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Decarolis B, Simon T, Krug B, Leuschner I, Vokuhl C, Kaatsch P, von Schweinitz D, Klingebiel T, Mueller I, Schweigerer L, Berthold F, Hero B. Treatment and outcome of Ganglioneuroma and Ganglioneuroblastoma intermixed. BMC Cancer 2016; 16:542. [PMID: 27465021 PMCID: PMC4964292 DOI: 10.1186/s12885-016-2513-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 06/27/2016] [Indexed: 12/12/2022] Open
Abstract
Background Ganglioneuroma (GN) and ganglioneuroblastoma intermixed (GNBI) are mature variants of neuroblastic tumors (NT). It is still discussed whether incomplete resection of GN/GNBI impairs the outcome of patients. Methods Clinical characteristics and outcome of localized GN/GNBI were retrospectively compared to localized neuroblastoma (NB) and ganglioneuroblastoma-nodular (GNBN) registered in the German neuroblastoma trials between 2000 and 2010. Results Of 808 consecutive localized NT, 162 (20 %) were classified as GN and 55 (7 %) as GNBI. GN/GNBI patients presented more often with stage 1 disease (68 % vs. 37 %, p < 0.001), less frequently with adrenal tumors (31 % vs. 43 %, p = 0.001) and positive mIBG-uptake (34 % vs. 90 %, p < 0.001), and had less often elevated urine catecholamine metabolites (homovanillic acid 39 % vs. 62 %, p < 0.001, vanillylmandelic acid 27 % vs. 64 %, p < 0.001). Median age at diagnosis increased with grade of differentiation (NB/GNBN: 9; GNBI: 61; GN-maturing: 71; GN-mature: 125 months, p < 0.001). Complete tumor resection was achieved at diagnosis in 70 % of 162 GN and 67 % of 55 GNBI, and after 4 to 32 months of observation in 4 GN (2 %) and 5 GNBI (9 %). Eleven patients received chemotherapy without substantial effect. Fifty-five residual tumors (42 GN, 13 GNBI) are currently under observation (median: 44 months). Five patients (3 GN, 2 GNBI) showed local progression; all had tumor residuals > 2 cm. No progression occurred after subtotal resection. Two patients died of treatment, none of tumor progression. Conclusions GN/GNBI account for one quarter of localized NT and differ from immature tumors in their clinical features. Chemotherapy is not effective. Subtotal resection appears to be a sufficient treatment. Trial registration ClinicalTrials.gov identifiers - NB97 (NCT00017225; registered June 6, 2001); NB2004 (NCT00410631; registered December 11, 2006) Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2513-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Boris Decarolis
- Department of Pediatric Hematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Thorsten Simon
- Department of Pediatric Hematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Barbara Krug
- Department of Radiology, University of Cologne, Cologne, Germany
| | - Ivo Leuschner
- Department of Pathology, University of Kiel, Kiel, Germany
| | | | - Peter Kaatsch
- German Childhood Cancer Registry, University of Mainz, Mainz, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas Klingebiel
- Clinic for Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ingo Mueller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Lothar Schweigerer
- Clinic for Pediatrics, Helios Klinikum Berlin-Buch, Berlin-Buch, Germany
| | - Frank Berthold
- Department of Pediatric Hematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Barbara Hero
- Department of Pediatric Hematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany.
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102
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Mao Y, Eissler N, Blanc KL, Johnsen JI, Kogner P, Kiessling R. Targeting Suppressive Myeloid Cells Potentiates Checkpoint Inhibitors to Control Spontaneous Neuroblastoma. Clin Cancer Res 2016; 22:3849-59. [DOI: 10.1158/1078-0432.ccr-15-1912] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/23/2016] [Indexed: 11/16/2022]
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103
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Yoneda A, Nishikawa M, Uehara S, Oue T, Usui N, Inoue M, Fukuzawa M, Okuyama H. Can neoadjuvant chemotherapy reduce the surgical risks for localized neuroblastoma patients with image-defined risk factors at the time of diagnosis? Pediatr Surg Int 2016; 32:209-14. [PMID: 26763000 DOI: 10.1007/s00383-016-3858-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To date, no detailed study of the changes in the image-defined risk factors (IDRFs) after neoadjuvant chemotherapy has been performed. The aim of this study was to investigate the effect of chemotherapy on IDRFs for stage L2 neuroblastomas. METHODS Fifteen stage L2 patients treated by neoadjuvant chemotherapy were selected. Changes after chemotherapy in the number of positive IDRFs, tumor size and major surgical complications were evaluated. RESULTS All IDRFs disappeared after chemotherapy in four patients (group A) and a reduction in the number of IDRFs, but not disappearance, after chemotherapy was observed in five patients (group B). No change in the number of IDRFs after chemotherapy was observed in six patients (group C). All tumors in groups A shrunk to <20 % of the pretreatment volume. Major surgical complications were observed in one of two, two of three and three of five patients who underwent tumor excision in groups A, B and C, respectively. CONCLUSIONS Only 27 % of the tumors with IDRFs became negative for IDRFs after chemotherapy. For negative IDRFs, tumors should shrink to <20 % of the volume at the time of diagnosis. Stage L2 tumors may have a potential risk for surgery even after neoadjuvant chemotherapy.
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Affiliation(s)
- Akihiro Yoneda
- Pediatric Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Osaka, Japan. .,Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan.
| | - Masanori Nishikawa
- Radiology, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan
| | - Shuichiro Uehara
- Pediatric Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Osaka, Japan.,Pediatric Surgery, Graduate School of Medicine, Osaka University, 1-1 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Takaharu Oue
- Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8131, Hyogo, Japan
| | - Noriaki Usui
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan
| | - Masami Inoue
- Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan
| | - Masahiro Fukuzawa
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan
| | - Hiroomi Okuyama
- Pediatric Surgery, Graduate School of Medicine, Osaka University, 1-1 Yamadaoka, Suita, 565-0871, Osaka, Japan
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104
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van Wezel EM, Decarolis B, Stutterheim J, Zappeij-Kannegieter L, Berthold F, Schumacher-Kuckelkorn R, Simon T, Fiocco M, van Noesel MM, Caron HN, van der Schoot CE, Hero B, Tytgat GAM. Neuroblastoma messenger RNA is frequently detected in bone marrow at diagnosis of localised neuroblastoma patients. Eur J Cancer 2016; 54:149-158. [PMID: 26796600 DOI: 10.1016/j.ejca.2015.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/25/2015] [Accepted: 11/09/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The clinical importance of the detection of neuroblastoma messenger RNA (mRNA) in bone marrow (BM) of localised neuroblastoma patients at diagnosis remains unclear. In this prospective multicentre study, BM samples of a large cohort, were studied using real-time quantitative polymerase chain reaction (qPCR). METHODS BM samples at diagnosis from 160 patients with localised neuroblastoma were prospectively collected at Dutch and German centres between 2009 and 2013. qPCR was performed using five neuroblastoma specific markers. The association with other biological factors and the prognostic impact of BM positivity and clinical response was assessed. RESULTS In 58 out of 160 patients neuroblastoma mRNA was detected in BM. In 47 of the 58 positive samples only one marker was found positive. BM positivity was significantly associated with MYCN amplification (p = 0.02) and deletion of chromosome 1p (p = 0.04). In total 31 patients had an event, of which only five patients had progression to stage IV. BM positivity was not associated with an unfavourable outcome. However, the detection of more than one marker was associated with an unfavourable outcome (systemic or local relapse) (event free survival 48% versus 85%; p = 0.03) in the whole cohort and in the observation group. CONCLUSIONS BM positivity was associated with unfavourable biological factors and might represent more aggressive tumours. Patients with qPCR positive BM should not be upstaged, because of very few systemic events in the cohort. However, for patients with more than one marker positive a more careful follow-up is advisable. These results need to be verified in a very large cohort of localised patients.
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Affiliation(s)
- Esther M van Wezel
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory of the AMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Boris Decarolis
- Children's Hospital, University of Cologne, Pediatric Hematology and Oncology, Germany
| | - Janine Stutterheim
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory of the AMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Lily Zappeij-Kannegieter
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory of the AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Berthold
- Children's Hospital, University of Cologne, Pediatric Hematology and Oncology, Germany
| | | | - Thorsten Simon
- Children's Hospital, University of Cologne, Pediatric Hematology and Oncology, Germany
| | - Marta Fiocco
- Department of Biostatistics, Leiden University Medical Center and Dutch Childhood Oncology Group, The Hague, The Netherlands
| | - Max M van Noesel
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands; Prinses Máxima Centrum, Utrecht, The Netherlands
| | - Huib N Caron
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory of the AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara Hero
- Children's Hospital, University of Cologne, Pediatric Hematology and Oncology, Germany
| | - Godelieve A M Tytgat
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands; Prinses Máxima Centrum, Utrecht, The Netherlands.
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105
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Pentek F, Schulte JH, Schweiger B, Metzelder M, Schündeln MM. Development of Port-Site Metastases Following Thoracoscopic Resection of a Neuroblastoma. Pediatr Blood Cancer 2016. [PMID: 26206749 DOI: 10.1002/pbc.25677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a 26-month-old female who developed port-site metastases of a neuroblastoma following minimally invasive thoracoscopic interventions. After diagnosis of an intrathoracic low-risk neuroblastoma and 6 months of observation, she developed respiratory problems. She subsequently underwent total resection of a locally progressive tumor via thoracoscopy. Six months later, she developed local relapse and subcutaneous metastases within the thoracic wall. These port-site metastases were most likely iatrogenic. After excision of metastases, the residual tumor responded well to salvage chemotherapy. The patient has remained in remission for over 4 years.
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Affiliation(s)
- Falk Pentek
- Department of Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Johannes H Schulte
- Department of Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.,Charité Universitätsmedizin, Department of Pediatrics, Division of Oncology and Hematology, Berlin, Germany.,German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,Translational Neuro-Oncology, West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Martin Metzelder
- Division of Pediatric Surgery, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.,Department of Pediatric Surgery, Medical University Vienna, Vienna, Austria
| | - Michael M Schündeln
- Department of Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
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106
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Gonzalez-Perez LM, Borrero-Martin JJ. An elderly man with a gingival mass that spontaneously regressed. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:348-52. [PMID: 26482192 DOI: 10.1016/j.oooo.2015.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 06/12/2015] [Accepted: 08/20/2015] [Indexed: 02/03/2023]
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107
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La Quaglia MP. The role of primary tumor resection in neuroblastoma: When and how much? Pediatr Blood Cancer 2015; 62:1516-7. [PMID: 25982246 DOI: 10.1002/pbc.25585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Michael P La Quaglia
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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108
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Monclair T, Mosseri V, Cecchetto G, De Bernardi B, Michon J, Holmes K. Influence of image-defined risk factors on the outcome of patients with localised neuroblastoma. A report from the LNESG1 study of the European International Society of Paediatric Oncology Neuroblastoma Group. Pediatr Blood Cancer 2015; 62:1536-42. [PMID: 25663103 DOI: 10.1002/pbc.25460] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/14/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The European multicenter study LNESG1 was designed to evaluate the safety and efficacy of surgical treatment alone in patients with localised neuroblastoma. In a retrospective, observational study we examined the impact of image-defined risk factors (IDRF) on operative complications and survival (EFS and OS). PROCEDURE 534 patients with localised, non-MYCN amplified neuroblastoma were recruited between 1995 and 1999. Group 1 consisted of 291 patients without IDRF (Stage L1 in the International Neuroblastoma Risk Group (INRG) staging system), all treated with primary surgery. Group 2: 118 patients with IDRF (INRG Stage L2), also treated with primary surgery. Group 3: 125 patients in whom primary surgery was not attempted, 106 receiving neo-adjuvant chemotherapy. RESULTS In L1 patients (Group 1) 5-year EFS was 92% and OS 98%. In L2 patients (Group 2 and 3) EFS was 79% and OS 89%. The differences in both EFS and OS were significant. EFS and OS in Group 2 (86% and 95%) were significantly better than 73% and 83% in Group 3. In INSS stage 1, 2 and 3, EFS were respectively 94%, 81% and 76%. Except between stage 2 and 3 the differences were significant. OS were respectively 99%, 93% and 83%, all significantly different. The 17% operative complication rate in L2 patients was significantly higher than 5% in L1 patients. CONCLUSIONS In localised neuroblastoma, IDRF at diagnosis are associated with worse survival rates and higher rates of operative complications. The impact of IDRF should become an integrated part of therapy planning.
