201
|
Zhao F, Li C, Zhou Q, Qu P, Wang B, Wang X, Zhang S, Wang X, Zhao C, Zhang J, Luo L, Ai L, Xu L, Liu P. Distinctive localization and MRI features correlate of molecular subgroups in adult medulloblastoma. J Neurooncol 2017; 135:353-360. [PMID: 28808827 DOI: 10.1007/s11060-017-2581-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/23/2017] [Indexed: 11/27/2022]
Abstract
Medulloblastoma (MB) is recognized as comprising four molecular subgroups with distinct transcriptional profiles, clinical features, and outcomes. Previous studies demonstrate that pediatric MBs present with subgroup-specific MRI manifestations. We hypothesized that combination of anatomical localization and conventional features based on MR imaging can predict these subgroups in adult MBs. MR Imaging manifestations of 125 adult patients with MB were analyzed retrospectively based on pre-operative MRI scans. MB molecular subgroups were evaluated by the expression profiling array and immunohistochemistry. A pediatric MB cohort of 60 patients were analyzed for comparison with data of adult patients. Multiple logistic regression analysis revealed that tumor location (P < 0.0001) and pattern of enhancement (P = 0.0048) were significantly correlated with molecular subgroups in adult MBs. Ninety-two percent of adult MBs were correctly predicted by using logistic regression model based on the anatomical localization patterns and pattern of enhancement. Exclusively intra-cerebellar growth, localization in the rostral cerebellum, and no brainstem contact were specific to adult SHH-MBs. Group 4-MBs in adult were characterized by minimal/no enhancement compared with other two subgroups. Infant SHH-MBs represented significant different localization patterns compared with SHH tumors in children and adults. We identified that molecular subgroups of adult MBs could be well predicted by tumor localization patterns and enhancement pattern. Our study also provided important evidence that MB subgroups in adult possibly derived from different cellular origins.
Collapse
Affiliation(s)
- Fu Zhao
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. .,Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China.
| | - Chunde Li
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Qiangyi Zhou
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Peiran Qu
- Department of Neuroimaging and Nuclear Medicine, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Xin Wang
- Department of Neuroimaging and Nuclear Medicine, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Shun Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Xingchao Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Chi Zhao
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lin Luo
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lin Ai
- Department of Neuroimaging and Nuclear Medicine, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pinan Liu
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. .,Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China.
| |
Collapse
|
202
|
Bennett J, Ashmawy R, Ramaswamy V, Stephens D, Bouffet E, Laperriere N, Taylor M, Shroff M, Bartels U. The clinical significance of equivocal findings on spinal MRI in children with medulloblastoma. Pediatr Blood Cancer 2017; 64. [PMID: 28205381 DOI: 10.1002/pbc.26472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/16/2016] [Accepted: 12/25/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Medulloblastoma (MB) is the most common malignant brain tumor of childhood, with cerebrospinal fluid spread the most common site of metastasis. Currently, children diagnosed with MB and evidence of spinal metastasis are treated with an increased dose of craniospinal radiation (CSI). This report reviewed equivocal abnormalities including nerve root clumping, linear vascular enhancement, nerve root enhancement and/or other vague findings on spinal magnetic resonance imaging (MRI) to elucidate their prognostic significance and aid in risk stratification. METHODS This retrospective cohort study identified children (≥3 years) diagnosed with MB between 1988 and 2012. Children treated with upfront CSI were included, and staging spine MRI must have been done preoperatively or within 72 hr of primary tumor resection. Initial MRI of the spine was assessed by two independent reviewers blinded to outcome to evaluate for equivocal findings. Survival analysis was done to determine impact on prognosis. RESULTS One hundred of 157 patients were eligible for the analysis. Equivocal findings were identified in 48 (48%) patients, with MRI done preoperatively in 45 (94%) patients. Analysis by subgroup identified a higher proportion of equivocal findings in the sonic hedgehog (SHH) subgroup (P = 0.007). Five-year overall survival (OS) in children with equivocal findings compared to those with normal MRI was not different, 80 vs. 84.8% respectively, while OS in M3 patients was worse at 54.7% (P = 0.02). CONCLUSION A higher proportion of equivocal findings was identified in the SHH subgroup. This institutional retrospective review demonstrates equivocal findings are common, not associated with decreased OS and should not prompt increased dose of CSI.
Collapse
Affiliation(s)
- Julie Bennett
- Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ramy Ashmawy
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Derek Stephens
- Division of Clinical Research Services, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Michael Taylor
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
203
|
Morana G, Alves CA, Tortora D, Severino M, Nozza P, Cama A, Ravegnani M, D'Apolito G, Raso A, Milanaccio C, da Costa Leite C, Garrè ML, Rossi A. Added value of diffusion weighted imaging in pediatric central nervous system embryonal tumors surveillance. Oncotarget 2017; 8:60401-60413. [PMID: 28947980 PMCID: PMC5601148 DOI: 10.18632/oncotarget.19553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/16/2017] [Indexed: 12/29/2022] Open
Abstract
Diffusion weighted imaging (DWI) has an established role in primary CNS embryonal tumor (ET) characterization; however, its diagnostic utility in detecting relapse has never been determined. We aimed to compare DWI and conventional MRI sensitivity in CNS ET recurrence detection, and to evaluate the DWI properties of contrast-enhancing radiation induced lesions (RIL). Fifty-six patients with CNS ET (25 with disease relapse, 6 with RIL and 25 with neither disease relapse nor RIL) were retrospectively evaluated with DWI, conventional MRI (including both T2/FLAIR and post-contrast images), or contrast-enhanced MR imaging (CE-MRI) alone. MRI studies were independently reviewed by two neuroradiologists for detection and localization of potential brain relapses. Sensitivity for focal relapse detection was calculated for each image set on a lesion-by-lesion basis. A descriptive per subject analysis was also performed. Evaluation of follow-up MRI studies served as standard of reference. Focal recurrence detection sensitivity of DWI (96%) was significantly higher than conventional MRI (77%) and CE-MRI alone (51%) (p=0.0003 and p<0.0001). On per subject analysis there were not missed diagnoses for DWI. At the time of DWI relapse detection, conventional MRI missed 2 diagnoses, and CE-MRI 8. Analysis of medulloblastoma relapses revealed that DWI identified a higher number of focal lesions than CE-MRI in subjects with classic variant. All but one RIL did not show restricted diffusion. In conclusion, DWI is a valuable complementary technique allowing for improved detection of focal relapse in CNS ET patients, particularly in children with classic medulloblastoma, and may assist in differentiating recurrence from RIL.
Collapse
Affiliation(s)
- Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Cesar Augusto Alves
- Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy.,Radiology Institute, Hospital das Clinicas, Sao Paulo, Brazil
| | | | | | - Paolo Nozza
- Pathology Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Armando Cama
- Neurosurgery Unit, Istituto Giannina Gaslini, Genova, Italy
| | | | | | | | | | | | | | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy
| |
Collapse
|
204
|
Craveiro RB, Ehrhardt M, Velz J, Olschewski M, Goetz B, Pietsch T, Dilloo D. The anti-neoplastic activity of Vandetanib against high-risk medulloblastoma variants is profoundly enhanced by additional PI3K inhibition. Oncotarget 2017; 8:46915-46927. [PMID: 28159923 PMCID: PMC5564532 DOI: 10.18632/oncotarget.14911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/26/2016] [Indexed: 12/26/2022] Open
Abstract
Medulloblastoma is comprised of at least four molecular subgroups with distinct clinical outcome (WHO classification 2016). SHH-TP53-mutated as well as MYC-amplified Non-WNT/Non-SHH medulloblastoma show the worst prognosis.Here we present evidence that single application of the multi-kinase inhibitor Vandetanib displays anti-neoplastic efficacy against cell lines derived from high-risk SHH-TP53-mutated and MYC-amplified Non-WNT/Non-SHH medulloblastoma. The narrow target spectrum of Vandetanib along with a favourable toxicity profile renders this drug ideal for multimodal treatment approaches. In this context our investigation documents that Vandetanib in combination with the clinically available PI3K inhibitor GDC-0941 leads to enhanced cytotoxicity against MYC-amplified and SHH-TP53-mutated medulloblastoma. In line with these findings we show for MYC-amplified medulloblastoma a profound reduction in activity of the oncogenes STAT3 and AKT. Furthermore, we document that Vandetanib and the standard chemotherapeutic Etoposide display additive anti-neoplastic efficacy in the investigated medulloblastoma cell lines that could be further enhanced by PI3K inhibition. Of note, the combination of Vandetanib, GDC-0941 and Etoposide results in MYC-amplified and SHH-TP53-mutated cell lines in complete loss of cell viability. Our findings therefore provide a rational to further evaluate Vandetanib in combination with PI3K inhibitors as well as standard chemotherapeutics in vivo for the treatment of most aggressive medulloblastoma variants.
Collapse
Affiliation(s)
- Rogerio B Craveiro
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Michael Ehrhardt
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Julia Velz
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Martin Olschewski
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Barbara Goetz
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn, D-53105 Bonn, Germany
| | - Dagmar Dilloo
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| |
Collapse
|
205
|
Miele E, Po A, Begalli F, Antonucci L, Mastronuzzi A, Marras CE, Carai A, Cucchi D, Abballe L, Besharat ZM, Catanzaro G, Infante P, Di Marcotullio L, Canettieri G, De Smaele E, Screpanti I, Locatelli F, Ferretti E. β-arrestin1-mediated acetylation of Gli1 regulates Hedgehog/Gli signaling and modulates self-renewal of SHH medulloblastoma cancer stem cells. BMC Cancer 2017; 17:488. [PMID: 28716052 PMCID: PMC5512842 DOI: 10.1186/s12885-017-3477-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 07/09/2017] [Indexed: 02/08/2023] Open
Abstract
Background Aberrant Sonic Hedgehog/Gli (Hh/Gli) signaling pathway is a critical regulator of Sonic hedgehog medulloblastoma (SHH-MB). Cancer stem cells (CSCs), thought to be largely responsible for tumor initiation, maintenance, dissemination and relapse, have been identified in SHH-MB. Since we previously demonstrated that Hh/Gli signaling controls CSCs features in SHH-MB and that in these tumors miR-326 is down regulated, here we investigated whether there is a functional link between Hh/Gli signaling and miR-326. Methods We evaluated β-arrestin1 (Arrb1) and its intragenic miR-326 levels in CSCs derived from SHH-MB. Subsequently, we modulated the expression of Arrb1 and miR-326 in CSCs in order to gain insight into their biological role. We also analyzed the mechanism by which Arrb1 and miR-326 control Hh/Gli signaling and self-renewal, using luciferase and protein immunoprecipitation assays. Results Low levels of Arrb1 and miR-326 represent a feature of CSCs derived from SHH-MB. We observed that re-expression of Arrb1 and miR-326 inhibits Hh/Gli signaling pathway at multiple levels, which cause impaired proliferation and self-renewal, accompanied by down regulation of Nanog levels. In detail, miR-326 negatively regulates two components of the Hh/Gli pathway the receptor Smoothened (Smo) and the transcription factor Gli2, whereas Arrb1 suppresses the transcriptional activity of Gli1, by potentiating its p300-mediated acetylation. Conclusions Our results identify a new molecular mechanism involving miR-326 and Arrb1 as regulators of SHH-MB CSCs. Specifically, low levels of Arrb1 and miR-326 trigger and maintain Hh/Gli signaling and self-renewal.
Collapse
Affiliation(s)
- Evelina Miele
- Center for Life NanoScience@Sapienza, Istituto Italiano di Tecnologia, 00161, Rome, Italy.,Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Agnese Po
- Department of Molecular Medicine Sapienza University, 00161, Rome, Italy
| | - Federica Begalli
- Department of Molecular Medicine Sapienza University, 00161, Rome, Italy
| | - Laura Antonucci
- Department of Molecular Medicine Sapienza University, 00161, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Andrea Carai
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Danilo Cucchi
- Department of Molecular Medicine Sapienza University, 00161, Rome, Italy
| | - Luana Abballe
- Department of Experimental Medicine Sapienza University, Viale Regina Elena, 291 - 00161, 00161, Rome, Italy
| | - Zein Mersini Besharat
- Department of Experimental Medicine Sapienza University, Viale Regina Elena, 291 - 00161, 00161, Rome, Italy
| | - Giuseppina Catanzaro
- Department of Experimental Medicine Sapienza University, Viale Regina Elena, 291 - 00161, 00161, Rome, Italy
| | - Paola Infante
- Center for Life NanoScience@Sapienza, Istituto Italiano di Tecnologia, 00161, Rome, Italy
| | | | | | - Enrico De Smaele
- Department of Experimental Medicine Sapienza University, Viale Regina Elena, 291 - 00161, 00161, Rome, Italy
| | - Isabella Screpanti
- Center for Life NanoScience@Sapienza, Istituto Italiano di Tecnologia, 00161, Rome, Italy.,Department of Molecular Medicine Sapienza University, 00161, Rome, Italy
| | - Franco Locatelli
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy.,Department of Pediatric Science, University of Pavia, Pavia, Italy
| | - Elisabetta Ferretti
- Department of Experimental Medicine Sapienza University, Viale Regina Elena, 291 - 00161, 00161, Rome, Italy. .,Neuromed Institute, 86077, Pozzilli, Italy.
| |
Collapse
|
206
|
Grausam KB, Dooyema SDR, Bihannic L, Premathilake H, Morrissy AS, Forget A, Schaefer AM, Gundelach JH, Macura S, Maher DM, Wang X, Heglin AH, Ge X, Zeng E, Puget S, Chandrasekar I, Surendran K, Bram RJ, Schüller U, Talyor MD, Ayrault O, Zhao H. ATOH1 Promotes Leptomeningeal Dissemination and Metastasis of Sonic Hedgehog Subgroup Medulloblastomas. Cancer Res 2017; 77:3766-3777. [PMID: 28490517 PMCID: PMC5512702 DOI: 10.1158/0008-5472.can-16-1836] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 02/16/2017] [Accepted: 05/03/2017] [Indexed: 12/17/2022]
Abstract
Medulloblastoma arising from the cerebellum is the most common pediatric brain malignancy, with leptomeningeal metastases often present at diagnosis and recurrence associated with poor clinical outcome. In this study, we used mouse medulloblastoma models to explore the relationship of tumor pathophysiology and dysregulated expression of the NOTCH pathway transcription factor ATOH1, which is present in aggressive medulloblastoma subtypes driven by aberrant Sonic Hedgehog/Patched (SHH/PTCH) signaling. In experiments with conditional ATOH1 mouse mutants crossed to Ptch1+/- mice, which develop SHH-driven medulloblastoma, animals with Atoh1 transgene expression developed highly penetrant medulloblastoma at a young age with extensive leptomeningeal disease and metastasis to the spinal cord and brain, resembling xenografts of human SHH medulloblastoma. Metastatic tumors retained abnormal SHH signaling like tumor xenografts. Conversely, ATOH1 expression was detected consistently in recurrent and metastatic SHH medulloblastoma. Chromatin immunoprecipitation sequencing and gene expression profiling identified candidate ATOH1 targets in tumor cells involved in development and tumorigenesis. Among these targets specific to metastatic tumors, there was an enrichment in those implicated in extracellular matrix remodeling activity, cytoskeletal network and interaction with microenvironment, indicating a shift in transcriptomic and epigenomic landscapes during metastasis. Treatment with bone morphogenetic protein or SHH pathway inhibitors decreased tumor cell proliferation and suppressed metastatic tumor growth, respectively. Our work reveals a dynamic ATOH1-driven molecular cascade underlying medulloblastoma metastasis that offers possible therapeutic opportunities. Cancer Res; 77(14); 3766-77. ©2017 AACR.
