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Morfouace M, Horak P, Kreutzfeldt S, Stevovic A, de Rojas T, Denisova E, Hutter B, Bautista F, Oliveira J, Defachelles AS, White J, Kasper B, Preusser M, Golfinopoulos V, Pfister S, Van der Graaf W, Wardelmann E, Shenjere P, Fröhling S, McCabe MG. Comprehensive molecular profiling of sarcomas in adolescent and young adult patients: Results of the EORTC SPECTA-AYA international proof-of-concept study. Eur J Cancer 2023; 178:216-226. [PMID: 36470093 DOI: 10.1016/j.ejca.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) patients with cancer are poorly recruited to molecularly targeted trials and have not witnessed the advances in cancer treatment and survival seen in other age groups. We report here a pan-European proof-of-concept study to identify actionable alterations in some of the worst prognosis AYA cancers: bone and soft tissue sarcomas. DESIGN Patients aged 12-29 years with newly diagnosed or recurrent, intermediate or high-grade bone and soft tissue sarcomas were recruited from six European countries. Pathological diagnoses were centrally reviewed. Formalin-fixed tissues were analysed by whole exome sequencing, methylation profiling and RNA sequencing and were discussed in a multidisciplinary, international molecular tumour board. RESULTS Of 71 patients recruited, 48 (median 20 years, range 12-28) met eligibility criteria. Central pathological review confirmed, modified and re-classified the diagnosis in 41, 3, and 4 cases, respectively. Median turnaround time to discussion at molecular tumour board was 8.4 weeks. whole exome sequencing (n = 48), methylation profiling (n = 44, 85%) and RNA sequencing (n = 24, 50%) led to therapeutic recommendations for 81% patients, including 4 with germ line alterations. The most common were for agents targeted towards tyrosine kinases (n = 20 recommendations), DNA repair (n = 18) and the PI3K/mTOR/AKT pathway (n = 15). Recommendations were generally based on weak evidence such as activity in a different tumour type (n = 68, 61%), reflecting the dearth of relevant molecular clinical trial data in the same tumour type. CONCLUSIONS We demonstrate here that comprehensive molecular profiling of AYA patients' samples is feasible and deliverable in a European programme.
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Affiliation(s)
- Marie Morfouace
- European Organisation for the Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Peter Horak
- Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Simon Kreutzfeldt
- Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Aleksandra Stevovic
- European Organisation for the Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Teresa de Rojas
- European Organisation for the Research and Treatment of Cancer (EORTC), Brussels, Belgium; Pediatric Oncogenomics Unit, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Evgeniya Denisova
- Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara Hutter
- Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Francisco Bautista
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology and Hematology, Hospital Niño Jesús, Madrid, Spain
| | - Júlio Oliveira
- Department of Medical Oncology, Instituto Português de Oncologia (IPO), Porto, Portugal
| | | | - Jeff White
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, Mannheim, Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Vassilis Golfinopoulos
- European Organisation for the Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Stefan Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Pediatric Neurooncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Winette Van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute (NKI), Amsterdam, Netherlands; Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Eva Wardelmann
- Gerhard-Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Patrick Shenjere
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Stefan Fröhling
- Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester, UK.
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Current status of precision medicine in pediatric oncology in Spain: a consensus report by the Spanish Society of Paediatric Haematology and Oncology (SEHOP). Clin Transl Oncol 2022; 24:809-815. [PMID: 35152364 DOI: 10.1007/s12094-021-02759-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
The study analyzes the current status of personalized medicine in pediatric oncology in Spain. It gathers national data on the tumor molecular studies and genomic sequencing carried out at diagnosis and at relapse, the centers that perform these studies, the technology used and the interpretation and clinical applicability of the results. Current challenges and future directions to achieve a coordinated national personalized medicine strategy in pediatric oncology are also discussed. Next generation sequencing-based (NGS) gene panels are the technology used in the majority of centers and financial limitations are the main reason for not incorporating these studies into routine care. Nowadays, the application of precision medicine in pediatric oncology is a reality in a great number of Spanish centers. However, its implementation is uneven and lacks standardization of protocols; therefore, national coordination to overcome the inequalities is required. Collaborative work within the Personalized Medicine Group of SEHOP is an adequate framework for encouraging a step forward in the effort to move precision medicine into the national healthcare system.
