1
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D'Aquila KR, Kessler E, Cooper KL, Durst A, Meade J. Assessment of Factors Associated With the Evaluation of Children for Leukemia Predisposition Syndromes: A Retrospective Single-center Study. J Pediatr Hematol Oncol 2023; 45:e597-e602. [PMID: 37027191 DOI: 10.1097/mph.0000000000002626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/06/2022] [Indexed: 04/08/2023]
Abstract
Five to 10% of children with cancer are thought to have a cancer predisposition syndrome (CPS). Referral guidelines for leukemia predisposition syndromes are limited and vague, requiring the treating provider to determine whether patients should have a genetics evaluation. We evaluated referrals to the pediatric cancer predisposition clinic (CPP), the prevalence of CPS in those who elected to pursue germline genetic testing, and assessed for associations between a patient's medical history and the diagnosis of a CPS. Data were obtained via chart review of children diagnosed with leukemia or myelodysplastic syndrome between November 1, 2017, and November 30, 2021. A total of 22.7% of pediatric leukemia patients were referred for evaluation in the CPP. Of the participants evaluated with germline genetic testing, the prevalence of a CPS was 25%. Our study was able to find a CPS in different malignancies, including acute lymphoblastic leukemia, acute myeloid leukemia, and myelodysplastic syndrome. We did not find associations between a participant with an abnormal CBC before diagnosis or hematology visit and the diagnosis of a CPS. Our study supports that a genetic evaluation should be available to all children with leukemia as medical and family history alone is not predictors of a CPS.
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Affiliation(s)
- Kristen R D'Aquila
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh
| | - Elena Kessler
- Division of Medical Genetics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh
| | - Kristine L Cooper
- Hillman Cancer Center, Biostatistics Facility, University of Pittsburgh
| | - Andrea Durst
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh
| | - Julia Meade
- Division of Medical Genetics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh
- Division of Pediatric Oncology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
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2
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Paramathas S, Guha T, Pugh TJ, Malkin D, Villani A. Considerations for the use of circulating tumor DNA sequencing as a screening tool in cancer predisposition syndromes. Pediatr Blood Cancer 2020; 67:e28758. [PMID: 33047872 DOI: 10.1002/pbc.28758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022]
Abstract
Liquid biopsy, specifically circulating tumor DNA (ctDNA) detection, has started to revolutionize the clinical management of patients with cancer by surpassing many limitations of traditional tissue biopsies, particularly for serial testing. ctDNA sequencing has been successfully utilized for cancer detection, prognostication, and assessment of disease response and evolution. While the applications of ctDNA analysis are growing, the majority of studies to date have primarily evaluated its use as a tool for tracking a known cancer, and in most cases at advanced stage. Herein, we discuss the potential application of ctDNA for surveillance and early cancer detection in patients with a cancer predisposition syndrome.
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Affiliation(s)
- Sangeetha Paramathas
- Department of Medical Biophysics, University of Toronto, Toronto, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Tanya Guha
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Trevor J Pugh
- Department of Medical Biophysics, University of Toronto, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - David Malkin
- Department of Medical Biophysics, University of Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,Division of Haematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Anita Villani
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
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3
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Stjernfelt KJ, von Stedingk K, Wiebe T, Hjorth L, Kristoffersson U, Stenmark-Askmalm M, Olsson H, Øra I. Increased Cancer Risk in Families with Pediatric Cancer Is Associated with Gender, Age, Diagnosis, and Degree of Relation to the Child. Cancer Epidemiol Biomarkers Prev 2020; 29:2171-2179. [PMID: 32856606 DOI: 10.1158/1055-9965.epi-20-0322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/07/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies of cancer risk among relatives of children with cancer beyond parents and siblings are limited. We have investigated the cancer risk up to the third degree of relation in families with pediatric cancer to reveal patterns of inheritance. METHODS A single-center cohort of 757 patients with pediatric cancer was linked to the Swedish National Population Register, resulting in 16,137 relatives up to the third degree of relation. All relatives were matched to the Swedish Cancer Register, and standard incidence ratios (SIR) were calculated to define relatives at risk. RESULTS Children and adults up to the third degree of relation had increased cancer risk, with SIRs of 1.48 (P = 0.01) and 1.07 (P < 0.01), respectively. The SIRs for first- and third-degree adult relatives were 1.22 and 1.10, respectively, but no increased risk was observed in second-degree relatives. Male relatives had a higher risk than females, especially when related to a girl and when the child had leukemia. The risk was mainly increased for lung, prostate, and gastrointestinal cancer. When excluding 29 families of children with known pathogenic germline variants, the increased risk remained. CONCLUSIONS Relatives to children with cancer up to third degree of relation have an increased cancer risk. Known pathogenic germline variants do not explain this increased risk. IMPACT The overall increased cancer risk among relatives of children with cancer in this population-based cohort strengthens the importance of surveillance programs for families with pediatric cancer.