Collapse
Affiliation(s)
- Katie B Grausam
- Children's Health Research Center, Sanford Research, Sioux Falls, South Dakota
- Division of Basic Biomedical Sciences, University of South Dakota Sanford School of Medicine, Vermillion, South Dakota
| | - Samuel D R Dooyema
- Children's Health Research Center, Sanford Research, Sioux Falls, South Dakota
| | - Laure Bihannic
- Institut Curie, PSL Research University, CNRS UMR, INSERM, Orsay, France
| | | | - A Sorana Morrissy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Antoine Forget
- Institut Curie, PSL Research University, CNRS UMR, INSERM, Orsay, France
| | - Amanda M Schaefer
- Cancer Biology Research Center, Sanford Research, Sioux Falls, South Dakota
| | - Justin H Gundelach
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Immunology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Slobodan Macura
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Minnesota
| | - Diane M Maher
- Cancer Biology Research Center, Sanford Research, Sioux Falls, South Dakota
| | - Xin Wang
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alex H Heglin
- Department of Biology, University of South Dakota, Vermillion, South Dakota
| | - Xijin Ge
- Department of Mathematics and Statistics, South Dakota State University, Brookings, South Dakota
| | - Erliang Zeng
- Department of Biology, University of South Dakota, Vermillion, South Dakota
- Department of Computer Science, University of South Dakota, Vermillion, South Dakota
| | - Stephanie Puget
- AP-HP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | - Indra Chandrasekar
- Children's Health Research Center, Sanford Research, Sioux Falls, South Dakota
- Division of Basic Biomedical Sciences, University of South Dakota Sanford School of Medicine, Vermillion, South Dakota
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Kameswaran Surendran
- Children's Health Research Center, Sanford Research, Sioux Falls, South Dakota
- Division of Basic Biomedical Sciences, University of South Dakota Sanford School of Medicine, Vermillion, South Dakota
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Richard J Bram
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Immunology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ulrich Schüller
- Research Institute Children's Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael D Talyor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Olivier Ayrault
- Institut Curie, PSL Research University, CNRS UMR, INSERM, Orsay, France
- Université Paris Sud, Université Paris-Saclay, CNRS UMR 3347, INSERM U1021, Orsay, France
| | - Haotian Zhao
- Children's Health Research Center, Sanford Research, Sioux Falls, South Dakota.
- Division of Basic Biomedical Sciences, University of South Dakota Sanford School of Medicine, Vermillion, South Dakota
- Cancer Biology Research Center, Sanford Research, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| |
Collapse
|
207
|
Abstract
Current therapies for medulloblastoma were introduced primarily in the 1980s and consist of predominantly cytotoxic, nontargeted approaches. Mortality from medulloblastoma remains significant. In addition, many survivors suffer from severe treatment-related effects of radiation and cytotoxic chemotherapy. Further intensification of nonspecific therapy is unlikely to offer additional benefits, because survival rates have reached a plateau. Recent publications in medulloblastoma have revolved largely around the recognition that medulloblastoma per se does not exist, but rather, that there are a group of histologically similar but clinically and molecularly distinct entities that have been grouped under that rubric. Distinguishing the four molecular subgroups of medulloblastoma-wingless (WNT), sonic hedgehog (SHH), group 3, and group 4-in the daily treatment of patients, as well in the setting of clinical trials, is an important challenge in the near term for the pediatric neuro-oncology community. The preponderance of morbidity in treating patients with medulloblastoma is secondary to the treatment or prophylaxis of leptomeningeal metastases, and the cause of most deaths is leptomeningeal metastases. Recurrence of medulloblastoma is a nearly universally fatal event, with no significant salvage rate. The extent of spatial and temporal intratumoral heterogeneity as medulloblastoma metastasizes to leptomeninges and as it evolves in the face of radiation and cytotoxic chemotherapy is just beginning to be understood as a major barrier to therapeutic success. Pediatric neuro-oncology clinicians and scientists must now determine how best to incorporate rapid changes in our biologic understanding of medulloblastoma into the next generation of upfront clinical trials, with the goal of both improving survival for the highest-risk patients and improving quality of life for survivors.
Collapse
Affiliation(s)
- Vijay Ramaswamy
- All authors: Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- All authors: Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
208
|
Cavalli FMG, Remke M, Rampasek L, Peacock J, Shih DJH, Luu B, Garzia L, Torchia J, Nor C, Morrissy AS, Agnihotri S, Thompson YY, Kuzan-Fischer CM, Farooq H, Isaev K, Daniels C, Cho BK, Kim SK, Wang KC, Lee JY, Grajkowska WA, Perek-Polnik M, Vasiljevic A, Faure-Conter C, Jouvet A, Giannini C, Nageswara Rao AA, Li KKW, Ng HK, Eberhart CG, Pollack IF, Hamilton RL, Gillespie GY, Olson JM, Leary S, Weiss WA, Lach B, Chambless LB, Thompson RC, Cooper MK, Vibhakar R, Hauser P, van Veelen MLC, Kros JM, French PJ, Ra YS, Kumabe T, López-Aguilar E, Zitterbart K, Sterba J, Finocchiaro G, Massimino M, Van Meir EG, Osuka S, Shofuda T, Klekner A, Zollo M, Leonard JR, Rubin JB, Jabado N, Albrecht S, Mora J, Van Meter TE, Jung S, Moore AS, Hallahan AR, Chan JA, Tirapelli DPC, Carlotti CG, Fouladi M, Pimentel J, Faria CC, Saad AG, Massimi L, Liau LM, Wheeler H, Nakamura H, Elbabaa SK, Perezpeña-Diazconti M, Chico Ponce de León F, Robinson S, Zapotocky M, Lassaletta A, Huang A, Hawkins CE, Tabori U, Bouffet E, Bartels U, Dirks PB, Rutka JT, Bader GD, Reimand J, Goldenberg A, Ramaswamy V, Taylor MD. Intertumoral Heterogeneity within Medulloblastoma Subgroups. Cancer Cell 2017; 31:737-754.e6. [PMID: 28609654 PMCID: PMC6163053 DOI: 10.1016/j.ccell.2017.05.005] [Citation(s) in RCA: 728] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/24/2017] [Accepted: 05/08/2017] [Indexed: 02/07/2023]
Abstract
While molecular subgrouping has revolutionized medulloblastoma classification, the extent of heterogeneity within subgroups is unknown. Similarity network fusion (SNF) applied to genome-wide DNA methylation and gene expression data across 763 primary samples identifies very homogeneous clusters of patients, supporting the presence of medulloblastoma subtypes. After integration of somatic copy-number alterations, and clinical features specific to each cluster, we identify 12 different subtypes of medulloblastoma. Integrative analysis using SNF further delineates group 3 from group 4 medulloblastoma, which is not as readily apparent through analyses of individual data types. Two clear subtypes of infants with Sonic Hedgehog medulloblastoma with disparate outcomes and biology are identified. Medulloblastoma subtypes identified through integrative clustering have important implications for stratification of future clinical trials.
Collapse
Affiliation(s)
- Florence M G Cavalli
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Marc Remke
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf 40225, Germany; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Department of Pediatric Neuro-Oncogenomics, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Düsseldorf 40225, Germany
| | - Ladislav Rampasek
- Department of Computer Science, University of Toronto, Toronto, ON M5S 2E4, Canada; Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - John Peacock
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - David J H Shih
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Betty Luu
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Livia Garzia
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Jonathon Torchia
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Carolina Nor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - A Sorana Morrissy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Sameer Agnihotri
- UPCI Brain Tumor Program, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Yuan Yao Thompson
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Claudia M Kuzan-Fischer
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Hamza Farooq
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Keren Isaev
- Informatics Program, Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Craig Daniels
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Byung-Kyu Cho
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Wieslawa A Grajkowska
- Department of Pathology, The Children's Memorial Health Institute, University of Warsaw, Warsaw 04-730, Poland
| | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, University of Warsaw, Warsaw 04-730, Poland
| | - Alexandre Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron 69677, France; ONCOFLAM - Neuro-Oncologie et Neuro-Inflammation Centre de Recherche en Neurosciences de Lyon, Lyon 69008, France
| | | | - Anne Jouvet
- Centre de Pathologie EST, Groupement Hospitalier EST, Université de Lyon, Bron 69677, France
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Kay Ka Wai Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Charles G Eberhart
- Departments of Pathology, Ophthalmology and Oncology, John Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ronald L Hamilton
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - G Yancey Gillespie
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - James M Olson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA; Division of Pediatric Hematology/Oncology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98145-5005, USA
| | - Sarah Leary
- Division of Pediatric Hematology/Oncology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98145-5005, USA
| | - William A Weiss
- Departments of Pediatrics, Neurological Surgery and Neurology, University of California San Francisco, San Francisco, CA 94143-0112, USA
| | - Boleslaw Lach
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada; Department of Pathology and Laboratory Medicine, Hamilton General Hospital, Hamilton, ON L8L 2X2, Canada
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Michael K Cooper
- Department of Neurology, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Marie-Lise C van Veelen
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam 3015 CE, the Netherlands
| | - Johan M Kros
- Department of Pathology, Erasmus University Medical Center, Rotterdam 3015 CN, the Netherlands
| | - Pim J French
- Department of Neurology, Erasmus University Medical Center, Rotterdam 3015 CE, the Netherlands
| | - Young Shin Ra
- Department of Neurosurgery, University of Ulsan, Asan Medical Center, Seoul 05505, South Korea
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Enrique López-Aguilar
- Division of Pediatric Hematology/Oncology, Hospital Pediatría Centro Médico Nacional Century XXI, Mexico City 06720, Mexico
| | - Karel Zitterbart
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Jaroslav Sterba
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Gaetano Finocchiaro
- Department of Neuro-Oncology, Istituto Neurologico Besta, Milan 20133, Italy
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale Tumori, Milan 20133, Italy
| | - Erwin G Van Meir
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Satoru Osuka
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, Osaka 540-0006, Japan
| | - Almos Klekner
- Department of Neurosurgery, University of Debrecen, Medical and Health Science Centre, Debrecen 4032, Hungary
| | - Massimo Zollo
- Dipartimento di Biochimica e Biotecnologie Mediche, University of Naples, Naples 80145, Italy
| | - Jeffrey R Leonard
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Joshua B Rubin
- Departments of Pediatrics, Anatomy and Neurobiology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Nada Jabado
- Division of Hematology/Oncology, Department of Pediatrics, McGill University, Montreal, QC H4A 3J1, Canada
| | - Steffen Albrecht
- Department of Pathology, McGill University, Montreal, QC H4A 3J1, Canada; Department of Pathology, Montreal Children's Hospital, Montreal, QC H4A 3J1, Canada
| | - Jaume Mora
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona 08950, Spain
| | - Timothy E Van Meter
- Department of Pediatrics, Virginia Commonwealth University, School of Medicine, Richmond, VA 23298-0646, USA
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun 519-763, Chonnam South Korea
| | - Andrew S Moore
- Lady Cilento Children's Hospital, The University of Queensland, Brisbane QLD 4102, Australia; Oncology Service, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4029, Australia
| | - Andrew R Hallahan
- Lady Cilento Children's Hospital, The University of Queensland, Brisbane QLD 4102, Australia; Oncology Service, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4029, Australia
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Daniela P C Tirapelli
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo 14049-900, Brazil
| | - Carlos G Carlotti
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo 14049-900, Brazil
| | - Maryam Fouladi
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - José Pimentel
- Divison of Pathology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon 1649-035, Portugal
| | - Claudia C Faria
- Division of Neurosurgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon 1649-035, Portugal
| | - Ali G Saad
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Luca Massimi
- Department of Pediatric Neurosurgery, Catholic University Medical School, Rome 00198, Italy
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Helen Wheeler
- Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW 2065, Australia
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto 860-8555, Japan
| | - Samer K Elbabaa
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | | | - Shenandoah Robinson
- Division of Pediatric Neurosurgery, Rainbow & Babies Children's Hospital, Case Western Reserve, Cleveland, OH 44106, USA
| | - Michal Zapotocky
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Alvaro Lassaletta
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Annie Huang
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Pathology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Uri Tabori
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Eric Bouffet
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Ute Bartels
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Peter B Dirks
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - James T Rutka
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Gary D Bader
- The Donnelly Centre, University of Toronto, Toronto, ON M5S 3E1, Canada; Banting and Best Department of Medical Research, University of Toronto, Toronto, ON M5G 1L6, Canada; McLaughlin Centre, University of Toronto, Toronto, ON M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada; Samuel Lunenfeld Research Institute at Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Jüri Reimand
- Informatics Program, Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Anna Goldenberg
- Department of Computer Science, University of Toronto, Toronto, ON M5S 2E4, Canada; Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Program in Neuroscience and Mental Health and Division of Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| |
Collapse
|
209
|
Liu H, Sun Q, Sun Y, Zhang J, Yuan H, Pang S, Qi X, Wang H, Zhang M, Zhang H, Yu C, Gu C. MELK and EZH2 Cooperate to Regulate Medulloblastoma Cancer Stem-like Cell Proliferation and Differentiation. Mol Cancer Res 2017; 15:1275-1286. [PMID: 28536141 DOI: 10.1158/1541-7786.mcr-17-0105] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/11/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022]
Abstract
Medulloblastoma is the most common malignant brain tumor in children. Although accumulated research has suggested that cancer stem-like cells play a key role in medulloblastoma tumorigenesis, the specific molecular mechanism regarding proliferation remains elusive. Here, we reported more abundant expression of maternal embryonic leucine-zipper kinase (MELK) and enhancer of zeste homolog 2 (EZH2) in medulloblastoma stem-like cells than in neural stem cells and the interaction between the two proteins could mediate the self-renewal of sonic hedgehog subtype medulloblastoma. In human medulloblastoma, extensive nodularity and large-cell/anaplastic subgroups differed according to the staining levels of MELK and EZH2 from the other two subgroups. The proportion of MELK- or EZH2-positive staining status could be considered as a potential indicator for survival. Mechanistically, MELK bound to and phosphorylated EZH2, and its methylation was induced by EZH2 in medulloblastoma, which could regulate the proliferation of cancer stem-like cells. In xenografts, loss of MELK or EZH2 attenuated medulloblastoma stem-like cell-derived tumor growth and promoted differentiation. These findings indicate that MELK-induced phosphorylation and EZH2-mediated methylation in MELK/EZH2 pathway are essential for medulloblastoma stem-like cell-derived tumor proliferation, thereby identifying a potential therapeutic strategy for these patients.Implications: This study demonstrates that the interaction occurring between MELK and EZH2 promotes self-proliferation and stemness, thus representing an attractive therapeutic target and potential candidate for diagnosis of medulloblastoma. Mol Cancer Res; 15(9); 1275-86. ©2017 AACR.