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van der Graaf W, Tesselaar M, McVeigh T, Oyen W, Fröhling S. Biology-Guided Precision Medicine in Rare Cancers: Lessons from Sarcomas and Neuroendocrine Tumours. Semin Cancer Biol 2022; 84:228-241. [DOI: 10.1016/j.semcancer.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
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Mittal N, Saha A, Avutu V, Monga V, Freyer DR, Roth M. Shared barriers and facilitators to enrollment of adolescents and young adults on cancer clinical trials. Sci Rep 2022; 12:3875. [PMID: 35264642 PMCID: PMC8907177 DOI: 10.1038/s41598-022-07703-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/14/2022] [Indexed: 12/12/2022] Open
Abstract
Adolescent and young adult (AYA) enrollment in cancer clinical trials (CCT) is suboptimal. Few studies have explored site level barriers and facilitators to AYA enrollment on CCTs and the efficacy of interventions to enhance enrollment. A cross sectional survey was developed by the COG AYA Oncology Discipline Committee Responsible Investigator (RI) Network to identify perceived barriers and facilitators to enrollment, as well as opportunities to improve enrollment. Associations of barriers and facilitators to enrollment with program demographics were assessed. The survey was sent to all AYA RI Network members (n = 143) and quantitative and thematic analyses were conducted. The overall response rate was 42% (n = 60/143). Participants represented diverse institutions based on size, presence or absence of dedicated AYA programs, and proximity and relationship between pediatric and medical oncology practices within the institution. The most frequently cited barriers to enrolling AYAs in CCTs were administrative logistical issues (45%), disparate enrollment practices (42%) and communication issues (27%) between pediatric and medical oncology and perceived limited trial availability (27%). The most frequently reported facilitators to enrollment included having strong communication between pediatric and medical oncology (48%), having a supportive research infrastructure (35%) and the presence of AYA champions (33%). Many barriers and facilitators were similar across institutions and AYA program types. Shared barriers and facilitators to AYA CCT enrollment exist across the landscape of cancer care settings. Interventions aimed at increasing coordination between pediatric and medical oncology clinical trials offices and providers have high potential to improve site-level AYA enrollment.
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Affiliation(s)
- Nupur Mittal
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - Aniket Saha
- Department of Pediatrics, Prisma Health Children's Hospital, Greenville, SC, USA
| | - Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varun Monga
- Division of Medical Oncology, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - David R Freyer
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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Avutu V, Monga V, Mittal N, Saha A, Andolina JR, Bell DE, Fair DB, Flerlage JE, Frediani JN, Heath JL, Kahn JM, Reichek JL, Super L, Terao MA, Freyer DR, Roth ME. Use of Communication Technology to Improve Clinical Trial Participation in Adolescents and Young Adults With Cancer: Consensus Statement From the Children's Oncology Group Adolescent and Young Adult Responsible Investigator Network. JCO Oncol Pract 2022; 18:224-231. [PMID: 34905405 PMCID: PMC8932547 DOI: 10.1200/op.21.00554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adolescents and young adults (AYAs; age 15-39 years) with cancer are under-represented in cancer clinical trials because of patient, provider, and institutional barriers. Health care technology is increasingly available to and highly used among AYAs and has the potential to improve cancer care delivery. The COVID-19 pandemic forced institutions to rapidly adopt novel approaches for enrollment and monitoring of patients on cancer clinical trials, many of which have the potential for improving AYA trial participation overall. This consensus statement from the Children's Oncology Group AYA Oncology Discipline Committee reviews opportunities to use technology to optimize AYA trial enrollment and study conduct, as well as considerations for widespread implementation of these practices. The use of remote patient eligibility screening, electronic informed consent, virtual tumor boards, remote study visits, and remote patient monitoring are recommended to increase AYA access to trials and decrease the burden of participation. Widespread adoption of these strategies will require new policies focusing on reimbursement for telehealth, license portability, facile communication between electronic health record systems and advanced safeguards to maintain patient privacy and security. Studies are needed to determine optimal approaches to further incorporate technology at every stage of the clinical trial process, from enrollment through study completion.
