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Gelderblom H, Razak AA, Taylor MH, Bauer TM, Wilky B, Martin-Broto J, Gonzalez AF, Rutkowski P, Szostakowski B, Alcindor T, Saleh R, Genta S, Stacchiotti S, van de Sande M, Wagner AJ, Bernthal N, Davis LE, Vuky J, Tait C, Matin B, Narasimhan S, Sharma MG, Ruiz-Soto R, Sherman ML, Tap WD. CSF1R Inhibition in Patients with Advanced Solid Tumors or Tenosynovial Giant Cell Tumor: A Phase I Study of Vimseltinib. Clin Cancer Res 2024; 30:3996-4004. [PMID: 38995311 PMCID: PMC11393540 DOI: 10.1158/1078-0432.ccr-24-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/15/2024] [Accepted: 07/10/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Tenosynovial giant cell tumor (TGCT) is a locally aggressive neoplasm caused by dysregulation of the colony-stimulating factor 1 (CSF1) gene and overexpression of the CSF1 ligand. Surgery is the standard of care for most patients, but there are limited treatment options for patients with TGCT not amenable to surgery. This study evaluates vimseltinib, an investigational, oral, switch-control tyrosine kinase inhibitor designed to selectively and potently inhibit the CSF1 receptor. PATIENTS AND METHODS This first-in-human, multicenter, open-label phase I/II study of vimseltinib in patients with malignant solid tumors (N = 37) or TGCT not amenable to surgery (N = 32) followed a pharmacologically guided 3 + 3 study design (NCT03069469). The primary objectives were to assess safety and tolerability, determine the recommended phase II dose, and characterize the pharmacokinetics; exploratory objectives included pharmacodynamics and efficacy. RESULTS Vimseltinib was well tolerated; the majority of non-laboratory treatment-emergent adverse events were of grade 1/2 severity. There was no evidence of cholestatic hepatotoxicity or drug-induced liver injury. The recommended phase II dose was determined to be 30 mg twice weekly (no loading dose), and vimseltinib plasma exposure increased with the dose. In patients with TGCT, the median treatment duration was 25.1 months (range, 0.7-46.9), and the objective response rate as assessed by independent radiological review using RECIST version 1.1 was 72%. CONCLUSIONS Vimseltinib demonstrated long-term tolerability, manageable safety, dose-dependent exposure, and robust antitumor activity in patients with TGCT not amenable to surgery.
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Affiliation(s)
| | | | - Matthew H. Taylor
- Earle A. Chiles Research Institute, Providence Medical Center, Portland, Oregon.
| | | | - Breelyn Wilky
- University of Colorado Cancer Center, Aurora, Colorado.
| | - Javier Martin-Broto
- Fundación Jiménez Díaz University Hospital, University Hospital General de Villalba, Instituto de Investigactión Sanitaria Fundación Jiménez Díaz (IIS, FJD, UAM), Madrid, Spain.
| | | | - Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland.
| | | | - Thierry Alcindor
- McGill University Health Centre Research Institute, Montreal, Canada.
| | - Ramy Saleh
- McGill University Health Centre Research Institute, Montreal, Canada.
| | - Sofia Genta
- Princess Margaret Cancer Center, Toronto, Canada.
| | | | | | | | | | | | | | | | - Bahar Matin
- Deciphera Pharmaceuticals, LLC, Waltham, Massachusetts.
| | | | | | | | | | - William D. Tap
- Memorial Sloan Kettering Cancer Center, New York, New York.
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Rungsiprakarn P, Ryan AL, Wong DD, Luo M, Kazahaya K, Arkader A, Lau LMS, Ajuyah P, Rudzinski E, Kreiger PA, Roebuck DJ, Surrey LF, Foo TSY. Keratin-Positive Giant Cell Tumor of Bone and Soft Tissue With HMGA2::NCOR2 Fusion in Children Under 10 With Response to Imatinib Therapy: A Case Series. JCO Precis Oncol 2024; 8:e2300659. [PMID: 38935896 DOI: 10.1200/po.23.00659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 06/29/2024] Open
Abstract
HMGA2::NCOR2 keratin-positive giant cell tumors in children with response to imatinib in an infant.
