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Lulla RR, Buxton A, Krailo MD, Lazow MA, Boue DR, Leach JL, Lin T, Geller JI, Kumar SS, Nikiforova MN, Chandran U, Jogal SS, Nelson MD, Onar-Thomas A, Haas-Kogan DA, Cohen KJ, Kieran MW, Gajjar A, Drissi R, Pollack IF, Fouladi M. Vorinostat, temozolomide or bevacizumab with irradiation and maintenance BEV/TMZ in pediatric high-grade glioma: A Children's Oncology Group Study. Neurooncol Adv 2024; 6:vdae035. [PMID: 38596718 PMCID: PMC11003537 DOI: 10.1093/noajnl/vdae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background Outcomes for children with high-grade gliomas (HGG) remain poor. This multicenter phase II trial evaluated whether concurrent use of vorinostat or bevacizumab with focal radiotherapy (RT) improved 1-year event-free survival (EFS) compared to temozolomide in children with newly diagnosed HGG who received maintenance temozolomide and bevacizumab. Methods Patients ≥ 3 and < 22 years with localized, non-brainstem HGG were randomized to receive RT (dose 54-59.4Gy) with vorinostat, temozolomide, or bevacizumab followed by 12 cycles of bevacizumab and temozolomide maintenance therapy. Results Among 90 patients randomized, the 1-year EFS for concurrent bevacizumab, vorinostat, or temozolomide with RT was 43.8% (±8.8%), 41.4% (±9.2%), and 59.3% (±9.5%), respectively, with no significant difference among treatment arms. Three- and five-year EFS for the entire cohort was 14.8% and 13.4%, respectively, with no significant EFS difference among the chemoradiotherapy arms. IDH mutations were associated with more favorable EFS (P = .03), whereas H3.3 K27M mutations (P = .0045) and alterations in PIK3CA or PTEN (P = .025) were associated with worse outcomes. Patients with telomerase- and alternative lengthening of telomeres (ALT)-negative tumors (n = 4) had an EFS of 100%, significantly greater than those with ALT or telomerase, or both (P = .002). While there was no difference in outcomes based on TERT expression, high TERC expression was associated with inferior survival independent of the telomere maintenance mechanism (P = .0012). Conclusions Chemoradiotherapy with vorinostat or bevacizumab is not superior to temozolomide in children with newly diagnosed HGG. Patients with telomerase- and ALT-negative tumors had higher EFS suggesting that, if reproduced, mechanism of telomere maintenance should be considered in molecular-risk stratification in future studies.
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Affiliation(s)
- Rishi R Lulla
- Department of Pediatrics, Hasbro Children’s Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Allen Buxton
- Department of Biostatistics, Children’s Oncology Group, Monrovia, California, USA
| | - Mark D Krailo
- Department of Biostatistics, Children’s Oncology Group, Monrovia, California, USA
| | - Margot A Lazow
- Pediatric Neuro‑Oncology Program, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Daniel R Boue
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - James L Leach
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tong Lin
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - James I Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Shiva Senthil Kumar
- Center for Childhood Cancer Research, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Marina N Nikiforova
- Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Uma Chandran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sachin S Jogal
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marvin D Nelson
- Department of Radiology, Children’s Hospital Los Angeles, Keck University of Southern California School of Medicine, Los Angeles, California, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston Children’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth J Cohen
- Division of Pediatric Oncology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark W Kieran
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amar Gajjar
- Department of Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Rachid Drissi
- Center for Childhood Cancer Research, Nationwide Children’s Hospital, Columbus, OH, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ian F Pollack
- Department of Neurosurgery, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maryam Fouladi
- Pediatric Neuro‑Oncology Program, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Kim N, Shin H, Lim DH, Nam DH, Lee JI, Seol HJ, Kong DS, Choi JW, Chong K, Lee WJ. Treatment Outcomes after Dose-Escalated Moderately Hypofractionated Radiotherapy for Frail Patients with High-Grade Glioma. Cancers (Basel) 2023; 16:64. [PMID: 38201492 PMCID: PMC10778244 DOI: 10.3390/cancers16010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
For high-grade glioma (HGG) patients with old age or poor performance status, hypofractionated radiotherapy (hypoRT) in 10-15 fractions is recommended. Also, limited data exist on the impact of salvage treatment after progression in frail patients. We retrospectively analyzed the outcomes of dose-escalated hypoRT in 40 frail HGG patients who were treated with hypoRT between 2013 and 2021. With a median biologically effective dose of 71.7 Gy, a total dose of 56 Gy in 20 fractions was the most frequently used regimen (53.7%). The median age and Karnofsky Performance Status of patients were 74 years and 70, respectively. Most patients (n = 31, 77.5%) were diagnosed with glioblastoma, IDH-wildtype, CNS WHO grade 4. Only 10 (25.0%) patients underwent surgical resection, and 28 (70.0%) patients received concurrent temozolomide during hypoRT. With a median follow-up of 9.7 months, the median overall survival (OS) was 12.2 months. Of the 30 (75.0%) patients with disease progression, only 12 patients received salvage treatment. The OS after progression differed significantly depending on salvage treatment (median OS, 9.6 vs. 4.6 months, p = 0.032). Dose-escalated hypoRT in 20 fractions produced survival outcomes outperforming historical data for frail patients.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (N.K.); (H.S.)
| | - Hyunju Shin
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (N.K.); (H.S.)
