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Bertero L, Siravegna G, Rudà R, Soffietti R, Bardelli A, Cassoni P. Review: Peering through a keyhole: liquid biopsy in primary and metastatic central nervous system tumours. Neuropathol Appl Neurobiol 2019; 45:655-670. [PMID: 30977933 PMCID: PMC6899864 DOI: 10.1111/nan.12553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/18/2019] [Indexed: 12/20/2022]
Abstract
Tumour molecular profiling by liquid biopsy is being investigated for a wide range of research and clinical purposes. The possibility of repeatedly interrogating the tumour profile using minimally invasive procedures is helping to understand spatial and temporal tumour heterogeneity, and to shed a light on mechanisms of resistance to targeted therapies. Moreover, this approach has been already implemented in clinical practice to address specific decisions regarding patients’ follow‐up and therapeutic management. For central nervous system (CNS) tumours, molecular profiling is particularly relevant for the proper characterization of primary neoplasms, while CNS metastases can significantly diverge from primary disease or extra‐CNS metastases, thus compelling a dedicated assessment. Based on these considerations, effective liquid biopsy tools for CNS tumours are highly warranted and a significant amount of data have been accrued over the last few years. These results have shown that liquid biopsy can provide clinically meaningful information about both primary and metastatic CNS tumours, but specific considerations must be taken into account, for example, when choosing the source of liquid biopsy. Nevertheless, this approach is especially attractive for CNS tumours, as repeated tumour sampling is not feasible. The aim of our review was to thoroughly report the state‐of‐the‐art regarding the opportunities and challenges posed by liquid biopsy in both primary and secondary CNS tumours.
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Affiliation(s)
- L Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Torino, Italy.,Pathology Unit, Città della Salute e della Scienza University Hospital, Turin, Torino, Italy
| | - G Siravegna
- Department of Oncology, University of Turin, Candiolo (Turin), Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo (Turin), Italy
| | - R Rudà
- Neuro-oncology Unit, Department of Neurosciences, University of Turin, Italy.,Neuro-oncology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - R Soffietti
- Neuro-oncology Unit, Department of Neurosciences, University of Turin, Italy.,Neuro-oncology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - A Bardelli
- Department of Oncology, University of Turin, Candiolo (Turin), Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo (Turin), Italy
| | - P Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, Torino, Italy.,Pathology Unit, Città della Salute e della Scienza University Hospital, Turin, Torino, Italy
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52
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Boire A, Brandsma D, Brastianos PK, Le Rhun E, Ahluwalia M, Junck L, Glantz M, Groves MD, Lee EQ, Lin N, Raizer J, Rudà R, Weller M, Van den Bent MJ, Vogelbaum MA, Chang S, Wen PY, Soffietti R. Liquid biopsy in central nervous system metastases: a RANO review and proposals for clinical applications. Neuro Oncol 2019; 21:571-584. [PMID: 30668804 PMCID: PMC6502489 DOI: 10.1093/neuonc/noz012] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Liquid biopsies collect and analyze tumor components in body fluids, and there is an increasing interest in the investigation of liquid biopsies as a surrogate for tumor tissue in the management of both primary and secondary brain tumors. Herein we critically review available literature on spinal fluid and plasma circulating tumor cells (CTCs) and cell-free tumor (ctDNA) for diagnosis and monitoring of leptomeningeal and parenchymal brain metastases. We discuss technical issues and propose several potential applications of liquid biopsies in different clinical settings (ie, for initial diagnosis, for assessment during treatment, and for guidance of treatment decisions). Last, ongoing clinical studies on CNS metastases that include liquid biopsies are summarized, and recommendations for future clinical studies are provided.