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Affiliation(s)
- Karl-Johan Stjernfelt
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden.
| | - Kristoffer von Stedingk
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Oncogenomics, University Medical Center AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas Wiebe
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden
| | - Lars Hjorth
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ulf Kristoffersson
- Department of Laboratory Medicine, Division of Clinical Genetics, Lund University, Lund, Sweden
| | - Marie Stenmark-Askmalm
- Department of Laboratory Medicine, Division of Clinical Genetics, Lund University, Lund, Sweden
| | - Håkan Olsson
- Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ingrid Øra
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden
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4
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Family history of cancer and the risk of childhood solid tumours: a Norwegian nationwide register-based cohort study. Br J Cancer 2018; 118:905-912. [PMID: 29462129 PMCID: PMC5886124 DOI: 10.1038/bjc.2017.493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/12/2017] [Accepted: 12/19/2017] [Indexed: 11/15/2022] Open
Abstract
Background: It is not clear if family history of cancer increases risk of cancer in children. Methods: We followed-up a total of 2 610 937 children born between 1960 and 2001 for cancer risk, and their parents and siblings. In this period, 2477 primary childhood solid tumours (except lymphoma) were diagnosed. The data from the Norwegian Family and Life Course Study and from the Norwegian Cancer Register were used. Classification of hereditary cancer syndromes was based on tumour histology, pedigrees and Chompret’s criteria. Results: An association between risk of childhood tumours and first-degree family history of early onset of solid tumours was observed for central nervous system tumours (2.3-fold), neuroblastoma (2.3-fold), retinoblastoma (6.1-fold), hepatic tumours (4.0-fold), and melanomas (8.3-fold). Elevated risk was also seen for osteosarcomas (1.5-fold) when considering first-degree family history of cancer diagnosed at any age. The risk of hepatic tumours, neuroblastomas and melanomas remained elevated even after controlling for probable hereditary cancer syndromes. Conclusions: The increased risk for several childhood solid site cancers among those with first-degree relatives diagnosed with solid cancer suggests that genetic or environmental factors are involved. The fact that these associations remained after controlling for hereditary cancer syndromes indicates other genetic mechanisms might be involved.