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (N.K.); (H.S.)
| | - Do-Hyun Nam
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.-H.N.); (J.-I.L.); (H.J.S.); (D.-S.K.); (J.W.C.); (K.C.); (W.J.L.)
| | - Jung-Il Lee
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.-H.N.); (J.-I.L.); (H.J.S.); (D.-S.K.); (J.W.C.); (K.C.); (W.J.L.)
| | - Ho Jun Seol
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.-H.N.); (J.-I.L.); (H.J.S.); (D.-S.K.); (J.W.C.); (K.C.); (W.J.L.)
| | - Doo-Sik Kong
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.-H.N.); (J.-I.L.); (H.J.S.); (D.-S.K.); (J.W.C.); (K.C.); (W.J.L.)
| | - Jung Won Choi
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.-H.N.); (J.-I.L.); (H.J.S.); (D.-S.K.); (J.W.C.); (K.C.); (W.J.L.)
| | - Kyuha Chong
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.-H.N.); (J.-I.L.); (H.J.S.); (D.-S.K.); (J.W.C.); (K.C.); (W.J.L.)
| | - Won Jae Lee
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.-H.N.); (J.-I.L.); (H.J.S.); (D.-S.K.); (J.W.C.); (K.C.); (W.J.L.)
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Novel Pharmacological Treatment Options in Pediatric Glioblastoma-A Systematic Review. Cancers (Basel) 2022; 14:cancers14112814. [PMID: 35681794 PMCID: PMC9179254 DOI: 10.3390/cancers14112814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Childhood glioblastoma is an aggressive brain tumor in children that has a very poor prognosis. Standard therapy includes surgery, irradiation and chemotherapy with temozolomide. So far, there is no effective drug treatment for pediatric glioblastoma patients. This systematic review aims to outline currently available data on novel pharmacological treatment options. None of the included phase II studies showed any benefit regarding overall survival or a prolongation of stable disease. New genomic technologies discovered the biologic heterogeneity of these tumors, demanding more individualized immunotherapeutic and targeted approaches. Autoimmune modulated therapies and further targeting of tumor-specific receptors provide promising preclinical results. Clinical trials aligned to the tumor characteristics are needed to establish effective new therapeutic approaches. Abstract Background: Pediatric glioblastoma (GBM) is an aggressive central nervous system tumor in children that has dismal prognosis. Standard of care is surgery with subsequent irradiation and temozolomide. We aimed to outline currently available data on novel pharmacological treatments for pediatric GBM. Methods: We conducted a systematic literature search in PubMed and Embase, including reports published in English from 2010 to 2021. We included randomized trials, cohort studies and case series. Phase I trials were not analyzed. We followed PRISMA guidelines, assessed the quality of the eligible reports using the Newcastle-Ottawa scale (NOS) and the RoB-2 tool and registered the protocol on PROSPERO. Results: We included 6 out of 1122 screened reports. All six selected reports were prospective, multicenter phase II trials (five single-arm and one randomized controlled trial). None of the investigated novel treatment modalities showed any benefit regarding overall or progression free survival. Conclusions: To date, the role of pharmacological approaches regarding pediatric GBM remains unclear, since no novel treatment approach could provide a significant impact on overall or progression free survival. Further research should aim to combine different treatment strategies in large international multicenter trials with central comprehensive diagnostics regarding subgrouping. These novel treatment approaches should include targeted and immunotherapeutic treatments, potentially leading to a more successful outcome.
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Evans M, Gill R, Bull KS. Does a Bevacizumab-based regime have a role in the treatment of children with diffuse intrinsic pontine glioma? A systematic review. Neurooncol Adv 2022; 4:vdac100. [PMID: 35821674 PMCID: PMC9270727 DOI: 10.1093/noajnl/vdac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There are no effective treatments for diffuse intrinsic pontine glioma (DIPG); median survival is 11.2 months. Bevacizumab has the potential to improve quality of life (QOL) and survival in DIPG but has never been evaluated systematically. The aim of this review was to assess Bevacizumab’s role in the treatment of DIPG. Methods MEDLINE, EMBASE, Scopus, and Web of Science were searched for relevant studies using terms developed from alternatives for Bevacizumab and DIPG. One reviewer screened titles and abstracts, then two reviewers screened full texts. Data were extracted into tables and quality assessed using methodological index for non-randomized studies and JBI tools. Results Searching revealed 1001 papers; after deduplication 851 remained. After screening of titles and abstracts, then 28 full texts, 11 studies were included. Four studies reported a median overall survival longer than historical data, however, two found no significant impact of Bevacizumab. Five studies reported a radiological response in a proportion of participants and two reported no response. Three studies, evaluating clinical response, reported improvement in a proportion of patients. Three studies, evaluating QOL, reported stability or improvement. Four studies, evaluating steroid use, reported reductions in the proportion of patients receiving steroids. In radiation necrosis treatment, Bevacizumab led to clinical improvement in 6/12 patients in 2 studies and permitted a reduction in steroid use in most patients. Conclusions Insufficient evidence means the role of Bevacizumab in the treatment of DIPG is unclear. However, Bevacizumab may be beneficial to some patients. The review highlights the need for further research in this area.
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Affiliation(s)
- Mia Evans
- Faculty of medicine, University of Southampton , Southampton , UK
| | - Ria Gill
- Faculty of medicine, University of Southampton , Southampton , UK
| | - Kim S Bull
- Clinical and Experimental Sciences, University of Southampton , Southampton , UK
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5
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Ozerov SS, Ryzhova MV, Kumirova EV. [Diffuse brainstem tumors in children. Tumor biology and hope for a better outcome. Current state of the problem]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:77-86. [PMID: 34463454 DOI: 10.17116/neiro20218504177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Diffuse brainstem tumor is a fatal disease and the main cause of child mortality from neoplasms of central nervous system. So far, no effective therapy has been found for this disease. The authors discuss the modern aspects of clinical data, biology, diagnosis and treatment of patients with diffuse brainstem tumors.