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Affiliation(s)
- Adrienne Boire
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute‒Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Priscilla K Brastianos
- Departments of Medicine and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Emilie Le Rhun
- Department of Neuro-Oncology/Neurosurgery, University Hospital, Lille, France
| | - Manmeet Ahluwalia
- Department of Medicine, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Larry Junck
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Glantz
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA
| | - Morris D Groves
- Department of Neuro-Oncology, Austin Brain Tumor Center and University of Texas, Austin, Texas, USA
| | - Eudocia Q Lee
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Raizer
- Department of Neurology and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, University Hospital, Zurich, Switzerland
| | | | - Michael A Vogelbaum
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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53
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Calapre L, Giardina T, Robinson C, Reid AL, Al‐Ogaili Z, Pereira MR, McEvoy AC, Warburton L, Hayward NK, Khattak MA, Meniawy TM, Millward M, Amanuel B, Ziman M, Gray ES. Locus-specific concordance of genomic alterations between tissue and plasma circulating tumor DNA in metastatic melanoma. Mol Oncol 2019; 13:171-184. [PMID: 30312528 PMCID: PMC6360370 DOI: 10.1002/1878-0261.12391] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/14/2018] [Accepted: 10/02/2018] [Indexed: 01/28/2023] Open
Abstract
Circulating tumor DNA (ctDNA) may serve as a surrogate to tissue biopsy for noninvasive identification of mutations across multiple genetic loci and for disease monitoring in melanoma. In this study, we compared the mutation profiles of tumor biopsies and plasma ctDNA from metastatic melanoma patients using custom sequencing panels targeting 30 melanoma-associated genes. Somatic mutations were identified in 20 of 24 melanoma biopsies, and 16 of 20 (70%) matched-patient plasmas had detectable ctDNA. In a subgroup of seven patients for whom matching tumor tissue and plasma were sequenced, 80% of the mutations found in tumor tissue were also detected in ctDNA. However, TERT promoter mutations were only detected by ddPCR, and promoter mutations were consistently found at lower concentrations than other driver mutations in longitudinal samples. In vitro experiments revealed that mutations in promoter regions of TERT and DPH3 are underrepresented in ctDNA. While the results underscore the utility of using ctDNA as an alternative to tissue biopsy for genetic profiling and surveillance of the disease, our study highlights the underrepresentation of promoter mutations in ctDNA and its potential impact on quantitative liquid biopsy applications.
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Affiliation(s)
- Leslie Calapre
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
| | - Tindaro Giardina
- Anatomical PathologyPathWest Laboratory MedicineQEII Medical CentreNedlandsAustralia
| | - Cleo Robinson
- Anatomical PathologyPathWest Laboratory MedicineQEII Medical CentreNedlandsAustralia
- School of Biomedical ScienceUniversity of Western AustraliaCrawleyAustralia
| | - Anna L. Reid
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
| | - Zeyad Al‐Ogaili
- Department of Molecular Imaging and Therapy ServiceFiona Stanley HospitalMurdochAustralia
| | - Michelle R. Pereira
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
| | - Ashleigh C. McEvoy
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
| | - Lydia Warburton
- Department of Medical OncologySir Charles Gairdner HospitalNedlandsAustralia
| | | | - Muhammad A. Khattak
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
- Department of Medical OncologyFiona Stanley HospitalMurdochAustralia
| | - Tarek M. Meniawy
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
| | - Michael Millward
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
| | - Benhur Amanuel
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
- Anatomical PathologyPathWest Laboratory MedicineQEII Medical CentreNedlandsAustralia
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
| | - Melanie Ziman
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
- School of Biomedical ScienceUniversity of Western AustraliaCrawleyAustralia
| | - Elin S. Gray
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
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54
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Zorofchian S, Iqbal F, Rao M, Aung PP, Esquenazi Y, Ballester LY. Circulating tumour DNA, microRNA and metabolites in cerebrospinal fluid as biomarkers for central nervous system malignancies. J Clin Pathol 2018; 72:271-280. [DOI: 10.1136/jclinpath-2018-205414] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/11/2018] [Accepted: 10/21/2018] [Indexed: 01/06/2023]
Abstract
Central nervous system (CNS) malignancies can be difficult to diagnose and many do not respond satisfactorily to existing therapies. Monitoring patients with CNS malignancies for treatment response and tumour recurrence can be challenging because of the difficulty and risks of brain biopsies, and the low specificity and sensitivity of the less invasive methodologies that are currently available. Uncertainty about tumour diagnosis or whether a tumour has responded to treatment or has recurred can cause delays in therapeutic decisions that can impact patient outcome. Therefore, there is an urgent need to develop and validate reliable and minimally invasive biomarkers for CNS tumours that can be used alone or in combination with current clinical practices. Blood-based biomarkers can be informative in the diagnosis and monitoring of various types of cancer. However, blood-based biomarkers have proven suboptimal for analysis of CNS tumours. In contrast, circulating biomarkers in cerebrospinal fluid (CSF), including circulating tumour DNA, microRNAs and metabolites, hold promise for accurate and minimally invasive assessment of CNS tumours. This review summarises the current understanding of these three types of CSF biomarkers and their potential use in neuro-oncologic clinical practice.