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5
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Maese L, Schiffman JD. The evidence for expanded genetic testing for pediatric patients with cancer. Future Oncol 2018; 14:187-190. [PMID: 29327612 DOI: 10.2217/fon-2017-0467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Luke Maese
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
| | - Joshua D Schiffman
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA.,Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
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6
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Stjernfelt KJ, von Stedingk K, Wiebe T, Hjorth L, Olsson H, Øra I. Predominance of girls with cancer in families with multiple childhood cancer cases. BMC Cancer 2017; 17:868. [PMID: 29258538 PMCID: PMC5738226 DOI: 10.1186/s12885-017-3899-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background Recent studies indicate that one of four childhood cancers can be attributed to hereditary genetic abnormalities. Methods The Lund Childhood Cancer Genetic study includes newly diagnosed childhood cancer patients as well as childhood cancer survivors visiting the Department of Pediatrics or the Late Effect Clinic at Skåne University Hospital, Lund, Sweden. Questionnaires regarding family history of cancer and blood samples were provided. Reported data were validated and extended by use of the Swedish Population- and Cancer Registries. Demographics in families with one case of childhood cancer (FAM1) were investigated and compared to families with multiple cases of childhood cancer (FAM > 1) as well as to childhood cancer in the general population. Results Forty-one out of 528 families (7.8%) had more than one case of childhood cancer. In 23 families the affected children were relatives up to a 3rd degree (4.4%). In FAM > 1, 69.2% of the children with leukemia and 60% of those with tumors in the central nervous system (CNS) had a childhood relative with matching diagnosis, both significantly higher than expected. Significantly more female than male patients were observed in FAM > 1 compared to FAM1. This female predominance was most striking in childhood leukemia (77% female) and also, yet to a lesser extent, in CNS tumors (68% female). Conclusions We conclude that the high proportion of children with leukemia or CNS tumors in FAM > 1 having a childhood relative with the same diagnosis suggests a hereditary background. Moreover, we report a female predominance in childhood leukemia and childhood CNS tumors in FAM > 1, which may indicate a hereditary gender-specific risk factor in these families.
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Affiliation(s)
- Karl-Johan Stjernfelt
- Department of Pediatrics, Pediatric Oncology and Hematology, Lund University, Skane University Hospital, Lund, Sweden
| | - Kristoffer von Stedingk
- Department of Pediatrics, Pediatric Oncology and Hematology, Lund University, Skane University Hospital, Lund, Sweden.,Translational Cancer Research, Medicon Village, Lund University, Lund, Sweden
| | - Thomas Wiebe
- Department of Pediatrics, Pediatric Oncology and Hematology, Lund University, Skane University Hospital, Lund, Sweden
| | - Lars Hjorth
- Department of Pediatrics, Pediatric Oncology and Hematology, Lund University, Skane University Hospital, Lund, Sweden
| | - Håkan Olsson
- Department of Oncology, Lund University, Skane University Hospital, Lund, Sweden
| | - Ingrid Øra
- Department of Pediatrics, Pediatric Oncology and Hematology, Lund University, Skane University Hospital, Lund, Sweden. .,Department of Pediatrics, Clinical Sciences, Lund University, Skane University Hospital, 22185, Lund, Sweden.
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7
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Goudie C, Coltin H, Witkowski L, Mourad S, Malkin D, Foulkes WD. The McGill Interactive Pediatric OncoGenetic Guidelines: An approach to identifying pediatric oncology patients most likely to benefit from a genetic evaluation. Pediatr Blood Cancer 2017; 64. [PMID: 28097779 DOI: 10.1002/pbc.26441] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/09/2022]
Abstract
Identifying cancer predisposition syndromes in children with tumors is crucial, yet few clinical guidelines exist to identify children at high risk of having germline mutations. The McGill Interactive Pediatric OncoGenetic Guidelines project aims to create a validated pediatric guideline in the form of a smartphone/tablet application using algorithms to process clinical data and help determine whether to refer a child for genetic assessment. This paper discusses the initial stages of the project, focusing on its overall structure, the methodology underpinning the algorithms, and the upcoming algorithm validation process.