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Affiliation(s)
- S S Ozerov
- Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - E V Kumirova
- Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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Metselaar DS, du Chatinier A, Stuiver I, Kaspers GJL, Hulleman E. Radiosensitization in Pediatric High-Grade Glioma: Targets, Resistance and Developments. Front Oncol 2021; 11:662209. [PMID: 33869066 PMCID: PMC8047603 DOI: 10.3389/fonc.2021.662209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022] Open
Abstract
Pediatric high-grade gliomas (pHGG) are the leading cause of cancer-related death in children. These epigenetically dysregulated tumors often harbor mutations in genes encoding histone 3, which contributes to a stem cell-like, therapy-resistant phenotype. Furthermore, pHGG are characterized by a diffuse growth pattern, which, together with their delicate location, makes complete surgical resection often impossible. Radiation therapy (RT) is part of the standard therapy against pHGG and generally the only modality, apart from surgery, to provide symptom relief and a delay in tumor progression. However, as a single treatment modality, RT still offers no chance for a cure. As with most therapeutic approaches, irradiated cancer cells often acquire resistance mechanisms that permit survival or stimulate regrowth after treatment, thereby limiting the efficacy of RT. Various preclinical studies have investigated radiosensitizers in pHGG models, without leading to an improved clinical outcome for these patients. However, our recently improved molecular understanding of pHGG generates new opportunities to (re-)evaluate radiosensitizers in these malignancies. Furthermore, the use of radio-enhancing agents has several benefits in pHGG compared to other cancers, which will be discussed here. This review provides an overview and a critical evaluation of the radiosensitization strategies that have been studied to date in pHGG, thereby providing a framework for improving radiosensitivity of these rapidly fatal brain tumors.
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Affiliation(s)
- Dennis S Metselaar
- Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Aimée du Chatinier
- Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Iris Stuiver
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Gertjan J L Kaspers
- Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Esther Hulleman
- Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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Cho SJ, Kim HS, Suh CH, Park JE. Radiological Recurrence Patterns after Bevacizumab Treatment of Recurrent High-Grade Glioma: A Systematic Review and Meta-Analysis. Korean J Radiol 2020; 21:908-918. [PMID: 32524791 PMCID: PMC7289701 DOI: 10.3348/kjr.2019.0898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/10/2020] [Accepted: 03/05/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To categorize the radiological patterns of recurrence after bevacizumab treatment and to derive the pooled proportions of patients with recurrent malignant glioma showing the different radiological patterns. Materials and Methods A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed to identify studies reporting radiological recurrence patterns in patients with recurrent malignant glioma after bevacizumab treatment failure until April 10, 2019. The pooled proportions according to radiological recurrence patterns (geographically local versus non-local recurrence) and predominant tumor portions (enhancing tumor versus non-enhancing tumor) after bevacizumab treatment were calculated. Subgroup and meta-regression analyses were also performed. Results The systematic review and meta-analysis included 17 articles. The pooled proportions were 38.3% (95% confidence interval [CI], 30.6–46.1%) for a geographical radiologic pattern of non-local recurrence and 34.2% (95% CI, 27.3–41.5%) for a non-enhancing tumor-predominant recurrence pattern. In the subgroup analysis, the pooled proportion of non-local recurrence in the patients treated with bevacizumab only was slightly higher than that in patients treated with the combination with cytotoxic chemotherapy (34.9% [95% CI, 22.8–49.4%] versus 22.5% [95% CI, 9.5–44.6%]). Conclusion A substantial proportion of high-grade glioma patients show non-local or non-enhancing radiologic patterns of recurrence after bevacizumab treatment, which may provide insight into surrogate endpoints for treatment failure in clinical trials of recurrent high-grade glioma.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Children with DIPG and high-grade glioma treated with temozolomide, irinotecan, and bevacizumab: the Seattle Children's Hospital experience. J Neurooncol 2020; 148:607-617. [PMID: 32556862 DOI: 10.1007/s11060-020-03558-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Beyond focal radiation, there is no consensus standard therapy for pediatric high-grade glioma (pHGG) and outcomes remain dismal. We describe the largest molecularly-characterized cohort of children with pHGG treated with a 3-drug maintenance regimen of temozolomide, irinotecan, and bevacizumab (TIB) following radiation. METHODS We retrospectively reviewed 36 pediatric patients treated with TIB at Seattle Children's Hospital from 2009 to 2018 and analyzed survival using the Kaplan-Meier method. Molecular profiling was performed by targeted DNA sequencing and toxicities, steroid use, and palliative care utilization were evaluated. RESULTS Median age at diagnosis was 10.9 years (18 months-18 years). Genetic alterations were detected in 26 genes and aligned with recognized molecular subgroups including H3 K27M-mutant (12), H3F3A G34-mutant (2), IDH-mutant (4), and hypermutator profiles (4). Fifteen patients (42%) completed 12 planned cycles of maintenance. Side effects associated with chemotherapy delays or modifications included thrombocytopenia (28%) and nausea/vomiting (19%), with temozolomide dosing most frequently modified. Median event-free survival (EFS) and overall survival (OS) was 16.2 and 20.1 months, with shorter survival seen in DIPG (9.3 and 13.3 months, respectively). Survival at 1, 2, and 5 years was 80%, 10% and 0% for DIPG and 85%, 38%, and 16% for other pHGG. CONCLUSION Our single-center experience demonstrates tolerability of this 3-drug regimen, with prolonged survival in DIPG compared to historical single-agent temozolomide. pHGG survival was comparable to analogous 3-drug regimens and superior to historical agents; however, cure was rare. Children with pHGG remain excellent candidates for the study of novel therapeutics combined with standard therapy.