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55
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Stallard S, Savelieff MG, Wierzbicki K, Mullan B, Miklja Z, Bruzek A, Garcia T, Siada R, Anderson B, Singer BH, Hashizume R, Carcaboso AM, McMurray KQ, Heth J, Muraszko K, Robertson PL, Mody R, Venneti S, Garton H, Koschmann C. CSF H3F3A K27M circulating tumor DNA copy number quantifies tumor growth and in vitro treatment response. Acta Neuropathol Commun 2018; 6:80. [PMID: 30111355 PMCID: PMC6094898 DOI: 10.1186/s40478-018-0580-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 01/06/2023] Open
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56
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Abstract
Leptomeningeal metastasis (LM) results from dissemination of cancer cells to both the leptomeninges (pia and arachnoid) and cerebrospinal fluid (CSF) compartment. Breast cancer, lung cancer, and melanoma are the most common solid tumors that cause LM. Recent approval of more active anticancer therapies has resulted in improvement in survival that is partly responsible for an increased incidence of LM. Neurologic deficits, once manifest, are mostly irreversible, and often have a significant impact on patient quality of life. LM-directed therapy is based on symptom palliation, circumscribed use of neurosurgery, limited field radiotherapy, intra-CSF and systemic therapies. Novel methods of detecting LM include detection of CSF circulating tumor cells and tumor cell-free DNA. A recent international guideline for a standardization of response assessment in LM may improve cross-trial comparisons as well as within-trial evaluation of treatment. An increasing number of retrospective studies suggest that molecular-targeted therapy, such as EGFR and ALK inhibitors in lung cancer, trastuzumab in HER2+ breast cancer, and BRAF inhibitors in melanoma, may be effective as part of the multidisciplinary management of LM. Prospective randomized trials with standardized response assessment are needed to further validate these preliminary findings.
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57
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Melms JC, Ho KW, Thummalapalli R, Tyler J, Brinker TJ, Singh V, Sengupta S, Mier J, Izar B. Implementation of cell-free tumor DNA sequencing from the cerebrospinal fluid to guide treatment in a patient with primary leptomeningeal melanoma: A case report. Mol Clin Oncol 2018; 9:58-61. [PMID: 29977540 PMCID: PMC6030997 DOI: 10.3892/mco.2018.1621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/08/2018] [Indexed: 02/06/2023] Open
Abstract
Primary leptomeningeal melanoma (PLM) is a rare type of cancer that represents a major clinical and molecular diagnostic challenge. A definitive diagnosis requires consistent magnetic resonance imaging findings and cerebrospinal fluid (CSF) cytology. Due to the small number of malignant cells in the CSF, routine testing for mutations in the BRAF gene is difficult, which prevents the stratification of these patients to potentially beneficial therapies. We herein present the case of a 62-year old man with CSF cytology indicating PLM, where BRAF mutation testing, from cell-free (cf) tumor DNA isolated from the CSF and plasma was implemented to guide clinical decision making. Testing for BRAFV600E mutation from the CSF and plasma was technically feasible, yielded concordant results, and guided the treatment for this patient. This case suggests that mutation testing of cfDNA isolated from the CSF is technically feasible and may guide therapy in cases where a tissue diagnosis is not possible for PLM and other malignancies with defined oncogenic driver mutations.
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Affiliation(s)
- Johannes C. Melms
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ka-Wai Ho
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Rohit Thummalapalli
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA 02215, USA
| | - Janice Tyler
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Titus Josef Brinker
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, University of Heidelberg, Heidelberg D-69120, Germany
| | | | - Soma Sengupta
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - James Mier
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Benjamin Izar
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Broad Institute of Harvard and MIT, Cambridge, MA 02139, USA
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58
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Nevel KS, Wilcox JA, Robell LJ, Umemura Y. The Utility of Liquid Biopsy in Central Nervous System Malignancies. Curr Oncol Rep 2018; 20:60. [PMID: 29876874 DOI: 10.1007/s11912-018-0706-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Liquid biopsy is a sampling of tumor cells or tumor nucleotides from biofluids. This review explores the roles of liquid biopsy for evaluation and management of patients with primary and metastatic CNS malignancies. RECENT FINDINGS Circulating tumor cell (CTC) detection has emerged as a relatively sensitive and specific tool for diagnosing leptomeningeal metastases. Circulating tumor DNA (ctDNA) detection can effectively demonstrate genetic markup of CNS tumors in the cerebrospinal fluid, though its role in managing CNS malignancies is less well-defined. The value of micro RNA (miRNA) detection in CNS malignancies is unclear at this time. Current standard clinical tools for the diagnosis and monitoring of CNS malignancies have limitations, and liquid biopsy may help address clinical practice and knowledge gaps. Liquid biopsy offers exciting potential for the diagnosis, prognosis, and treatment of CNS malignancies, but each modality needs to be studied in large prospective trials to better define their use.
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Affiliation(s)
- Kathryn S Nevel
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jessica A Wilcox
- Department of Neurology, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, 520 E 70th St, Starr Pavilion 607, New York, NY, 10021, USA
| | - Lindsay J Robell
- Department of Neurology, University of Michigan, 1914 Taubman Center, 1500 E. Medical Center Dr., SPC 5316, Ann Arbor, MI, 48109-5316, USA
| | - Yoshie Umemura
- Department of Neurology, University of Michigan, 1914 Taubman Center, 1500 E. Medical Center Dr., SPC 5316, Ann Arbor, MI, 48109-5316, USA.