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Affiliation(s)
- Catherine Goudie
- Division of Hematology/Oncology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hallie Coltin
- Division of Hematology/Oncology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Leora Witkowski
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Stephanie Mourad
- Division of Hematology/Oncology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - David Malkin
- Division of Hematology/Oncology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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8
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Grohar PJ, Janeway KA, Mase LD, Schiffman JD. Advances in the Treatment of Pediatric Bone Sarcomas. Am Soc Clin Oncol Educ Book 2017; 37:725-735. [PMID: 28561686 PMCID: PMC6066791 DOI: 10.1200/edbk_175378] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bone tumors make up a significant portion of noncentral nervous system solid tumor diagnoses in pediatric oncology patients. Ewing sarcoma and osteosarcoma, both with distinct clinical and pathologic features, are the two most commonly encountered bone cancers in pediatrics. Although mutations in the germline have classically been more associated with osteosarcoma, there is recent evidence germline alterations in patients with Ewing sarcoma also play a significant role in pathogenesis. Treatment advances in this patient population have lagged behind that of other pediatric malignancies, particularly targeted interventions directed at the biologic underpinnings of disease. Recent advances in biologic and genomic understanding of these two cancers has expanded the potential for therapeutic advancement and prevention. In Ewing sarcoma, directed focus on inhibition of EWSR1-FLI1 and its effectors has produced promising results. In osteosarcoma, instead of a concentrated focus on one particular change, largely due to tumor heterogeneity, a more diversified approach has been adopted including investigations of growth factors inhibitors, signaling pathway inhibitors, and immune modulation. Continuing recently made treatment advances relies on clinical trial design and enrollment. Clinical trials should include incorporation of biological findings; specifically, for Ewing sarcoma, assessment of alternative fusions and, for osteosarcoma, stratification utilizing biomarkers. Expanded cancer genomics knowledge, particularly with solid tumors, as it relates to heritability and incorporation of family history has led to early identification of patients with cancer predisposition. In these patients through application of cost-effective evidence-based screening techniques the ultimate goal of cancer prevention is becoming a realization.
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Affiliation(s)
- Patrick J Grohar
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Katherine A Janeway
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Luke D Mase
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Joshua D Schiffman
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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9
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Testa JR, Malkin D, Schiffman JD. Connecting molecular pathways to hereditary cancer risk syndromes. AMERICAN SOCIETY OF CLINICAL ONCOLOGY EDUCATIONAL BOOK. AMERICAN SOCIETY OF CLINICAL ONCOLOGY. ANNUAL MEETING 2015. [PMID: 23714463 DOI: 10.1200/edbook_am.2013.33.81] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An understanding of the genetic causes and molecular pathways of hereditary cancer syndromes has historically informed our knowledge and treatment of all types of cancers. For this review, we focus on three rare syndromes and their associated genetic mutations including BAP1, TP53, and SDHx (SDHA, SDHB, SDHC, SDHD, SDHAF2). BAP1 encodes an enzyme that catalyzes the removal of ubiquitin from protein substrates, and germline mutations of BAP1 cause a novel cancer syndrome characterized by high incidence of benign atypical melanocytic tumors, uveal melanomas, cutaneous melanomas, malignant mesotheliomas, and potentially other cancers. TP53 mutations cause Li-Fraumeni syndrome (LFS), a highly penetrant cancer syndrome associated with multiple tumors including but not limited to sarcomas, breast cancers, brain tumors, and adrenocortical carcinomas. Genomic modifiers for tumor risk and genotype-phenotype correlations in LFS are beginning to be identified. SDH is a mitochondrial enzyme complex involved in the tricarboxylic acid (TCA) cycle, and germline SDHx mutations lead to increased succinate with subsequent paragangliomas, pheochromocytomas, renal cell carcinomas (RCCs), gastrointestinal stromal tumors (GISTs), and other rarer cancers. In all of these syndromes, the molecular pathways have informed our understanding of tumor risk and successful early tumor surveillance and screening programs.
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Affiliation(s)
- Joseph R Testa
- From the Cancer Biology Program, Fox Chase Cancer Center, Philadelphia, PA; Division of Hematology/Oncology, University of Toronto, and Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada; High Risk Pediatric Cancer Clinic, and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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10
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Abstract
The acquisition of de novo somatic mutations accounts for approximately 90% of all new cancer diagnoses, while the remaining 10% is due to inherited genetic traits. In this latter category, individuals harbouring germline mutations show a higher likelihood of developing potentially life-threatening cancers, often at a very young age. The study of cancer genetics has profoundly helped our understanding of cancer biology, leading to better characterised malignancies, tailored targeted therapies and the identification of individuals at high risk of cancer diagnosis. This review will discuss examples of cancer syndromes in children, adolescents and young adults, the main underlying gene mutations, and the use of genetic testing to identify gene mutation carriers. Finally, we will describe how gene mutation detection is employed for the life-long management of patients with high susceptibility to cancer, including genetic counselling, increased surveillance, early intervention and use of targeted therapies.