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Affiliation(s)
- Tom Monclair
- Department of Hepatic, Gastrointestinal and Paediatric surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | | | - Giovanni Cecchetto
- Pediatric Surgery Unit-Women's and Children Health Department, University Hospital of Padua, Italy
| | - Bruno De Bernardi
- Department of Paediatric Haematology-Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Jean Michon
- Department of Paediatric Oncology, Institut Curie, Paris, France
| | - Keith Holmes
- Department of Paediatric Surgery, St Georges Hospital, London, United Kingdom
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109
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Pinto NR, Applebaum MA, Volchenboum SL, Matthay KK, London WB, Ambros PF, Nakagawara A, Berthold F, Schleiermacher G, Park JR, Valteau-Couanet D, Pearson ADJ, Cohn SL. Advances in Risk Classification and Treatment Strategies for Neuroblastoma. J Clin Oncol 2015; 33:3008-17. [PMID: 26304901 DOI: 10.1200/jco.2014.59.4648] [Citation(s) in RCA: 579] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Risk-based treatment approaches for neuroblastoma have been ongoing for decades. However, the criteria used to define risk in various institutional and cooperative groups were disparate, limiting the ability to compare clinical trial results. To mitigate this problem and enhance collaborative research, homogenous pretreatment patient cohorts have been defined by the International Neuroblastoma Risk Group classification system. During the past 30 years, increasingly intensive, multimodality approaches have been developed to treat patients who are classified as high risk, whereas patients with low- or intermediate-risk neuroblastoma have received reduced therapy. This treatment approach has resulted in improved outcome, although survival for high-risk patients remains poor, emphasizing the need for more effective treatments. Increased knowledge regarding the biology and genetic basis of neuroblastoma has led to the discovery of druggable targets and promising, new therapeutic approaches. Collaborative efforts of institutions and international cooperative groups have led to advances in our understanding of neuroblastoma biology, refinements in risk classification, and stratified treatment strategies, resulting in improved outcome. International collaboration will be even more critical when evaluating therapies designed to treat small cohorts of patients with rare actionable mutations.
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Affiliation(s)
- Navin R Pinto
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Mark A Applebaum
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Samuel L Volchenboum
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Katherine K Matthay
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Wendy B London
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Peter F Ambros
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Akira Nakagawara
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Frank Berthold
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Gudrun Schleiermacher
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Julie R Park
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Dominique Valteau-Couanet
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Andrew D J Pearson
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom
| | - Susan L Cohn
- Navin R. Pinto, Mark A. Applebaum, Samuel L. Volchenboum, and Susan L. Cohn, Comer Children's Hospital, University of Chicago, Chicago, IL; Katherine K. Matthay, University of California San Francisco (UCSF) Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA; Wendy B. London, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ambros, Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Vienna, Austria; Akira Nakagawara, Saga Medical Center Koseikan, Saga, Japan; Frank Berthold, Children's Hospital, University of Cologne, Koln, Germany; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; Julie R. Park, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; and Andrew D.J. Pearson, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom.
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110
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Shao JB, Lu ZH, Huang WY, Lv ZB, Jiang H. A single center clinical analysis of children with neuroblastoma. Oncol Lett 2015; 10:2311-2318. [PMID: 26622841 DOI: 10.3892/ol.2015.3588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 06/16/2015] [Indexed: 12/14/2022] Open
Abstract
In the present study, the cases of 59 children diagnosed with neuroblastoma (NB) were retrospectively analyzed to assess the association between the short-term efficacy of treatment and prognostic factors. In total, 59 patients with NB that were diagnosed between July 1, 2008 and June 30, 2013 at Shanghai Children's Hospital were enrolled in the present study. The follow-up was performed until December 31, 2013, and the data revealed that 43 patients (72.9%) achieved complete remission (CR) or partial remission (PR). The 3-year overall survival (OS) rate of patients with stage I, II, III, IV and IVs disease was 100, 100, 65.6, 34.8 and 85.7%, respectively (P=0.02). The 3-year OS and event-free survival rates were evidently increased in patients with favorable histology compared with the rates in the patients with unfavorable histology (P=0.046 and 0.030, respectively). Univariate statistical analysis revealed that the factors significantly associated with prognosis were patient age, tumor stage and risk group (P=0.004, 0.02 and 0.001, respectively). The present study identified that tumor stage, risk group and patient age are important prognostic factors for NB. An age of 18 months was also hypothesized to be the cut-off for the prognosis of patients.
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Affiliation(s)
- Jing-Bo Shao
- Department of Hematology/Oncology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Zheng-Hua Lu
- Department of Hematology/Oncology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Wen-Yan Huang
- Department of Nephrology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Zhi-Bao Lv
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Hui Jiang
- Department of Hematology/Oncology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
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111
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Eleveld TF, Oldridge DA, Bernard V, Koster J, Colmet Daage L, Diskin SJ, Schild L, Bentahar NB, Bellini A, Chicard M, Lapouble E, Combaret V, Legoix-Né P, Michon J, Pugh TJ, Hart LS, Rader J, Attiyeh EF, Wei JS, Zhang S, Naranjo A, Gastier-Foster JM, Hogarty MD, Asgharzadeh S, Smith MA, Guidry Auvil JM, Watkins TBK, Zwijnenburg DA, Ebus ME, van Sluis P, Hakkert A, van Wezel E, van der Schoot CE, Westerhout EM, Schulte JH, Tytgat GA, Dolman MEM, Janoueix-Lerosey I, Gerhard DS, Caron HN, Delattre O, Khan J, Versteeg R, Schleiermacher G, Molenaar JJ, Maris JM. Relapsed neuroblastomas show frequent RAS-MAPK pathway mutations. Nat Genet 2015; 47:864-71. [PMID: 26121087 PMCID: PMC4775079 DOI: 10.1038/ng.3333] [Citation(s) in RCA: 375] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022]
Abstract
The majority of patients with neuroblastoma have tumors that initially respond to chemotherapy, but a large proportion will experience therapy-resistant relapses. The molecular basis of this aggressive phenotype is unknown. Whole-genome sequencing of 23 paired diagnostic and relapse neuroblastomas showed clonal evolution from the diagnostic tumor, with a median of 29 somatic mutations unique to the relapse sample. Eighteen of the 23 relapse tumors (78%) showed mutations predicted to activate the RAS-MAPK pathway. Seven of these events were detected only in the relapse tumor, whereas the others showed clonal enrichment. In neuroblastoma cell lines, we also detected a high frequency of activating mutations in the RAS-MAPK pathway (11/18; 61%), and these lesions predicted sensitivity to MEK inhibition in vitro and in vivo. Our findings provide a rationale for genetic characterization of relapse neuroblastomas and show that RAS-MAPK pathway mutations may function as a biomarker for new therapeutic approaches to refractory disease.
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Affiliation(s)
- Thomas F Eleveld
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Derek A Oldridge
- 1] Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [2] Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [3] Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jan Koster
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Léo Colmet Daage
- 1] ICGEX Platform, Institut Curie, Paris, France. [2] Laboratory RTOP (Recherche Translationelle en Oncologie Pédiatrique), Transfer Department, Institut Curie, Paris, France
| | - Sharon J Diskin
- 1] Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [2] Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [3] Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda Schild
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | | | - Angela Bellini
- Laboratory RTOP (Recherche Translationelle en Oncologie Pédiatrique), Transfer Department, Institut Curie, Paris, France
| | - Mathieu Chicard
- Laboratory RTOP (Recherche Translationelle en Oncologie Pédiatrique), Transfer Department, Institut Curie, Paris, France
| | - Eve Lapouble
- Unité de Génétique Somatique, Institut Curie, Paris, France
| | - Valérie Combaret
- Centre Léon-Bérard, Laboratoire de Recherche Translationnelle Lyon, Lyon, France
| | | | - Jean Michon
- Département de Pédiatrie, Institut Curie, Paris, France
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Lori S Hart
- 1] Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [2] Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - JulieAnn Rader
- 1] Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [2] Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Edward F Attiyeh
- 1] Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [2] Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [3] Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jun S Wei
- Pediatric Oncology Branch, Oncogenomics Section, Center for Cancer Research, US National Institutes of Health, Gaithersburg, Maryland, USA
| | - Shile Zhang
- Pediatric Oncology Branch, Oncogenomics Section, Center for Cancer Research, US National Institutes of Health, Gaithersburg, Maryland, USA
| | - Arlene Naranjo
- Department of Biostatistics, University of Florida, Children's Oncology Group (COG), Gainesville, Florida, USA
| | - Julie M Gastier-Foster
- 1] The Ohio State University College of Medicine, Columbus, Ohio, USA. [2] Biopathology Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michael D Hogarty
- 1] Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [2] Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [3] Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shahab Asgharzadeh
- 1] Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA. [2] Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, USA. [3] Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Thomas B K Watkins
- Translational Cancer Therapeutics Laboratory, Cancer Research UK, London, UK
| | - Danny A Zwijnenburg
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Marli E Ebus
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Peter van Sluis
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Anne Hakkert
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Esther van Wezel
- 1] Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands. [2] Landsteiner Laboratory, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - C Ellen van der Schoot
- 1] Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands. [2] Landsteiner Laboratory, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen M Westerhout
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes H Schulte
- 1] Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany. [2] German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany. [3] Department of Pediatric Oncology and Hematology, University Children's Hospital Essen, Essen, Germany. [4] Translational Neuro-Oncology, West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - Godelieve A Tytgat
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - M Emmy M Dolman
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | | | - Daniela S Gerhard
- Biopathology Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Huib N Caron
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Olivier Delattre
- INSERM U830, Laboratoire de Génétique et Biologie des Cancers, Institut Curie, Paris, France
| | - Javed Khan
- Pediatric Oncology Branch, Oncogenomics Section, Center for Cancer Research, US National Institutes of Health, Gaithersburg, Maryland, USA
| | - Rogier Versteeg
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - Gudrun Schleiermacher
- 1] Laboratory RTOP (Recherche Translationelle en Oncologie Pédiatrique), Transfer Department, Institut Curie, Paris, France. [2] Département de Pédiatrie, Institut Curie, Paris, France. [3] INSERM U830, Laboratoire de Génétique et Biologie des Cancers, Institut Curie, Paris, France
| | - Jan J Molenaar
- Department of Oncogenomics, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
| | - John M Maris
- 1] Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [2] Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. [3] Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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112
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Parikh NS, Howard SC, Chantada G, Israels T, Khattab M, Alcasabas P, Lam CG, Faulkner L, Park JR, London WB, Matthay KK. SIOP-PODC adapted risk stratification and treatment guidelines: Recommendations for neuroblastoma in low- and middle-income settings. Pediatr Blood Cancer 2015; 62:1305-16. [PMID: 25810263 PMCID: PMC5132052 DOI: 10.1002/pbc.25501] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/30/2015] [Indexed: 12/11/2022]
Abstract
Neuroblastoma is the most common extracranial solid tumor in childhood in high-income countries (HIC), where consistent treatment approaches based on clinical and tumor biological risk stratification have steadily improved outcomes. However, in low- and middle- income countries (LMIC), suboptimal diagnosis, risk stratification, and treatment may occur due to limited resources and unavailable infrastructure. The clinical practice guidelines outlined in this manuscript are based on current published evidence and expert opinions. Standard risk stratification and treatment explicitly adapted to graduated resource settings can improve outcomes for children with neuroblastoma by reducing preventable toxic death and relapse.