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59
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Wu X, Zhu L, Ma PC. Next-Generation Novel Noninvasive Cancer Molecular Diagnostics Platforms Beyond Tissues. Am Soc Clin Oncol Educ Book 2018; 38:964-977. [PMID: 30231325 PMCID: PMC6381937 DOI: 10.1200/edbk_199767] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In recent years, there has been a revolutionary expansion in technologic advances and therapeutic innovations in cancer medicine. Cancer diagnostics has begun to move away from a sole dependence on direct tumor tissue biopsy for cancer detection, diagnosis, and treatment monitoring. The need for improvement in molecular cancer diagnostics has never been more important, with not only the advent of cancer genomics and genomics-guided precision medicine but also the recent arrival of cancer immunotherapies. Owing to the practical limitations and risks associated with tissue-based biopsy diagnostics, novel noninvasive cancer diagnostics platforms have continued to evolve and expand in recent years. Examples of these platforms include the liquid biopsy, which is used to interrogate ctDNA or circulating tumor cells, proteomics, metabolomics, and exosomes; the urine biopsy, which is used to assay ctDNAs; saliva and stool biopsies, which are used for molecular genomics assays; and the breath biopsy, which measures volatile organic compounds. These next-generation noninvasive molecular diagnostics assays beyond tissues fundamentally transform the potential utilities of cancer diagnostics to enable repeat, prospective, and serial longitudinal "biopsies" to monitor disease response resistance and progression on therapies. Moreover, they allow continual interrogation and molecular in-depth analysis of the evolving tumor's pan-canceromics under therapeutic stress. These technological and diagnostic advances have already brought about paradigm-changing next-generation cancer therapeutic strategies to enhance overall treatment efficacies. This article reviews the key noninvasive next-generation molecular diagnostics platforms beyond tissues, with emphasis on clinical utilities and applications.
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Affiliation(s)
- Xiaoliang Wu
- From the West Virginia University Cancer Institute, West Virginia University Medicine, West Virginia University, Morgantown, WA; West Virginia Clinical and Translational Institute, Morgantown, WV
| | - Lin Zhu
- From the West Virginia University Cancer Institute, West Virginia University Medicine, West Virginia University, Morgantown, WA; West Virginia Clinical and Translational Institute, Morgantown, WV
| | - Patrick C Ma
- From the West Virginia University Cancer Institute, West Virginia University Medicine, West Virginia University, Morgantown, WA; West Virginia Clinical and Translational Institute, Morgantown, WV
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60
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Pedrosa RMSM, Mustafa DAM, Aerts JGJV, Kros JM. Potential Molecular Signatures Predictive of Lung Cancer Brain Metastasis. Front Oncol 2018; 8:159. [PMID: 29868480 PMCID: PMC5958181 DOI: 10.3389/fonc.2018.00159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 12/25/2022] Open
Abstract
Brain metastases are the most common tumors of the central nervous system (CNS). Incidence rates vary according to primary tumor origin, whereas the majority of the cerebral metastases arise from primary tumors in the lung (40-50%). Brain metastases from lung cancer can occur concurrently or within months after lung cancer diagnosis. Survival rates after lung cancer brain metastasis diagnosis remain poor, to an utmost of 10 months. Therefore, prevention of brain metastasis is a critical concern in order to improve survival among cancer patients. Although several studies have been made in order to disclose the genetic and molecular mechanisms associated with CNS metastasis, the precise mechanisms that govern the CNS metastasis from lung cancer are yet to be clarified. The ability to forecast, which patients have a higher risk of brain metastasis occurrence, would aid cancer management approaches to diminish or prevent the development of brain metastasis and improve the clinical outcome for such patients. In this work, we revise genetic and molecular targets suitable for prediction of lung cancer CNS disease.