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Su JMF, Murray JC, McNall-Knapp RY, Bowers DC, Shah S, Adesina AM, Paulino AC, Jo E, Mo Q, Baxter PA, Blaney SM. A phase 2 study of valproic acid and radiation, followed by maintenance valproic acid and bevacizumab in children with newly diagnosed diffuse intrinsic pontine glioma or high-grade glioma. Pediatr Blood Cancer 2020; 67:e28283. [PMID: 32285998 DOI: 10.1002/pbc.28283] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE To study the efficacy and tolerability of valproic acid (VPA) and radiation, followed by VPA and bevacizumab in children with newly diagnosed diffuse intrinsic pontine glioma (DIPG) or high-grade glioma (HGG). METHODS Children 3 to 21 years of age received radiation therapy and VPA at 15 mg/kg/day and dose adjusted to maintain a trough range of 85 to 115 μg/mL. VPA was continued post-radiation, and bevacizumab was started at 10 mg/kg intravenously biweekly, four weeks after completing radiation therapy. RESULTS From September 2009 through August 2015, 20 DIPG and 18 HGG patients were enrolled (NCT00879437). During radiation and VPA, grade 3 or higher toxicities requiring discontinuation or modification of VPA dosing included grade 3 thrombocytopenia (1), grade 3 weight gain (1), and grade 3 pancreatitis (1). During VPA and bevacizumab, the most common grade 3 or higher toxicities were grade 3 neutropenia (3), grade 3 thrombocytopenia (3), grade 3 fatigue (3), and grade 3 hypertension (4). Two patients discontinued protocol therapy prior to disease progression (one grade 4 thrombosis and one grade 1 intratumoral hemorrhage). Median event-free survival (EFS) and overall survival (OS) for DIPG were 7.8 (95% CI 5.6-8.2) and 10.3 (7.4-13.4) months, and estimated one-year EFS was 12% (2%-31%). Median EFS and OS for HGG were 9.1 (6.4-11) and 12.1 (10-22.1) months, and estimated one-year EFS was 24% (7%-45%). Four patients with glioblastoma and mismatch-repair deficiency syndrome had EFS of 28.5, 16.7, 10.4, and 9 months. CONCLUSION Addition of VPA and bevacizumab to radiation was well tolerated but did not appear to improve EFS or OS in children with DIPG or HGG.
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Affiliation(s)
- Jack Meng-Fen Su
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | | | - Rene Y McNall-Knapp
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Daniel C Bowers
- Children's Medical Center/The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shafqat Shah
- The University of Texas Health Science Center, Department of Pediatric Hematology-Oncology, San Antonio, Texas
| | | | - Arnold C Paulino
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eunji Jo
- Dan L Duncan Cancer Center, Department of Medicine, Biostatistics and Bioinformatics, Houston, Texas
| | - Qianxing Mo
- Dan L Duncan Cancer Center, Department of Medicine, Biostatistics and Bioinformatics, Houston, Texas
| | - Patricia A Baxter
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Susan M Blaney
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
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Cooney T, Lane A, Bartels U, Bouffet E, Goldman S, Leary SES, Foreman NK, Packer RJ, Broniscer A, Minturn JE, Shih CS, Chintagumpala M, Hassall T, Gottardo NG, Dholaria H, Hoffman L, Chaney B, Baugh J, Doughman R, Leach JL, Jones BV, Fouladi M, Warren KE, Monje M. Contemporary survival endpoints: an International Diffuse Intrinsic Pontine Glioma Registry study. Neuro Oncol 2019; 19:1279-1280. [PMID: 28821206 DOI: 10.1093/neuonc/nox107] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Tabitha Cooney
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Adam Lane
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Ute Bartels
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Eric Bouffet
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Stewart Goldman
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Sarah E S Leary
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Nicholas K Foreman
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Roger J Packer
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Alberto Broniscer
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Jane E Minturn
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Chie-Schin Shih
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Murali Chintagumpala
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Tim Hassall
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Nicholas G Gottardo
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Hetal Dholaria
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Lindsey Hoffman
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Brooklyn Chaney
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Joshua Baugh
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Renee Doughman
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - James L Leach
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Blaise V Jones
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Maryam Fouladi
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Katherine E Warren
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Michelle Monje
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
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11
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Mueller S, Jain P, Liang WS, Kilburn L, Kline C, Gupta N, Panditharatna E, Magge SN, Zhang B, Zhu Y, Crawford JR, Banerjee A, Nazemi K, Packer RJ, Petritsch CK, Truffaux N, Roos A, Nasser S, Phillips JJ, Solomon D, Molinaro A, Waanders AJ, Byron SA, Berens ME, Kuhn J, Nazarian J, Prados M, Resnick AC. A pilot precision medicine trial for children with diffuse intrinsic pontine glioma-PNOC003: A report from the Pacific Pediatric Neuro-Oncology Consortium. Int J Cancer 2019; 145:1889-1901. [PMID: 30861105 DOI: 10.1002/ijc.32258] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/21/2019] [Accepted: 02/15/2019] [Indexed: 12/13/2022]
Abstract
This clinical trial evaluated whether whole exome sequencing (WES) and RNA sequencing (RNAseq) of paired normal and tumor tissues could be incorporated into a personalized treatment plan for newly diagnosed patients (<25 years of age) with diffuse intrinsic pontine glioma (DIPG). Additionally, whole genome sequencing (WGS) was compared to WES to determine if WGS would further inform treatment decisions, and whether circulating tumor DNA (ctDNA) could detect the H3K27M mutation to allow assessment of therapy response. Patients were selected across three Pacific Pediatric Neuro-Oncology Consortium member institutions between September 2014 and January 2016. WES and RNAseq were performed at diagnosis and recurrence when possible in a CLIA-certified laboratory. Patient-derived cell line development was attempted for each subject. Collection of blood for ctDNA was done prior to treatment and with each MRI. A specialized tumor board generated a treatment recommendation including up to four FDA-approved agents based upon the genomic alterations detected. A treatment plan was successfully issued within 21 business days from tissue collection for all 15 subjects, with 14 of the 15 subjects fulfilling the feasibility criteria. WGS results did not significantly deviate from WES-based therapy recommendations; however, WGS data provided further insight into tumor evolution and fidelity of patient-derived cell models. Detection of the H3F3A or HIST1H3B K27M (H3K27M) mutation using ctDNA was successful in 92% of H3K27M mutant cases. A personalized treatment recommendation for DIPG can be rendered within a multicenter setting using comprehensive next-generation sequencing technology in a clinically relevant timeframe.