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Affiliation(s)
- Nehal S. Parikh
- Department of PediatricsDivision of Hematology‐OncologyConnecticut Children's Medical CenterHartfordConnecticut
| | | | | | - Trijn Israels
- VU University Medical CenterAmsterdamthe Netherlands
| | - Mohammed Khattab
- Department of PaediatricsChildren's Hospital of RabatRabatMorocco
| | - Patricia Alcasabas
- University of the Philippines‐Philippine General HospitalManilaPhilippines
| | - Catherine G. Lam
- Department of Oncology and International Outreach ProgramSt. Jude Children's Research HospitalMemphisTennessee
| | | | - Julie R. Park
- Seattle Children's HospitalUniversity of Washington School of Medicine and Fred Hutchinson Cancer Research CenterSeattleWashington
| | - Wendy B. London
- Harvard Medical SchoolBoston Children's Hospital and Dana Farber Cancer InstituteBostonMaryland
| | - Katherine K. Matthay
- Department of PediatricsUCSF School of Medicine and UCSF Benioff Children's HospitalSan FranciscoCalifornia
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113
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Mussai F, Egan S, Hunter S, Webber H, Fisher J, Wheat R, McConville C, Sbirkov Y, Wheeler K, Bendle G, Petrie K, Anderson J, Chesler L, De Santo C. Neuroblastoma Arginase Activity Creates an Immunosuppressive Microenvironment That Impairs Autologous and Engineered Immunity. Cancer Res 2015; 75:3043-53. [PMID: 26054597 PMCID: PMC4527662 DOI: 10.1158/0008-5472.can-14-3443] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 05/09/2015] [Indexed: 11/16/2022]
Abstract
Neuroblastoma is the most common extracranial solid tumor of childhood, and survival remains poor for patients with advanced disease. Novel immune therapies are currently in development, but clinical outcomes have not matched preclinical results. Here, we describe key mechanisms in which neuroblastoma inhibits the immune response. We show that murine and human neuroblastoma tumor cells suppress T-cell proliferation through increased arginase activity. Arginase II is the predominant isoform expressed and creates an arginine-deplete local and systemic microenvironment. Neuroblastoma arginase activity results in inhibition of myeloid cell activation and suppression of bone marrow CD34(+) progenitor proliferation. Finally, we demonstrate that the arginase activity of neuroblastoma impairs NY-ESO-1-specific T-cell receptor and GD2-specific chimeric antigen receptor-engineered T-cell proliferation and cytotoxicity. High arginase II expression correlates with poor survival for patients with neuroblastoma. The results support the hypothesis that neuroblastoma creates an arginase-dependent immunosuppressive microenvironment in both the tumor and blood that leads to impaired immunosurveillance and suboptimal efficacy of immunotherapeutic approaches.
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MESH Headings
- Animals
- Antigens, Neoplasm/immunology
- Antigens, Neoplasm/metabolism
- Arginase/immunology
- Arginase/metabolism
- Arginine/metabolism
- Cell Proliferation
- Gangliosides/metabolism
- Humans
- Lymphocyte Activation/immunology
- Membrane Proteins/immunology
- Membrane Proteins/metabolism
- Mice
- Neoplasms, Experimental/immunology
- Neoplasms, Experimental/metabolism
- Neoplasms, Experimental/pathology
- Neuroblastoma/immunology
- Neuroblastoma/metabolism
- Neuroblastoma/mortality
- Neuroblastoma/pathology
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Receptors, Antigen, T-Cell/metabolism
- Recombinant Proteins/genetics
- Recombinant Proteins/immunology
- Recombinant Proteins/metabolism
- Tumor Microenvironment/immunology
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Affiliation(s)
- Francis Mussai
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Sharon Egan
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, Sutton Bonnington, United Kingdom
| | - Stuart Hunter
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hannah Webber
- Paediatric Solid Tumour Biology and Therapeutics, Institute of Cancer Research, London, United Kingdom
| | - Jonathan Fisher
- Unit of Molecular Haematology and Cancer Biology, Institute of Child Health, University College London, United Kingdom
| | - Rachel Wheat
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Carmel McConville
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Yordan Sbirkov
- Paediatric Solid Tumour Biology and Therapeutics, Institute of Cancer Research, London, United Kingdom
| | - Kate Wheeler
- Department of Paediatric Oncology, Children's Hospital Oxford, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gavin Bendle
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kevin Petrie
- Paediatric Solid Tumour Biology and Therapeutics, Institute of Cancer Research, London, United Kingdom
| | - John Anderson
- Unit of Molecular Haematology and Cancer Biology, Institute of Child Health, University College London, United Kingdom
| | - Louis Chesler
- Paediatric Solid Tumour Biology and Therapeutics, Institute of Cancer Research, London, United Kingdom
| | - Carmela De Santo
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
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114
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Lew T, Chauhan A, Vasquez R, Warrier R. Massive Hepatomegaly With Respiratory Distress in a Newborn. Clin Pediatr (Phila) 2015; 54:907-9. [PMID: 26137965 DOI: 10.1177/0009922815591095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tony Lew
- University of Queensland Clinical School at Ochsner, New Orleans, LA, USA
| | - Aman Chauhan
- LSUHSC/Children's Hospital, New Orleans, LA, USA
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115
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Aguado del Hoyo A, Ruiz Martín Y, Lancharro Zapata Á, Marín Rodríguez C, Gordillo Gutiérrez I. [Radiological evaluation of congenital tumors]. RADIOLOGIA 2015; 57:391-401. [PMID: 26115799 DOI: 10.1016/j.rx.2015.03.003] [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: 06/26/2014] [Revised: 03/05/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
In this article, we consider tumors that are diagnosed during pregnancy or in the first three months of life. This is a heterogeneous group of neoplasms with special biological and epidemiological characteristics that differentiate them from tumors arising in children or adults. In the last two decades, the prenatal detection of congenital tumors has increased due to the generalized use of prenatal sonographic screening. Advances in imaging techniques, especially in fetal magnetic resonance imaging, have enabled improvements in the diagnosis, follow-up, clinical management, and perinatal treatment of these tumors. This image-based review of the most common congenital tumors describes their histologic types, locations, and characteristics on the different imaging techniques used.
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Affiliation(s)
- A Aguado del Hoyo
- Sección de Radiología Pediátrica, Hospital Materno Infantil Gregorio Marañón, Madrid, España.
| | - Y Ruiz Martín
- Sección de Radiología Pediátrica, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - Á Lancharro Zapata
- Sección de Radiología Pediátrica, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - C Marín Rodríguez
- Sección de Radiología Pediátrica, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - I Gordillo Gutiérrez
- Sección de Radiología Pediátrica, Hospital Materno Infantil Gregorio Marañón, Madrid, España
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116
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Peinemann F, Kahangire DA, van Dalen EC, Berthold F. Rapid COJEC versus standard induction therapies for high-risk neuroblastoma. Cochrane Database Syst Rev 2015; 2015:CD010774. [PMID: 25989478 PMCID: PMC10501324 DOI: 10.1002/14651858.cd010774.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neuroblastoma is a rare malignant disease and mainly affects infants and very young children. The tumors mainly develop in the adrenal medullary tissue and an abdominal mass is the most common presentation. The high-risk group is characterized by metastasis and other characteristics that increase the risk for an adverse outcome. In the rapid COJEC induction schedule, higher single doses of selected drugs than standard induction schedules are administered over a substantially shorter treatment period, with shorter intervals between cycles. Shorter intervals and higher doses increase the dose intensity of chemotherapy and might improve survival. OBJECTIVES The aim of this study was to evaluate the efficacy and adverse events of the rapid COJEC induction schedule as compared to standard induction schedules in patients with high-risk neuroblastoma (as defined by the International Neuroblastoma Risk Group (INRG) classification system). Outcomes of interest were complete response, early toxicity and treatment-related mortality as primary endpoints and overall survival, progression- and event-free survival, late non-hematological toxicity, and health-related quality of life as secondary endpoints. SEARCH METHODS We searched the electronic databases CENTRAL (2014, Issue 11), MEDLINE (PubMed), and EMBASE (Ovid) for articles from inception to 11 November 2014. Further searches included trial registries, conference proceedings, and reference lists of recent reviews and relevant articles. We did not apply limits on publication year or languages. SELECTION CRITERIA Randomized controlled trials evaluating the rapid COJEC induction schedule for high-risk neuroblastoma patients compared to standard induction schedules. DATA COLLECTION AND ANALYSIS Two review authors performed study selection, abstracted data on study and patient characteristics, and assessed risk of bias independently. We resolved differences by discussion or by appeal to a third review author. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We used the five GRADE considerations, study limitations, consistency of effect, imprecision, indirectness, and publication bias, to judge the quality of the evidence. We downgraded for risk of bias and imprecision MAIN RESULTS We identified one randomized controlled trial (CCLG-ENSG-5) that included 262 patients with high-risk neuroblastoma who were randomized to receive either rapid COJEC (N = 130) or standard OPEC/COJEC (N = 132) induction chemotherapy. We graded the evidence as low quality; we downgraded for risk of bias and imprecision.There was no clear evidence of a difference between the treatment groups in complete response (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.71 to 1.38), treatment-related mortality (RR 1.21, 95% CI 0.33 to 4.39), overall survival (hazard ratio (HR) 0.83, 95% CI 0.63 to 1.10), and event-free survival (HR 0.86, 95% CI 0.65 to 1.13). We calculated the HRs using the complete follow-up period of the trial.Febrile neutropenia (two or more episodes), proven fungal infections, septicemia (one or more episodes), gastrointestinal toxicity (grade 3 or 4), renal toxicity (glomerular filtration rate < 80 ml/min per body surface area of 1.73 m(2)), neurological toxicity (grade 3 or 4), and ototoxicity (Brock grade 2 to 4) were addressed as early toxicities (during pre-operative chemotherapy). For febrile neutropenia, septicemia, and renal toxicity, a statistically significant difference in favor of the standard treatment arm was identified; for all other early toxicities no clear evidence of a difference between treatment groups was identified. With regard to late non-hematological toxicities (median follow-up 12.7 years; range 6.9 to 16.5 years), the study provided data on any complication, renal toxicity (glomerular filtration rate < 80 ml/min per body surface area of 1.73m(2)), ototoxicity (Brock grade 1 to 4), endocrine complications, neurocognitive complications (i.e. behavioral, speech, or learning difficulties), and second malignancies. For endocrine complications and neurocognitive complications, a statistically significant difference in favor of the rapid COJEC arm was found; for all other late non-hematological toxicities no clear evidence of a difference between treatment groups was identified.Data on progression-free survival and health-related quality of life were not reported. AUTHORS' CONCLUSIONS We identified one randomized controlled trial that evaluated rapid COJEC versus standard induction therapy in patients with high-risk neuroblastoma. No clear evidence of a difference in complete response, treatment-related mortality, overall survival, and event-free survival between the treatment alternatives was found. This could be the result of low power or too short a follow-up period. Results of both early and late toxicities were ambiguous. Information on progression-free survival and health-related quality of life were not available. This trial was performed in the 1990s. Since then, many changes in, for example, treatment and risk classification have occurred. Therefore, based on the currently available evidence, we are uncertain about the effects of rapid COJEC and standard induction therapy in patients with high-risk neuroblastoma. More research is needed for a definitive conclusion.