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Affiliation(s)
- Federica Saletta
- 1 Children's Cancer Research Unit, Kids Research Institute, 2 Oncology Department, 3 The University of Sydney Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Westmead 2145, NSW, Australia
| | - Luciano Dalla Pozza
- 1 Children's Cancer Research Unit, Kids Research Institute, 2 Oncology Department, 3 The University of Sydney Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Westmead 2145, NSW, Australia
| | - Jennifer A Byrne
- 1 Children's Cancer Research Unit, Kids Research Institute, 2 Oncology Department, 3 The University of Sydney Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Westmead 2145, NSW, Australia
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11
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Abstract
PURPOSE OF REVIEW The present study describes the recent advances in the identification of targetable genomic alterations in pediatric cancers, along with the progress and associated challenges in translating these findings into therapeutic benefit. RECENT FINDINGS Each field within pediatric cancer has rapidly and comprehensively begun to define genomic targets in tumors that potentially can improve the clinical outcome of patients, including hematologic malignancies (leukemia and lymphoma), solid malignancies (neuroblastoma, rhabdomyosarcoma, Ewing sarcoma, and osteosarcoma), and brain tumors (gliomas, ependymomas, and medulloblastomas). Although each tumor has specific and sometimes overlapping genomic targets, the translation to the clinic of new targeted trials and precision medicine protocols is still in its infancy. The first clinical tumor profiling studies in pediatric oncology have demonstrated feasibility and patient enthusiasm for the personalized medicine paradigm, but have yet to demonstrate clinical utility. Complexities influencing implementation include rapidly evolving sequencing technologies, tumor heterogeneity, and lack of access to targeted therapies. The return of incidental findings from the germline also remains a challenge, with evolving policy statements and accepted standards. SUMMARY The translation of genomic discoveries to the clinic in pediatric oncology continues to move forward at a brisk pace. Early adoption of genomics for tumor classification, risk stratification, and initial trials of targeted therapeutic agents has led to powerful results. As our experience grows in the integration of genomic and clinical medicine, the outcome for children with cancer should continue to improve.
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12
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Roth JJ, Santi M, Rorke-Adams LB, Harding BN, Busse TM, Tooke LS, Biegel JA. Diagnostic application of high resolution single nucleotide polymorphism array analysis for children with brain tumors. Cancer Genet 2014; 207:111-23. [PMID: 24767714 DOI: 10.1016/j.cancergen.2014.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 12/21/2022]
Abstract
Single nucleotide polymorphism (SNP) array analysis is currently used as a first tier test for pediatric brain tumors at The Children's Hospital of Philadelphia. The results from 100 consecutive patients are summarized in the present report. Eighty-seven percent of the tumors had at least one pathogenic copy number alteration. Nineteen of 56 low grade gliomas (LGGs) demonstrated a duplication in 7q34, which resulted in a KIAA1549-BRAF fusion. Chromosome band 7q34 deletions, which resulted in a FAM131B-BRAF fusion, were identified in one pilocytic astrocytoma (PA) and one dysembryoplastic neuroepithelial tumor (DNT). One ganglioglioma (GG) demonstrated a 6q23.3q26 deletion that was predicted to result in a MYB-QKI fusion. Gains of chromosomes 5, 6, 7, 11, and 20 were seen in a subset of LGGs. Monosomy 6, deletion of 9q and 10q, and an i(17)(q10) were each detected in the medulloblastomas (MBs). Deletions and regions of loss of heterozygosity that encompassed TP53, RB1, CDKN2A/B, CHEK2, NF1, and NF2 were identified in a variety of tumors, which led to a recommendation for germline testing. A BRAF p.Thr599dup or p.V600E mutation was identified by Sanger sequencing in one and five gliomas, respectively, and a somatic TP53 mutation was identified in a fibrillary astrocytoma. No TP53 hot-spot mutations were detected in the MBs. SNP array analysis of pediatric brain tumors can be combined with pathologic examination and molecular analyses to further refine diagnoses, offer more accurate prognostic assessments, and identify patients who should be referred for cancer risk assessment.