Collapse
Affiliation(s)
- Hailong Liu
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing, P.R. China
| | - Qianwen Sun
- Department of Neurology, Qilu Hospital Shandong University, Jinan, P.R. China
| | - Youliang Sun
- School of Basic Medical Science, Capital Medical University, Beijing, P.R. China
| | - Junping Zhang
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing, P.R. China
| | - Hongyu Yuan
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | | | - Xueling Qi
- Department of Pathology, Sanbo Brain Hospital Capital Medical University, Beijing, P.R. China
| | - Haoran Wang
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing, P.R. China
| | - Mingshan Zhang
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing, P.R. China
| | - Hongwei Zhang
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing, P.R. China
| | - Chunjiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing, P.R. China.
| | - Chunyu Gu
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing, P.R. China.
| |
Collapse
|
210
|
Jiang T, Zhang Y, Wang J, Du J, Raynald, Qiu X, Wang Y, Li C. A Retrospective Study of Progression-Free and Overall Survival in Pediatric Medulloblastoma Based on Molecular Subgroup Classification: A Single-Institution Experience. Front Neurol 2017; 8:198. [PMID: 28553259 PMCID: PMC5427081 DOI: 10.3389/fneur.2017.00198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/24/2017] [Indexed: 01/09/2023] Open
Abstract
Background Medulloblastoma (MB) has been classified into four core subgroups according to the transcriptional profile in recent years. However, some disagreement among researchers remains regarding the prognoses and most effective treatments of the different subgroups with different age distributions. Objective The objective of this study was to analyze MB prognosis in children population based on the classification of four molecular subgroups. Methods From January 2011 to January 2013, 84 consecutive MB patients aged underwent tumor removal at Beijing Tiantan Hospital. A total of 55 patients who ranged in age from 4 to 18 years underwent detailed follow-up. Molecular subgrouping was performed using RT-PCR. Results The 2-year progression-free survival (PFS) and overall survival (OS) rates for the entire cohort were 76.2 ± 5.8 and 81.8 ± 5.2%, respectively. Univariate analysis revealed that the Group 4 patients had a better survival (2-year OS, 90.6 ± 5.2%) than the SHH subgroup (P = 0.002) and Group 3 patients (P = 0.008). Only two of the 23 non-metastasized Group 4 patients relapsed, and chemotherapy did significantly affect these patients (PFS, P = 0.685). One out of five WNT patients had tumor relapse and died at last. Large cell/anaplastic (LC/A) histology and chemotherapy were independent risk factors in multivariate analysis. Conclusion In our study, the non-metastasized Group 4 patients had an excellent prognosis. The SHH subgroup and Group 3 patients had worst prognoses. LC/A histology had a dismal prognosis in our cohorts, which warrants intensive treatment.
Collapse
Affiliation(s)
- Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuqi Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Yuquan Hospital, Medical Center, Tsinghua University, Beijing, China
| | - Junmei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiang Du
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Raynald
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaoguang Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ying Wang
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| |
Collapse
|
211
|
Stensvold E, Krossnes BK, Lundar T, Due-Tønnessen BJ, Frič R, Due-Tønnessen P, Bechensteen AG, Myklebust TÅ, Johannesen TB, Brandal P. Outcome for children treated for medulloblastoma and supratentorial primitive neuroectodermal tumor (CNS-PNET) - a retrospective analysis spanning 40 years of treatment. Acta Oncol 2017; 56:698-705. [PMID: 28325133 DOI: 10.1080/0284186x.2017.1301679] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor of the central nervous system (CNS-PNET) are among the most common pediatric brain tumors. The diagnosis, treatment, and outcome of MB/CNS-PNET patients treated during the last four decades at Oslo University Hospital (OUH) are described. MATERIAL AND METHODS All patients younger than 20 years of age diagnosed and treated for MB/CNS-PNET at OUH between 1 January 1974 and 31 December 2013 were identified. RESULTS We found 175 patients. In 13 of them, the diagnosis was changed upon histopathological review and in 4 patients part of the treatment was administered at other hospitals. Thus, 158 patients were included for further analysis. Eight patients did not receive adjuvant therapy because of a dismal clinical condition. The overall 5-year survival rate for MB and CNS-PNET was 54%, for MB 57%, and for CNS-PNET 41%. Gross total resection (GTR) was achieved in 118 patients and 5-year overall survival for patients with GTR versus those with non-GTR differed significantly with 64% versus 22%. Cytological examination of the cerebrospinal fluid was performed in 52 patients. A total of 126 patients received radiotherapy as part of the primary treatment and 24 did not due to young age. Median time from surgery to start of radiotherapy was 33 days. Duration of radiotherapy was more than 48 days in 22% of patients. At the time of analysis, 63 patients were alive and disease-free, one alive with disease, and 94 patients were deceased; 84 of these due to MB/CNS-PNET and 10 due to supposed late effects from the treatment. CONCLUSIONS Survival was comparable to data from other population-based studies. The importance of GTR for survival was corroborated. Reporting real-world data remains crucial to know the true outcome of patients treated outside clinical trials.
Collapse
Affiliation(s)
- Einar Stensvold
- The Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
| | | | - Tryggve Lundar
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Radek Frič
- The Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Paulina Due-Tønnessen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
212
|
Gottlieb A, Althoff K, Grunewald L, Thor T, Odersky A, Schulte M, Deubzer HE, Heukamp L, Eggert A, Schramm A, Schulte JH, Künkele A. RITA displays anti-tumor activity in medulloblastomas independent of TP53 status. Oncotarget 2017; 8:27882-27891. [PMID: 28427187 PMCID: PMC5438615 DOI: 10.18632/oncotarget.15840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/20/2017] [Indexed: 01/08/2023] Open
Abstract
Current therapy of medulloblastoma, the most common malignant brain tumor of childhood, achieves 40-70% survival. Secondary chemotherapy resistance contributes to treatment failure, where TP53 pathway dysfunction plays a key role. MDM2 interaction with TP53 leads to its degradation. Reactivating TP53 functionality using small-molecule inhibitors, such as RITA, to disrupt TP53-MDM2 binding may have therapeutic potential. We show here that RITA decreased viability of all 4 analyzed medulloblastoma cell lines, regardless of TP53 functional status. The decrease in cell viability was accompanied in 3 of the 4 medulloblastoma cell lines by accumulation of TP53 protein in the cells and increased CDKN1A expression. RITA treatment in mouse models inhibited medulloblastoma xenograft tumor growth. These data demonstrate that RITA treatment reduces medulloblastoma cell viability in both in vitro and in vivo models, and acts independently of cellular TP53 status, identifying RITA as a potential therapeutic agent to treat medulloblastoma.
Collapse
Affiliation(s)
- Aline Gottlieb
- Department of Pediatric Oncology, University Hospital Essen, 45122 Essen, Germany
| | - Kristina Althoff
- Department of Pediatric Oncology, University Hospital Essen, 45122 Essen, Germany
| | - Laura Grunewald
- Department of Pediatric Oncology, Hematology and SCT, Charité, 13353 Berlin, Germany
| | - Theresa Thor
- Department of Pediatric Oncology, University Hospital Essen, 45122 Essen, Germany
| | - Andrea Odersky
- Department of Pediatric Oncology, University Hospital Essen, 45122 Essen, Germany
| | - Marc Schulte
- Department of Pediatric Oncology, University Hospital Essen, 45122 Essen, Germany
| | - Hedwig E. Deubzer
- Department of Pediatric Oncology, Hematology and SCT, Charité, 13353 Berlin, Germany
- Junior Neuroblastoma Research Group, Experimental and Clinical Research Center of the Max-Delbrück Center for Molecular Medicine (MDC), 13125 Berlin, Germany
| | - Lukas Heukamp
- Institute for Pathology, University Hospital of Cologne, 50924 Cologne, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology, Hematology and SCT, Charité, 13353 Berlin, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
| | - Alexander Schramm
- Department of Pediatric Oncology, University Hospital Essen, 45122 Essen, Germany
| | - Johannes H. Schulte
- Department of Pediatric Oncology, Hematology and SCT, Charité, 13353 Berlin, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Annette Künkele
- Department of Pediatric Oncology, Hematology and SCT, Charité, 13353 Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
| |
Collapse
|
213
|
Synergistic anti-cancer effects of epigenetic drugs on medulloblastoma cells. Cell Oncol (Dordr) 2017; 40:263-279. [PMID: 28429280 DOI: 10.1007/s13402-017-0319-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Medulloblastomas are aggressive brain malignancies. While considerable progress has been made in the treatment of medulloblastoma patients with respect to overall survival, these patients are still at risk of developing neurologic and cognitive deficits as a result of anti-cancer therapies. It is hypothesized that targeted molecular therapies represent a better treatment option for medulloblastoma patients. Therefore, the aim of the present study was to test a panel of epigenetic drugs for their effect on medulloblastoma cells under mild hypoxic conditions that reflect the physiological concentrations of oxygen in the brain. METHODS Protein levels of histone deacetylase 1 (HDAC1) and DNA methyltransferase 1 (DNMT1) in medulloblastoma-derived cells (Daoy and D283 Med), as well as in developing and differentiated brain cells, were determined and compared. Class I and II histone deacetylase inhibitors (HDACi) and a DNMT inhibitor, 5-aza-2'-deoxycytidine (5-aza-dC), were applied to Daoy and D283 Med cells, and their effects were studied using viability, apoptosis and cancer sphere assays. RESULTS We found that in HDAC1 and DNMT1 overexpressing medulloblastoma-derived cells, cell death was induced under various epigenetic drug conditions tested. At low HDACi concentrations, however, a pro-proliferative effect was observed. Parthenolide, a drug that affects cancer stem cells, was found to be efficient in inducing cell death in both cell lines tested. In contrast, we found that Daoy cells were more resistant to 5-aza-dC than D283 Med cells. When suberoylanilide hydroxamic acid (SAHA) and parthenolide were individually applied to both cell lines in combination with 5-aza-dC, a synergistic effect on cell survival was observed. CONCLUSIONS Our current results suggest that the application of HDACi in combination with drugs that target DNMT may represent a promising option for the treatment of medulloblastoma.
Collapse
|
214
|
Abstract
Recent advances in cancer genomics have revolutionized the characterization and classification of medulloblastomas. According to the current WHO guidelines, medulloblastomas are now classified into the following molecularly defined groups: Wnt signaling pathway (WNT)-activated, sonic hedgehog signaling pathway (SHH)-activated and tumor suppressor protein p53 (TP53)-mutant, SHH-activated and TP53-wildtype, and non-WNT/non-SHH (i.e. group 3 and group 4). Importantly, genomic, epigenomic, and proteomic advances have created a potential paradigm shift in therapeutic options. The challenge now is to (i) translate these observations into new therapeutic approaches and (ii) employ these observations in clinical practice, utilizing the classification following a molecular analysis for diagnosis and application of new subgroup-specific targeted therapeutics.
Collapse
Affiliation(s)
- Soma Sengupta
- Winship Cancer Institute, Emory University Hospital, Atlanta, GA, USA
| | | | - Scott Pomeroy
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
215
|
Archer TC, Mahoney EL, Pomeroy SL. Medulloblastoma: Molecular Classification-Based Personal Therapeutics. Neurotherapeutics 2017; 14:265-273. [PMID: 28386677 PMCID: PMC5398996 DOI: 10.1007/s13311-017-0526-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Recent advances in cancer genomics have revealed 4 distinct subgroups of medulloblastomas, each with unique transcription profiles, DNA alterations and clinical outcome. Molecular classification of medulloblastomas improves predictions of clinical outcome, allowing more accurate matching of intensity of conventional treatments with chemotherapy and radiation to overall prognosis and setting the stage for the introduction of targeted therapies.
Collapse
Affiliation(s)
- Tenley C Archer
- Department of Neurology, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | | | - Scott L Pomeroy
- Department of Neurology, Boston Children's Hospital, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| |
Collapse
|
216
|
Lu Y, Labak CM, Jain N, Purvis IJ, Guda MR, Bach SE, Tsung AJ, Asuthkar S, Velpula KK. OTX2 expression contributes to proliferation and progression in Myc-amplified medulloblastoma. Am J Cancer Res 2017; 7:647-656. [PMID: 28401018 PMCID: PMC5385649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 06/07/2023] Open
Abstract
Medulloblastoma is one of the most prevalent pediatric brain malignancies, accounting for approximately 20% of all primary CNS tumors in children under the age of 19. OTX2 is the member of a highly conserved family of bicoid-like homeodomain transcription factors responsible for the regulation of cerebellar development and of current investigational interest in the tumorigenesis of medulloblastoma. Recent studies have revealed that Group 3 and Group 4 medulloblastomas show marked overexpression of OTX2 with a concurrent amplification of the MYC and MYCN oncogenes, respectively, correlating with anaplasticity and unfavorable patient outcomes. More recent attempts at elucidating the mechanism of OTX2-driven oncogenesis at the cellular level has also revealed that OTX2 may confer stem-cell like properties to tumor cells via epigenetic regulation. The review seeks to define the interaction pathways and binding partners involved in OTX2 function, its usefulness as a molecular marker for risk stratification and prognosis, and the mechanism by which it drives tumor maintenance. Additionally, it will preview unpublished data by our group highlighting the unanticipated involvement of OTX2 in the control of cellular metabolism.
Collapse
Affiliation(s)
- Yining Lu
- Department of Cancer Biology and Pharmacology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
| | - Collin M Labak
- Department of Cancer Biology and Pharmacology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
| | - Neha Jain
- Department of Cancer Biology and Pharmacology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
| | - Ian J Purvis
- Department of Cancer Biology and Pharmacology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
| | - Maheedhara R Guda
- Department of Cancer Biology and Pharmacology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
| | - Sarah E Bach
- Department of Pathology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
| | - Andrew J Tsung
- Department of Cancer Biology and Pharmacology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
- Department of Neurosurgery, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
- Illinois Neurological InstitutePeoria 61656, IL, U. S. A.
| | - Swapna Asuthkar
- Department of Cancer Biology and Pharmacology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
| | - Kiran K Velpula
- Department of Cancer Biology and Pharmacology, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
- Department of Neurosurgery, College of Medicine, University of IllinoisPeoria 61656, IL, U. S. A.
| |
Collapse
|
217
|
Srinivasan VM, Ghali MGZ, North RY, Boghani Z, Hansen D, Lam S. Modern management of medulloblastoma: Molecular classification, outcomes, and the role of surgery. Surg Neurol Int 2016; 7:S1135-S1141. [PMID: 28194300 PMCID: PMC5299153 DOI: 10.4103/2152-7806.196922] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Visish M Srinivasan
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Texas, USA
| | - Michael G Z Ghali
- Department of Neurobiology, Drexel University College of Medicine, Philadelphia, USA
| | - Robert Y North
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Texas, USA
| | - Zain Boghani
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Texas, USA
| | - Daniel Hansen
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Texas, USA
| | - Sandi Lam
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Texas, USA
| |
Collapse
|
218
|
Li C, Li H, Zhang P, Yu LJ, Huang TM, Song X, Kong QY, Dong JL, Li PN, Liu J. SHP2, SOCS3 and PIAS3 Expression Patterns in Medulloblastomas: Relevance to STAT3 Activation and Resveratrol-Suppressed STAT3 Signaling. Nutrients 2016; 9:nu9010003. [PMID: 28035977 PMCID: PMC5295047 DOI: 10.3390/nu9010003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/02/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Activated STAT3 signaling is critical for human medulloblastoma cells. SHP2, SOCS3 and PIAS3 are known as the negative regulators of STAT3 signaling, while their relevance to frequent STAT3 activation in medulloblastomas remains unknown. METHODS Tissue microarrays were constructed with 17 tumor-surrounding noncancerous brain tissues and 61 cases of the classic medulloblastomas, 44 the large-cell medulloblastomas, and 15 nodular medulloblastomas, which were used for immunohistochemical profiling of STAT3, SHP2, SOCS3 and PIAS3 expression patterns and the frequencies of STAT3 nuclear translocation. Three human medulloblastoma cell lines (Daoy, UW228-2 and UW228-3) were cultured with and without 100 μM resveratrol supplementation. The influences of resveratrol in SHP2, SOCS3 and PIAS3 expression and SOCS3 knockdown in STAT3 activation were analyzed using multiple experimental approaches. RESULTS SHP2, SOCS3 and PIAS3 levels are reduced in medulloblastomas in vivo and in vitro, of which PIAS3 downregulation is more reversely correlated with STAT3 activation. In resveratrol-suppressed medulloblastoma cells with STAT3 downregulation and decreased incidence of STAT3 nuclear translocation, PIAS3 is upregulated, the SHP2 level remains unchanged and SOCS3 is downregulated. SOCS3 proteins are accumulated in the distal ends of axon-like processes of resveratrol-differentiated medulloblastoma cells. Knockdown of SOCS3 expression by siRNA neither influences cell proliferation nor STAT3 activation or resveratrol sensitivity but inhibits resveratrol-induced axon-like process formation. CONCLUSION Our results suggest that (1) the overall reduction of SHP2, SOCS3 and PIAS3 in medulloblastoma tissues and cell lines; (2) the more inverse relevance of PIAS3 expression with STAT3 activation; (3) the favorable prognostic values of PIAS3 for medulloblastomas and (4) the involvement of SOCS3 in resveratrol-promoted axon regeneration of medulloblastoma cells.