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Affiliation(s)
- Frank Peinemann
- University of CologneChildren's HospitalKerpener Str. 62CologneNWGermany50937
| | - Doreen A Kahangire
- University of BirminghamBirmingham and Black Country NIHR CLAHRCSchool of Health and population, Public Health BuildingCollege of Medical and Dental SciencesBirminghamWest MidlandsUKB15 2TT
| | - Elvira C van Dalen
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660 (room H4‐139)AmsterdamNetherlands1100 DD
| | - Frank Berthold
- Children's Hospital, University of ColognePediatric Oncology and HematologyKerpener Strasse 62CologneGermany50937
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Abstract
OBJECTIVE To determine outcome of neuroblastoma (NBL) in children under 18 mo of age who had been treated with national protocols. METHODS The characteristics and treatment outcomes of 27 children were evaluated retrospectively. RESULTS The event-free survival (EFS) at 60 and 108 mo were 84.7 % ± 7.7 and 72.6 % ± 7.7, respectively. The overall survival (OS) was 91.7 % ± 8 at 108 mo. The only significant risk factor for OS in children with neuroblastoma was the treatment response at the end of therapy (p = 0.001). "Wait and see" policy was applied to two infants with low risk NBL and one infant with stage 4S neuroblastoma and all 3 of these infants have been in remission at last followup. Four of the five patients with MYCN-amplified neuroblastoma were alive at a median follow-up time of 54 mo (range: 5-108 mo). CONCLUSIONS The EFS and OS of the present group were similar to that of the previous series which included children under 18 mo of age with neuroblastoma. Well known prognostic factors did not affect EFS and OS significantly; this may be related to the retrospective design of the present study and the small number of patients reviewed. High survival rate in infants with MYCN-amplified tumors suggests the difference in the biology of infant neuroblastoma.
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118
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Saettini F, Agazzi R, Giraldi E, Foglia C, Cavalleri L, Morali L, Fasolini G, Spotti A, Provenzi M. Percutaneous transhepatic biliary drainage in an infant with obstructive jaundice caused by neuroblastoma. Pediatr Hematol Oncol 2015; 32:223-8. [PMID: 25551550 DOI: 10.3109/08880018.2014.981901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuroblastoma presenting with obstructive jaundice is a rare event. Management of this condition includes surgery, chemotherapy, radiotherapy, temporary cholecystostomy tube, endoscopic retrograde cholangiopancreatography (ERCP), and internal biliary drainage (IBD). We herein describe our experience with one infant affected by neuroblastoma presenting with jaundice, who successfully underwent percutaneous transhepatic biliary drainage (PTBD). This report introduces PTBD as a viable treatment option for neuroblastoma and obstructive jaundice and provides a review of the pertinent literature.
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Affiliation(s)
- Francesco Saettini
- 1Department of Pediatrics, Oncohematology Unit, Ospedale Papa Giovanni XXIII - University of Milan-Bicocca , Bergamo , Italy
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119
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Marcus PM, Prorok PC, Miller AB, DeVoto EJ, Kramer BS. Conceptualizing overdiagnosis in cancer screening. J Natl Cancer Inst 2015; 107:djv014. [PMID: 25663695 DOI: 10.1093/jnci/djv014] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of cancer screening is to detect asymptomatic cancers whose treatment will result in extension of life, relative to length of life absent screening. Unfortunately, cancer screening also results in overdiagnosis, the detection of cancers that, in the absence of screening, would not present symptomatically during one's lifetime. Thus, their detection and subsequent treatment is unnecessary and detrimental. This definition of overdiagnosis, while succinct, does not capture the ways it can occur, and our interactions with patients, advocates, researchers, clinicians, and journalists have led us to believe that the concept of overdiagnosis is difficult to explain and, for some, difficult to accept. We propose a dichotomy, the "tumor-patient" classification, to aid in understanding overdiagnosis. The tumor category includes asymptomatic malignant disease that would regress spontaneously if left alone, as well as asymptomatic malignant disease that stagnates or progresses too slowly to be life threatening in even the longest of lifetimes. The patient category includes asymptomatic malignant disease that would progress quickly enough to be life threatening during a lifetime of typical length, but lacks clinical relevance because death due to another cause intercedes prior to what would have been the date of symptomatic diagnosis had screening not occurred. Cancer screening of most organs is likely to result in overdiagnosis of both types. However, the ratio of tumor- to patient-driven overdiagnosis almost certainly varies, and may vary drastically, by organ, screening modality, patient characteristics, and other factors.
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Affiliation(s)
- Pamela M Marcus
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD).
| | - Philip C Prorok
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD)
| | - Anthony B Miller
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD)
| | - Emily J DeVoto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD)
| | - Barnett S Kramer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD)
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120
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Abstract
Neuroblastoma (NB) is the third most common pediatric cancer. Although NB accounts for 7% of pediatric malignancies, it is responsible for more than 10% of childhood cancer-related mortality. Prognosis and treatment are determined by clinical and biological risk factors. Estimated 5-year survival rates for patients with non-high-risk and high-risk NB are more than 90% and less than 50%, respectively. Recent clinical trials have continued to reduce therapy for patients with non-high-risk NB, including the most favorable subsets who are often followed with observation approaches. In contrast, high-risk patients are treated aggressively with chemotherapy, radiation, surgery, and myeloablative and immunotherapies.
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121
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Peinemann F, van Dalen EC, Tushabe DA, Berthold F. Retinoic acid post consolidation therapy for high-risk neuroblastoma patients treated with autologous hematopoietic stem cell transplantation. Cochrane Database Syst Rev 2015; 1:CD010685. [PMID: 25634649 DOI: 10.1002/14651858.cd010685.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neuroblastoma is a rare malignant disease and mainly affects infants and very young children. The tumors mainly develop in the adrenal medullary tissue and an abdominal mass is the most common presentation. About 50% of patients have metastatic disease at diagnosis. The high-risk group is characterized by metastasis and other characteristics that increase the risk for an adverse outcome. High-risk patients have a five-year event-free survival of less than 50%. Retinoic acid has been shown to inhibit growth of human neuroblastoma cells and has been considered as a potential candidate for improving the outcome of patients with high-risk neuroblastoma. OBJECTIVES To evaluate efficacy and adverse events of retinoic acid after consolidation with high-dose chemotherapy followed by bone marrow transplantation as compared to placebo or no therapy in patients with high-risk neuroblastoma (as defined by the International Neuroblastoma Risk Group (INRG) classification system). Our outcomes of interest were overall survival and treatment-related mortality as primary outcomes; and progression- and event-free survival, early and late toxicity, and health-related quality of life as secondary outcomes. SEARCH METHODS We searched the electronic databases CENTRAL (2014, Issue 8) on The Cochrane Library, MEDLINE (1946 to October 2014), and EMBASE (1947 to October 2014). Further searches included trial registries, conference proceedings, and reference lists of recent reviews and relevant articles. We did not apply limits on publication year or languages. SELECTION CRITERIA Randomized controlled trials (RCTs) evaluating retinoic acid post consolidation therapy for high-risk neuroblastoma patients treated with autologous hematopoietic stem cell transplantation (HSCT) compared to placebo or no further treatment. DATA COLLECTION AND ANALYSIS Two review authors performed the study selection, extracted the data on study and patient characteristics and assessed the risk of bias independently. We resolved differences by discussion or by appeal to a third review author. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The authors of the included study did not report the results specifically for the treatment groups relevant to this Cochrane Review. Therefore, we deduced the appropriate survival data from the published survival curves and calculated a hazard ratio (HR) based on the deduced data. MAIN RESULTS We identified one RCT (CCG-3891) that included patients with high-risk neuroblastoma who received high-dose chemotherapy followed by autologous HSCT (N = 98) after a first random allocation and who received retinoic acid (13-cis-retinoic acid; N = 50) or no further therapy (N = 48) after a subsequent second random allocation. These patients had no progressive disease after consolidation therapy. There was no clear evidence of difference between the treatment groups in both overall survival (HR 0.87, 95% CI 0.46 to 1.63; one trial; P = 0.66, low quality of evidence) and event-free survival (HR 0.86, 95% CI 0.50 to 1.49; one trial; P = 0.59, low quality of evidence). We calculated these HR values using the complete follow-up period of the trial. The study also reported five-year overall survival rates: 59% for the retinoic acid group and 41% for the no further therapy group (P value not reported). We did not identify results for treatment-related mortality, progression-free survival, early or late toxicity, or health-related quality of life. Also, we could not rule out the possible presence of selection bias, performance bias, attrition bias, and other bias. AUTHORS' CONCLUSIONS We identified one RCT that evaluated retinoic acid as a consolidation therapy versus no further therapy after high-dose chemotherapy followed by bone-marrow transplantation in patients with high-risk neuroblastoma. The difference in overall survival and event-free survival between both treatment alternatives was not statistically significantly different. This could be the result of low power. Information on other outcomes was not available. This trial was performed in the 1990s, since then many changes in for example treatment and risk classification have occurred. Therefore, based on the currently available evidence, we are uncertain about the effects of retinoic acid in patients with high-risk neuroblastoma. More research is needed for a definitive conclusion.
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Affiliation(s)
- Frank Peinemann
- Pediatric Oncology and Hematology, Children's Hospital, University of Cologne, Kerpener Str. 62, Cologne, NW, Germany, 50937
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122
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Yu DMT, Huynh T, Truong AM, Haber M, Norris MD. ABC transporters and neuroblastoma. Adv Cancer Res 2015; 125:139-70. [PMID: 25640269 DOI: 10.1016/bs.acr.2014.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Neuroblastoma is the most common cancer of infancy and accounts for 15% of all pediatric oncology deaths. Survival rates of high-risk neuroblastoma remain less than 50%, with amplification of the MYCN oncogene the most important aberration associated with poor outcome. Direct transcriptional targets of MYCN include a number of ATP-binding cassette (ABC) transporters, of which ABCC1 (MRP1), ABCC3 (MRP3), and ABCC4 (MRP4) are the best characterized. These three transporter genes have been shown to be strongly prognostic of neuroblastoma outcome in primary untreated neuroblastoma. In addition to their ability to efflux a number of chemotherapeutic drugs, evidence suggests that these transporters also contribute to neuroblastoma outcome independent of any role in cytotoxic drug efflux. Endogenous substrates of ABCC1 and ABCC4 that may be potential candidates affecting neuroblastoma biology include molecules such as prostaglandins and leukotrienes. These bioactive lipid mediators have the ability to influence biological processes contributing to cancer initiation and progression, such as angiogenesis, cell signaling, inflammation, proliferation, and migration and invasion. ABCC1 and ABCC4 are thus potential targets for therapeutic suppression in high-risk neuroblastoma, and recently developed small-molecule inhibitors may be an effective strategy in treating aggressive forms of this cancer, as well as other cancers that express high levels of these transporters.