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Affiliation(s)
- Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center; New York, NY,Viswatej Avutu, MD, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th Floor 14, New York, NY 10065; e-mail:
| | - Varun Monga
- Division of Medical Oncology, Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Nupur Mittal
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Aniket Saha
- Division of Pediatric Hematology-Oncology, University of South Carolina School of Medicine, Greenville, SC
| | - Jeffrey R. Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Danielle E. Bell
- Department of Pediatrics, Ascension St John Hospital, Detroit, MI
| | - Douglas B. Fair
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Huntsman Cancer Institute, Salt Lake City, UT
| | - Jamie E. Flerlage
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Jessica L. Heath
- Departments of Pediatrics and Biochemistry, University of Vermont, Burlington, VT
| | - Justine M. Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
| | - Jennifer L. Reichek
- Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Leanne Super
- Department of Paediatrics, School of Medicine, Monash University, Melbourne, Australia
| | - Michael A. Terao
- Division of Pediatric Adolescent and Young Adult Hematology and Oncology, Department of Pediatrics, Medstar Georgetown University Hospital, Washington, DC
| | - David R. Freyer
- Departments of Pediatrics, Medicine, and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
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Yan H, Zabih V, Bartels U, Das S, Nathan P, Gupta S. Prognostic factors related to overall survival in adolescent and young adults with medulloblastoma: a systematic review. Neurooncol Adv 2022; 4:vdac016. [PMID: 35669013 PMCID: PMC9161716 DOI: 10.1093/noajnl/vdac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Medulloblastoma is a rare diagnosis among adolescents and young adults (AYA). Though prognostic factors and treatment are well characterized among children with medulloblastoma, equivalent data for AYA are sparse. We conducted a systematic review to identify predictors of survival among AYA with medulloblastoma. Methods We searched for primary studies of AYA (age 15–39 at diagnosis) with medulloblastoma in high-income countries within OVID MEDLINE, EMBASE, and EBM Reviews-Cochrane library databases from inception to August 2020. Patient demographics, primary outcomes, and univariate and multivariable data on all prognostic factors were collected from included studies. Prognosticators were characterized as patient, disease, or treatment-related. Results We identified 18 articles. 5-year overall survival ranged between 40% and 89%, while disease-free survival ranged from 49% to 89%. Study quality was low as assessed by the Quality in Prognostic factor Studies tool. Though meta-analyses were not possible due heterogeneity, narrative summaries suggested that lower disease burden, superior postoperative functional status, and higher doses and larger fields of radiation were associated with improved survival. Reported chemotherapy regimens were heterogeneous in timing, agents, and relationship with radiation, precluding meaningful comparisons. Only one study included molecular subgroups for analysis, with the majority (76.5%) of tumors classified as Sonic Hedgehog (SHH). Conclusions Prognostication and treatment of AYA medulloblastoma is limited by a dearth of primary evidence and lack of specificity for patients aged 15–39. Dedicated prospective trials to delineate the benefit of various chemotherapy and radiation regimens are required in this population to identify prognosticators and ideal treatment regimens.
