology care, rigorous investigation has provided important insights. For example, the first decade of research focused on end-of-life experiences of the child and the family, underscoring the high prevalence of symptom burden, the barriers to parent-provider concordance with regards to prognosis, as well as the need for bereavement supports. The second decade expanded PPC oncology investigation to include the entire cancer continuum and the voices of patients. Other studies identified the need for support of parents, siblings, and racial and ethnic minority groups. Promising interventions designed to improve outcomes were tested in randomised clinical trials. Future research will build on these findings and pose novel questions about how to continue to reduce the burdens of paediatric cancer.
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Affiliation(s)
- Abby R Rosenberg
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, WA, USA (A R Rosenberg MD); Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA (A R Rosenberg); Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA (A R Rosenberg); Department of Psychosocial Oncology and Palliative Care, and Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA (J Wolfe MD); Department of Medicine, Boston Children's Hospital, Boston, MA, USA (J Wolfe); and Harvard Medical School, Boston, MA, USA (J Wolfe)
| | - Joanne Wolfe
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, WA, USA (A R Rosenberg MD); Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA (A R Rosenberg); Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA (A R Rosenberg); Department of Psychosocial Oncology and Palliative Care, and Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA (J Wolfe MD); Department of Medicine, Boston Children's Hospital, Boston, MA, USA (J Wolfe); and Harvard Medical School, Boston, MA, USA (J Wolfe)
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61
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Janeway KA. Molecular profiling in the clinic: Moving from feasibility assessment to evaluating clinical impact. Pediatr Blood Cancer 2017; 64. [PMID: 28233398 DOI: 10.1002/pbc.26482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Katherine A Janeway
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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