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Affiliation(s)
- Sabine Mueller
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA.,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
| | - Payal Jain
- Center for Data-Driven Discovery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Winnie S Liang
- Translational Genomic Research Institute (TGEN), Phoenix, AZ, USA
| | - Lindsay Kilburn
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC, USA.,Brain Tumor Institute, Children's National Health System, Washington, DC, USA
| | - Cassie Kline
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA.,Department of Pediatrics, 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
| | - Eshini Panditharatna
- Brain Tumor Institute, Children's National Health System, Washington, DC, USA.,Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA
| | - Suresh N Magge
- Division of Neurosurgery, Children's National Health System, Washington, DC, USA
| | - Bo Zhang
- Center for Data-Driven Discovery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yuankun Zhu
- Center for Data-Driven Discovery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Anu Banerjee
- 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
| | - Kellie Nazemi
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - Roger J Packer
- Brain Tumor Institute, Children's National Health System, Washington, DC, USA
| | - Claudia K Petritsch
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nathalene Truffaux
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Alison Roos
- Translational Genomic Research Institute (TGEN), Phoenix, AZ, USA
| | - Sara Nasser
- Translational Genomic Research Institute (TGEN), Phoenix, AZ, USA
| | - Joanna J Phillips
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - David Solomon
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Annette Molinaro
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Angela J Waanders
- Center for Data-Driven Discovery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Children's Brain Tumor Tissue Consortium, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sara A Byron
- Translational Genomic Research Institute (TGEN), Phoenix, AZ, USA
| | - Michael E Berens
- Translational Genomic Research Institute (TGEN), Phoenix, AZ, USA
| | - John Kuhn
- College of Pharmacy, University of Texas Health Science Center, San Antonio, TX, USA
| | - Javad Nazarian
- Center for Data-Driven Discovery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC, USA.,Brain Tumor Institute, Children's National Health System, Washington, DC, USA.,Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA
| | - Michael Prados
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Adam C Resnick
- Center for Data-Driven Discovery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Children's Brain Tumor Tissue Consortium, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Mackay A, Burford A, Molinari V, Jones DTW, Izquierdo E, Brouwer-Visser J, Giangaspero F, Haberler C, Pietsch T, Jacques TS, Figarella-Branger D, Rodriguez D, Morgan PS, Raman P, Waanders AJ, Resnick AC, Massimino M, Garrè ML, Smith H, Capper D, Pfister SM, Würdinger T, Tam R, Garcia J, Thakur MD, Vassal G, Grill J, Jaspan T, Varlet P, Jones C. Molecular, Pathological, Radiological, and Immune Profiling of Non-brainstem Pediatric High-Grade Glioma from the HERBY Phase II Randomized Trial. Cancer Cell 2018; 33:829-842.e5. [PMID: 29763623 PMCID: PMC5956280 DOI: 10.1016/j.ccell.2018.04.004] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/28/2018] [Accepted: 04/10/2018] [Indexed: 12/30/2022]
Abstract
The HERBY trial was a phase II open-label, randomized, multicenter trial evaluating bevacizumab (BEV) in addition to temozolomide/radiotherapy in patients with newly diagnosed non-brainstem high-grade glioma (HGG) between the ages of 3 and 18 years. We carried out comprehensive molecular analysis integrated with pathology, radiology, and immune profiling. In post-hoc subgroup analysis, hypermutator tumors (mismatch repair deficiency and somatic POLE/POLD1 mutations) and those biologically resembling pleomorphic xanthoastrocytoma ([PXA]-like, driven by BRAF_V600E or NF1 mutation) had significantly more CD8+ tumor-infiltrating lymphocytes, and longer survival with the addition of BEV. Histone H3 subgroups (hemispheric G34R/V and midline K27M) had a worse outcome and were immune cold. Future clinical trials will need to take into account the diversity represented by the term "HGG" in the pediatric population.