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Affiliation(s)
| | - Dana A M Mustafa
- Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Johan M Kros
- Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
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61
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Frankel D, Nanni-Metellus I, Robaglia-Schlupp A, Tomasini P, Guinde J, Barlesi F, Astoul P, Ouafik L, Amatore F, Secq V, Kaspi E, Roll P. Detection of EGFR, KRAS and BRAF mutations in metastatic cells from cerebrospinal fluid. Clin Chem Lab Med 2018; 56:851-856. [PMID: 29306909 DOI: 10.1515/cclm-2017-0527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND In lung adenocarcinoma, molecular profiling of actionable genes has become essential to set up targeted therapies. However, the feasibility and the relevance of molecular profiling from the cerebrospinal fluid (CSF) in the context of meningeal metastasis have been poorly assessed. METHODS We selected patients with stage IV lung adenocarcinoma harbouring metastatic cells in the CSF after cytological analysis. Seven samples from six patients were eligible for molecular testing of epidermal growth factor receptor (EGFR), V-Ki-ras2 Kirsten rat sarcoma viral oncogene homologue (KRAS), v-Raf murine sarcoma viral oncogene homologue B1 (BRAF) and human epidermal growth factor receptor 2 (HER2) mutations using quantitative polymerase chain reaction (PCR) high-resolution melting curve analysis and Sanger sequencing after DNA extraction from the cell pellets of the CSF. RESULTS Five patients showed mutations in one or two actionable genes, two harboured an EGFR mutation (exons 19 and 21), one only a KRAS mutation, one both EGFR and KRAS mutations and one a BRAF mutation. In all cases, the results of mutation testing provided new major information for patient management, leading to therapeutic adaptation. CSF molecular analysis identified mutations not detected in other neoplastic sites for two patients. In one case, the EGFR p.Thr790Met was identified. CSF was also the only sample available for genetic testing for almost all patients at the time of disease progression. CONCLUSIONS When cancer cells are present in the CSF, the molecular profiling from the cell pellets is relevant, as it can detect supplemental or different mutations compared to a previous analysis of the primitive tumour or plasma cell-free DNA and allows the adaptation of the treatment strategy.
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Affiliation(s)
- Diane Frankel
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Isabelle Nanni-Metellus
- APHM, Faculté de Médecine Nord, Laboratoire de Transfert d'Oncologie Biologique, Marseille, France
| | - Andrée Robaglia-Schlupp
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Pascale Tomasini
- APHM, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Julien Guinde
- Aix Marseille Univ, INSERM, MMG, Marseille, France.,APHM, Hôpital Nord, Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France
| | - Fabrice Barlesi
- APHM, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Philippe Astoul
- APHM, Hôpital Nord, Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France.,Aix Marseille Univ, Marseille, France
| | - L'Houcine Ouafik
- APHM, Faculté de Médecine Nord, Laboratoire de Transfert d'Oncologie Biologique, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Florent Amatore
- APHM, Hôpital Nord, Département de Dermatologie, Marseille, France
| | - Véronique Secq
- APHM, Hôpital Nord, Service Hospitalier d'Anatomie et Cytologie Pathologiques, Marseille, France.,Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmette, CRCM, Marseille, France
| | - Elise Kaspi
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Patrice Roll
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
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62
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Vanden Bempt I, Wauters E, Vansteenkiste J. Genetic profiling of cell-free DNA from cerebrospinal fluid: opening the barrier to leptomeningeal metastasis in EGFR-mutant NSCLC. Ann Oncol 2018; 29:789-791. [DOI: 10.1093/annonc/mdy053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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63
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Pellerino A, Bertero L, Rudà R, Soffietti R. Neoplastic meningitis in solid tumors: from diagnosis to personalized treatments. Ther Adv Neurol Disord 2018. [PMID: 29535794 PMCID: PMC5844521 DOI: 10.1177/1756286418759618] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Neoplastic meningitis (NM) is a devastating complication of solid tumors with poor outcome. Some randomized clinical trials have been conducted with heterogeneous inclusion criteria, diagnostic parameters, response evaluation and primary endpoints. Recently, the Leptomeningeal Assessment in Neuro-Oncology (LANO) Group and the European Society for Medical Oncology/European Association for Neuro-Oncology have proposed some recommendations in order to provide diagnostic criteria and response evaluation scores for NM. The aim of these guidelines is to integrate the neurological examination with magnetic resonance imaging and cerebrospinal fluid findings as well as to provide a framework for use in clinical trials. However, this composite assessment needs further validation. Since intrathecal therapy represents a treatment with limited efficacy in NM, many studies have been conducted on systemic therapies, including target therapies, with some encouraging results in terms of disease control. In this review, we have analyzed the clinical aspects and the most recent diagnostic tools and therapeutic options in NM.