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Affiliation(s)
- Phassawan Rungsiprakarn
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Anne L Ryan
- Department of Hematology, Oncology and Bone Marrow Transplant, Perth Children's Hospital, Nedlands, Australia
- Telethon Kids Insitute, University of Western Australia, Nedlands, Australia
| | - Daniel D Wong
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Australia
| | - Minjie Luo
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alexandre Arkader
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Loretta M S Lau
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, Australia
| | | | - Erin Rudzinski
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA
| | - Portia A Kreiger
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Derek J Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, Australia
- Division of Pediatrics, Medical School, University of Western Australia, Crawley, Australia
| | - Lea F Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Tiffany S Y Foo
- PathWest Laboratory Medicine, Perth Children's Hospital, Nedlands, WA, Australia
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3
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Bernthal NM, Healey JH, Palmerini E, Bauer S, Schreuder H, Leithner A, Martin-Broto J, Gouin F, Lopez-Bastida J, Gelderblom H, Staals EL, Burke ZD, Geiger EJ, Spierenburg G, Laeis P, Beyerlein E, Ye X, van de Sande M. A prospective real-world study of the diffuse-type tenosynovial giant cell tumor patient journey: A 2-year observational analysis. J Surg Oncol 2022; 126:1520-1532. [PMID: 36006054 DOI: 10.1002/jso.27067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/18/2022] [Accepted: 08/06/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Diffuse-tenosynovial giant cell tumor (D-TGCT) is a rare, locally aggressive, typically benign neoplasm affecting mainly large joints, representing a wide clinical spectrum. We provide a picture of the treatment journey of D-TGCT patients as a 2-year observational follow-up. METHODS The TGCT Observational Platform Project registry was a multinational, multicenter, prospective observational study at tertiary sarcoma centers spanning seven European countries and two US sites. Histologically confirmed D-TGCT patients were categorized as either those who remained on initial treatment strategy (determined at baseline visit) or those who changed treatment strategy with specific changes documented (e.g., systemic treatment to surgery) at the 1-year and/or 2-year follow-up visits. RESULTS A total of 176 patients were assessed, mean diagnosis age was 38.4 (SD ± 14.6) years; most patients had a knee tumor (120/176, 68.2%). For the 2-year observation period, most patients (75.5%) remained on the baseline treatment strategy throughout, 54/79 patients (68.4%) remained no treatment, 30/45 patients (66.7%) remained systemic treatment, 39/39 patients (100%) remained surgery. Those who changed treatment strategy utilized multimodal treatment options. CONCLUSIONS This is the first prospectively collected analysis to describe D-TGCT patient treatments over an extended follow-up and demonstrates the need for multidisciplinary teams to determine an optimal treatment strategy.
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Affiliation(s)
- Nicholas M Bernthal
- Division of Musculoskeletal Oncology, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - John H Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innoviative Therapies Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Hendrik Schreuder
- Department of Orthopaedics, Radboud University, Nijmegen, The Netherlands
| | - Andreas Leithner
- Deptartment of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Javier Martin-Broto
- Oncology Department, Fundacíon Jiménez Díaz University Hospital, Madrid, Spain
| | - Francois Gouin
- Department of Surgery, Onco-Orthopedic, Centre Léon Bérard, Lyon, France
| | - Julio Lopez-Bastida
- Faculty of Health Sciences, University Castilla-La Mancha, Talavera de la Reina, Spain
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eric L Staals
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Zachary D Burke
- Division of Musculoskeletal Oncology, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Erik J Geiger
- Division of Musculoskeletal Oncology, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Geert Spierenburg
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra Laeis
- Clinical Operations, Daiichi Sankyo Europe GMbH, Munich, Germany
| | - Elisabeth Beyerlein
- Biostatistics & Data Management, Daiichi Sankyo Europe GMbH, Munich, Germany
| | - Xin Ye
- Global Specialty Value, Access & Pricing, Daiichi Sankyo, Inc., Basking Ridge, New Jersey, USA
| | - Michiel van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Smith SC, Snyder GM. Orthopedic management of a patient with pigmented villonodular synovitis. JAAPA 2022; 35:1-4. [PMID: 36282584 DOI: 10.1097/01.jaa.0000885160.53208.1d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Pigmented villonodular synovitis (PVNS), sometimes also called tenosynovial giant cell tumor, is a rare, slow-growing, benign soft-tissue disorder. PVNS most commonly affects the knee and is associated with painful hemarthrosis and joint swelling. The condition also can affect the hip, ankle, shoulder, or elbow. This article reviews practice guidelines for PVNS, diagnosis, and surgical and nonsurgical treatments.
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Affiliation(s)
- Shawn C Smith
- Shawn C. Smith and Garrett M. Snyder practice orthopedics at Banner Health's Skyline Medical Pavilion in Loveland, Colo. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Huang WP, Gao G, Yang Q, Chen Z, Qiu YK, Gao JB, Kang L. Malignant giant cell tumors of the tendon sheath of the right hip: A case report. World J Clin Cases 2022; 10:10763-10771. [PMID: 36312472 PMCID: PMC9602230 DOI: 10.12998/wjcc.v10.i29.10763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malignant giant cell tumor of the tendon sheath (MGCTTS) is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively. How to systemically treat MGCTTS remains a challenge. In this case, a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy, but the treatment outcome remained poor. More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.
CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago. Two months before his attending to hospital, the patient's pain worsened, presenting as severe pain when standing or walking, limping, and inability to straighten or move the right lower extremity. Surgical excision was performed and MGCTTS was confirmed by pathology examination. Two recurrences occurred after surgical resection, moreover, the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy. The patient died only 10 mo after the initial diagnosis.
CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion. It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue, with a stubborn tendency to relapse, as well as pulmonary metastasis. Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint. Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.
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Affiliation(s)
- Wen-Peng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Ge Gao
- Department of Medical Imaging, Peking University First Hospital, Beijing 100034, China
| | - Qi Yang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Zhao Chen
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Yong-Kang Qiu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
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Thirasastr P, Brahmi M, Dufresne A, Somaiah N, Blay JY. New Drug Approvals for Sarcoma in the Last 5 Years. Surg Oncol Clin N Am 2022; 31:361-380. [PMID: 35715139 DOI: 10.1016/j.soc.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sarcoma and locally aggressive connective tissue tumors are a complex group of diseases with a growing number of histotypes in the most recent WHO classification. Most of these tumors are rare (incidence <6/105/y) or ultrarare (<1/106/y). Despite their rarity, sarcomas are often good models for the development of personalized medicine, and a large number of new clinical trials in select histotypes and molecular subsets were reported during the past 5 years, leading to a faster rate of new drug approvals. We analyzed the published literature and the abstracts reported in major congresses dedicated to sarcoma and connective tissue tumor management in the last 5 years. Several targeted therapies, cytotoxic treatments, and immunotherapies have demonstrated activity in dedicated histologic and molecular subtypes of sarcomas. The majority of the studies for ultrarare entities are uncontrolled studies, as a consequence of the rarity of histotypes, but randomized controlled trials were available in the less rare histotypes. Most successful trials were based on biomarker selection, which were often driver molecular alterations, while a large number of ongoing research programs aim to identify biomarkers in parallel to new drug development. Availability of the new agents varies across countries. This article describes the new drugs that made it through to the finish line and new agents with promising activity that are in later stages of investigation in the large family of malignant connective tissue tumors.
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Affiliation(s)
- Prapassorn Thirasastr
- University of Texas M D Anderson Cancer Center, 1400 Holcombe Blvd., Unit 450, Houston, TX-77030, USA
| | - Mehdi Brahmi
- CLCC Léon Bérard, 28 Rue Laënnec, 69373 LYON CEDEX 8, FRANCE
| | | | - Neeta Somaiah
- University of Texas M D Anderson Cancer Center, 1400 Holcombe Blvd., Unit 450, Houston, TX-77030, USA.
| | - Jean-Yves Blay
- CLCC Léon Bérard, 28 Rue Laënnec, 69373 LYON CEDEX 8, FRANCE.
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7
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Abstract
PURPOSE OF REVIEW Diffuse-type tenosynovial giant cell tumor (dt-TGCT) is a benign clonal neoplastic proliferation arising from the synovium. Patients are often symptomatic, require multiple surgical procedures during their lifetime, and have reduced quality of life (QoL). Surgery is the main treatment with relapse rates ranging from 14 to 55%. The treatment strategy for patients with dt-TGCT is evolving. The purpose of this review is to describe current treatment options, and to highlight recent developments in the knowledge of the molecular pathogenesis of dt-TGCT as well as related therapeutic implications. RECENT FINDINGS TGCT cells overexpress colony-stimulating factor 1 (CSF1), resulting in recruitment of CSF1 receptor (CSF1R)-bearing macrophages that are polyclonal and make up the bulk of the tumor, has led to clinical trials with CSF1R inhibitors. These inhibitors include small molecules such as pexidatinib, imatinib, nilotinib, DCC-3014 (vimseltinib), and the monoclonal antibody RG7155 (emactuzumab). SUMMARY In conclusion, D-TGCT impairs patients' QoL. The evidence that the pathogenetic loop of D-TGCT can be inhibited has changed the therapeutic armamentarium for this condition. Clinical trials of agents that target CSF1R are currently ongoing. All this new evidence should be taken into consideration within multidisciplinary management.