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Affiliation(s)
- Jacquelyn J Roth
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lucy B Rorke-Adams
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Brian N Harding
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Tracy M Busse
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Laura S Tooke
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jaclyn A Biegel
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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13
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Schiffman JD, Geller JI, Mundt E, Means A, Means L, Means V. Update on pediatric cancer predisposition syndromes. Pediatr Blood Cancer 2013; 60:1247-52. [PMID: 23625733 DOI: 10.1002/pbc.24555] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/08/2013] [Indexed: 12/21/2022]
Abstract
Hereditary cancer syndromes in children and adolescents are becoming more recognized in the field of pediatric hematology/oncology. A recent workshop held at the American Society of Pediatric Hematology/Oncology (ASPHO) 2012 Annual Meeting included several interactive sessions related to specific familial cancer syndromes, genetic testing and screening, and ethical issues in caring for families with inherited cancer risk. This review highlights the workshop presentations, including a brief background about pediatric cancer predisposition syndromes and the importance of learning about them for the practicing pediatric hematologists/oncologists. This is followed by a brief summary of the newly described cancer predisposition syndromes including Rhabdoid Tumor Predisposition Syndrome, Hereditary Paragangliomas and Pheochromocytoma Syndrome, and Familial Pleuropulmonaryblastoma Tumor Predisposition (DICER1) Syndrome. The next section covers genetic testing and screening for pediatric cancer predisposition syndromes. Ethical issues are also discussed including preimplantation genetic diagnosis or testing (PGD/PGT), suspicious lesions found on tumor screening, and incidental mutations discovered by whole genome sequencing. Finally, the perspective of a family with Li-Fraumeni Syndrome is shared.
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Affiliation(s)
- Joshua D Schiffman
- Center for Children's Cancer Research and Department of Pediatrics, University of Utah, Salt Lake City, Utah 84112, USA.
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14
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Spitsbergen JM, Frattini SA, Bowser PR, Getchell RG, Coffee LL, Wolfe MJ, Fisher JP, Marinovic SJ, Harr KE. Epizootic neoplasia of the lateral line system of lake trout (Salvelinus namaycush) in New York's Finger Lakes. Vet Pathol 2013; 50:418-33. [PMID: 23528941 DOI: 10.1177/0300985813482949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article documents an epizootic of inflammation and neoplasia selectively affecting the lateral line system of lake trout (Salvelinus namaycush) in 4 Finger Lakes in New York from 1985 to 1994. We studied more than 100 cases of this disease. Tumors occurred in 8% (5/64) of mature and 21% (3/14) of immature lake trout in the most severely affected lake. Lesions consisted of 1 or more neoplasm(s) in association with lymphocytic inflammation, multifocal erosions, and ulcerations of the epidermis along the lateral line. Lesions progressed from inflammatory to neoplastic, with 2-year-old lake trout showing locally extensive, intense lymphocytic infiltrates; 2- to 3-year-old fish having multiple, variably sized white masses up to 3 mm in diameter; and fish over 5 years old exhibiting 1 or more white, cerebriform masses greater than 1 cm in diameter. Histologic diagnoses of the tumors were predominantly spindle cell sarcomas or benign or malignant peripheral nerve sheath neoplasms, with fewer epitheliomas and carcinomas. Prevalence estimates did not vary significantly between sexes or season. The cause of this epizootic remains unclear. Tumor transmission trials, virus isolation procedures, and ultrastructural study of lesions failed to reveal evidence of a viral etiology. The Finger Lakes in which the disease occurred did not receive substantially more chemical pollution than unaffected lakes in the same chain during the epizootic, making an environmental carcinogen an unlikely primary cause of the epizootic. A hereditary component, however, may have contributed to this syndrome since only fish of the Seneca Lake strain were affected.
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Affiliation(s)
- J M Spitsbergen
- Department of Microbiology, 220 Nash Hall, Oregon State University, Corvallis, OR 97331, USA.