Collapse
Affiliation(s)
- Cong Li
- Liaoning Laboratory of Cancer Genetics and Epigenetics and Department of Cell Biology, Dalian Medical University, Dalian 116044, China.
| | - Hong Li
- Liaoning Laboratory of Cancer Genetics and Epigenetics and Department of Cell Biology, Dalian Medical University, Dalian 116044, China.
| | - Peng Zhang
- Liaoning Laboratory of Cancer Genetics and Epigenetics and Department of Cell Biology, Dalian Medical University, Dalian 116044, China.
| | - Li-Jun Yu
- Liaoning Laboratory of Cancer Genetics and Epigenetics and Department of Cell Biology, Dalian Medical University, Dalian 116044, China.
| | - Tian-Miao Huang
- Liaoning Laboratory of Cancer Genetics and Epigenetics and Department of Cell Biology, Dalian Medical University, Dalian 116044, China.
| | - Xue Song
- Liaoning Laboratory of Cancer Genetics and Epigenetics and Department of Cell Biology, Dalian Medical University, Dalian 116044, China.
| | - Qing-You Kong
- Liaoning Laboratory of Cancer Genetics and Epigenetics and Department of Cell Biology, Dalian Medical University, Dalian 116044, China.
| | - Jian-Li Dong
- Department of Orthopedic Surgery, Second Hospital of Dalian Medical University, Dalian 116011, China.
| | - Pei-Nan Li
- Department of Orthopedic Surgery, Second Hospital of Dalian Medical University, Dalian 116011, China.
| | - Jia Liu
- Liaoning Laboratory of Cancer Genetics and Epigenetics and Department of Cell Biology, Dalian Medical University, Dalian 116044, China.
| |
Collapse
|
219
|
von Bueren AO, Kortmann RD, von Hoff K, Friedrich C, Mynarek M, Müller K, Goschzik T, Zur Mühlen A, Gerber N, Warmuth-Metz M, Soerensen N, Deinlein F, Benesch M, Zwiener I, Kwiecien R, Faldum A, Bode U, Fleischhack G, Hovestadt V, Kool M, Jones D, Northcott P, Kuehl J, Pfister S, Pietsch T, Rutkowski S. Treatment of Children and Adolescents With Metastatic Medulloblastoma and Prognostic Relevance of Clinical and Biologic Parameters. J Clin Oncol 2016; 34:4151-4160. [PMID: 27863192 DOI: 10.1200/jco.2016.67.2428] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess an intensified treatment in the context of clinical and biologic risk factors in metastatic medulloblastoma. Patients and Methods Patients (4 to 21 years old, diagnosed between 2001 and 2007) received induction chemotherapy, dose-escalated hyperfractionated craniospinal radiotherapy, and maintenance chemotherapy. Subgroup status and other biologic parameters were assessed. Results In 123 eligible patients (median age, 8.2 years old; median follow-up, 5.38 years), 5-year event-free survival (EFS) and overall survival (OS) were 62% (95% CI, 52 to 72) and 74% (95% CI, 66 to 82), respectively. OS was superior compared with the precedent HIT '91 trial. The 5-year EFS and OS were both 89% (95% CI, 67 to 100) for desmoplastic/nodular (n = 11), 61% (95% CI, 51 to 71) and 75% (95% CI, 65 to 85) for classic (n = 107), and 20% (95% CI, 0 to 55) and 40% (95% CI, 0 to 83) for large-cell/anaplastic (n = 5) medulloblastoma ( P < .001 for EFS; P = .001 for OS). Histology (hazard ratio, 0.19 for desmoplastic/nodular and 45.97 for large-cell/anaplastic medulloblastoma) and nonresponse to the first chemotherapy cycle (hazard ratio, 1.97) were independent risk factors (EFS). Among 81 (66%) patients with tumor material, 5-year EFS and OS differed between low-risk (wingless [WNT], n = 4; both 100%), high-risk ( MYCC/ MYCN amplification; n = 5, both 20%), and intermediate-risk patients (neither; n = 72, 63% and 73%, respectively). Survival rates were different between molecular subgroups (WNT, n = 4; sonic hedgehog [SHH; n = 4]; group 4 [n = 41]; group 3 with [n = 3] or without [n = 17] MYCC/MYCN amplification; P < .001). All cases showed p53 immuno-negativity. There was no association between patients with nonresponding tumors to induction chemotherapy and WNT ( P = .143) or MYCC/MYCN status ( P = .075), histologic subtype ( P = .814), or molecular subtype ( P = .383), as assessed by Fisher's exact test. Conclusion This regimen was feasible and conferred overall favorable survival. Our data confirm the relevance of subgroup status and biologic parameters (WNT/ MYCC/ MYCN status) in a homogeneous prospective trial population, and show that metastatic group 3 patients do not uniformly have poor outcomes. Biologic subgroup, MYCC/ MYCN status, response to induction chemotherapy, and histologic subtype may serve for improved treatment stratification.
Collapse
Affiliation(s)
- André O von Bueren
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Rolf-Dieter Kortmann
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Katja von Hoff
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Carsten Friedrich
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Martin Mynarek
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Klaus Müller
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Tobias Goschzik
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Anja Zur Mühlen
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Nicolas Gerber
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Monika Warmuth-Metz
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Niels Soerensen
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Frank Deinlein
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Martin Benesch
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Isabella Zwiener
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Robert Kwiecien
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Andreas Faldum
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Udo Bode
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Gudrun Fleischhack
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Volker Hovestadt
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Marcel Kool
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - David Jones
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Paul Northcott
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Joachim Kuehl
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Stefan Pfister
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Torsten Pietsch
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Stefan Rutkowski
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
220
|
Staal JA, Pei Y, Rood BR. A Proteogenomic Approach to Understanding MYC Function in Metastatic Medulloblastoma Tumors. Int J Mol Sci 2016; 17:ijms17101744. [PMID: 27775567 PMCID: PMC5085772 DOI: 10.3390/ijms17101744] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/23/2016] [Accepted: 10/10/2016] [Indexed: 12/31/2022] Open
Abstract
Brain tumors are the leading cause of cancer-related deaths in children, and medulloblastoma is the most prevalent malignant childhood/pediatric brain tumor. Providing effective treatment for these cancers, with minimal damage to the still-developing brain, remains one of the greatest challenges faced by clinicians. Understanding the diverse events driving tumor formation, maintenance, progression, and recurrence is necessary for identifying novel targeted therapeutics and improving survival of patients with this disease. Genomic copy number alteration data, together with clinical studies, identifies c-MYC amplification as an important risk factor associated with the most aggressive forms of medulloblastoma with marked metastatic potential. Yet despite this, very little is known regarding the impact of such genomic abnormalities upon the functional biology of the tumor cell. We discuss here how recent advances in quantitative proteomic techniques are now providing new insights into the functional biology of these aggressive tumors, as illustrated by the use of proteomics to bridge the gap between the genotype and phenotype in the case of c-MYC-amplified/associated medulloblastoma. These integrated proteogenomic approaches now provide a new platform for understanding cancer biology by providing a functional context to frame genomic abnormalities.
Collapse
Affiliation(s)
- Jerome A Staal
- Multiple Sclerosis Department, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3052, Australia.
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC 20010, USA.
| | - Yanxin Pei
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC 20010, USA.
| | - Brian R Rood
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC 20010, USA.
| |
Collapse
|
221
|
Abstract
Medulloblastoma accounts for nearly 10% of all childhood brain tumors. These tumors occur exclusively in the posterior fossa and have the potential for leptomeningeal spread. Treatment includes a combination of surgery, radiation therapy (in patients >3 years old). Patients >3 years old are stratified based on the volume of postoperative residual tumor and the presence or absence of metastases into "standard risk" and "high risk" categories with long-term survival rates of approximately 85% and 70%, respectively. Outcomes are inferior in infants and children younger than 3 years with exception of those patients with the medulloblastoma with extensive nodularity histologic subtype. Treatment for medulloblastoma is associated with significant morbidity, especially in the youngest patients. Recent molecular subclassification of medulloblastoma has potential prognostic and therapeutic implications. Future incorporation of molecular subgroups into treatment protocols will hopefully improve both survival outcomes and posttreatment quality of life.
Collapse
Affiliation(s)
- Nathan E Millard
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C De Braganca
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
222
|
Coluccia D, Figuereido C, Isik S, Smith C, Rutka JT. Medulloblastoma: Tumor Biology and Relevance to Treatment and Prognosis Paradigm. Curr Neurol Neurosci Rep 2016; 16:43. [PMID: 27021772 DOI: 10.1007/s11910-016-0644-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Medulloblastoma is a malignant embryonic brain tumor arising in the posterior fossa and typically occurring in pediatric patients. Current multimodal treatment regimes have significantly improved the survival rates; however, a marked heterogeneity in therapy response is observed, and one third of all patients die within 5 years after diagnosis. Large-scale genetic and transcriptome analysis revealed four medulloblastoma subgroups (WNT, SHH, Group 3, and Group 4) associated with different demographic parameters, tumor manifestation, and clinical behavior. Future treatment protocols will integrate molecular classification schemes to evaluate subgroup-specific intensification or de-escalation of adjuvant therapies aimed to increase tumor control and reduce iatrogenic induced morbidity. Furthermore, the identification of genetic drivers allows assessing target therapies in order to increase the chemotherapeutic armamentarium. This review highlights the biology behind the current classification system and elucidates relevant aspects of the disease influencing forthcoming clinical trials.
Collapse
Affiliation(s)
- Daniel Coluccia
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Carlyn Figuereido
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Semra Isik
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Christian Smith
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - James T Rutka
- The Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, The Hospital for Sick Children, the University of Toronto, Suite 1503, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| |
Collapse
|
223
|
Wang CY, Hsieh YT, Fang KM, Yang CS, Tzeng SF. Reduction of CD200 expression in glioma cells enhances microglia activation and tumor growth. J Neurosci Res 2016; 94:1460-1471. [PMID: 27629530 DOI: 10.1002/jnr.23922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 01/01/2023]
Abstract
CD200, a type I transmembrane glycoprotein, can interact with its receptor CD200R, which plays an inhibitory role in the activation of microglia-the resident macrophages of the central nervous system. In this study, the rat C6 glioma cell line (C6-1) that was previously characterized with high in vivo tumorigenicity was found to generate CD200 mRNA abundantly. However, CD200 expression was barely detected in another C6 glioma cell clone (C6-2) that was previously found to display low tumorigenic behavior. The results from CD200 immunohistochemistry on human glioma tissue array also showed that tumor cells in Grade I-II astrocytoma expressed a lower level of CD200 immunoreactivity than those detected in Grade III-IV glioblastoma multiforme. C6-1 transfectants with stable downregulation of CD200 gene expression using lentivirus knockdown approach were generated (C6-KD). Microglia and iNOS+ cells were increased when microglia were co-cultured with C6-KD cells. The colony formation of C6-KD was also augmented when those cells were co-cultured with microglia. Yet, increased colony formation of C6-KD transfectants in the co-culture with microglia was effectively suppressed by interleukin (IL)-4 and IL-10. The in vivo results indicated that the tumor formation of C6-1 cells in rat brain was promoted after CD200 gene knockdown. Moreover, CD11b+ activated microglia and iNOS+ microglia were highly accumulated in the tumor site formed by C6-KD. In conclusion, our findings demonstrate that the downregulation of CD200 expression in CD200-rich glioma cells could foster the formation of an activated microglia-associated tumor microenvironment, leading to glioma progression. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Chih-Yen Wang
- Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Yun-Ti Hsieh
- Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Kuan-Min Fang
- Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Shi Yang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Shun-Fen Tzeng
- Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
224
|
Lafay-Cousin L, Smith A, Chi SN, Wells E, Madden J, Margol A, Ramaswamy V, Finlay J, Taylor MD, Dhall G, Strother D, Kieran MW, Foreman NK, Packer RJ, Bouffet E. Clinical, Pathological, and Molecular Characterization of Infant Medulloblastomas Treated with Sequential High-Dose Chemotherapy. Pediatr Blood Cancer 2016; 63:1527-34. [PMID: 27145464 PMCID: PMC5031363 DOI: 10.1002/pbc.26042] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/04/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND High-dose chemotherapy (HDC) strategies were developed to avoid unacceptable neurotoxicity associated with craniospinal irradiation in infants with embryonal brain tumors. However, the impact of molecular and pathological characterizations in such approaches and long-term outcome have not been widely described in young children. METHODS We retrospectively collected information from seven North American institutions, on young children with medulloblastoma (MB) treated with sequential HDC, as per the CCG 99703 protocol. Data collection included clinical presentation, histology, molecular subgroup, irradiation, ototoxicity, and neurocognitive evaluations. RESULTS The cohort included 53 patients diagnosed at a median age of 24 months (2.9-63.2). Seventeen patients (32.1%) had nodular desmoplatic MB, all belonging to the sonic Hedgehog (SHH) subgroup, as did 30% of classic MB. The 5-year progression-free survival (PFS) and overall survival (OS) was 69.6% (±6·9%) and 76.1% (±6.5%), respectively. Seventeen (32.1%) patients received irradiation (nine adjuvant radiotherapy [RT]). Patients with SHH and group 3 MB had a 5-year PFS of 86·2% (±7.4%) and 49·1% (±14%), respectively (P = 0.03). The 5-year PFS radiation free for group 3 MB was 46.4%. Patients with macroscopic metastasis (M2 and M3) had a worst survival. Fifteen (45.5%) patients had significant ototoxicity. Mean Full Scale Intellectual Quotient (FSIQ) for 24 survivors was 91.6 (range 52-119). CONCLUSIONS This HDC strategy led to an encouraging OS while only 20% of the patients received adjuvant RT. SHH MB, irrespective of histological subgroup, had an excellent outcome. Such intensive therapy may not be needed for this subgroup. Patients with classic histology or group 3 had an encouraging PFS of 58% and 46.4%, respectively, in the absence of adjuvant RT. The neurocognitive profile of the survivors appears to be within the normal range.