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Affiliation(s)
- Denise M T Yu
- Lowy Cancer Research Centre, Children's Cancer Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Tony Huynh
- Lowy Cancer Research Centre, Children's Cancer Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Alan M Truong
- Lowy Cancer Research Centre, Children's Cancer Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Haber
- Lowy Cancer Research Centre, Children's Cancer Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Murray D Norris
- Lowy Cancer Research Centre, Children's Cancer Institute, University of New South Wales, Sydney, New South Wales, Australia.
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123
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Abstract
Recent genomic and biological studies of neuroblastoma have shed light on the dramatic heterogeneity in the clinical behaviour of this disease, which spans from spontaneous regression or differentiation in some patients, to relentless disease progression in others, despite intensive multimodality therapy. This evidence also suggests several possible mechanisms to explain the phenomena of spontaneous regression in neuroblastomas, including neurotrophin deprivation, humoral or cellular immunity, loss of telomerase activity and alterations in epigenetic regulation. A better understanding of the mechanisms of spontaneous regression might help to identify optimal therapeutic approaches for patients with these tumours. Currently, the most druggable mechanism is the delayed activation of developmentally programmed cell death regulated by the tropomyosin receptor kinase A pathway. Indeed, targeted therapy aimed at inhibiting neurotrophin receptors might be used in lieu of conventional chemotherapy or radiation in infants with biologically favourable tumours that require treatment. Alternative approaches consist of breaking immune tolerance to tumour antigens or activating neurotrophin receptor pathways to induce neuronal differentiation. These approaches are likely to be most effective against biologically favourable tumours, but they might also provide insights into treatment of biologically unfavourable tumours. We describe the different mechanisms of spontaneous neuroblastoma regression and the consequent therapeutic approaches.
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Affiliation(s)
- Garrett M Brodeur
- Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104-4302, USA
| | - Rochelle Bagatell
- Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104-4302, USA
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124
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Meany HJ, London WB, Ambros PF, Matthay KK, Monclair T, Simon T, Garaventa A, Berthold F, Nakagawara A, Cohn SL, Pearson ADJ, Park JR. Significance of clinical and biologic features in Stage 3 neuroblastoma: a report from the International Neuroblastoma Risk Group project. Pediatr Blood Cancer 2014; 61:1932-9. [PMID: 25044743 DOI: 10.1002/pbc.25134] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/13/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND International Neuroblastoma Staging System (INSS) Stage 3 neuroblastoma is a heterogeneous disease. Data from the International Neuroblastoma Risk Group (INRG) database were analyzed to define patient and tumor characteristics predictive of outcome. PROCEDURE Of 8,800 patients in the INRG database, 1,483 with INSS Stage 3 neuroblastoma and complete follow-up data were analyzed. Secondary analysis was performed in 1,013 patients (68%) with MYCN-non-amplified (NA) tumors. Significant prognostic factors were identified via log-rank test comparisons of survival curves. Multivariable Cox proportional hazards regression model was used to identify factors independently predictive of event-free survival (EFS). RESULTS Age at diagnosis (P < 0.0001), tumor MYCN status (P < 0.0001), and poorly differentiating/undifferentiated histology (P = 0.03) were independent predictors of EFS. Compared to other Stage 3 subgroups, outcome was inferior for patients ≥ 547 days with MYCN-NA neuroblastoma (P < 0.0001), and within this cohort, serum ferritin ≥ 96 ng/ml was associated with inferior EFS (P = 0.02). For patients <547 days of age with MYCN-NA tumors, serum ferritin levels were prognostic of overall survival (OS) (P = 0.04) and chromosome 11q aberration was prognostic of EFS (P = 0.03). CONCLUSIONS Among patients with INSS Stage 3 neuroblastoma patients, age at diagnosis, MYCN status and histology predict outcome. Patients <547 days of age with MYCN-NA tumors that lack chromosome 11q aberrations or those with serum ferritin <96 ng/ml have excellent prognosis and should be considered for therapy reduction. Prospective clinical trials are needed to identify optimal therapy for those patients ≥ 547 days of age with undifferentiated histology or elevated serum ferritin.
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Affiliation(s)
- Holly J Meany
- Department of Hematology/Oncology, Children's National Medical Center, Washington, District of Columbia
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125
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Coon ER, Quinonez RA, Moyer VA, Schroeder AR. Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics 2014; 134:1013-23. [PMID: 25287462 DOI: 10.1542/peds.2014-1778] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Overdiagnosis occurs when a true abnormality is discovered, but detection of that abnormality does not benefit the patient. It should be distinguished from misdiagnosis, in which the diagnosis is inaccurate, and it is not synonymous with overtreatment or overuse, in which excess medication or procedures are provided to patients for both correct and incorrect diagnoses. Overdiagnosis for adult conditions has gained a great deal of recognition over the last few years, led by realizations that certain screening initiatives, such as those for breast and prostate cancer, may be harming the very people they were designed to protect. In the fall of 2014, the second international Preventing Overdiagnosis Conference will be held, and the British Medical Journal will produce an overdiagnosis-themed journal issue. However, overdiagnosis in children has been less well described. This special article seeks to raise awareness of the possibility of overdiagnosis in pediatrics, suggesting that overdiagnosis may affect commonly diagnosed conditions such as attention-deficit/hyperactivity disorder, bacteremia, food allergy, hyperbilirubinemia, obstructive sleep apnea, and urinary tract infection. Through these and other examples, we discuss why overdiagnosis occurs and how it may be harming children. Additionally, we consider research and education strategies, with the goal to better elucidate pediatric overdiagnosis and mitigate its influence.
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Affiliation(s)
- Eric R Coon
- Division of Inpatient Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah;
| | - Ricardo A Quinonez
- Baylor College of Medicine, San Antonio Children's Hospital, San Antonio, Texas
| | - Virginia A Moyer
- American Board of Pediatrics, Maintenance of Certification and Quality, Chapel Hill, North Carolina; and
| | - Alan R Schroeder
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
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126
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Abbasi MR, Rifatbegovic F, Brunner C, Ladenstein R, Ambros IM, Ambros PF. Bone marrows from neuroblastoma patients: an excellent source for tumor genome analyses. Mol Oncol 2014; 9:545-54. [PMID: 25467309 PMCID: PMC5528711 DOI: 10.1016/j.molonc.2014.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 02/01/2023] Open
Abstract
Neuroblastoma is the most common extra‐cranial solid tumor in childhood. Presence of disseminated tumor cells (DTCs) in the bone marrow (BM) at diagnosis and at relapse is a common event in stage M neuroblastomas. Although the clinical heterogeneity of disseminated neuroblastomas is frequently associated with genomic diversity, so far, only little information exists about the genomic status of DTCs. This lack of knowledge is mainly due to the varying amount of BM infiltrating tumor cells, which is usually below 30% even at diagnosis thereby hampering systematic analyses. Thus, a valuable chance to analyze metastatic and relapse clones is, so far, completely unexploited. In this study, we show that the enrichment of tumor cells in fresh or DMSO frozen BM samples with a minimum of 0.05% or 0.1% infiltration rate, respectively, by applying magnetic bead‐based technique increased the DTC content to a sufficient level to allow SNP array analyses in 49 out of 69 samples. In addition, we successfully used non‐enriched BM samples with ≥30% DTCs including non‐stained and immunostained cytospin and BM smear slides for SNP array analyses in 44 cases. We analyzed the genomic profile of DTCs by an ultra‐high density SNP array technique with highest performance detecting all segmental chromosomal aberrations, amplified regions, acquired loss of heterozygosity events and minor aberrations affecting single genes or parts thereof. Genomic analysis of bone marrow micrometastases by ultra‐high density SNP array. Routinely processed bone marrow (BM) samples allow detailed genomic studies. Enrichment of BM samples with >0.05% tumor cells allows detailed genomic analyses.
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Affiliation(s)
- M Reza Abbasi
- Tumor Biology, Children's Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria.
| | - Fikret Rifatbegovic
- Tumor Biology, Children's Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Clemens Brunner
- Tumor Biology, Children's Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Ruth Ladenstein
- SiRP, Children's Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria; Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Inge M Ambros
- Tumor Biology, Children's Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Peter F Ambros
- Tumor Biology, Children's Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria; Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
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127
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Abstract
Neuroblastoma is a developmental tumor of young children arising from the embryonic sympathoadrenal lineage of the neural crest. Neuroblastoma is the primary cause of death from pediatric cancer for children between the ages of one and five years and accounts for ∼13% of all pediatric cancer mortality. Its clinical impact and unique biology have made this aggressive malignancy the focus of a large concerted translational research effort. New insights into tumor biology are driving the development of new classification schemas. Novel targeted therapeutic approaches include small-molecule inhibitors as well as epigenetic, noncoding-RNA, and cell-based immunologic therapies. In this review, recent insights regarding the pathogenesis and biology of neuroblastoma are placed in context with the current understanding of tumor biology and tumor/host interactions. Systematic classification of patients coupled with therapeutic advances point to a future of improved clinical outcomes for this biologically distinct and highly aggressive pediatric malignancy.
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Affiliation(s)
- Chrystal U Louis
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas 77030; ,
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128
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Arakawa A, Oguma E, Aihara T, Kishimoto H, Kikuchi A, Hanada R, Koh K. Long-term follow-up results of the observation program for neuroblastoma detected at 6-month mass screening. J Pediatr 2014; 165:855-7.e1. [PMID: 25091258 DOI: 10.1016/j.jpeds.2014.06.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 05/02/2014] [Accepted: 06/24/2014] [Indexed: 11/25/2022]
Abstract
We conducted an observation program of neuroblastoma in infants, detected by mass screening at 6 months of age; we followed up with them for 15 years. No recurrence was observed after disappearance of tumors, and persistent tumors showed no malignant transformation or metastasis. Histology of the resected tumors showed age-related differentiation.
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Affiliation(s)
- Ayumu Arakawa
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan.