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Affiliation(s)
- Alan Mackay
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - Anna Burford
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - Valeria Molinari
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany; Division of Paediatric Neuro-oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisa Izquierdo
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | | | - Felice Giangaspero
- Department of Radiology, Oncology and Anatomic-Pathology Sciences, Sapienza University, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Christine Haberler
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Torsten Pietsch
- DGNN Brain Tumor Reference Center, Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Thomas S Jacques
- UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | | | | | | | - Pichai Raman
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angela J Waanders
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam C Resnick
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | | | - Helen Smith
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - David Capper
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Institute of Neuropathology, Berlin, Germany; Department of Neuropathology, University Hospital Heidelberg and Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany; Division of Paediatric Neuro-oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Würdinger
- Department of Neurosurgery, Brain Tumor Center Amsterdam, VU Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Gilles Vassal
- Pediatric and Adolescent Oncology and Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Jacques Grill
- Pediatric and Adolescent Oncology and Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Tim Jaspan
- Nottingham University Hospitals, Nottingham, UK
| | - Pascale Varlet
- Sainte-Anne Hospital, Paris-Descartes University, Paris, France
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK.
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13
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Grill J, Massimino M, Bouffet E, Azizi AA, McCowage G, Cañete A, Saran F, Le Deley MC, Varlet P, Morgan PS, Jaspan T, Jones C, Giangaspero F, Smith H, Garcia J, Elze MC, Rousseau RF, Abrey L, Hargrave D, Vassal G. Phase II, Open-Label, Randomized, Multicenter Trial (HERBY) of Bevacizumab in Pediatric Patients With Newly Diagnosed High-Grade Glioma. J Clin Oncol 2018; 36:951-958. [PMID: 29412784 DOI: 10.1200/jco.2017.76.0611] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Bevacizumab (BEV) is approved in more than 60 countries for use in adults with recurrent glioblastoma. We evaluated the addition of BEV to radiotherapy plus temozolomide (RT+TMZ) in pediatric patients with newly diagnosed high-grade glioma (HGG). Methods The randomized, parallel group, multicenter, open-label HERBY trial ( ClinicalTrials.gov identifier: NCT01390948) enrolled patients age ≥ 3 years to ≤ 18 years with localized, centrally neuropathology-confirmed, nonbrainstem HGG. Eligible patients were randomly assigned to receive RT + TMZ (RT: 1.8 Gy, 5 days per week, and TMZ: 75 mg/m2 per day for 6 weeks; 4-week treatment break; then up to 12 × 28-day cycles of TMZ [cycle 1: 150 mg/m2 per day, days 1 to 5; cycles 2 to 12: 200 mg/m2 per day, days 1 to 5]) with or without BEV (10 mg/kg every 2 weeks). The primary end point was event-free survival (EFS) as assessed by a central radiology review committee that was blinded to treatment. We report findings of EFS at 12 months after the enrollment of the last patient. Results One hundred twenty-one patients were enrolled (RT+TMZ [n = 59]; BEV plus RT+TMZ [n = 62]). Central radiology review committee-assessed median EFS did not differ significantly between treatment groups (RT+TMZ, 11.8 months; 95% CI, 7.9 to 16.4 months; BEV plus RT+TMZ, 8.2 months; 95% CI, 7.8 to 12.7 months; hazard ratio, 1.44; P = .13 [stratified log-rank test]). In the overall survival analysis, the addition of BEV did not reduce the risk of death (hazard ratio, 1.23; 95% CI, 0.72 to 2.09). More patients in the BEV plus RT+TMZ group versus the RT+TMZ group experienced one or more serious adverse events (n = 35 [58%] v n = 27 [48%]), and more patients who received BEV discontinued study treatment as a result of adverse events (n = 13 [22%] v n = 3 [5%]). Conclusion Adding BEV to RT+TMZ did not improve EFS in pediatric patients with newly diagnosed HGG. Our findings were not comparable to those of previous adult trials, which highlights the importance of performing pediatric-specific studies.
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Affiliation(s)
- Jacques Grill
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Maura Massimino
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Eric Bouffet
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Amedeo A Azizi
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Geoffrey McCowage
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Adela Cañete
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Frank Saran
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Marie-Cécile Le Deley
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Pascale Varlet
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Paul S Morgan
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Tim Jaspan
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Chris Jones
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Felice Giangaspero
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Helen Smith
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Josep Garcia
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Markus C Elze
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Raphaël F Rousseau
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Lauren Abrey
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Darren Hargrave
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
| | - Gilles Vassal
- Jacques Grill, Marie-Cécile Le Deley, and Gilles Vassal, Institut Gustave-Roussy, Villejuif; Marie-Cécile Le Deley, Paris-Saclay and Paris-Sud Universities, CESP, Institut National de la Santé et de la Recherche Médicale, Orsay; Pascale Varlet, Sainte-Anne Hospital, Paris, France; Maura Massimino, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan; Felice Giangaspero, Sapienza University, Rome; Felice Giangaspero, IRCCS Neuromed, Pozzilli, Italy; Eric Bouffet, Hospital for Sick Children, Toronto, Ontario, Canada; Amedeo A. Azizi, Medical University of Vienna, Vienna, Austria; Geoffrey McCowage, Australasian Children's Cancer Trials, Clayton, Victoria, Australia; Adela Cañete, Hospital La Fe, Valencia, Spain; Frank Saran, The Royal Marsden Hospital; Chris Jones, The Institute of Cancer Research; Darren Hargrave, Great Ormond Street Hospital, London; Paul S. Morgan and Tim Jaspan, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; Helen Smith, Josep Garcia, Markus C. Elze, and Lauren Abrey, F. Hoffmann-La Roche Ltd, Basel, Switzerland; and Raphaël F. Rousseau, Gritstone Oncology, Emeryville, CA