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Affiliation(s)
- Han Yan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Veda Zabih
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario Canada
| | - Paul Nathan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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7
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Ferrari A, Stark D, Peccatori FA, Fern L, Laurence V, Gaspar N, Bozovic-Spasojevic I, Smith O, De Munter J, Derwich K, Hjorth L, van der Graaf WTA, Soanes L, Jezdic S, Blondeel A, Bielack S, Douillard JY, Mountzios G, Saloustros E. Adolescents and young adults (AYA) with cancer: a position paper from the AYA Working Group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). ESMO Open 2021; 6:100096. [PMID: 33926710 PMCID: PMC8103533 DOI: 10.1016/j.esmoop.2021.100096] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
It is well recognised that adolescents and young adults (AYA) with cancer have inequitable access to oncology services that provide expert cancer care and consider their unique needs. Subsequently, survival gains in this patient population have improved only modestly compared with older adults and children with cancer. In 2015, the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE) established the joint Cancer in AYA Working Group in order to increase awareness among adult and paediatric oncology communities, enhance knowledge on specific issues in AYA and ultimately improve the standard of care for AYA with cancer across Europe. This manuscript reflects the position of this working group regarding current AYA cancer care, the challenges to be addressed and possible solutions. Key challenges include the lack of specific biological understanding of AYA cancers, the lack of access to specialised centres with age-appropriate multidisciplinary care and the lack of available clinical trials with novel therapeutics. Key recommendations include diversifying interprofessional cooperation in AYA care and specific measures to improve trial accrual, including centralising care where that is the best means to achieve trial accrual. This defines a common vision that can lead to improved outcomes for AYA with cancer in Europe.
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Affiliation(s)
- A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK.
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Fern
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Laurence
- Medical Oncology Department and SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - O Smith
- National Children's Cancer Service, Children's Health Ireland at Crumlin and Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - J De Munter
- University Hospital Ghent Cancer Center, UZ Gent, Ghent, Belgium
| | - K Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - L Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - W T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Soanes
- Teenage Cancer Trust, London, UK
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, KlinikumStuttgart - Olgahospital, Stuttgart, Germany
| | - J-Y Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
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IJzerman NS, Drabbe C, den Hollander D, Mohammadi M, van Boven H, Desar IME, Gelderblom H, Grünhagen DJ, Reyners AKL, van Noesel MM, Mathijssen RHJ, Steeghs N, van der Graaf WTA. Gastrointestinal Stromal Tumours (GIST) in Young Adult (18-40 Years) Patients: A Report from the Dutch GIST Registry. Cancers (Basel) 2020; 12:cancers12030730. [PMID: 32244864 PMCID: PMC7140070 DOI: 10.3390/cancers12030730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal stromal tumour (GIST) is a disease of older adults and is dominated by KIT/PDGFR mutations. In children, GIST is rare, predominantly occurs in girls, has a stomach location and generally lacks KIT/PDGFR mutations. For young adults (YA), aged 18 to 40 years, the typical phenotypic and genotypic patterns are unknown. We therefore aimed to describe the clinical, pathological and molecular characteristics of GIST in in YA. YA GIST patients registered in the Dutch GIST Registry (DGR) were included, and data were compared to those of older adults (OA). From 1010 patients in the DGR, 52 patients were YA (54% male). Main tumour locations were stomach (46%) and small intestine (46%). GIST genetic profiles were mutations in KIT (69%), PDGFRA (6%), SDH deficient (8%), NF1 associated (4%), ETV6-NTRK3 gene fusion (2%) or wildtype (10%). Statistically significant differences were found between the OA and YA patients (localisation, syndromic and mutational status). YA presented more often than OA in an emergency setting (18% vs. 9%). The overall five-year survival rate was 85%. In conclusion, YA GISTs are not similar to typical adult GISTs and also differ from paediatric GISTs, as described in the literature. In this series, we found a relatively high percentage of small intestine GIST, emergency presentation, 25% non-KIT/PDGFRA mutations and a relatively good survival.
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Affiliation(s)
- Nikki S. IJzerman
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands (C.D.); (D.d.H.); (N.S.)
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Cas Drabbe
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands (C.D.); (D.d.H.); (N.S.)
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Dide den Hollander
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands (C.D.); (D.d.H.); (N.S.)
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Mahmoud Mohammadi
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; (M.M.)
| | - Hester van Boven
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - Ingrid M. E. Desar
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; (M.M.)
| | - Dirk J. Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - An K. L. Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Max M. van Noesel
- Department of Solid Tumors, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands;
| | - Ron H. J. Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Neeltje Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands (C.D.); (D.d.H.); (N.S.)
| | - Winette T. A. van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands (C.D.); (D.d.H.); (N.S.)
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
- Correspondence: ; Tel: +31-20-512-6979
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