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Toshinori Aihara
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kishimoto
- Department of Pathology, Saitama Children's Medical Center, Saitama, Japan
| | - Akira Kikuchi
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryoji Hanada
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
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129
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Oberthuer A, Juraeva D, Hero B, Volland R, Sterz C, Schmidt R, Faldum A, Kahlert Y, Engesser A, Asgharzadeh S, Seeger R, Ohira M, Nakagawara A, Scaruffi P, Tonini GP, Janoueix-Lerosey I, Delattre O, Schleiermacher G, Vandesompele J, Speleman F, Noguera R, Piqueras M, Bénard J, Valent A, Avigad S, Yaniv I, Grundy RG, Ortmann M, Shao C, Schwab M, Eils R, Simon T, Theissen J, Berthold F, Westermann F, Brors B, Fischer M. Revised risk estimation and treatment stratification of low- and intermediate-risk neuroblastoma patients by integrating clinical and molecular prognostic markers. Clin Cancer Res 2014; 21:1904-15. [PMID: 25231397 DOI: 10.1158/1078-0432.ccr-14-0817] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To optimize neuroblastoma treatment stratification, we aimed at developing a novel risk estimation system by integrating gene expression-based classification and established prognostic markers. EXPERIMENTAL DESIGN Gene expression profiles were generated from 709 neuroblastoma specimens using customized 4 × 44 K microarrays. Classification models were built using 75 tumors with contrasting courses of disease. Validation was performed in an independent test set (n = 634) by Kaplan-Meier estimates and Cox regression analyses. RESULTS The best-performing classifier predicted patient outcome with an accuracy of 0.95 (sensitivity, 0.93; specificity, 0.97) in the validation cohort. The highest potential clinical value of this predictor was observed for current low-risk patients [5-year event-free survival (EFS), 0.84 ± 0.02 vs. 0.29 ± 0.10; 5-year overall survival (OS), 0.99 ± 0.01 vs. 0.76 ± 0.11; both P < 0.001] and intermediate-risk patients (5-year EFS, 0.88 ± 0.06 vs. 0.41 ± 0.10; 5-year OS, 1.0 vs. 0.70 ± 0.09; both P < 0.001). In multivariate Cox regression models for low-risk/intermediate-risk patients, the classifier outperformed risk assessment of the current German trial NB2004 [EFS: hazard ratio (HR), 5.07; 95% confidence interval (CI), 3.20-8.02; OS: HR, 25.54; 95% CI, 8.40-77.66; both P < 0.001]. On the basis of these findings, we propose to integrate the classifier into a revised risk stratification system for low-risk/intermediate-risk patients. According to this system, we identified novel subgroups with poor outcome (5-year EFS, 0.19 ± 0.08; 5-year OS, 0.59 ± 0.1), for whom we propose intensified treatment, and with beneficial outcome (5-year EFS, 0.87 ± 0.05; 5-year OS, 1.0), who may benefit from treatment de-escalation. CONCLUSIONS Combination of gene expression-based classification and established prognostic markers improves risk estimation of patients with low-risk/intermediate-risk neuroblastoma. We propose to implement our revised treatment stratification system in a prospective clinical trial.
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Affiliation(s)
- André Oberthuer
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Dilafruz Juraeva
- Department of Theoretical Bioinformatics (B080), German Cancer Research Center, Heidelberg, Germany
| | - Barbara Hero
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Ruth Volland
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Carolina Sterz
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Rene Schmidt
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Yvonne Kahlert
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Anne Engesser
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Shahab Asgharzadeh
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Robert Seeger
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Miki Ohira
- Laboratory of Cancer Genomics, Chiba Cancer Center Research Institute, Chuoh-ku, Chiba, Japan
| | - Akira Nakagawara
- Division of Biochemistry and Innovative Cancer Therapeutics, Chiba Cancer Center Research Institute, Chuoh-ku, Chiba, Japan
| | - Paola Scaruffi
- Center of Physiopathology of Human Reproduction, Department of Obstetrics and Gynecology, IRCCS San Martino Hospital, National Cancer Research Institute (IST), Genoa, Italy
| | - Gian Paolo Tonini
- Laboratory of Neuroblastoma, Onco/Hematology Laboratory Department SDB University of Padua, Pediatric Research Institute, Padua, Italy
| | | | | | | | - Jo Vandesompele
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Frank Speleman
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Rosa Noguera
- Department of Pathology, University of Valencia, Valencia, Spain
| | - Marta Piqueras
- Department of Pathology, University of Valencia, Valencia, Spain
| | - Jean Bénard
- Department of Tumor Genetics, Institut Gustave Roussy, Villejuif, France
| | - Alexander Valent
- Department of Tumor Genetics, Institut Gustave Roussy, Villejuif, France
| | - Smadar Avigad
- Schneider Children's Medical Center of Israel, Pediatric Hematology Oncology, Petah Tikva, Israel. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Isaac Yaniv
- Schneider Children's Medical Center of Israel, Pediatric Hematology Oncology, Petah Tikva, Israel. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Richard G Grundy
- Children's Cancer Leukaemia Group, University of Leicester, Leicester, United Kingdom
| | - Monika Ortmann
- Department of Pathology, University of Cologne, Cologne, Germany
| | - Chunxuan Shao
- Department of Neuroblastoma Genomics (B087), German Cancer Research Center, Heidelberg, Germany
| | - Manfred Schwab
- Department of Neuroblastoma Genomics (B087), German Cancer Research Center, Heidelberg, Germany
| | - Roland Eils
- Department of Theoretical Bioinformatics (B080), German Cancer Research Center, Heidelberg, Germany. Department for Bioinformatics and Functional Genomics, Institute for Pharmacy and Molecular Biotechnology (IPMB) and BioQuant, Heidelberg University, Heidelberg, Germany
| | - Thorsten Simon
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Jessica Theissen
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Frank Berthold
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Frank Westermann
- Department of Neuroblastoma Genomics (B087), German Cancer Research Center, Heidelberg, Germany
| | - Benedikt Brors
- Department of Theoretical Bioinformatics (B080), German Cancer Research Center, Heidelberg, Germany
| | - Matthias Fischer
- Children's Hospital, Department of Pediatric Oncology and Hematology, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
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Shah N, Wang J, Selich-Anderson J, Graham G, Siddiqui H, Li X, Khan J, Toretsky J. PBX1 is a favorable prognostic biomarker as it modulates 13-cis retinoic acid-mediated differentiation in neuroblastoma. Clin Cancer Res 2014; 20:4400-12. [PMID: 24947929 PMCID: PMC4134768 DOI: 10.1158/1078-0432.ccr-13-1486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Neuroblastoma is an embryonic childhood cancer with high mortality. 13-cis retinoic acid (13-cisRA) improves survival for some patients, but many recur, suggesting clinical resistance. The mechanism of resistance and the normal differentiation pathway are poorly understood. Three-amino-acid loop extension (TALE) family genes are master regulators of differentiation. Because retinoids promote differentiation in neuroblastoma, we evaluated TALE family gene expression in neuroblastoma. EXPERIMENTAL DESIGN We evaluated expression of TALE family genes in RA-sensitive and -resistant neuroblastoma cell lines, with and without 13-cisRA treatment, identifying genes whose expression correlates with retinoid sensitivity. We evaluated the roles of one gene, PBX1, in neuroblastoma cell lines, including proliferation and differentiation. We evaluated PBX1 expression in primary human neuroblastoma samples by qRT-PCR, and three independent clinical cohort microarray datasets. RESULTS We confirmed that induction of PBX1 expression, and no other TALE family genes, was associated with 13-cisRA responsiveness in neuroblastoma cell lines. Exogenous PBX1 expression in neuroblastoma cell lines, mimicking induced PBX1 expression, significantly impaired proliferation and anchorage-independent growth, and promoted RA-dependent and -independent differentiation. Reduced PBX1 protein levels produced an aggressive growth phenotype and RA resistance. PBX1 expression correlated with histologic neuroblastoma subtypes, with highest expression in benign ganglioneuromas and lowest in high-risk neuroblastomas. High PBX1 expression is prognostic of survival, including in multivariate analysis, in the three clinical cohorts. CONCLUSIONS PBX1 is an essential regulator of differentiation in neuroblastoma and potentiates retinoid-induced differentiation. Neuroblastoma cells and tumors with low PBX1 expression have an immature phenotype with poorer prognosis, independent of other risk factors.
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Affiliation(s)
- Nilay Shah
- Center for Childhood Cancer and Blood Diseases, The Research Institute of Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio;
| | - Jianjun Wang
- Oncogenomics Section, Advanced Technology Center, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Gaithersburg, Maryland
| | - Julia Selich-Anderson
- Center for Childhood Cancer and Blood Diseases, The Research Institute of Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Garrett Graham
- Department of Oncology, Lombardi Comprehensive Cancer Center; and
| | - Hasan Siddiqui
- Center for Childhood Cancer and Blood Diseases, The Research Institute of Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Xin Li
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, D.C
| | - Javed Khan
- Oncogenomics Section, Advanced Technology Center, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Gaithersburg, Maryland
| | - Jeffrey Toretsky
- Department of Oncology, Lombardi Comprehensive Cancer Center; and
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131
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Adult versus Pediatric Neuroblastoma: The M.D. Anderson Cancer Center Experience. Sarcoma 2014; 2014:375151. [PMID: 25024639 PMCID: PMC4082947 DOI: 10.1155/2014/375151] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/15/2014] [Accepted: 05/18/2014] [Indexed: 12/28/2022] Open
Abstract
Background. Staging and treatment of adult neuroblastoma has yet to be formalized. We sought to determine the utility of the pediatric classification system in adults and determine the efficacy of different treatment modalities. Methods. Medical records of 118 adults (patients >17 years old) and 112 pediatric patients (ages 2–17), who were treated for neuroblastoma at M.D. Anderson Cancer Center from January 1994 to September 2012, were reviewed. International neuroblastoma risk group (INRG) variables were abstracted. The primary outcome of interest was actuarial progression-free survival. Results. Median age of pediatric patients was 5 years (range 3–16) and 47 years (range 18–82) for adult patients. There were no differences in PFS or OS between stage-matched risk categories between pediatric and adult patients (L1-P = 0.40, L2-P = 0.54, and M-P = 0.73). In the treatment of L1 disease, median PFS for adults treated with surgery and radiation was 11.1 months compared with single modality local treatment ± chemotherapy (6.4 and 5.1 months, resp.; P = 0.07). Median PFS in L2 adult patients was 5.2 months with local therapy and 4 months with the addition of chemotherapy (P = 0.23). Conclusions. Adult and pediatric patients with neuroblastoma achieve similar survival outcomes. INRG classification should be employed to stratify adult neuroblastoma patients and help select treatment.
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Abstract
Four out of five children diagnosed with cancer can be cured with contemporary cancer therapy. This represents a dramatic improvement since 50 years ago when the cure rate of childhood cancer was <25% in the pre-chemotherapy era. Over the past ten years, while improvement in overall survival (OS) has been marginal, progress in pediatric oncology lies with adopting risk-adapted therapeutic approach. This has been made possible through identifying clinical and biologic prognostic factors with rigorous research and stratifying patients using these risk factors, and subsequently modifying therapy according to risk group assignment. This review provides a perspective for eight distinct pediatric malignancies, in which significant advances in treatment were made in the last decade and are leading to changes in standard of care. This includes four hematologic malignancies [acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL)] and four solid tumors [medulloblastoma (MB), low grade glioma (LGG), neuroblastoma (NB) and Ewing sarcoma (ES)]. Together, they comprise 60% of childhood cancer. Improved patient outcome is not limited to better survival, but encompasses reducing both short and long-term treatment-related complications which is as important as cure, given the majority of childhood cancer patients will become long-term survivors. Risk-adapted approach allows treatment intensification in the high-risk cohort while therapy can be de-escalated in the low-risk to minimize toxicity and late sequelae without compromising survival. Advances in medical research technology have also led to a rapid increase in the understanding of the genetics of childhood cancer in the last decade, facilitating identification of molecular targets that can potentially be exploited for therapeutic benefits. As we move into the era of targeted therapeutics, searching for novel agents that target specific genetic lesions becomes a major research focus. We provide an overview of seven novel agents (bevacizumab, bortezomib, vorinostat, sorafenib, tipifarnib, erlotinib and mTOR inhibitors), which have been most frequently pursued in childhood cancers in the last decade, as well as reporting the progress of clinical trials involving these agents.