Collapse
Affiliation(s)
- Lucie Lafay-Cousin
- Department of Pediatrics and Oncology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amy Smith
- Arnold Palmer Hospital, Orlando, Florida
| | - Susan N Chi
- Dana-Farber Cancer Institute, Pediatric Neuro-Oncology, Boston, Massachusetts
| | - Elizabeth Wells
- Department of Pediatrics, Neurology & Integrative Systems Biology Brain Tumor Institute, Children's National Health System, Washington, District of Colombia
| | - Jennifer Madden
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Ashley Margol
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Vijay Ramaswamy
- Division of Pediatric Hematology Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Finlay
- Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Girish Dhall
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Douglas Strother
- Department of Pediatrics and Oncology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Mark W Kieran
- Dana-Farber Cancer Institute, Pediatric Neuro-Oncology, Boston, Massachusetts
| | | | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute Children's National Health System, Washington, District of Colombia
| | - Eric Bouffet
- Division of Pediatric Hematology Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
225
|
Hanaford AR, Archer TC, Price A, Kahlert UD, Maciaczyk J, Nikkhah G, Kim JW, Ehrenberger T, Clemons PA, Dančík V, Seashore-Ludlow B, Viswanathan V, Stewart ML, Rees MG, Shamji A, Schreiber S, Fraenkel E, Pomeroy SL, Mesirov JP, Tamayo P, Eberhart CG, Raabe EH. DiSCoVERing Innovative Therapies for Rare Tumors: Combining Genetically Accurate Disease Models with In Silico Analysis to Identify Novel Therapeutic Targets. Clin Cancer Res 2016; 22:3903-14. [PMID: 27012813 PMCID: PMC5055054 DOI: 10.1158/1078-0432.ccr-15-3011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/10/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE We used human stem and progenitor cells to develop a genetically accurate novel model of MYC-driven Group 3 medulloblastoma. We also developed a new informatics method, Disease-model Signature versus Compound-Variety Enriched Response ("DiSCoVER"), to identify novel therapeutics that target this specific disease subtype. EXPERIMENTAL DESIGN Human neural stem and progenitor cells derived from the cerebellar anlage were transduced with oncogenic elements associated with aggressive medulloblastoma. An in silico analysis method for screening drug sensitivity databases (DiSCoVER) was used in multiple drug sensitivity datasets. We validated the top hits from this analysis in vitro and in vivo RESULTS Human neural stem and progenitor cells transformed with c-MYC, dominant-negative p53, constitutively active AKT and hTERT formed tumors in mice that recapitulated Group 3 medulloblastoma in terms of pathology and expression profile. DiSCoVER analysis predicted that aggressive MYC-driven Group 3 medulloblastoma would be sensitive to cyclin-dependent kinase (CDK) inhibitors. The CDK 4/6 inhibitor palbociclib decreased proliferation, increased apoptosis, and significantly extended the survival of mice with orthotopic medulloblastoma xenografts. CONCLUSIONS We present a new method to generate genetically accurate models of rare tumors, and a companion computational methodology to find therapeutic interventions that target them. We validated our human neural stem cell model of MYC-driven Group 3 medulloblastoma and showed that CDK 4/6 inhibitors are active against this subgroup. Our results suggest that palbociclib is a potential effective treatment for poor prognosis MYC-driven Group 3 medulloblastoma tumors in carefully selected patients. Clin Cancer Res; 22(15); 3903-14. ©2016 AACR.
Collapse
Affiliation(s)
- Allison R Hanaford
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tenley C Archer
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Department of Neurology, Boston Children's Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Antoinette Price
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ulf D Kahlert
- Department of Neurosurgery, Heinrich-Heine University Hospital, Duesseldorf, Germany
| | - Jarek Maciaczyk
- Department of Neurosurgery, Heinrich-Heine University Hospital, Duesseldorf, Germany
| | - Guido Nikkhah
- Department of Neurosurgery, University Hospital, Stuttgart, Germany
| | - Jong Wook Kim
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tobias Ehrenberger
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Paul A Clemons
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Center for the Science of Therapeutics, Broad Institute, Cambridge, Massachusetts
| | - Vlado Dančík
- Center for the Science of Therapeutics, Broad Institute, Cambridge, Massachusetts
| | | | - Vasanthi Viswanathan
- Center for the Science of Therapeutics, Broad Institute, Cambridge, Massachusetts
| | - Michelle L Stewart
- Center for the Science of Therapeutics, Broad Institute, Cambridge, Massachusetts
| | - Matthew G Rees
- Center for the Science of Therapeutics, Broad Institute, Cambridge, Massachusetts
| | - Alykhan Shamji
- Center for the Science of Therapeutics, Broad Institute, Cambridge, Massachusetts
| | - Stuart Schreiber
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Center for the Science of Therapeutics, Broad Institute, Cambridge, Massachusetts. Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts. Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Ernest Fraenkel
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Scott L Pomeroy
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Department of Neurology, Boston Children's Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Jill P Mesirov
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Department of Medicine, University of California San Diego, La Jolla, California. Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Pablo Tamayo
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts. Department of Medicine, University of California San Diego, La Jolla, California. Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Charles G Eberhart
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Eric H Raabe
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland. Division of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland.
| |
Collapse
|
226
|
Worst BC, van Tilburg CM, Balasubramanian GP, Fiesel P, Witt R, Freitag A, Boudalil M, Previti C, Wolf S, Schmidt S, Chotewutmontri S, Bewerunge-Hudler M, Schick M, Schlesner M, Hutter B, Taylor L, Borst T, Sutter C, Bartram CR, Milde T, Pfaff E, Kulozik AE, von Stackelberg A, Meisel R, Borkhardt A, Reinhardt D, Klusmann JH, Fleischhack G, Tippelt S, Dirksen U, Jürgens H, Kramm CM, von Bueren AO, Westermann F, Fischer M, Burkhardt B, Wößmann W, Nathrath M, Bielack SS, Frühwald MC, Fulda S, Klingebiel T, Koscielniak E, Schwab M, Tremmel R, Driever PH, Schulte JH, Brors B, von Deimling A, Lichter P, Eggert A, Capper D, Pfister SM, Jones DTW, Witt O. Next-generation personalised medicine for high-risk paediatric cancer patients - The INFORM pilot study. Eur J Cancer 2016; 65:91-101. [PMID: 27479119 DOI: 10.1016/j.ejca.2016.06.009] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023]
Abstract
The 'Individualized Therapy for Relapsed Malignancies in Childhood' (INFORM) precision medicine study is a nationwide German program for children with high-risk relapsed/refractory malignancies, which aims to identify therapeutic targets on an individualised basis. In a pilot phase, reported here, we developed the logistical and analytical pipelines necessary for rapid and comprehensive molecular profiling in a clinical setting. Fifty-seven patients from 20 centers were prospectively recruited. Malignancies investigated included sarcomas (n = 25), brain tumours (n = 23), and others (n = 9). Whole-exome, low-coverage whole-genome, and RNA sequencing were complemented with methylation and expression microarray analyses. Alterations were assessed for potential targetability according to a customised prioritisation algorithm and subsequently discussed in an interdisciplinary molecular tumour board. Next-generation sequencing data were generated for 52 patients, with the full analysis possible in 46 of 52. Turnaround time from sample receipt until first report averaged 28 d. Twenty-six patients (50%) harbored a potentially druggable alteration with a prioritisation score of 'intermediate' or higher (level 4 of 7). Common targets included receptor tyrosine kinases, phosphoinositide 3-kinase-mammalian target of rapamycin pathway, mitogen-activated protein kinase pathway, and cell cycle control. Ten patients received a targeted therapy based on these findings, with responses observed in some previously treatment-refractory tumours. Comparative primary relapse analysis revealed substantial tumour evolution as well as one case of unsuspected secondary malignancy, highlighting the importance of re-biopsy at relapse. This study demonstrates the feasibility of comprehensive, real-time molecular profiling for high-risk paediatric cancer patients. This extended proof-of-concept, with examples of treatment consequences, expands upon previous personalised oncology endeavors, and presents a model with considerable interest and practical relevance in the burgeoning era of personalised medicine.
Collapse
Affiliation(s)
- Barbara C Worst
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Cornelis M van Tilburg
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; NCT Trial Center, National Center for Tumor Diseases, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Gnana Prakash Balasubramanian
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Petra Fiesel
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, 69120, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, Heidelberg, 69120, Germany.
| | - Ruth Witt
- NCT Trial Center, National Center for Tumor Diseases, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany.
| | - Angelika Freitag
- NCT Trial Center, National Center for Tumor Diseases, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany.
| | - Miream Boudalil
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, 69120, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, Heidelberg, 69120, Germany.
| | - Christopher Previti
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Stephan Wolf
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Sabine Schmidt
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Sasithorn Chotewutmontri
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Matthias Schick
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Matthias Schlesner
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Barbara Hutter
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Lenka Taylor
- Pharmacy Department, Heidelberg University Hospital, Im Neuenheimer Feld 670, Heidelberg, 69120, Germany.
| | - Tobias Borst
- Pharmacy Department, Erlangen University Hospital, Palmsanlage 3, Erlangen, 91054, Germany.
| | - Christian Sutter
- Institute of Human Genetics, Heidelberg University Hospital, Im Neuenheimer Feld 366, Heidelberg, 69120, Germany.
| | - Claus R Bartram
- Institute of Human Genetics, Heidelberg University Hospital, Im Neuenheimer Feld 366, Heidelberg, 69120, Germany.
| | - Till Milde
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Elke Pfaff
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Andreas E Kulozik
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany.
| | - Arend von Stackelberg
- Department of Pediatric Oncology & Hematology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - Roland Meisel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Düsseldorf University Hospital, Medical Faculty, Moorenstr. 5, Düsseldorf, 40225, Germany.
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Düsseldorf University Hospital, Medical Faculty, Moorenstr. 5, Düsseldorf, 40225, Germany.
| | - Dirk Reinhardt
- Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Jan-Henning Klusmann
- Department of Pediatric Hematology & Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
| | - Gudrun Fleischhack
- Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Stephan Tippelt
- Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Uta Dirksen
- Department of Pediatric Hematology & Oncology, University Hospital of Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany.
| | - Heribert Jürgens
- Department of Pediatric Hematology & Oncology, University Hospital of Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany.
| | - Christof M Kramm
- Division of Pediatric Hematology & Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, 37075, Germany.
| | - Andre O von Bueren
- Division of Pediatric Hematology & Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, 37075, Germany; Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland.
| | - Frank Westermann
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Matthias Fischer
- Department of Pediatric Hematology & Oncology, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50937, Germany; Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Robert-Koch-Str. 21, Cologne, 50931, Germany; Max Planck Institute for Metabolism Research, Gleueler Str. 50, Cologne, 50931, Germany.
| | - Birgit Burkhardt
- Department of Pediatric Hematology & Oncology, University Hospital of Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany.
| | - Wilhelm Wößmann
- Department of Pediatric Hematology and Oncology, University Hospital of Gießen, Feulgenstr. 12, Gießen, 35392, Germany.
| | - Michaela Nathrath
- Department of Pediatric Oncology, Klinikum Kassel, Mönchebergstr. 41-43, Kassel, 34125, Germany; Pediatric Oncology Center, Technische Universität München, Kölner Platz 1, Munich, 80804, Germany.
| | - Stefan S Bielack
- Department of Pediatric Oncology, Hematology and Immunology, Klinikum Stuttgart Olgahospital, Kriegsbergstr. 62, Stuttgart, 70174, Germany.
| | - Michael C Frühwald
- Swabian Children's Cancer Center, Children's Hospital, Klinikum Augsburg, Stenglinstr. 2, Augsburg, 86156, Germany.
| | - Simone Fulda
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Institute for Experimental Cancer Research in Pediatrics, University Hospital Frankfurt, Komturstr. 3a, Frankfurt am Main, 60528, Germany.
| | - Thomas Klingebiel
- Department of Pediatric Oncology & Hematology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany.
| | - Ewa Koscielniak
- Department of Pediatric Oncology, Hematology and Immunology, Klinikum Stuttgart Olgahospital, Kriegsbergstr. 62, Stuttgart, 70174, Germany.
| | - Matthias Schwab
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstr. 112, Stuttgart, 70376, Germany; Departments of Clinical Pharmacology and Pharmacy and Biochemistry, University of Tübingen, Auf der Morgenstelle 8, Tübingen, 72076, Germany.
| | - Roman Tremmel
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstr. 112, Stuttgart, 70376, Germany; Departments of Clinical Pharmacology and Pharmacy and Biochemistry, University of Tübingen, Auf der Morgenstelle 8, Tübingen, 72076, Germany.
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology & Hematology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - Johannes H Schulte
- Department of Pediatric Oncology & Hematology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany; Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Benedikt Brors
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Andreas von Deimling
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, 69120, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, Heidelberg, 69120, Germany.
| | - Peter Lichter
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Angelika Eggert
- Department of Pediatric Oncology & Hematology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - David Capper
- German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, 69120, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, Heidelberg, 69120, Germany.
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Olaf Witt
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany; German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany; Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| |
Collapse
|
227
|
Relapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study. J Neurooncol 2016; 129:515-524. [PMID: 27423645 PMCID: PMC5020107 DOI: 10.1007/s11060-016-2202-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Abstract
The HIT-SIOP-PNET4 randomised trial for standard risk medulloblastoma (MB) (2001–2006) included 338 patients and compared hyperfractionated and conventional radiotherapy. We here report the long-term outcome after a median follow up of 7.8 years, including detailed information on relapse and the treatment of relapse. Data were extracted from the HIT Group Relapsed MB database and by way of a specific case report form. The event-free and overall (OS) survival at 10 years were 76 ± 2 % and 78 ± 2 % respectively with no significant difference between the treatment arms. Seventy-two relapses and three second malignant neoplasms were reported. Thirteen relapses (18 %) were isolated local relapses in the posterior fossa (PF) and 59 (82 %) were craniospinal, metastatic relapses (isolated or multiple) with or without concurrent PF disease. Isolated PF relapse vs all other relapses occurred at mean/median of 38/35 and 28/26 months respectively (p = 0.24). Late relapse, i.e. >5 years from diagnosis, occurred in six patients (8 %). Relapse treatment consisted of combinations of surgery (25 %), focal radiotherapy (RT 22 %), high dose chemotherapy with stem cell rescue (HDSCR 21 %) and conventional chemotherapy (90 %). OS at 5 years after relapse was 6.0 ± 4 %. In multivariate analysis; isolated relapse in PF, and surgery were significantly associated with prolonged survival whereas RT and HDSCR were not. Survival after relapse was not related to biological factors and was very poor despite several patients receiving intensive treatments. Exploration of new drugs is warranted, preferably based on tumour biology from biopsy of the relapsed tumour.
Collapse
|
228
|
IGF1R as a Key Target in High Risk, Metastatic Medulloblastoma. Sci Rep 2016; 6:27012. [PMID: 27255663 PMCID: PMC4891740 DOI: 10.1038/srep27012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/12/2016] [Indexed: 12/21/2022] Open
Abstract
Risk or presence of metastasis in medulloblastoma causes substantial treatment-related morbidity and overall mortality. Through the comparison of cytokines and growth factors in the cerebrospinal fluid (CSF) of metastatic medulloblastoma patients with factors also in conditioned media of metastatic MYC amplified medulloblastoma or leptomeningeal cells, we were led to explore the bioactivity of IGF1 in medulloblastoma by elevated CSF levels of IGF1, IGF-sequestering IGFBP3, IGFBP3-cleaving proteases (MMP and tPA), and protease modulators (TIMP1 and PAI-1). IGF1 led not only to receptor phosphorylation but also accelerated migration/adhesion in MYC amplified medulloblastoma cells in the context of appropriate matrix or meningothelial cells. Clinical correlation suggests a peri-/sub-meningothelial source of IGF-liberating proteases that could facilitate leptomeningeal metastasis. In parallel, studies of key factors responsible for cell autonomous growth in MYC amplified medulloblastoma prioritized IGF1R inhibitors. Together, our studies identify IGF1R as a high value target for clinical trials in high risk medulloblastoma.