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Affiliation(s)
- Alessia Pellerino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, Turin, 10126 Italy
| | - Luca Bertero
- Section of Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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Glitza IC, Rohlfs M, Guha-Thakurta N, Bassett RL, Bernatchez C, Diab A, Woodman SE, Yee C, Amaria RN, Patel SP, Tawbi H, Wong M, Hwu WJ, Hwu P, Heimberger A, McCutcheon IE, Papadopoulos N, Davies MA. Retrospective review of metastatic melanoma patients with leptomeningeal disease treated with intrathecal interleukin-2. ESMO Open 2018; 3:e000283. [PMID: 29387478 PMCID: PMC5786950 DOI: 10.1136/esmoopen-2017-000283] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives Metastatic melanoma patients with leptomeningeal disease (LMD) have an extremely poor prognosis, with a median survival measured in weeks, and few treatment options. Outcomes of a retrospective cohort of patients with LMD that were treated with intrathecal interleukin-2 (IT IL-2) were reviewed to assess the long-term efficacy of this therapy. Methods The records of metastatic melanoma patients with LMD who were treated with IT IL-2 from 2006 to 2014 in a Compassionate Investigational New Drug study were reviewed. IL-2 (1.2 mIU) was administered intrathecally via Ommaya reservoir up to five times per week in the inpatient setting for 4 weeks; patients with good tolerance and clinical benefit received maintenance IT IL-2 every 1–3 months thereafter. Results The cohort included 43 patients. The median age of the patients was 47 years (range 18–71), and 32 (74%) were male. 23 patients (53%) had positive cerebrospinal fluid (CSF) cytology and radiographic evidence of LMD, 8 (19%) had positive CSF cytology only, 9 (21%) had radiographic evidence only and 3 (7%) were diagnosed based on pathology review after craniotomy. The median overall survival (OS) from initiation of IT IL-2 was 7.8 months (range, 0.4–90.8 months), with 1-year, 2-year and 5-year OS rates of 36%, 26% and 13%. The presence of neurological symptoms (HR 2.1, P=0.03), positive baseline CSF cytology (HR 4.1, P=0.001) and concomitant use of targeted therapy (HR 3.0, P=0.02) was associated with shorter OS on univariate analysis. All patients developed symptoms due to increased intracranial pressure which was managed with supportive medications and/or CSF removal, and there were no treatment-related deaths. Conclusion These results demonstrate that despite their historically dismal prognosis a subset of metastatic melanoma patients with LMD treated with IT IL-2 can achieve long-term survival, but these data need to be verified in a prospective trial setting.
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Affiliation(s)
- Isabella C Glitza
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle Rohlfs
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nandita Guha-Thakurta
- Department of Diagnostic Radiology/ Neuro Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chantale Bernatchez
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adi Diab
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Scott E Woodman
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cassian Yee
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sapna P Patel
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hussein Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Wong
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick Hwu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Heimberger
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicholas Papadopoulos
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Connolly ID, Li Y, Pan W, Johnson E, You L, Vogel H, Ratliff J, Hayden Gephart M. A pilot study on the use of cerebrospinal fluid cell-free DNA in intramedullary spinal ependymoma. J Neurooncol 2017; 135:29-36. [PMID: 28900844 DOI: 10.1007/s11060-017-2557-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/25/2017] [Indexed: 01/02/2023]
Abstract
Cerebrospinal fluid (CSF) represents a promising source of cell-free DNA (cfDNA) for tumors of the central nervous system. A CSF-based liquid biopsy may obviate the need for riskier tissue biopsies and serve as a means for monitoring tumor recurrence or response to therapy. Spinal ependymomas most commonly occur in adults, and aggressive resection must be delicately balanced with the risk of injury to adjacent normal tissue. In patients with subtotal resection, recurrence commonly occurs. A CSF-based liquid biopsy matched to the patient's spinal ependymoma mutation profile has potential to be more sensitive then surveillance MRI, but the utility has not been well characterized for tumors of the spinal cord. In this study, we collected matched blood, tumor, and CSF samples from three adult patients with WHO grade II intramedullary spinal ependymoma. We performed whole exome sequencing on matched tumor and normal DNA to design Droplet Digital™ PCR (ddPCR) probes for tumor and wild-type mutations. We then interrogated CSF samples for tumor-derived cfDNA by performing ddPCR on extracted cfDNA. Tumor cfDNA was not reliably detected in the CSF of our cohort. Anatomic sequestration and low grade of intramedullary spinal cord tumors likely limits the role of CSF liquid biopsy.
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Affiliation(s)
- Ian David Connolly
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive MC 5327, Stanford, CA, 94305, USA
| | - Yingmei Li
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive MC 5327, Stanford, CA, 94305, USA
| | - Wenying Pan
- Department of Bioengineering, James H. Clark Center, Stanford University, Stanford, CA, USA
| | - Eli Johnson
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive MC 5327, Stanford, CA, 94305, USA
| | - Linya You
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive MC 5327, Stanford, CA, 94305, USA
| | - Hannes Vogel
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - John Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive MC 5327, Stanford, CA, 94305, USA
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive MC 5327, Stanford, CA, 94305, USA.