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Affiliation(s)
- Federica Saletta
- 1 Children's Cancer Research Unit, Kid's Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 2 Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michaela S Seng
- 1 Children's Cancer Research Unit, Kid's Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 2 Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Loretta M S Lau
- 1 Children's Cancer Research Unit, Kid's Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 2 Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Inazawa N, Hatakeyama N, Hori T, Yamamoto M, Igarashi K, Tadashi H, Ogino J, Tsutsumi H, Suzuki N. Primary orbital neuroblastoma in a 1-month-old boy. Pediatr Int 2014; 56:122-5. [PMID: 24548201 DOI: 10.1111/ped.12239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 05/23/2013] [Accepted: 09/10/2013] [Indexed: 11/28/2022]
Abstract
Neuroblastoma is a malignant tumor predominantly occurring in children and usually arising from the adrenal gland or sympathetic ganglia. We describe a neuroblastoma in a 1-month-old boy arising from his left orbital cavity. This tumor was refractory to chemotherapy or radiotherapy, requiring enucleation of the left eye for complete removal of the intraorbital tumor. Thereafter, he received high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation, and has been in complete remission for 3 years. Unlike neuroblastomas arising from the adrenal gland or sympathetic ganglia, primary orbital neuroblastoma may be refractory even in early infancy.
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Affiliation(s)
- Natsuko Inazawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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134
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Gustafson WC, Matthay KK. Progress towards personalized therapeutics: biologic- and risk-directed therapy for neuroblastoma. Expert Rev Neurother 2014; 11:1411-23. [DOI: 10.1586/ern.11.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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135
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Handlungsempfehlung nach der Leitlinie „Neuroblastom“. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-3047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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136
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Kohler J, Rubie H, Castel V, Beiske K, Holmes K, Gambini C, Casale F, Munzer C, Erminio G, Parodi S, Navarro S, Marquez C, Peuchmaur M, Cullinane C, Brock P, Valteau-Couanet D, Garaventa A, Haupt R. Treatment of children over the age of one year with unresectable localised neuroblastoma without MYCN amplification: Results of the SIOPEN study. Eur J Cancer 2013; 49:3671-9. [DOI: 10.1016/j.ejca.2013.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 06/06/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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137
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Peinemann F, Tushabe DA, Berthold F. Rapid COJEC versus standard induction therapies for high-risk neuroblastoma. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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138
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Rossig C, Juergens H, Schrappe M, Moericke A, Henze G, von Stackelberg A, Reinhardt D, Burkhardt B, Woessmann W, Zimmermann M, Gadner H, Mann G, Schellong G, Mauz-Koerholz C, Dirksen U, Bielack S, Berthold F, Graf N, Rutkowski S, Calaminus G, Kaatsch P, Creutzig U. Effective childhood cancer treatment: the impact of large scale clinical trials in Germany and Austria. Pediatr Blood Cancer 2013; 60:1574-81. [PMID: 23737479 DOI: 10.1002/pbc.24598] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/22/2013] [Indexed: 01/07/2023]
Abstract
In Germany and Austria, more than 90% of pediatric cancer patients are enrolled into nationwide disease-specific first-line clinical trials or interim registries. Essential components are a pediatric cancer registry and centralized reference laboratories, imaging review, and tumor board assistance. The five-year overall survival rate in countries where such infrastructures are established has improved from <20% before 1950 to >80% since 1995. Today, treatment intensity is tailored to the individual patient's risk to provide the highest chances of survival while minimizing deleterious late effects. Multicenter clinical trials are internationalized and serve as platforms for further improvements by novel drugs and biologicals.
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Affiliation(s)
- C Rossig
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany.
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Pasquier E, Andre N, Trahair T, Kavallaris M. Reply: Comment on 'Beta-blockers increase response to chemotherapy via direct anti-tumour and anti-angiogenic mechanisms in neuroblastoma'--β-blockers are potent anti-angiogenic and chemo-sensitising agents, rather than cytotoxic drugs. Br J Cancer 2013; 109:2024-5. [PMID: 23969728 PMCID: PMC3790159 DOI: 10.1038/bjc.2013.498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- E Pasquier
- 1] Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW 2031, Australia [2] Metronomics Global Health Initiative, Marseille 13005, France
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140
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Peinemann F, Bartel C, Grouven U, Berthold F. Retinoic acid post consolidation therapy for high-risk neuroblastoma. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Long-term follow-up of the "wait and see" approach to localized perinatal adrenal neuroblastoma. World J Surg 2013; 37:459-65. [PMID: 23135423 DOI: 10.1007/s00268-012-1837-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence-based guidelines for the management of localized perinatal adrenal neuroblastoma are not yet available. We describe our preliminary experience managing this tumor with a "wait and see" policy. METHODS A single-center prospective study (February 2002 to December 2009) was conducted with 12 consecutive patients in whom an adrenal mass was detected antenatally or within the first 3 months of life. Diagnostic workup included the following investigations: measurement of urine catecholamine metabolites, imaging studies (ultrasonography, magnetic resonance imaging, or computed tomography), metaiodobenzylguanidine scintigraphy, and/or core needle biopsy. RESULTS The male/female ratio was 1.4:1.0. Median tumor size at presentation was 29 mm (range 10-50 mm). Eight lesions were detected antenatally. Ten lesions were diagnosed as localized neuroblastoma. Of these ten lesions, four were excised because of parental preference (n = 2), tumor enlargement (n = 1) or tumor persistence (n = 1). The remaining six patients underwent watchful clinical observation, which showed progressive tumor shrinkage and complete regression within 10-39 months (median 12.5 months). The final two lesions were small predominantly cystic lesions without a clear-cut diagnosis. They were managed noninvasively. At an overall median follow-up of 109 months (range 30-122 months), all patients are alive and disease-free, although one patient progressed to stage 4 disease despite early excision of the primary tumor. CONCLUSIONS Spontaneous regression of localized perinatal adrenal neuroblastoma occurs often, and a "wait and see" strategy seems justified in these small infants. Patients with enlarging or stable lesions that have persisted for several months may benefit from surgery, although prompt excision may not prevent tumor progression.
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142
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Li Y, Nakagawara A. Apoptotic cell death in neuroblastoma. Cells 2013; 2:432-59. [PMID: 24709709 PMCID: PMC3972687 DOI: 10.3390/cells2020432] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 05/30/2013] [Accepted: 06/08/2013] [Indexed: 12/16/2022] Open
Abstract
Neuroblastoma (NB) is one of the most common malignant solid tumors in childhood, which derives from the sympathoadrenal lineage of the neural crest and exhibits extremely heterogeneous biological and clinical behaviors. The infant patients frequently undergo spontaneous regression even with metastatic disease, whereas the patients of more than one year of age who suffer from disseminated disease have a poor outcome despite intensive multimodal treatment. Spontaneous regression in favorable NBs has been proposed to be triggered by nerve growth factor (NGF) deficiency in the tumor with NGF dependency for survival, while aggressive NBs have defective apoptotic machinery which enables the tumor cells to evade apoptosis and confers the resistance to treatment. This paper reviews the molecules and pathways that have been recently identified to be involved in apoptotic cell death in NB and discusses their potential prospects for developing more effective therapeutic strategies against aggressive NB.
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Affiliation(s)
- Yuanyuan Li
- Division of Biochemistry and Innovative Cancer Therapeutics, Chiba Cancer Center Research Institute, 666-2 Nitona, Chuoh-ku, Chiba 260-8717, Japan.
| | - Akira Nakagawara
- Division of Biochemistry and Innovative Cancer Therapeutics, Chiba Cancer Center Research Institute, 666-2 Nitona, Chuoh-ku, Chiba 260-8717, Japan.
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Schoot RA, Bleeker G, Caron HN, van Eck BL, Heij HA, de Kraker J, Tytgat GA. The role of 131I-metaiodobenzylguanidine (MIBG) therapy in unresectable and compromising localised neuroblastoma. Eur J Nucl Med Mol Imaging 2013; 40:1516-22. [PMID: 23740371 PMCID: PMC3779309 DOI: 10.1007/s00259-013-2455-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/03/2013] [Indexed: 12/01/2022]
Abstract
Purpose In patients with localised neuroblastoma without adverse genetic aberrations, observational treatment is justified. Therapy is required when organ or respiratory functions have become compromised. As the outcome is good, side effects of treatment should be prevented. The aim of this retrospective study was to evaluate response and outcome in patients treated with 131I-metaiodobenzylguanidine (MIBG) for unresectable localised neuroblastoma, with compromised organ functions. Methods Patients with localised neuroblastoma [median age 1.6 years (0–5.5 years)] diagnosed between 1989 and 2008 were included in this retrospective study (n = 21). Primary tumours were unresectable and there was a compromised organ or respiratory function. Diagnosis and staging were performed according to the International Neuroblastoma Staging System. Fixed doses of 131I-MIBG therapy (50–200 mCi) were given. The median number of infusions was two (range one to seven). Response was graded according to the International Neuroblastoma Response Criteria. Results Of the 21 patients, 14 did not need any chemotherapy. Patients were treated with 131I-MIBG therapy and, in most cases, with additional surgery and/or chemotherapy. Sixteen achieved complete response (CR), three very good partial response (VGPR), one partial response (PR) and one progressive disease (PD). Two patients died of PD after having achieved CR initially and due to surgical complications a few months after resection. Ten-year overall survival and event-free survival were 90.5 %. The median follow-up was 8.5 years (range 0.4–19.6 years). Conclusion 131I-MIBG therapy is an effective treatment modality for unresectable localised neuroblastoma with compromised organ functions. However, this was a small and heterogeneous cohort and further studies are needed. Electronic supplementary material The online version of this article (doi:10.1007/s00259-013-2455-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Reineke A Schoot
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre (AMC), PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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Park JR, Bagatell R, London WB, Maris JM, Cohn SL, Mattay KK, Hogarty M. Children's Oncology Group's 2013 blueprint for research: neuroblastoma. Pediatr Blood Cancer 2013; 60:985-93. [PMID: 23255319 DOI: 10.1002/pbc.24433] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/11/2012] [Indexed: 12/12/2022]
Abstract
Estimated 5-year survival rates for patients with non-high-risk and high-risk neuroblastoma are 90% and 50%, respectively. Recent clinical trials have shown excellent outcomes with reduced therapy for non-high-risk disease. For patients with high-risk neuroblastoma treated with chemoradiotherapy, surgery, and stem cell transplantation, the addition of anti-disialoganglioside (GD2) immunotherapy plus cytokines improves survival. Upcoming trials will study the incorporation of targeted radionuclide therapy prior to myeloablative chemotherapy into high-risk treatment. Phase 2 trials will investigate druggable target(s) including mTOR inhibition and GD2-directed therapy in combination with chemotherapy for patients with recurrent neuroblastoma, and ALK inhibition for those with ALK-aberrant tumors.
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Affiliation(s)
- Julie R Park
- Seattle Children's Hospital, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA 98106, USA.
