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Golding R, Abuqubo R, Pansa CJ, Bhatta M, Shankar V, Mani K, Kleinbart E, Gelfand Y, Murthy S, De la Garza Ramos R, Krystal J, Eleswarapu A, Yassari R, Mostafa E, Fourman MS, Schlumprecht A. Immunologic and Targeted Molecular Therapies for Chordomas: A Narrative Review. J Clin Med 2024; 13:5679. [PMID: 39407739 PMCID: PMC11476405 DOI: 10.3390/jcm13195679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 09/17/2024] [Accepted: 09/20/2024] [Indexed: 10/20/2024] Open
Abstract
Chordomas are rare sarcomas arising from notochordal tissue and occur most commonly in the spine. The standard of care for chordomas without evidence of metastatic disease generally consists of en bloc resection followed by adjuvant radiotherapy. However, long-term (20-year) survival rates are approximately 30%. Chordomas are generally considered as chemo resistant. Therefore, systemic therapies have rarely been employed. Novel immunotherapies, including antibody therapy and tumor vaccines, have shown promise in early trials, leading to extended progression-free survival and symptom relief. However, the outcomes of larger trials using these vectors are heterogeneous. The aim of this review is to summarize novel chordoma treatments in immune-targeted therapies. The current merits, trial outcomes, and toxicities of these novel immune and targeted therapies, including those targeting vascular endothelial growth factor receptor (VEGFR) targets and the epidermal growth factor receptor (EGFR), will be discussed.
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Affiliation(s)
- Regina Golding
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (R.G.); (J.K.); (A.E.); (E.M.); (A.S.)
| | - Rami Abuqubo
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.A.); (C.J.P.); (M.B.); (V.S.); (K.M.); (E.K.)
| | - Christopher J. Pansa
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.A.); (C.J.P.); (M.B.); (V.S.); (K.M.); (E.K.)
| | - Manish Bhatta
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.A.); (C.J.P.); (M.B.); (V.S.); (K.M.); (E.K.)
| | - Vishal Shankar
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.A.); (C.J.P.); (M.B.); (V.S.); (K.M.); (E.K.)
| | - Kyle Mani
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.A.); (C.J.P.); (M.B.); (V.S.); (K.M.); (E.K.)
| | - Emily Kleinbart
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.A.); (C.J.P.); (M.B.); (V.S.); (K.M.); (E.K.)
| | - Yaroslav Gelfand
- Department of Neurological Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (Y.G.); (S.M.); (R.D.l.G.R.); (R.Y.)
| | - Saikiran Murthy
- Department of Neurological Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (Y.G.); (S.M.); (R.D.l.G.R.); (R.Y.)
| | - Rafael De la Garza Ramos
- Department of Neurological Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (Y.G.); (S.M.); (R.D.l.G.R.); (R.Y.)
| | - Jonathan Krystal
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (R.G.); (J.K.); (A.E.); (E.M.); (A.S.)
| | - Ananth Eleswarapu
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (R.G.); (J.K.); (A.E.); (E.M.); (A.S.)
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (Y.G.); (S.M.); (R.D.l.G.R.); (R.Y.)
| | - Evan Mostafa
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (R.G.); (J.K.); (A.E.); (E.M.); (A.S.)
| | - Mitchell S. Fourman
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (R.G.); (J.K.); (A.E.); (E.M.); (A.S.)
| | - Anne Schlumprecht
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY 10461, USA; (R.G.); (J.K.); (A.E.); (E.M.); (A.S.)
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Cheng P, Xie X, Knoedler S, Mi B, Liu G. Predicting overall survival in chordoma patients using machine learning models: a web-app application. J Orthop Surg Res 2023; 18:652. [PMID: 37660044 PMCID: PMC10474690 DOI: 10.1186/s13018-023-04105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/16/2023] [Indexed: 09/04/2023] Open
Abstract
OBJECTIVE The goal of this study was to evaluate the efficacy of machine learning (ML) techniques in predicting survival for chordoma patients in comparison with the standard Cox proportional hazards (CoxPH) model. METHODS Using a Surveillance, Epidemiology, and End Results database of consecutive newly diagnosed chordoma cases between January 2000 and December 2018, we created and validated three ML survival models as well as a traditional CoxPH model in this population-based cohort study. Randomly, the dataset was divided into training and validation datasets. Tuning hyperparameters on the training dataset involved a 1000-iteration random search with fivefold cross-validation. Concordance index (C-index), Brier score, and integrated Brier score were used to evaluate the performance of the model. The receiver operating characteristic (ROC) curves, calibration curves, and area under the ROC curves (AUC) were used to assess the reliability of the models by predicting 5- and 10-year survival probabilities. RESULTS A total of 724 chordoma patients were divided into training (n = 508) and validation (n = 216) cohorts. Cox regression identified nine significant prognostic factors (p < 0.05). ML models showed superior performance over CoxPH model, with DeepSurv having the highest C-index (0.795) and the best discrimination for 5- and 10-year survival (AUC 0.84 and 0.88). Calibration curves revealed strong correlation between DeepSurv predictions and actual survival. Risk stratification by DeepSurv model effectively discriminated high- and low-risk groups (p < 0.01). The optimized DeepSurv model was implemented into a web application for clinical use that can be found at https://hust-chengp-ml-chordoma-app-19rjyr.streamlitapp.com/ . CONCLUSION ML algorithms based on time-to-event results are effective in chordoma prediction, with DeepSurv having the best discrimination performance and calibration.