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14
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Sewing ACP, Lagerweij T, van Vuurden DG, Meel MH, Veringa SJE, Carcaboso AM, Gaillard PJ, Peter Vandertop W, Wesseling P, Noske D, Kaspers GJL, Hulleman E. Preclinical evaluation of convection-enhanced delivery of liposomal doxorubicin to treat pediatric diffuse intrinsic pontine glioma and thalamic high-grade glioma. J Neurosurg Pediatr 2017; 19:518-530. [PMID: 28291423 DOI: 10.3171/2016.9.peds16152] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Pediatric high-grade gliomas (pHGGs) including diffuse intrinsic pontine gliomas (DIPGs) are primary brain tumors with high mortality and morbidity. Because of their poor brain penetrance, systemic chemotherapy regimens have failed to deliver satisfactory results; however, convection-enhanced delivery (CED) may be an alternative mode of drug delivery. Anthracyclines are potent chemotherapeutics that have been successfully delivered via CED in preclinical supratentorial glioma models. This study aims to assess the potency of anthracyclines against DIPG and pHGG cell lines in vitro and to evaluate the efficacy of CED with anthracyclines in orthotopic pontine and thalamic tumor models. METHODS The sensitivity of primary pHGG cell lines to a range of anthracyclines was tested in vitro. Preclinical CED of free doxorubicin and pegylated liposomal doxorubicin (PLD) to the brainstem and thalamus of naïve nude mice was performed. The maximum tolerated dose (MTD) was determined based on the observation of clinical symptoms, and brains were analyzed after H & E staining. Efficacy of the MTD was tested in adult glioma E98-FM-DIPG and E98-FM-thalamus models and in the HSJD-DIPG-007-Fluc primary DIPG model. RESULTS Both pHGG and DIPG cells were sensitive to anthracyclines in vitro. Doxorubicin was selected for further preclinical evaluation. Convection-enhanced delivery of the MTD of free doxorubicin and PLD in the pons was 0.02 mg/ml, and the dose tolerated in the thalamus was 10 times higher (0.2 mg/ml). Free doxorubicin or PLD via CED was ineffective against E98-FM-DIPG or HSJD-DIPG-007-Fluc in the brainstem; however, when applied in the thalamus, 0.2 mg/ml of PLD slowed down tumor growth and increased survival in a subset of animals with small tumors. CONCLUSIONS Local delivery of doxorubicin to the brainstem causes severe toxicity, even at doxorubicin concentrations that are safe in the thalamus. As a consequence, the authors could not establish a therapeutic window for treating orthotopic brainstem tumors in mice. For tumors in the thalamus, therapeutic concentrations to slow down tumor growth could be reached. These data suggest that anatomical location determines the severity of toxicity after local delivery of therapeutic agents and that caution should be used when translating data from supratentorial CED studies to treat infratentorial tumors.
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Affiliation(s)
- A Charlotte P Sewing
- Departments of 1 Pediatric Oncology.,Neuro-Oncology Research Group.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam
| | - Tonny Lagerweij
- Neurosurgery, and.,Neuro-Oncology Research Group.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam
| | - Dannis G van Vuurden
- Departments of 1 Pediatric Oncology.,Neuro-Oncology Research Group.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam
| | - Michaël H Meel
- Departments of 1 Pediatric Oncology.,Neurosurgery, and.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam
| | - Susanna J E Veringa
- Departments of 1 Pediatric Oncology.,Neuro-Oncology Research Group.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam
| | - Angel M Carcaboso
- Preclinical Therapeutics and Drug Delivery Research Program, Department of Oncology, Hospital Sant Joan de Déu Barcelona, Spain
| | | | - W Peter Vandertop
- Neurosurgery, and.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam
| | - Pieter Wesseling
- Pathology.,Neuro-Oncology Research Group.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam.,2-BBB Medicines, Leiden.,Department of Pathology, RadboudUMC, Nijmegen
| | - David Noske
- Neurosurgery, and.,Neuro-Oncology Research Group.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam
| | - Gertjan J L Kaspers
- Neuro-Oncology Research Group.,Academy of Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands ; and
| | - Esther Hulleman
- Departments of 1 Pediatric Oncology.,Neuro-Oncology Research Group.,Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam
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15
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Greenfield JP, Castañeda Heredia A, George E, Kieran MW, Morales La Madrid A. Gliomatosis cerebri: A consensus summary report from the First International Gliomatosis cerebri Group Meeting, March 26-27, 2015, Paris, France. Pediatr Blood Cancer 2016; 63:2072-2077. [PMID: 27466787 DOI: 10.1002/pbc.26169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/01/2016] [Indexed: 02/02/2023]
Abstract
Gliomatosis cerebri (GC) is a universally fatal extensive and diffuse infiltration of brain parenchyma by a glial tumor. Many aspects of this phenomenon remain unknown. The First International Gliomatosis cerebri Group Meeting had the following goals: refine the clinical and radiologic diagnostic criteria for GC, suggest appropriate diagnostic procedures, standardize tissue manipulation for histologic and molecular characterization, and prioritize relevant preclinical projects. Also, general treatment recommendations were outlined for the pediatric population. Importantly, this meeting was the starting point for meaningful collaborative international research projects. This review is a consensus summary of discussions shared and conclusions derived from this meeting.
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Affiliation(s)
- Jeffrey P Greenfield
- Children's Brain Tumor Project, Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | | | - Emilie George
- Children's Brain Tumor Project, Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Mark W Kieran
- The Pediatric Brain Tumor Center, Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Andres Morales La Madrid
- Department of Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain. .,Division of Pediatric Neuro-Oncology, Department of Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain.