Collapse
|
229
|
Ramaswamy V, Remke M, Bouffet E, Bailey S, Clifford SC, Doz F, Kool M, Dufour C, Vassal G, Milde T, Witt O, von Hoff K, Pietsch T, Northcott PA, Gajjar A, Robinson GW, Padovani L, André N, Massimino M, Pizer B, Packer R, Rutkowski S, Pfister SM, Taylor MD, Pomeroy SL. Risk stratification of childhood medulloblastoma in the molecular era: the current consensus. Acta Neuropathol 2016; 131:821-31. [PMID: 27040285 DOI: 10.1007/s00401-016-1569-6] [Citation(s) in RCA: 422] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
Historical risk stratification criteria for medulloblastoma rely primarily on clinicopathological variables pertaining to age, presence of metastases, extent of resection, histological subtypes and in some instances individual genetic aberrations such as MYC and MYCN amplification. In 2010, an international panel of experts established consensus defining four main subgroups of medulloblastoma (WNT, SHH, Group 3 and Group 4) delineated by transcriptional profiling. This has led to the current generation of biomarker-driven clinical trials assigning WNT tumors to a favorable prognosis group in addition to clinicopathological criteria including MYC and MYCN gene amplifications. However, outcome prediction of non-WNT subgroups is a challenge due to inconsistent survival reports. In 2015, a consensus conference was convened in Heidelberg with the objective to further refine the risk stratification in the context of subgroups and agree on a definition of risk groups of non-infant, childhood medulloblastoma (ages 3-17). Published and unpublished data over the past 5 years were reviewed, and a consensus was reached regarding the level of evidence for currently available biomarkers. The following risk groups were defined based on current survival rates: low risk (>90 % survival), average (standard) risk (75-90 % survival), high risk (50-75 % survival) and very high risk (<50 % survival) disease. The WNT subgroup and non-metastatic Group 4 tumors with whole chromosome 11 loss or whole chromosome 17 gain were recognized as low-risk tumors that may qualify for reduced therapy. High-risk strata were defined as patients with metastatic SHH or Group 4 tumors, or MYCN-amplified SHH medulloblastomas. Very high-risk patients are Group 3 with metastases or SHH with TP53 mutation. In addition, a number of consensus points were reached that should be standardized across future clinical trials. Although we anticipate new data will emerge from currently ongoing and recently completed clinical trials, this consensus can serve as an outline for prioritization of certain molecular subsets of tumors to define and validate risk groups as a basis for future clinical trials.
Collapse
Affiliation(s)
- Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Marc Remke
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
- Department of Pediatric Neuro-Oncogenomics, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Düsseldorf, Germany.
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Simon Bailey
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Steven C Clifford
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Francois Doz
- Department of Paediatric, Adolescents and Young Adults Oncology, Curie Institute, and University Paris Descartes, Paris, France
| | - Marcel Kool
- Division of Pediatric Neurooncology (B062), DKFZ, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Institut Gustave-Roussy, Villejuif, France
| | - Gilles Vassal
- Department of Pediatric and Adolescent Oncology, Institut Gustave-Roussy, Villejuif, France
| | - Till Milde
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology (G340), DKFZ, Heidelberg, Germany
| | - Olaf Witt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology (G340), DKFZ, Heidelberg, Germany
| | - Katja von Hoff
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Amar Gajjar
- St. Jude's Research Hospital, Memphis, TN, USA
| | | | - Laetitia Padovani
- Aix-Marseille Université, Inserm, CRO2 UMR_S 911, 27 bd Jean Moulin, 13385, Marseille Cedex 05, France
| | - Nicolas André
- Department of Pediatric Hematology and Oncology, AP-HM, Marseille, France
| | - Maura Massimino
- Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
| | - Barry Pizer
- Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Roger Packer
- Department of Neurology, Children's National Medical Center, Washington, DC, USA
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology (B062), DKFZ, and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Scott L Pomeroy
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
230
|
Eskilsson E, Verhaak RGW. Longitudinal genomic characterization of brain tumors for identification of therapeutic vulnerabilities. Neuro Oncol 2016; 18:1037-9. [PMID: 27236194 DOI: 10.1093/neuonc/now064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
- Eskil Eskilsson
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.E., R.G.W.V.); Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (R.G.W.V.)
| | - Roel G W Verhaak
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.E., R.G.W.V.); Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (R.G.W.V.)
| |
Collapse
|
231
|
Abstract
Medulloblastoma (MB) is one of the most frequent malignant brain tumors in children. The current standard treatment regimen consists of surgical resection, craniospinal irradiation, and adjuvant chemotherapy. Although these treatments have the potential to increase the survival of 70–80% of patients with MB, they are also associated with serious treatment-induced morbidity. The current risk stratification of MB is based on clinical factors, including age at presentation, metastatic status, and the presence of residual tumor following resection. In addition, recent genomic studies indicate that MB consists of at least four distinct molecular subgroups: WNT, sonic hedgehog (SHH), Group 3, and Group 4. WNT and SHH MBs are characterized by aberrations in the WNT and SHH signaling pathways, respectively. WNT MB has the best prognosis compared to the other MBs, while SHH MB has an intermediate prognosis. The underlying signaling pathways associated with Group 3 and 4 MBs have not been identified. Group 3 MB is frequently associated with metastasis, resulting in a poor prognosis, while Group 4 is sometimes associated with metastasis and has an intermediate prognosis. Group 4 is the most frequent MB and represents 35% of all MBs. These findings suggest that MB is a heterogeneous disease, and that MB subgroups have distinct molecular, demographic, and clinical characteristics. The molecular classification of MBs is redefining the risk stratification of patients with MB, and has the potential to identify new therapeutic strategies for the treatment of MB.
Collapse
Affiliation(s)
- Noriyuki Kijima
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization
| | | |
Collapse
|
232
|
Staal JA, Lau LS, Zhang H, Ingram WJ, Hallahan AR, Northcott PA, Pfister SM, Wechsler-Reya RJ, Rusert JM, Taylor MD, Cho YJ, Packer RJ, Brown KJ, Rood BR. Proteomic profiling of high risk medulloblastoma reveals functional biology. Oncotarget 2016; 6:14584-95. [PMID: 25970789 PMCID: PMC4546489 DOI: 10.18632/oncotarget.3927] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 12/11/2022] Open
Abstract
Genomic characterization of medulloblastoma has improved molecular risk classification but struggles to define functional biological processes, particularly for the most aggressive subgroups. We present here a novel proteomic approach to this problem using a reference library of stable isotope labeled medulloblastoma-specific proteins as a spike-in standard for accurate quantification of the tumor proteome. Utilizing high-resolution mass spectrometry, we quantified the tumor proteome of group 3 medulloblastoma cells and demonstrate that high-risk MYC amplified tumors can be segregated based on protein expression patterns. We cross-validated the differentially expressed protein candidates using an independent transcriptomic data set and further confirmed them in a separate cohort of medulloblastoma tissue samples to identify the most robust proteogenomic differences. Interestingly, highly expressed proteins associated with MYC-amplified tumors were significantly related to glycolytic metabolic pathways via alternative splicing of pyruvate kinase (PKM) by heterogeneous ribonucleoproteins (HNRNPs). Furthermore, when maintained under hypoxic conditions, these MYC-amplified tumors demonstrated increased viability compared to non-amplified tumors within the same subgroup. Taken together, these findings highlight the power of proteomics as an integrative platform to help prioritize genetic and molecular drivers of cancer biology and behavior.
Collapse
Affiliation(s)
- Jerome A Staal
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington DC, USA
| | - Ling San Lau
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington DC, USA
| | - Huizhen Zhang
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington DC, USA
| | - Wendy J Ingram
- UQ Child Health Research Centre, The University of Queensland and Queensland Children's Medical Research Institute, Children's Health, Queensland, Australia
| | - Andrew R Hallahan
- UQ Child Health Research Centre, The University of Queensland and Queensland Children's Medical Research Institute, Children's Health, Queensland, Australia
| | - Paul A Northcott
- Division of Pediatric Neurooncology, German Cancer Research Center, Heidleberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center, Heidleberg, Germany
| | | | - Jessica M Rusert
- Sanford-Burnham Medical Research Institute, La Jolla, California, USA
| | - Michael D Taylor
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Canada
| | - Yoon-Jae Cho
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington DC, USA
| | - Kristy J Brown
- Center for Genetic Medicine, Children's National Medical Center, Washington DC, USA
| | - Brian R Rood
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington DC, USA
| |
Collapse
|
233
|
Abstract
Survival after recurrence of medulloblastoma has not been reported in an unselected cohort of patients in the contemporary era. We reviewed 55 patients diagnosed with medulloblastoma between 2000 and 2010, and treated at Seattle Children's Hospital to evaluate patterns of relapse treatment and survival. Fourteen of 47 patients (30%) over the age of 3 experienced recurrent or progressive medulloblastoma after standard therapy. The median time from diagnosis to recurrence was 18.0 months (range, 3.6 to 62.6 mo), and site of recurrence was metastatic in 86%. The median survival after relapse was 10.3 months (range, 1.3 to 80.5 mo); 3-year survival after relapse was 18%. There were trend associations between longer survival and having received additional chemotherapy (median survival 12.8 vs. 1.3 mo, P=0.16) and radiation therapy (15.4 vs. 5.9 mo, P=0.20). Isolated local relapse was significantly associated with shorter survival (1.3 vs. 12.8 mo, P=0.009). Recurrence of medulloblastoma is more likely to be metastatic than reported in previous eras. Within the limits of our small sample, our data suggest a potential survival benefit from retreatment with cytotoxic chemotherapy and radiation even in heavily pretreated patients. This report serves as a baseline against which to evaluate novel therapy combinations.
Collapse
|
234
|
Hemmesi K, Squadrito ML, Mestdagh P, Conti V, Cominelli M, Piras IS, Sergi LS, Piccinin S, Maestro R, Poliani PL, Speleman F, De Palma M, Galli R. miR-135a Inhibits Cancer Stem Cell-Driven Medulloblastoma Development by Directly Repressing Arhgef6 Expression. Stem Cells 2016; 33:1377-89. [PMID: 25639612 DOI: 10.1002/stem.1958] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/26/2014] [Indexed: 01/01/2023]
Abstract
microRNAs (miRNAs) are short noncoding RNAs, which regulate gene expression post-transcriptionally and play crucial roles in relevant biological and pathological processes. Here, we investigated the putative role of miRNAs in modulating the tumor-initiating potential of mouse medulloblastoma (MB)-derived cancer stem cells (CSCs). We first subjected bona fide highly tumorigenic (HT) CSCs as well as lowly tumorigenic MB CSCs and normal neural stem cells to miRNA profiling, which identified a HT CSC-specific miRNA signature. Next, by cross-checking CSC mRNA/miRNA profiles, we pinpointed miR-135a as a potential tumor suppressor gene, which was strongly downregulated in HT CSCs as well as in the highly malignant experimental tumors derived from them. Remarkably, enforced expression of miR-135a in HT CSCs strongly inhibited tumorigenesis by repressing the miR-135a direct target gene Arhgef6. Considering the upregulation of Arhgef6 in human MBs and its involvement in mediating experimental medulloblastomagenesis, its efficient suppression by miR-135a might make available an effective therapeutic strategy to selectively impair the tumorigenic potential of MB CSCs. Stem Cells 2015;33:1377-1389.
Collapse
Affiliation(s)
- Katayoun Hemmesi
- Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells and Gene Therapy, Telethon Institute for Gene Therapy, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
235
|
Thompson EM, Hielscher T, Bouffet E, Remke M, Luu B, Gururangan S, McLendon RE, Bigner DD, Lipp ES, Perreault S, Cho YJ, Grant G, Kim SK, Lee JY, Rao AAN, Giannini C, Li KKW, Ng HK, Yao Y, Kumabe T, Tominaga T, Grajkowska WA, Perek-Polnik M, Low DCY, Seow WT, Chang KTE, Mora J, Pollack IF, Hamilton RL, Leary S, Moore AS, Ingram WJ, Hallahan AR, Jouvet A, Fèvre-Montange M, Vasiljevic A, Faure-Conter C, Shofuda T, Kagawa N, Hashimoto N, Jabado N, Weil AG, Gayden T, Wataya T, Shalaby T, Grotzer M, Zitterbart K, Sterba J, Kren L, Hortobágyi T, Klekner A, László B, Pócza T, Hauser P, Schüller U, Jung S, Jang WY, French PJ, Kros JM, van Veelen MLC, Massimi L, Leonard JR, Rubin JB, Vibhakar R, Chambless LB, Cooper MK, Thompson RC, Faria CC, Carvalho A, Nunes S, Pimentel J, Fan X, Muraszko KM, López-Aguilar E, Lyden D, Garzia L, Shih DJH, Kijima N, Schneider C, Adamski J, Northcott PA, Kool M, Jones DTW, Chan JA, Nikolic A, Garre ML, Van Meir EG, Osuka S, Olson JJ, Jahangiri A, Castro BA, Gupta N, Weiss WA, Moxon-Emre I, Mabbott DJ, Lassaletta A, Hawkins CE, Tabori U, Drake J, Kulkarni A, Dirks P, Rutka JT, Korshunov A, Pfister SM, Packer RJ, Ramaswamy V, Taylor MD. Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis. Lancet Oncol 2016; 17:484-495. [PMID: 26976201 PMCID: PMC4907853 DOI: 10.1016/s1470-2045(15)00581-1] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 12/12/2022]
Abstract
Background Incomplete surgical resection of medulloblastoma is controversially considered a marker of high-risk disease; driving aggressive surgical resections, “second-look” surgeries, and/or intensified chemoradiotherapy. All prior publications evaluating the clinical importance of extent of resection (EOR) failed to account for molecular subgroup. We analysed the prognostic value of EOR across 787 medulloblastoma samples in a subgroup-specific manner. Methods We retrospectively identified patients from Medulloblastoma Advanced Genomics International Consortium (MAGIC) centres with a histological diagnosis of medulloblastoma and complete extent of resection and survival data. Specimens were collected from 35 international institutions. Medulloblastoma subgroup affiliation was determined using nanoString gene expression profiling on frozen or formalin-fixed paraffin-embedded tissues. Extent of resection (EOR) based on post-operative imaging was classified as gross total (GTR), near total (NTR, <1·5cm2), or subtotal (STR, ≥ 1·5cm2). Overall survival (OS) and progression-free survival (PFS) multivariable analyses including subgroup, age, metastatic status, geographical location of therapy (North America/Australia vs world), and adjuvant therapy regimen were performed. The primary endpoint was the impact of surgical EOR by molecular subgroup and other clinical variables on OS and PFS. Findings 787 medulloblastoma patients (86 WNT, 242 SHH, 163 Group 3, and 296 Group 4) were included in a multivariable Cox model of PFS and OS. The marked benefit of EOR in the overall cohort was greatly attenuated after including molecular subgroup in the multivariable analysis. There was an observed PFS benefit of GTR over STR (hazard ration [HR] 1·45, 95% CI; 1·07–1·96, p=0·02) but there was no observed PFS or OS benefit of GTR over NTR (HR 1·05, 0·71–1·53, p=0·82 and HR 1·14, 0·75–1·72, p=0.55). There was no statistically significant survival benefit to greater EOR for patients with WNT, SHH, or Group 3 patients (HR 1·03, 0·67–1·58, p=0·9 for STR vs. GTR). There was a PFS benefit for GTR over STR in patients with Group 4 medulloblastoma (HR1·97, 1·22–3·17, p=0·01), particularly those with metastatic disease (HR 2·22, 1–4·93, p=0·05). A nomogram based on this multivariable cox proportional hazards model shows the comparably smaller impact of EOR on relative risk for PFS and OS than subgroup affiliation, metastatic status, radiation dose, and adjuvant chemotherapy. Interpretation The prognostic benefit of EOR for patients with medulloblastoma is attenuated after accounting for molecular subgroup affiliation. Although maximal safe surgical resection should remain the standard of care, surgical removal of small residual portions of medulloblastoma is not recommended when the likelihood of neurological morbidity is high as there is no definitive benefit to GTR over NTR. Our results suggest a re-evaluation of the long-term implications of intensified craniospinal irradiation (36 Gy) in children with small residual portions of medulloblastoma. Funding Funding Canadian Cancer Society Research Institute, Terry Fox Research Institute, Canadian Institutes of Health Research, National Institutes of Health, Pediatric Brain Tumor Foundation, Garron Family Chair in Childhood Cancer Research.