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Affiliation(s)
- Peng Cheng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Xudong Xie
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Samuel Knoedler
- Department of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02215, USA
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, Hubei, China.
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, Hubei, China.
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Walhart TA, Vacca B, Hepperla AJ, Hamad SH, Petrongelli J, Wang Y, McKean EL, Moksa M, Cao Q, Yip S, Hirst M, Weissman BE. SMARCB1 Loss in Poorly Differentiated Chordomas Drives Tumor Progression. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:456-473. [PMID: 36657718 PMCID: PMC10123523 DOI: 10.1016/j.ajpath.2022.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023]
Abstract
Poorly differentiated (PD) chordoma, a rare, aggressive tumor originating from notochordal tissue, shows loss of SMARCB1 expression, a core component of the Switch/Sucrose Non-Fermentable (SWI/SNF) chromatin remodeling complexes. To determine the impact of SMARCB1 re-expression on cell growth and gene expression, two SMARCB1-negative PD chordoma cell lines with an inducible SMARCB1 expression system were generated. After 72 hours of induction of SMARCB1, both SMARCB1-negative PD chordoma cell lines continued to proliferate. This result contrasted with those observed with SMARCB1-negative rhabdoid cell lines in which SMARCB1 re-expression caused the rapid inhibition of growth. We found that the lack of growth inhibition may arise from the loss of CDKN2A (p16INK4A) expression in PD chordoma cell lines. RNA-sequencing of cell lines after SMARCB1 re-expression showed a down-regulation for rRNA and RNA processing as well as metabolic processing and increased expression of genes involved in cell adhesion, cell migration, and development. Taken together, these data establish that SMARCB1 re-expression in PD chordomas alters the repertoire of SWI/SNF complexes, perhaps restoring those associated with cellular differentiation. These novel findings support a model in which SMARCB1 inactivation blocks the conversion of growth-promoting SWI/SNF complexes to differentiation-inducing ones, and they implicate SMARCB1 loss as a late event in tumorigenic progression. Importantly, the absence of growth inhibition after SMARCB1 restoration creates a unique opportunity to identify therapeutic vulnerabilities.
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Affiliation(s)
- Tara A Walhart
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Bryanna Vacca
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Austin J Hepperla
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Samera H Hamad
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - James Petrongelli
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Yemin Wang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Erin L McKean
- Department of Otolaryngology and Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Michelle Moksa
- Department of Microbiology & Immunology, Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada; Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, British Columbia, Canada
| | - Qi Cao
- Department of Microbiology & Immunology, Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada; Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, British Columbia, Canada
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Martin Hirst
- Department of Microbiology & Immunology, Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada; Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, British Columbia, Canada
| | - Bernard E Weissman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
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Vanderheijden C, Vaessen T, Yakkioui Y, Riedl R, Temel Y, Hovinga K, Hoogland G. LIM and SH3 protein 1 (LASP1) differentiates malignant chordomas from less malignant chondrosarcomas. J Neurooncol 2022; 158:81-88. [PMID: 35507100 PMCID: PMC9166821 DOI: 10.1007/s11060-022-04012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Chordomas are malignant tumors that develop along the neuraxis between skull-base and sacrum. Chondrosarcomas show similarities with chordomas, yet show less malignant behavior. LIM and SH3 protein 1 (LASP1) is a cytoskeletal protein known to promote the malignant behavior of tumors. LASP1 was previously identified as a possibly overexpressed protein in a chordoma proteomics experiment. In this study we compare LASP1 expression in chordoma and chondrosarcoma tissue. METHODS Biopsies of primary tumors were collected from surgically treated chordoma (n = 6) and chondrosarcoma (n = 6) patients, flash-frozen upon collection and collectively analyzed for LASP1 RNA (real-time PCR) and protein expression (western blotting). Additionally, tissue micro array (TMA)-based immunohistochemistry was applied to an archive of 31 chordoma and 1 chondrosarcoma specimen. RESULTS In chordoma samples, LASP1 mRNA was detected in 4/6 cases and a strong 36 kDa immunoreactive protein band was observed in 4/5 cases. In contrast, 0/6 chondrosarcoma samples showed detectable levels of LASP1 mRNA and only a weak 36 kDa band was observed in 4/5 cases. Immunohistochemical analysis showed LASP1 expression in all chordoma samples, whereas chondrosarcoma specimen did not show immunoreactivity. CONCLUSION LASP1 is strongly expressed in the majority of chordoma cases and shows low expression in chondrosarcoma tissue. Since LASP1 is known to function as oncogene and regulate cell proliferation in other tumor types, this study implicates a role for LASP1 in chordoma biology. Further studies are warranted to improve understanding of LASP1's expression and functioning within chordoma, both in vitro and in vivo.
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Affiliation(s)
- Cas Vanderheijden
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Thomas Vaessen
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Youssef Yakkioui
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurosurgery, Noordwest Hospital, Alkmaar, The Netherlands
| | - Robert Riedl
- Department of Pathology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Koos Hovinga
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
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