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145
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Kocak H, Ackermann S, Hero B, Kahlert Y, Oberthuer A, Juraeva D, Roels F, Theissen J, Westermann F, Deubzer H, Ehemann V, Brors B, Odenthal M, Berthold F, Fischer M. Hox-C9 activates the intrinsic pathway of apoptosis and is associated with spontaneous regression in neuroblastoma. Cell Death Dis 2013; 4:e586. [PMID: 23579273 PMCID: PMC3668636 DOI: 10.1038/cddis.2013.84] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neuroblastoma is an embryonal malignancy of the sympathetic nervous system. Spontaneous regression and differentiation of neuroblastoma is observed in a subset of patients, and has been suggested to represent delayed activation of physiologic molecular programs of fetal neuroblasts. Homeobox genes constitute an important family of transcription factors, which play a fundamental role in morphogenesis and cell differentiation during embryogenesis. In this study, we demonstrate that expression of the majority of the human HOX class I homeobox genes is significantly associated with clinical covariates in neuroblastoma using microarray expression data of 649 primary tumors. Moreover, a HOX gene expression-based classifier predicted neuroblastoma patient outcome independently of age, stage and MYCN amplification status. Among all HOX genes, HOXC9 expression was most prominently associated with favorable prognostic markers. Most notably, elevated HOXC9 expression was significantly associated with spontaneous regression in infant neuroblastoma. Re-expression of HOXC9 in three neuroblastoma cell lines led to a significant reduction in cell viability, and abrogated tumor growth almost completely in neuroblastoma xenografts. Neuroblastoma growth arrest was related to the induction of programmed cell death, as indicated by an increase in the sub-G1 fraction and translocation of phosphatidylserine to the outer membrane. Programmed cell death was associated with the release of cytochrome c from the mitochondria into the cytosol and activation of the intrinsic cascade of caspases, indicating that HOXC9 re-expression triggers the intrinsic apoptotic pathway. Collectively, our results show a strong prognostic impact of HOX gene expression in neuroblastoma, and may point towards a role of Hox-C9 in neuroblastoma spontaneous regression.
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Affiliation(s)
- H Kocak
- Children's Hospital, Department of Pediatric Oncology and Hematology and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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146
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Prenatal diagnosis of adrenal neuroblastoma: a case report with a brief review of the literature. Case Rep Obstet Gynecol 2013; 2013:506490. [PMID: 23607014 PMCID: PMC3623461 DOI: 10.1155/2013/506490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/12/2013] [Indexed: 11/18/2022] Open
Abstract
A case of adrenal cystic neuroblastoma detected at 37 weeks of gestation is reported. Postnatal ultrasonographic examination showed slightly increased in size demonstrating marked septations within the cyst. After the tumor was resected, histopathological examinations confirmed the diagnosis. The patient is developing normally at 1 year of age.
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147
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Lundberg G, Jin Y, Sehic D, Øra I, Versteeg R, Gisselsson D. Intratumour diversity of chromosome copy numbers in neuroblastoma mediated by on-going chromosome loss from a polyploid state. PLoS One 2013; 8:e59268. [PMID: 23555645 PMCID: PMC3605453 DOI: 10.1371/journal.pone.0059268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/13/2013] [Indexed: 12/18/2022] Open
Abstract
Neuroblastomas (NBs) are tumours of the sympathetic nervous system accounting for 8–10% of paediatric cancers. NBs exhibit extensive intertumour genetic heterogeneity, but their extent of intratumour genetic diversity has remained unexplored. We aimed to assess intratumour genetic variation in NBs with a focus on whole chromosome changes and their underlying mechanism. Allelic ratios obtained by SNP-array data from 30 aneuploid primary NBs and NB cell lines were used to quantify the size of clones harbouring specific genomic imbalances. In 13 cases, this was supplemented by fluorescence in situ hybridisation to assess copy number diversity in detail. Computer simulations of different mitotic segregation errors, single cell cloning, analysis of mitotic figures, and time lapse imaging of dividing NB cells were used to infer the most likely mechanism behind intratumour variation in chromosome number. Combined SNP array and FISH analyses showed that all cases exhibited higher inter-cellular copy number variation than non-neoplastic control tissue, with up to 75% of tumour cells showing non-modal chromosome copy numbers. Comparisons of copy number profiles, resulting from simulations of different segregation errors to genomic profiles of 120 NBs indicated that loss of chromosomes from a tetraploid state was more likely than other mechanisms to explain numerical aberrations in NB. This was supported by a high frequency of lagging chromosomes at anaphase and polyploidisation events in growing NB cells. The dynamic nature of numerical aberrations was corroborated further by detecting substantial copy number diversity in cell populations grown from single NB cells. We conclude that aneuploid NBs typically show extensive intratumour chromosome copy number diversity, and that this phenomenon is most likely explained by continuous loss of chromosomes from a polyploid state.
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Affiliation(s)
- Gisela Lundberg
- Department of Clinical Genetics, Lund University, Skåne University and Regional Laboratories, Lund, Sweden
| | - Yuesheng Jin
- Department of Clinical Genetics, Lund University, Skåne University and Regional Laboratories, Lund, Sweden
| | - Daniel Sehic
- Department of Clinical Genetics, Lund University, Skåne University and Regional Laboratories, Lund, Sweden
| | - Ingrid Øra
- Department of Paediatric Oncology and Haematology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Human Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rogier Versteeg
- Department of Human Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David Gisselsson
- Department of Clinical Genetics, Lund University, Skåne University and Regional Laboratories, Lund, Sweden
- Department of Pathology, Skåne University and Regional Laboratories, Lund, Sweden
- * E-mail:
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148
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Decarolis B, Schneider C, Hero B, Simon T, Volland R, Roels F, Dietlein M, Berthold F, Schmidt M. Iodine-123 Metaiodobenzylguanidine Scintigraphy Scoring Allows Prediction of Outcome in Patients With Stage 4 Neuroblastoma: Results of the Cologne Interscore Comparison Study. J Clin Oncol 2013; 31:944-51. [DOI: 10.1200/jco.2012.45.8794] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Radioiodinated metaiodobenzylguanidine (123I-mIBG) scintigraphy is an established imaging method in neuroblastoma. Semiquantitative scoring systems have been developed to assess the extent of disease and response to chemotherapy. We present the results of the comparison between the SIOPEN [International Society of Pediatric Oncology Europe Neuroblastoma Group] score and the modified Curie score. Patients and Methods We retrospectively analyzed 147 mIBG scans of 58 patients older than 1 year of age with stage 4 neuroblastoma from German Neuroblastoma Trial NB97 that were assessed according to the SIOPEN and the Curie scoring method. mIBG examinations were performed at diagnosis and after four and six cycles of chemotherapy. Results Scoring results were highly correlated between both methods, and interobserver reliability was excellent. A Curie score ≤ 2 and a SIOPEN score ≤ 4 (best cutoff) at diagnosis were correlated to significantly better event-free and overall survival compared with higher scores. After four cycles of chemotherapy, overall survival was significantly better for mIBG-negative patients compared with those with any residual mIBG-positive metastases. After six cycles of chemotherapy, there was no difference in survival between mIBG-negative patients and patients with residual mIBG-positive metastases. Patients without mIBG-positive metastases after four and six cycles of chemotherapy had a better overall survival, but late clearance of mIBG-positive metastases did not improve outcome. Conclusion Higher mIBG scores at diagnosis and occurrence of any residual mIBG-positive metastases after four cycles of chemotherapy predicted unfavorable outcome for patients with stage 4 neuroblastoma. Later clearance of metastases did not improve prognosis. The Curie and the SIOPEN score were equally reliable and predictive.
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Affiliation(s)
- Boris Decarolis
- All authors: University Hospital of Cologne, Cologne, Germany
| | | | - Barbara Hero
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Thorsten Simon
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Ruth Volland
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Frederik Roels
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Markus Dietlein
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Frank Berthold
- All authors: University Hospital of Cologne, Cologne, Germany
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149
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Moreno L, Marshall LV, Pearson ADJ. At the frontier of progress for paediatric oncology: the neuroblastoma paradigm. Br Med Bull 2013; 108:173-88. [PMID: 24211816 DOI: 10.1093/bmb/ldt033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Neuroblastoma is one of the commonest and deadliest forms of childhood cancer and major initiatives are ongoing to improve the outcome of these patients. SOURCES OF DATA Data for this review were obtained from PubMed and abstracts from the American Society of Clinical Oncology and Advances in Neuroblastoma Research. AREAS OF AGREEMENT Collaborative clinical trials have led to major improvements in treatment outcomes for low and intermediate risk neuroblastoma, and international initiatives such as the International Neuroblastoma Risk Group have produced a very refined risk stratification incorporating clinical and biological risk factors. AREAS OF CONTROVERSY Despite many efforts, the outcome for high-risk neuroblastoma is still poor and the only new strategy incorporated into frontline treatment is anti-GD2 immunotherapy. It is unclear how new drugs targeting specific molecular aberrations will be incorporated. GROWING POINTS Genomic characterization and drug development have undergone major advances in the last 5 years leading to a much deeper understanding of tumour biology as well as active biomarker-driven preclinical and clinical research on new molecules that will hopefully progress faster and more efficiently into frontline combination treatment strategies. AREAS TIMELY FOR DEVELOPING RESEARCH Significant effort remains to be done in integrating the different new strategies, combining new molecularly targeted agents to maximize therapeutic benefit and incorporate immunotherapy together with targeted therapies.
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Affiliation(s)
- Lucas Moreno
- Paediatric Drug Development Team, Di visions of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
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150
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A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg 2012; 256:573-80. [PMID: 22964741 DOI: 10.1097/sla.0b013e31826cbbbd] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate that expectant observation of young infants with small adrenal masses would result in excellent event-free and overall survival. BACKGROUND Neuroblastoma is the most common malignant tumor in infants, and in young infants, 90% of neuroblastomas are located in the adrenal gland. Although surgical resection is standard therapy, multiple observations suggest that expectant observation could be a safe alternative for infants younger than 6 months who have small adrenal masses. METHODS A prospective study of infants younger than 6 months with small adrenal masses and no evidence of spreading beyond the primary tumor was performed at participating Children's Oncology Group institutions. Parents could choose observation or immediate surgical resection. Serial abdominal sonograms and urinary vanillylmandelic acid and homovanillic acid measurements were performed during a 90-week interval. Infants experiencing a 50% increase in the volume of the mass, urine catecholamine values, or an increase in the homovanillic acid to vanillylmandelic acid ratio greater than 2, were referred for surgical resection. RESULTS Eighty-seven eligible patients were enrolled: 83 elected observation and 4 chose immediate surgery. Sixteen observational patients ultimately had surgery; 8 had International Neuroblastoma Staging System stage 1 neuroblastoma, 2 had higher staged neuroblastoma (2B and 4S), 2 had low-grade adrenocortical neoplasm, 2 had adrenal hemorrhage, and 2 had extralobar pulmonary sequestration. The 2 patients with adrenocortical tumors were resected because of a more than 50% increase in tumor volume. The 3-year event-free survival for a neuroblastoma event was 97.7 ± 2.2% within the entire cohort of patients (n = 87). The 3-year overall survival was 100%, with a median follow-up of 3.2 years. Eighty-one percent of patients on the observation arm were spared resection. CONCLUSIONS Expectant observation of infants younger than 6 months with small adrenal masses led to excellent event-free survival and overall survival while avoiding surgical intervention in a large majority of the patients.
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