Collapse
Affiliation(s)
- Eric M Thompson
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marc Remke
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Betty Luu
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Darell D Bigner
- Department of Pathology, Duke University, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, USA
| | - Eric S Lipp
- Department of Pathology, Duke University, Durham, NC, USA
| | | | - Yoon-Jae Cho
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford, CA, USA
| | - Seung-Ki Kim
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | | | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kay Ka Wai Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Yu Yao
- Department of Neurosurgery, Hua Shan Hospital, Fudan University, Shanghai, China
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, Warsaw, Poland
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kenneth T E Chang
- Department of Pathology & Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jaume Mora
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ronald L Hamilton
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Andrew S Moore
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia; Oncology Service, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Wendy J Ingram
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Andrew R Hallahan
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia; Oncology Service, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Anne Jouvet
- Centre de Pathologie EST, Groupement Hospitalier EST, Université de Lyon, Lyon, France
| | - Michelle Fèvre-Montange
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences, Université de Lyon, Lyon, France
| | - Alexandre Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; ONCOFLAM, Neuro-Oncologie et Neuro-Inflammation Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | | | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, Osaka, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nada Jabado
- Division of Hematology/Oncology, McGill University, Montreal, QC, Canada
| | - Alexander G Weil
- Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Tenzin Gayden
- Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Takafumi Wataya
- Department of Pediatric Neurosurgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Tarek Shalaby
- Departments of Oncology and Neuro-Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Michael Grotzer
- Departments of Oncology and Neuro-Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Karel Zitterbart
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Sterba
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno, Czech Republic
| | - Leos Kren
- Department of Pathology, University Hospital Brno, Brno, Czech Republic
| | - Tibor Hortobágyi
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Almos Klekner
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Bognár László
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Tímea Pócza
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Ulrich Schüller
- Center for Neuropathology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Chonnam South Korea
| | - Woo-Youl Jang
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Chonnam South Korea
| | - Pim J French
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johan M Kros
- Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Luca Massimi
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Jeffrey R Leonard
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO, USA
| | - Joshua B Rubin
- Departments of Pediatrics, Anatomy and Neurobiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO, USA
| | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN, USA
| | - Michael K Cooper
- Department of Neurology, Vanderbilt Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN, USA
| | - Claudia C Faria
- Division of Neurosurgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Alice Carvalho
- Departamento de Oncologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar de Coimbra, Coimbra, Portugal
| | - Sofia Nunes
- Unidade de Neuro-Oncologia Pediátrica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - José Pimentel
- Divison of Pathology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Xing Fan
- Department of Neurosurgery and Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Enrique López-Aguilar
- Division of Pediatric Hematology/Oncology, Hospital Pediatría Centro Médico Nacional Century XXI, Mexico City, Mexico
| | - David Lyden
- Department of Pediatrics and Cell and Developmental Biology, Weill Cornell Medical College, New York, NY, USA
| | - Livia Garzia
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - David J H Shih
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Noriyuki Kijima
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christian Schneider
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Adamski
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul A Northcott
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Ana Nikolic
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Erwin G Van Meir
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Satoru Osuka
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Arman Jahangiri
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brandyn A Castro
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - William A Weiss
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Iska Moxon-Emre
- Program in Neuroscience and Mental Health and Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donald J Mabbott
- Program in Neuroscience and Mental Health and Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alvaro Lassaletta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia E Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - James Drake
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Abhaya Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Roger J Packer
- Department of Neurology, Children's National Medical Center, Washington, DC, USA
| | - Vijay Ramaswamy
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Michael D Taylor
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
236
|
Nikiforova MN, Wald AI, Melan MA, Roy S, Zhong S, Hamilton RL, Lieberman FS, Drappatz J, Amankulor NM, Pollack IF, Nikiforov YE, Horbinski C. Targeted next-generation sequencing panel (GlioSeq) provides comprehensive genetic profiling of central nervous system tumors. Neuro Oncol 2016; 18:379-87. [PMID: 26681766 PMCID: PMC4767245 DOI: 10.1093/neuonc/nov289] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/25/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Identification of genetic changes in CNS tumors is important for the appropriate clinical management of patients. Our objective was to develop a next-generation sequencing (NGS) assay for simultaneously detecting the various types of genetic alterations characteristic for adult and pediatric CNS tumors that can be applied to small brain biopsies. METHODS We report an amplification-based targeted NGS assay (GlioSeq) that analyzes 30 genes for single nucleotide variants (SNVs) and indels, 24 genes for copy number variations (CNVs), and 14 types of structural alterations in BRAF, EGFR, and FGFR3 genes in a single workflow. GlioSeq performance was evaluated in 54 adult and pediatric CNS tumors, and the results were compared with fluorescence in-situ hybridization, Sanger sequencing, and reverse transcription PCR. RESULTS GlioSeq correctly identified 71/71 (100%) genetic alterations known to be present by conventional techniques, including 56 SNVs/indels, 9 CNVs, 3 EGFRvIII, and 3 KIAA1549-BRAF fusions. Only 20 ng of DNA and 10 ng of RNA were required for successful sequencing of 100% frozen and 96% formalin-fixed, paraffin-embedded tissue specimens. The assay sensitivity was 3%-5% of mutant alleles for SNVs and 1%-5% for gene fusions. The most commonly detected alterations were IDH1, TP53, TERT, ATRX. CDKN2A, and PTEN in high-grade gliomas, followed by BRAF fusions in low-grade gliomas and H3F3A mutations in pediatric gliomas. CONCLUSIONS GlioSeq NGS assay offers accurate and sensitive detection of a wide range of genetic alterations in a single workflow. It allows rapid and cost-effective profiling of brain tumor specimens and thus provides valuable information for patient management.
Collapse
Affiliation(s)
- Marina N Nikiforova
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Abigail I Wald
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Melissa A Melan
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Somak Roy
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Shan Zhong
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Ronald L Hamilton
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Frank S Lieberman
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Jan Drappatz
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Nduka M Amankulor
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Ian F Pollack
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Yuri E Nikiforov
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Craig Horbinski
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| |
Collapse
|
237
|
Abstract
PURPOSE OF REVIEW Central nervous system tumors represent the most common solid tumors in children and are a leading cause of cancer-related fatalities in this age group. Here, we provide an update on insights gained through molecular profiling of the most common malignant childhood brain tumors. RECENT FINDINGS Genomic profiling studies of medulloblastoma, ependymoma, and diffuse intrinsic pontine glioma (diffuse midline glioma, with H3-K27M mutation), have refined, if not redefined, the diagnostic classification and therapeutic stratification of patients with these tumors. They detail the substantial genetic heterogeneity across each disease type and, importantly, link genotypic information to clinical course. The most aggressive, treatment-resistant (and also treatment-sensitive) forms within each disease entity are identified, and their potentially actionable targets. SUMMARY Molecularly based classification of pediatric brain tumors provides a critical framework for the more precise stratification and treatment of children with brain tumors.
Collapse
|
238
|
Divergent clonal selection dominates medulloblastoma at recurrence. Nature 2016; 529:351-7. [PMID: 26760213 DOI: 10.1038/nature16478] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 11/23/2015] [Indexed: 12/11/2022]
Abstract
The development of targeted anti-cancer therapies through the study of cancer genomes is intended to increase survival rates and decrease treatment-related toxicity. We treated a transposon-driven, functional genomic mouse model of medulloblastoma with 'humanized' in vivo therapy (microneurosurgical tumour resection followed by multi-fractionated, image-guided radiotherapy). Genetic events in recurrent murine medulloblastoma exhibit a very poor overlap with those in matched murine diagnostic samples (<5%). Whole-genome sequencing of 33 pairs of human diagnostic and post-therapy medulloblastomas demonstrated substantial genetic divergence of the dominant clone after therapy (<12% diagnostic events were retained at recurrence). In both mice and humans, the dominant clone at recurrence arose through clonal selection of a pre-existing minor clone present at diagnosis. Targeted therapy is unlikely to be effective in the absence of the target, therefore our results offer a simple, proximal, and remediable explanation for the failure of prior clinical trials of targeted therapy.
Collapse
|
239
|
Wang C, Yuan XJ, Jiang MW, Wang LF. Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma. J Neurosurg Pediatr 2016; 17:49-56. [PMID: 26451721 DOI: 10.3171/2015.5.peds1573] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECT The purpose of this study was to explore the clinical features and outcome of medulloblastoma in Chinese children. The authors analyze the reasons that treatment is abandoned and attempt to provide evidence-based recommendations for improving the prognosis of medulloblastoma in this population. METHODS A total of 67 pediatric cases of newly diagnosed medulloblastoma were included in this study. All of the children were treated at Xinhua Hospital between January 2007 and June 2013. The authors retrospectively analyzed the clinical data, treatment modalities, and outcome. The male-to-female ratio was 2:1, and the patients' median age at diagnosis was 51.96 months (range 3.96-168.24 months). The median duration of follow-up was 32 months (range 3-70 months). RESULTS At the most recent follow-up date, 31 patients (46%) were alive, 30 (45%) had died, and 6 (9%) had been lost to follow-up. The estimated 3-year overall survival and progression-free survival, based on Kaplan-Meier analysis, were 55.1% ± 6.4% and 45.6% ± 6.7%, respectively. Univariate analysis showed that standard-risk group (p = 0.009), postoperative radiotherapy (RT) combined with chemotherapy (p < 0.001), older age (≥ 3 years) at diagnosis (p = 0.010), gross-total resection (p = 0.012), annual family income higher than $3000 (p = 0.033), and living in urban areas (p = 0.008) were favorable prognostic factors. Multivariate analysis revealed that postoperative RT combined with chemotherapy was an independent prognostic factor (p < 0.001). The treatment abandonment rate in this cohort was 31% (21 of 67 cases). CONCLUSIONS There was a large gap between the outcome of medulloblastoma in Chinese children and the outcome in Western children. Based on our data, treatment abandonment was the major cause of therapeutic failure. Parents' misunderstanding of medulloblastoma played a major role in abandonment, followed by financial and transportation difficulties. Establishment of multidisciplinary treatment teams could improve the prognosis of medulloblastoma in Chinese children.
Collapse
Affiliation(s)
- Chen Wang
- Departments of 1 Pediatric Hematology/Oncology
| | | | | | - Li-Feng Wang
- Pathology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
240
|
Abstract
Our understanding of medulloblastoma biology has increased dramatically over the past decade, in part a result of the recognition that there exists tremendous intertumoral heterogeneity not apparent by morphology alone. A particular area that significantly changed our approach to medulloblastoma has been an increased understanding of the role of p53. A role for p53 in medulloblastoma has been established over the past 20 years, however, not until recently has its significance been identified. Recent developments in the understanding of intertumor heterogeneity has clarified the role of TP53 mutations, as the importance of TP53 mutations is highly dependent on the molecular subgroup of medulloblastoma, with TP53 mutant Sonic Hedgehog medulloblastomas forming an extremely high-risk group of patients. As such, there is now a tremendous push to understand the role that p53 plays in treatment resistance of medulloblastoma. In this review, we will summarize the current understanding of p53 in medulloblastoma drawn primarily from recent advances in integrated genomics.
Collapse
Affiliation(s)
- Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A1, Canada Program in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Carolina Nör
- Program in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Michael D Taylor
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A1, Canada Program in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| |
Collapse
|
241
|
Brandes AA, Franceschi E. Shedding light on adult medulloblastoma: current management and opportunities for advances. Am Soc Clin Oncol Educ Book 2015:e82-7. [PMID: 24857151 DOI: 10.14694/edbook_am.2014.34.e82] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Few evidence-based guidelines are available for the treatment of adult medulloblastoma, an extremely rare disease. Therapeutic regimens, typically modeled following pediatric protocols, consist of surgical resection followed by radiotherapy with or without adjuvant chemotherapy. Because of the rarity of this disease in adults, any treatment undertaken is based mainly on small and retrospective studies. Unlike pediatric patients, adults with medulloblastoma have been treated according to risk-adapted therapeutic strategies in only a few prospective studies. Overall, approximately 30% of patients experience recurrence and die of disease-related causes. Although the patients could respond to second-line treatments, the prognosis of patients with recurrence remains dismal. An important challenge for the future will be the biologic characterization of medulloblastoma in adults, with the identification of specific genetic patterns of patients with different prognosis and different response to targeted treatments.
Collapse
Affiliation(s)
- Alba A Brandes
- From the Department of Medical Oncology, Azienda USL-IRCCS Institute of Neurological Science, Bologna, Italy
| | - Enrico Franceschi
- From the Department of Medical Oncology, Azienda USL-IRCCS Institute of Neurological Science, Bologna, Italy
| |
Collapse
|
242
|
Patay Z, DeSain LA, Hwang SN, Coan A, Li Y, Ellison DW. MR Imaging Characteristics of Wingless-Type-Subgroup Pediatric Medulloblastoma. AJNR Am J Neuroradiol 2015; 36:2386-93. [PMID: 26338912 DOI: 10.3174/ajnr.a4495] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/13/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE "Transcriptionally different" medulloblastoma groups are associated with specific signaling pathway abnormalities; hence, they may present with distinct imaging manifestations. In this study, we sought to describe the MR imaging features of wingless-type-subgroup medulloblastomas with embryologic correlations. MATERIALS AND METHODS Pre- and postoperative imaging studies of 16 patients with wingless-type-subgroup medulloblastoma were evaluated for tumor location, involvement of surrounding CSF spaces or parenchymal structures, conventional and DWI signal properties, and postsurgical damage patterns. Laterality scores were assigned to tumors at each step in the evaluation process. Continuous variables were summarized by using descriptive statistics. The Wilcoxon signed rank test was performed to compare laterality scores. To determine the interobserver variability, we computed the intraclass correlation and Cohen κ coefficients. RESULTS Wingless-type-subgroup medulloblastomas in our series were histopathologically "classic." Wingless-type-subgroup medulloblastomas occur in specific sites, with involvement of the foramen of Luschka (75%), the fourth ventricle (68.75%), the cisterna magna (31.25%), and the cerebellopontine angle cistern (18.75%). Laterality scores were low (<2) when preoperative primary and secondary anatomic features were evaluated separately, but they increased (>2) when all pre- and postoperative anatomic features were considered. Results were statistically shown to be reproducible (interclass correlation coefficient, 0.71-0.94; Cohen κ, 0.63-1.00). On the basis of anatomic lesion patterns, 4 location-based subtypes may be distinguished: 1) midline-intraventricular, 2) midline-extraventricular, 3) off-midline-intraventricular, and 4) off-midline-extraventricular, which represent a continuum. CONCLUSIONS Wingless-type-subgroup medulloblastomas are lateralized tumors arising from the brain stem and cerebellum around the foramen of Luschka. Our current understanding of their embryologic origins is in concordance with the spatial distribution of these tumors.