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Calapre L, Warburton L, Millward M, Ziman M, Gray ES. Circulating tumour DNA (ctDNA) as a liquid biopsy for melanoma. Cancer Lett 2017; 404:62-69. [PMID: 28687355 DOI: 10.1016/j.canlet.2017.06.030] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 01/10/2023]
Abstract
Circulating tumour DNA (ctDNA) has emerged as a promising blood-based biomarker for monitoring disease status of patients with advanced cancers. In melanoma, ctDNA has been shown to have clinical value as an alternative tumour source for the detection clinically targetable mutations for the assessment of response to therapy. This review provides a critical summary of the evidence that gives credence to the utility of ctDNA as a biomarker for monitoring of disease status in advanced melanoma and the steps required for its implementation into clinical settings.
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Affiliation(s)
- Leslie Calapre
- School of Medical Science, Edith Cowan University, Joondalup, WA, Australia.
| | - Lydia Warburton
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Michael Millward
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Mel Ziman
- School of Medical Science, Edith Cowan University, Joondalup, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia
| | - Elin S Gray
- School of Medical Science, Edith Cowan University, Joondalup, WA, Australia
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Le Rhun E, Weller M, Brandsma D, Van den Bent M, de Azambuja E, Henriksson R, Boulanger T, Peters S, Watts C, Wick W, Wesseling P, Rudà R, Preusser M. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours. Ann Oncol 2017; 28:iv84-iv99. [PMID: 28881917 DOI: 10.1093/annonc/mdx221] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- E Le Rhun
- Neuro-Oncology, Department of Neurosurgery, Lille University Hospital, Lille
- Neurology, Medical Oncology Department, Oscar Lambret Center, Lille
- Lille University, Inserm U-1192, Villeneuve d'Ascq, France
| | - M Weller
- Department of Neurology and Brain Tumour Center, University Hospital, Zurich, Switzerland
| | - D Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam
| | - M Van den Bent
- The Brain Tumour Center at the Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - E de Azambuja
- Medical Oncology Department, Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - R Henriksson
- Regional Cancer Center, Stockholm
- Department of Radiation Sciences and Oncology, University, Umea, Sweden
| | - T Boulanger
- Neuroradiology, Imaging Department, Oscar Lambret Center, Lille, France
| | - S Peters
- Department of Oncology, University Hospital, Lausanne, Switzerland
| | - C Watts
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - W Wick
- Neurology Clinic, Heidelberg University Hospital, Heidelberg
- Clinical Cooperation Unit Neuro-Oncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - P Wesseling
- Department of Pathology, VU University Medical Centre and Brain Tumour Center, Amsterdam
- Department of Pathology, Princess Máxima Center for Paediatric Oncology and University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R Rudà
- Department of Neuro-Oncology, City of Health and Science Hospital, University of Turin, Turin, Italy
| | - M Preusser
- Clinical Division of Oncology, Department of Medicine 1, CNS Unit Comprehensive Cancer Centre (CCC-CNS), Medical University, Vienna, Austria
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Gershanov S, Michowiz S, Toledano H, Yahav G, Barinfeld O, Hirshberg A, Ben-Zvi H, Mircus G, Salmon-Divon M, Fixler D, Goldenberg-Cohen N. Fluorescence Lifetime Imaging Microscopy, a Novel Diagnostic Tool for Metastatic Cell Detection in the Cerebrospinal Fluid of Children with Medulloblastoma. Sci Rep 2017. [PMID: 28623325 PMCID: PMC5473849 DOI: 10.1038/s41598-017-03892-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In pediatric brain tumours, dissemination of malignant cells within the central nervous system confers poor prognosis and determines treatment intensity, but is often undetectable by imaging or cytology. This study describes the use of fluorescence lifetime (FLT) imaging microscopy (FLIM), a novel diagnostic tool, for detection of metastatic spread. The study group included 15 children with medulloblastoma and 2 with atypical teratoid/rhabdoid tumour. Cells extracted from the tumour and the cerebrospinal fluid (CSF) 2 weeks postoperatively and repeatedly during chemo/radiotherapy were subjected to nuclear staining followed by FLT measurement and cytological study. Control CSF samples were collected from patients with infectious/inflammatory disease attending the same hospital. Median FLT was prolonged in tumour cells (4.27 ± 0.28 ns; P < 2.2*10−16) and CSF metastatic cells obtained before chemo/radiotherapy (6.28 ± 0.22 ns; P < 2.2*10−16); normal in inflammatory control cells (2.6 ± 0.04 ns) and cells from children without metastasis before chemo/radiotherapy (2.62 ± 0.23 ns; P = 0.858) and following treatment (2.62 ± 0.21 ns; P = 0.053); and short in CSF metastatic cells obtained after chemo/radiotherapy (2.40 ± 0.2 ns; P < 2.2*10−16). FLIM is a simple test that can potentially identify CSF spread of brain tumours. FLT changes in accordance with treatment, with significant prolonged median values in tumours and metastases. More accurate detection of metastatic cells may guide personalised treatment and improve the therapeutic outcome.