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16
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Jansen MHA, Lagerweij T, Sewing ACP, Vugts DJ, van Vuurden DG, Molthoff CFM, Caretti V, Veringa SJE, Petersen N, Carcaboso AM, Noske DP, Vandertop WP, Wesseling P, van Dongen GAMS, Kaspers GJL, Hulleman E. Bevacizumab Targeting Diffuse Intrinsic Pontine Glioma: Results of 89Zr-Bevacizumab PET Imaging in Brain Tumor Models. Mol Cancer Ther 2016; 15:2166-74. [PMID: 27325687 DOI: 10.1158/1535-7163.mct-15-0558] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 05/26/2016] [Indexed: 11/16/2022]
Abstract
The role of the VEGF inhibitor bevacizumab in the treatment of diffuse intrinsic pontine glioma (DIPG) is unclear. We aim to study the biodistribution and uptake of zirconium-89 ((89)Zr)-labeled bevacizumab in DIPG mouse models. Human E98-FM, U251-FM glioma cells, and HSJD-DIPG-007-FLUC primary DIPG cells were injected into the subcutis, pons, or striatum of nude mice. Tumor growth was monitored by bioluminescence imaging (BLI) and visualized by MRI. Seventy-two to 96 hours after (89)Zr-bevacizumab injections, mice were imaged by positron emission tomography (PET), and biodistribution was analyzed ex vivo High VEGF expression in human DIPG was confirmed in a publically available mRNA database, but no significant (89)Zr-bevacizumab uptake could be detected in xenografts located in the pons and striatum at an early or late stage of the disease. E98-FM, and to a lesser extent the U251-FM and HSJD-DIPG-007 subcutaneous tumors, showed high accumulation of (89)Zr-bevacizumab. VEGF expression could not be demonstrated in the intracranial tumors by in situ hybridization (ISH) but was clearly present in the perinecrotic regions of subcutaneous E98-FM tumors. The poor uptake of (89)Zr-bevacizumab in xenografts located in the brain suggests that VEGF targeting with bevacizumab has limited efficacy for diffuse infiltrative parts of glial brain tumors in mice. Translating these results to the clinic would imply that treatment with bevacizumab in patients with DIPG is only justified after targeting of VEGF has been demonstrated by (89)Zr-bevacizumab immuno-PET. We aim to confirm this observation in a clinical PET study with patients with DIPG. Mol Cancer Ther; 15(9); 2166-74. ©2016 AACR.
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Affiliation(s)
- Marc H A Jansen
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands
| | - Tonny Lagerweij
- Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands. Department of Neurosurgery VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
| | - A Charlotte P Sewing
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands
| | - Danielle J Vugts
- Department of Radiology & Nuclear Medicine VU University Medical Center, Amsterdam, the Netherlands
| | - Dannis G van Vuurden
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands
| | - Carla F M Molthoff
- Department of Radiology & Nuclear Medicine VU University Medical Center, Amsterdam, the Netherlands
| | - Viola Caretti
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands. Departments of Neurology, Pediatrics and Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Susanna J E Veringa
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands
| | - Naomi Petersen
- Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands
| | - Angel M Carcaboso
- Preclinical Therapeutics and Drug Delivery Research Program, Department of Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - David P Noske
- Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands. Department of Neurosurgery VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
| | - Pieter Wesseling
- Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands. Department of Pathology VU University Medical Center. Amsterdam, the Netherlands. Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guus A M S van Dongen
- Department of Radiology & Nuclear Medicine VU University Medical Center, Amsterdam, the Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands
| | - Esther Hulleman
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands.
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17
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Vanan MI, Eisenstat DD. DIPG in Children - What Can We Learn from the Past? Front Oncol 2015; 5:237. [PMID: 26557503 PMCID: PMC4617108 DOI: 10.3389/fonc.2015.00237] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 10/08/2015] [Indexed: 02/02/2023] Open
Abstract
Brainstem tumors represent 10–15% of pediatric central nervous system tumors and diffuse intrinsic pontine glioma (DIPG) is the most common brainstem tumor of childhood. DIPG is almost uniformly fatal and is the leading cause of brain tumor-related death in children. To date, radiation therapy (RT) is the only form of treatment that offers a transient benefit in DIPG. Chemotherapeutic strategies including multi-agent neoadjuvant chemotherapy, concurrent chemotherapy with RT, and adjuvant chemotherapy have not provided any survival advantage. To overcome the restrictive ability of the intact blood–brain barrier (BBB) in DIPG, several alternative drug delivery strategies have been proposed but have met with minimal success. Targeted therapies either alone or in combination with RT have also not improved survival. Five decades of unsuccessful therapies coupled with recent advances in the genetics and biology of DIPG have taught us several important lessons (1). DIPG is a heterogeneous group of tumors that are biologically distinct from other pediatric and adult high grade gliomas (HGG). Adapting chemotherapy and targeted therapies that are used in pediatric or adult HGG for the treatment of DIPG should be abandoned (2). Biopsy of DIPG is relatively safe and informative and should be considered in the context of multicenter clinical trials (3). DIPG probably represents a whole brain disease so regular neuraxis imaging is important at diagnosis and during therapy (4). BBB permeability is of major concern in DIPG and overcoming this barrier may ensure that drugs reach the tumor (5). Recent development of DIPG tumor models should help us accurately identify and validate therapeutic targets and small molecule inhibitors in the treatment of this deadly tumor.
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Affiliation(s)
- Magimairajan Issai Vanan
- Department of Pediatrics and Child Health, University of Manitoba , Winnipeg, MB , Canada ; Department of Biochemistry and Medical Genetics, University of Manitoba , Winnipeg, MB , Canada
| | - David D Eisenstat
- Department of Pediatrics, University of Alberta , Edmonton, AB , Canada ; Department of Medical Genetics, University of Alberta , Edmonton, AB , Canada ; Department of Oncology, University of Alberta , Edmonton, AB , Canada
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