Collapse
Affiliation(s)
- Z Patay
- From the Departments of Diagnostic Imaging (Z.P., L.A.D., S.N.H.)
| | - L A DeSain
- From the Departments of Diagnostic Imaging (Z.P., L.A.D., S.N.H.)
| | - S N Hwang
- From the Departments of Diagnostic Imaging (Z.P., L.A.D., S.N.H.)
| | - A Coan
- Biostatistics (A.C., Y.L.)
| | - Y Li
- Biostatistics (A.C., Y.L.)
| | - D W Ellison
- Pathology (D.W.E.), St. Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|
243
|
Khatua S. Evolving molecular era of childhood medulloblastoma: time to revisit therapy. Future Oncol 2015; 12:107-17. [PMID: 26617331 DOI: 10.2217/fon.15.284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Currently medulloblastoma is treated with a uniform therapeutic approach based on histopathology and clinico-radiological risk stratification, resulting in unpredictable treatment failure and relapses. Improved understanding of the biological, molecular and genetic make-up of these tumors now clearly identifies it as a compendium of four distinct subtypes (WNT, SHH, group 3 and 4). Advances in utilization of the genomic and epigenomic machinery have now delineated genetic aberrations and epigenetic perturbations in each subgroup as potential druggable targets. This has resulted in endeavors to profile targeted therapy. The challenge and future of medulloblastoma therapeutics will be to keep pace with the evolving novel biological insights and translating them into optimal targeted treatment regimens.
Collapse
Affiliation(s)
- Soumen Khatua
- Pediatric Neuro-Oncology, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 87, Houston, TX 77030, USA
| |
Collapse
|
244
|
Selt F, Deiß A, Korshunov A, Capper D, Witt H, van Tilburg CM, Jones DTW, Witt R, Sahm F, Reuss D, Kölsche C, Ecker J, Oehme I, Hielscher T, von Deimling A, Kulozik AE, Pfister SM, Witt O, Milde T. Pediatric Targeted Therapy: Clinical Feasibility of Personalized Diagnostics in Children with Relapsed and Progressive Tumors. Brain Pathol 2015; 26:506-16. [PMID: 26445087 DOI: 10.1111/bpa.12326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/17/2015] [Indexed: 01/12/2023] Open
Abstract
The "pediatric targeted therapy" (PTT) program aims to identify the presence and activity of druggable targets and evaluate the clinical benefit of a personalized treatment approach in relapsed or progressive tumors on an individual basis. 10 markers (HDAC2, HR23B, p-AKT, p-ERK, p-S6, p-EGFR, PDGFR-alpha/beta, p53 and BRAFV600E) were analyzed by immunohistochemistry. Pediatric patients with tumors independent of the histological diagnosis, with relapse or progression after treatment according to standard protocols were included. N = 61/145 (42%) cases were eligible for analysis between 2009 and 2013, the most common entities being brain tumors. Immunohistochemical stainings were evaluated by the H-Score (0-300). In 93% of the cases potentially actionable targets were identified. The expressed or activated pathways were histone deacetylase (HDACs; 83.0% of cases positive), EGFR (87.2%), PDGFR (75.9%), p53 (50.0%), MAPK/ERK (43.3%) and PI3K/mTOR (36.1%). Follow-up revealed partial or full implementation of PTT results in treatment decision-making in 41% of the cases. Prolonged disease stabilization responses in single cases were noticed, however, response rates did not differ from cases treated with other modalities. Further studies evaluating the feasibility and clinical benefit of personalized diagnostic approaches using paraffin material are warranted.
Collapse
Affiliation(s)
- Florian Selt
- Clinical Cooperation Unit Pediatric Oncology (G340), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Section of Pediatric Brain Tumors, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.,National Center for Tumor diseases (NCT), Clinical Trial Center, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Alica Deiß
- Clinical Cooperation Unit Pediatric Oncology (G340), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Andrey Korshunov
- Department of Neuropathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology (G380), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg
| | - David Capper
- Department of Neuropathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology (G380), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg
| | - Hendrik Witt
- Department of Pediatric Oncology, Hematology and Immunology, Section of Pediatric Brain Tumors, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg
| | - Cornelis M van Tilburg
- Department of Pediatric Oncology, Hematology and Immunology, Section of Pediatric Brain Tumors, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.,National Center for Tumor diseases (NCT), Clinical Trial Center, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg
| | - Ruth Witt
- Clinical Cooperation Unit Pediatric Oncology (G340), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Section of Pediatric Brain Tumors, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.,National Center for Tumor diseases (NCT), Clinical Trial Center, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology (G380), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology (G380), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg
| | - Christian Kölsche
- Department of Neuropathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology (G380), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg
| | - Jonas Ecker
- Clinical Cooperation Unit Pediatric Oncology (G340), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Ina Oehme
- Clinical Cooperation Unit Pediatric Oncology (G340), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics (C060), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology (G380), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg
| | - Andreas E Kulozik
- Department of Pediatric Oncology, Hematology and Immunology, Section of Pediatric Brain Tumors, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Stefan M Pfister
- Department of Pediatric Oncology, Hematology and Immunology, Section of Pediatric Brain Tumors, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Heidelberg.,National Center for Tumor diseases (NCT), Clinical Trial Center, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Olaf Witt
- Clinical Cooperation Unit Pediatric Oncology (G340), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Section of Pediatric Brain Tumors, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.,National Center for Tumor diseases (NCT), Clinical Trial Center, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Till Milde
- Clinical Cooperation Unit Pediatric Oncology (G340), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Section of Pediatric Brain Tumors, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.,National Center for Tumor diseases (NCT), Clinical Trial Center, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| |
Collapse
|
245
|
Huse JT, Rosenblum MK. The Emerging Molecular Foundations of Pediatric Brain Tumors. J Child Neurol 2015; 30:1838-50. [PMID: 25873586 DOI: 10.1177/0883073815579709] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/10/2015] [Indexed: 01/23/2023]
Abstract
Recent years have witnessed extensive molecular characterization of several pediatric brain tumor variants. These studies have dramatically shifted notions of disease classification and are likely to have similarly profound effects on patient management in the near future. In this review, we cover the molecular foundations of low-grade glial and glioneuronal neoplasms, high-grade glioma, ependymoma, and medulloblastoma, the details of which have only been recently elucidated in many cases. In doing so, we describe an array of biomarkers likely to play a major role in clinically relevant molecular stratification moving forward. We also discuss strategies for robust and efficient biomarker assessment in the clinical environment.
Collapse
Affiliation(s)
- Jason T Huse
- Department of Pathology and Memorial Sloan-Kettering Cancer Center, New York, NY, USA Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Marc K Rosenblum
- Department of Pathology and Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
246
|
Raybaud C, Ramaswamy V, Taylor MD, Laughlin S. Posterior fossa tumors in children: developmental anatomy and diagnostic imaging. Childs Nerv Syst 2015; 31:1661-76. [PMID: 26351220 DOI: 10.1007/s00381-015-2834-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/10/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Modern understanding of the relation between the mutated cancer stem cell and its site of origin and of its interaction with the tissue environment is enhancing the importance of developmental anatomy in the diagnostic assessment of posterior fossa tumors in children. The aim of this review is to show how MR imaging can improve on the exact identification of the tumors in the brainstem and in the vicinity of the fourth ventricle in children, using both structural imaging data and a precise topographical assessment guided by the developmental anatomy. RESULTS The development of the hindbrain results from complex processes of brainstem segmentation, ventro-dorsal patterning, multiple germinative zones, and diverse migration pathways of the neural progenitors. Depending on their origin in the brainstem, gliomas may be infiltrative or not, as well as overwhelmingly malignant (pons), or mostly benign (cervicomedullary, medullo-pontine tegmental, gliomas of the cerebellar peduncles). In the vicinity of the fourth ventricles, the prognosis of the medulloblastomas (MB) correlates the molecular subtyping as well as the site of origin: WNT MB develop from the Wnt-expressing lower rhombic lip and have a good prognosis; SHH MB develop from the Shh-modulated cerebellar cortex with an intermediate prognosis (dependent on age); recurrences are local mostly. The poor prognosis group 3 MB is radiologically heterogeneous: some tumors present classic features but are juxtaventricular (rather than intraventricular); others have highly malignant features with a small principal tumor and an early dissemination. Group 4 MB has classic features, but characteristically usually does not enhance; dissemination is common. Although there is as yet no clear molecular subgrouping of the ependymomas, their sites of origin and their development can be clearly categorized, as most develop in an exophytic way from the ventricular surface of the medulla in clearly specific locations: the obex region with expansion in the cistern magna, or the lateral recess region with expansion in the CPA and prepontine cisterns (cerebellar ependymomas, and still more intra-brainstem ependymomas are rare). Finally, almost all cerebellar gliomas are pilocytic astrocytomas. CONCLUSIONS A developmental and anatomic approach to the posterior fossa tumors in children (together with diffusion imaging data) provides a reliable pre-surgical identification of the tumor and of its aggressiveness.
Collapse
Affiliation(s)
- Charles Raybaud
- Pediatric Neuroradiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
| | - Vijay Ramaswamy
- Neurooncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Michael D Taylor
- Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Suzanne Laughlin
- Pediatric Neuroradiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| |
Collapse
|
247
|
Skowron P, Ramaswamy V, Taylor MD. Genetic and molecular alterations across medulloblastoma subgroups. J Mol Med (Berl) 2015; 93:1075-84. [PMID: 26350064 PMCID: PMC4599700 DOI: 10.1007/s00109-015-1333-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/03/2015] [Accepted: 08/10/2015] [Indexed: 01/01/2023]
Abstract
Medulloblastoma is the most common malignant brain tumour diagnosed in children. Over the last few decades, advances in radiation and chemotherapy have significantly improved the odds of survival. Nevertheless, one third of all patients still succumb to their disease, and many long-term survivors are afflicted with neurocognitive sequelae. Large-scale multi-institutional efforts have provided insight into the transcriptional and genetic landscape of medulloblastoma. Four distinct subgroups of medulloblastoma have been identified, defined by distinct transcriptomes, genetics, demographics and outcomes. Integrated genomic profiling of each of these subgroups has revealed distinct genetic alterations, driving pathways and in some instances cells of origin. In this review, we highlight, in a subgroup-specific manner, our current knowledge of the genetic and molecular alterations in medulloblastoma and underscore the possible avenues for future therapeutic intervention.
Collapse
Affiliation(s)
- Patryk Skowron
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
- Division of Neurosurgery, The Hospital for Sick Children, 555, University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| |
Collapse
|
248
|
|
249
|
Silva PBGD, Rodini CO, Kaid C, Nakahata AM, Pereira MCL, Matushita H, Costa SSD, Okamoto OK. Establishment of a novel human medulloblastoma cell line characterized by highly aggressive stem-like cells. Cytotechnology 2015; 68:1545-60. [PMID: 26358937 DOI: 10.1007/s10616-015-9914-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/02/2015] [Indexed: 01/09/2023] Open
Abstract
Medulloblastoma is a highly aggressive brain tumor and one of the leading causes of morbidity and mortality related to childhood cancer. These tumors display differential ability to metastasize and respond to treatment, which reflects their high degree of heterogeneity at the genetic and molecular levels. Such heterogeneity of medulloblastoma brings an additional challenge to the understanding of its physiopathology and impacts the development of new therapeutic strategies. This translational effort has been the focus of most pre-clinical studies which invariably employ experimental models using human tumor cell lines. Nonetheless, compared to other cancers, relatively few cell lines of human medulloblastoma are available in central repositories, partly due to the rarity of these tumors and to the intrinsic difficulties in establishing continuous cell lines from pediatric brain tumors. Here, we report the establishment of a new human medulloblastoma cell line which, in comparison with the commonly used and well-established cell line Daoy, is characterized by enhanced proliferation and invasion capabilities, stem cell properties, increased chemoresistance, tumorigenicity in an orthotopic metastatic model, replication of original medulloblastoma behavior in vivo, strong chromosome structural instability and deregulation of genes involved in neural development. These features are advantageous for designing biologically relevant experimental models in clinically oriented studies, making this novel cell line, named USP-13-Med, instrumental for the study of medulloblastoma biology and treatment.
Collapse
Affiliation(s)
- Patrícia Benites Gonçalves da Silva
- Departamento de Genética e Biologia Evolutiva, Centro de Pesquisa sobre o Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, Rua do Matão 277, Cidade Universitária, São Paulo, SP, CEP 05508-090, Brazil
| | - Carolina Oliveira Rodini
- Departamento de Genética e Biologia Evolutiva, Centro de Pesquisa sobre o Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, Rua do Matão 277, Cidade Universitária, São Paulo, SP, CEP 05508-090, Brazil
| | - Carolini Kaid
- Departamento de Genética e Biologia Evolutiva, Centro de Pesquisa sobre o Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, Rua do Matão 277, Cidade Universitária, São Paulo, SP, CEP 05508-090, Brazil
| | - Adriana Miti Nakahata
- Fundação Antônio Prudente, A.C. Camargo Cancer Center, Rua Tagua, 440, Liberdade, São Paulo, CEP 01508-010, Brazil
| | - Márcia Cristina Leite Pereira
- Departamento de Genética e Biologia Evolutiva, Centro de Pesquisa sobre o Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, Rua do Matão 277, Cidade Universitária, São Paulo, SP, CEP 05508-090, Brazil
| | - Hamilton Matushita
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar 255, Cerqueira César, São Paulo, CEP 05403-000, Brazil
| | - Silvia Souza da Costa
- Departamento de Genética e Biologia Evolutiva, Centro de Pesquisa sobre o Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, Rua do Matão 277, Cidade Universitária, São Paulo, SP, CEP 05508-090, Brazil
| | - Oswaldo Keith Okamoto
- Departamento de Genética e Biologia Evolutiva, Centro de Pesquisa sobre o Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, Rua do Matão 277, Cidade Universitária, São Paulo, SP, CEP 05508-090, Brazil.
| |
Collapse
|
250
|
Gajjar A, Pfister SM, Taylor MD, Gilbertson RJ. Molecular insights into pediatric brain tumors have the potential to transform therapy. Clin Cancer Res 2015; 20:5630-40. [PMID: 25398846 DOI: 10.1158/1078-0432.ccr-14-0833] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
High-throughput genomic technologies have shed light on the biologic heterogeneity of several pediatric brain tumors. The biology of the four common pediatric brain tumors-namely medulloblastoma; ependymoma; high-grade glioma (HGG), including diffuse intrinsic pontine glioma; and low-grade glioma-is highlighted in this CCR Focus article. The discovery that medulloblastoma consists of four different subgroups, namely WNT, SHH, Group 3, and Group 4, each with distinct clinical and molecular features, has affected the treatment of children with medulloblastoma. Prospective studies have documented the efficacy of SMO inhibitors in a subgroup of patients with SHH medulloblastoma. Efforts are ongoing to develop specific therapies for each of the subgroups of medulloblastoma. Similar efforts are being pursued for ependymoma, HGG, and diffuse intrinsic pontine glioma where the disease outcome for the latter two tumors has not changed over the past three decades despite several prospective clinical trials. Developing and testing targeted therapies based on this new understanding remains a major challenge to the pediatric neuro-oncology community. The focus of this review is to summarize the rapidly evolving understanding of the common pediatric brain tumors based on genome-wide analysis. These novel insights will add impetus to translating these laboratory-based discoveries to newer therapies for children diagnosed with these tumors.
Collapse
Affiliation(s)
- Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Stefan M Pfister
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Division of Pediatric Neuro Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Richard J Gilbertson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|