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Affiliation(s)
- Sivan Gershanov
- Genomic Bioinformatics Laboratory, Department of Molecular Biology, Ariel University, Ariel, 40700, Israel.,The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Beilinson Hospital, Petach Tikva 4941492, affiliated to Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Shalom Michowiz
- Department of Pediatric Neurosurgery, Schneider Children's Medical Center of Israel, Petach Tikva, 4920235, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Helen Toledano
- Department of Pediatric Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, 4920235, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Gilad Yahav
- Faculty of Engineering and Institute of Nanotechnology and Advanced Materials, Bar Ilan University, Ramat Gan, 5290002, Israel
| | - Orit Barinfeld
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Beilinson Hospital, Petach Tikva 4941492, affiliated to Tel Aviv University, Tel Aviv, 6997801, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Avraham Hirshberg
- Department of Oral Pathology and Oral Medicine, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Haim Ben-Zvi
- Laboratory of Microbiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel
| | - Gabriel Mircus
- Laboratory of Microbiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel
| | - Mali Salmon-Divon
- Genomic Bioinformatics Laboratory, Department of Molecular Biology, Ariel University, Ariel, 40700, Israel
| | - Dror Fixler
- Faculty of Engineering and Institute of Nanotechnology and Advanced Materials, Bar Ilan University, Ramat Gan, 5290002, Israel
| | - Nitza Goldenberg-Cohen
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Beilinson Hospital, Petach Tikva 4941492, affiliated to Tel Aviv University, Tel Aviv, 6997801, Israel. .,Department of Ophthalmology, Bnai Zion Medical Center, Haifa, 3339419, Israel.
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Huang TY, Piunti A, Lulla RR, Qi J, Horbinski CM, Tomita T, James CD, Shilatifard A, Saratsis AM. Detection of Histone H3 mutations in cerebrospinal fluid-derived tumor DNA from children with diffuse midline glioma. Acta Neuropathol Commun 2017; 5:28. [PMID: 28416018 PMCID: PMC5392913 DOI: 10.1186/s40478-017-0436-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/08/2017] [Indexed: 02/08/2023] Open
Abstract
Diffuse midline gliomas (including diffuse intrinsic pontine glioma, DIPG) are highly morbid glial neoplasms of the thalamus or brainstem that typically arise in young children and are not surgically resectable. These tumors are characterized by a high rate of histone H3 mutation, resulting in replacement of lysine 27 with methionine (K27M) in genes encoding H3 variants H3.3 (H3F3A) and H3.1 (HIST1H3B). Detection of these gain-of-function mutations has clinical utility, as they are associated with distinct tumor biology and clinical outcomes. Given the paucity of tumor tissue available for molecular analysis and relative morbidity of midline tumor biopsy, CSF-derived tumor DNA from patients with diffuse midline glioma may serve as a viable alternative for clinical detection of histone H3 mutation. We demonstrate the feasibility of two strategies to detect H3 mutations in CSF-derived tumor DNA from children with brain tumors (n = 11) via either targeted Sanger sequencing of H3F3A and HIST1H3B, or H3F3A c.83 A > T detection via nested PCR with mutation-specific primers. Of the six CSF specimens from children with diffuse midline glioma in our cohort, tumor DNA sufficient in quantity and quality for analysis was isolated from five (83%), with H3.3K27M detected in four (66.7%). In addition, H3.3G34V was identified in tumor DNA from a patient with supratentorial glioblastoma. Test sensitivity (87.5%) and specificity (100%) was validated via immunohistochemical staining and Sanger sequencing in available matched tumor tissue specimens (n = 8). Our results indicate that histone H3 gene mutation is detectable in CSF-derived tumor DNA from children with brain tumors, including diffuse midline glioma, and suggest the feasibility of “liquid biopsy” in lieu of, or to complement, tissue diagnosis, which may prove valuable for stratification to targeted therapies and monitoring treatment response.
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Sakaizawa K, Ashida A, Uhara H, Okuyama R. Detection of BRAFV600K mutant tumor-derived DNA in the pleural effusion from a patient with metastatic melanoma. Clin Chem Lab Med 2017; 55:e92-e95. [PMID: 27665423 DOI: 10.1515/cclm-2016-0634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/15/2016] [Indexed: 11/15/2022]
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Dagogo-Jack I, Carter SL, Brastianos PK. Brain Metastasis: Clinical Implications of Branched Evolution. Trends Cancer 2016; 2:332-337. [DOI: 10.1016/j.trecan.2016.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022]
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