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15
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Testa JR, Malkin D, Schiffman JD. Connecting molecular pathways to hereditary cancer risk syndromes. Am Soc Clin Oncol Educ Book 2013:81-90. [PMID: 23714463 PMCID: PMC5889618 DOI: 10.14694/edbook_am.2013.33.81] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
An understanding of the genetic causes and molecular pathways of hereditary cancer syndromes has historically informed our knowledge and treatment of all types of cancers. For this review, we focus on three rare syndromes and their associated genetic mutations including BAP1, TP53, and SDHx (SDHA, SDHB, SDHC, SDHD, SDHAF2). BAP1 encodes an enzyme that catalyzes the removal of ubiquitin from protein substrates, and germline mutations of BAP1 cause a novel cancer syndrome characterized by high incidence of benign atypical melanocytic tumors, uveal melanomas, cutaneous melanomas, malignant mesotheliomas, and potentially other cancers. TP53 mutations cause Li-Fraumeni syndrome (LFS), a highly penetrant cancer syndrome associated with multiple tumors including but not limited to sarcomas, breast cancers, brain tumors, and adrenocortical carcinomas. Genomic modifiers for tumor risk and genotype-phenotype correlations in LFS are beginning to be identified. SDH is a mitochondrial enzyme complex involved in the tricarboxylic acid (TCA) cycle, and germline SDHx mutations lead to increased succinate with subsequent paragangliomas, pheochromocytomas, renal cell carcinomas (RCCs), gastrointestinal stromal tumors (GISTs), and other rarer cancers. In all of these syndromes, the molecular pathways have informed our understanding of tumor risk and successful early tumor surveillance and screening programs.
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Affiliation(s)
- Joseph R Testa
- From the Cancer Biology Program, Fox Chase Cancer Center, Philadelphia, PA; Division of Hematology/Oncology, University of Toronto, and Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada; High Risk Pediatric Cancer Clinic, and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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16
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Knapke S, Zelley K, Nichols KE, Kohlmann W, Schiffman JD. Identification, management, and evaluation of children with cancer-predisposition syndromes. Am Soc Clin Oncol Educ Book 2012:576-584. [PMID: 24451799 DOI: 10.14694/edbook_am.2012.32.8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A substantial proportion of childhood cancers are attributable to an underlying genetic syndrome or inherited susceptibility. Recognition of affected children allows for appropriate cancer risk assessment, genetic counseling, and testing. Identification of individuals who are at increased risk to develop cancers during childhood can guide cancer surveillance and clinical management, which may improve outcomes for both the patient and other at-risk relatives. The information provided through this article will focus on the current complexities involved in the evaluation and management of children with cancer-predisposing genetic conditions and highlight remaining questions for discussion.
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Affiliation(s)
- Sara Knapke
- From the Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's Hospital of Philadelphia, Philadelphia, PA; Huntsman Cancer Institute, Salt Lake City, UT; Center for Children's Cancer Research (C3R), Huntsman Cancer Institute, Salt Lake City, UT
| | - Kristin Zelley
- From the Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's Hospital of Philadelphia, Philadelphia, PA; Huntsman Cancer Institute, Salt Lake City, UT; Center for Children's Cancer Research (C3R), Huntsman Cancer Institute, Salt Lake City, UT
| | - Kim E Nichols
- From the Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's Hospital of Philadelphia, Philadelphia, PA; Huntsman Cancer Institute, Salt Lake City, UT; Center for Children's Cancer Research (C3R), Huntsman Cancer Institute, Salt Lake City, UT
| | - Wendy Kohlmann
- From the Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's Hospital of Philadelphia, Philadelphia, PA; Huntsman Cancer Institute, Salt Lake City, UT; Center for Children's Cancer Research (C3R), Huntsman Cancer Institute, Salt Lake City, UT
| | - Joshua D Schiffman
- From the Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's Hospital of Philadelphia, Philadelphia, PA; Huntsman Cancer Institute, Salt Lake City, UT; Center for Children's Cancer Research (C3R), Huntsman Cancer Institute, Salt Lake City, UT
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