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Spierenburg G, van der Heijden L, van Langevelde K, Szuhai K, Bovée JVGM, van de Sande MAJ, Gelderblom H. Tenosynovial giant cell tumors (TGCT): molecular biology, drug targets and non-surgical pharmacological approaches. Expert Opin Ther Targets 2022; 26:333-345. [PMID: 35443852 DOI: 10.1080/14728222.2022.2067040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Tenosynovial giant cell tumor (TGCT) is a mono-articular, benign or locally aggressive and often debilitating neoplasm. Systemic therapies are becoming part of the multimodal armamentarium when surgery alone will not confer improvements. Since TGCT is characterized by colony-stimulating factor-1 (CSF1) rearrangements, the most studied molecular pathway is the CSF1 and CSF1 receptor (CSF1R) axis. Inhibiting CSF1-CSF1R interaction often yields considerable radiological and clinical responses; however, adverse events may cause treatment discontinuation because of an unfavorable risk-benefit ratio in benign disease. Only Pexidartinib is approved by the US FDA; however, the European Medicines Agency has not approved it due to uncertainties on the risk-benefit ratio. Thus, there is a need for safer and effective therapies. AREAS COVERED Light is shed on disease mechanisms and potential drug targets. The safety and efficacy of different systemic therapies are evaluated. EXPERT OPINION The CSF1-CSF1R axis is the principal drug target; however, the effect of CSF1R inhibition on angiogenesis and the role of macrophages, which are essential in the postoperative course, needs further elucidation. Systemic therapies have a promising role in treating mainly diffuse-type, TGCT patients who are not expected to clinically improve from surgery. Future drug development should focus on targeting neoplastic TGCT cells.
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Affiliation(s)
- Geert Spierenburg
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Karoly Szuhai
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith V G M Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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9
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Peterfy C, Chen Y, Countryman P, Chmielowski B, Anthony SP, Healey JH, Wainberg ZA, Cohn AL, Shapiro GI, Keedy VL, Singh A, Puzanov I, Wagner AJ, Qian M, Sterba M, Hsu HH, Tong-Starksen S, Tap WD. CSF1 receptor inhibition of tenosynovial giant cell tumor using novel disease-specific MRI measures of tumor burden. Future Oncol 2022; 18:1449-1459. [PMID: 35040698 PMCID: PMC11197039 DOI: 10.2217/fon-2021-1437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: Monitoring treatment of tenosynovial giant cell tumor (TGCT) is complicated by the irregular shape and asymmetrical growth of the tumor. We compared responses to pexidartinib by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 with those by tumor volume score (TVS) and modified RECIST (m-RECIST). Materials & methods: MRIs acquired every two cycles were assessed centrally using RECIST 1.1, m-RECIST and TVS and tissue damage score (TDS). Results: Thirty-one evaluable TGCT patients were treated with pexidartinib. From baseline to last visit, 94% of patients (29/31) showed a decrease in tumor size (median change: -60% [RECIST], -66% [m-RECIST], -79% [TVS]). All methods showed 100% disease control rate. For TDS, improvements were seen in bone erosion (32%), bone marrow edema (58%) and knee effusion (46%). Conclusion: TVS and m-RECIST offer potentially superior alternatives to conventional RECIST for monitoring disease progression and treatment response in TGCT. TDS adds important information about joint damage associated with TGCT.
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Affiliation(s)
| | - Yan Chen
- Spire Sciences, Inc., Boca Raton,
FL, USA
| | | | - Bartosz Chmielowski
- University of California Los Angeles, Jonsson Comprehensive Cancer Center,
Los Angeles, CA90095, USA
| | | | - John H Healey
- Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College,
New York, NY10065, USA
| | | | - Allen L Cohn
- Rocky Mountain Cancer Centers,
Denver, CO80216, USA
| | - Geoffrey I Shapiro
- Dana–Farber Cancer Institute & Harvard Medical School,
Boston, MA02215, USA
| | - Vicki L Keedy
- Vanderbilt University Medical Center,
Nashville, TN37235, USA
| | - Arun Singh
- UCLA Medical Center,
Santa Monica, CA90404, USA
| | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center,
Buffalo, NY14203, USA
| | - Andrew J Wagner
- Dana–Farber Cancer Institute & Harvard Medical School,
Boston, MA02215, USA
| | - Meng Qian
- Daiichi Sankyo, Inc.,
Basking Ridge, NJ07920, USA
| | - Mike Sterba
- Plexxikon Inc.,
South San Francisco,
CA94080, USA
| | - Henry H Hsu
- Plexxikon Inc.,
South San Francisco,
CA94080, USA
| | | | - William D Tap
- Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College,
New York, NY10065, USA
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10
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Robert M, Farese H, Miossec P. Update on Tenosynovial Giant Cell Tumor, an Inflammatory Arthritis With Neoplastic Features. Front Immunol 2022; 13:820046. [PMID: 35265077 PMCID: PMC8899011 DOI: 10.3389/fimmu.2022.820046] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/03/2022] [Indexed: 12/28/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to joint destruction and bone erosion. Even if many treatments were developed with success in the last decades, some patients fail to respond, and disease chronicity is still a burden. Mechanisms involved in such resistance may include molecular changes in stromal cells. Other explanations can come from observations of tenosynovial giant cell tumor (TGCT), first considered as an inflammatory arthritis, but with unusual neoplastic features. TGCT leads to synovium hypertrophy and hyperplasia with hemosiderin deposition. It affects young adults, resulting in secondary osteoarthritis and increased morbidity. TGCT shows clinical, histological and genetic similarities with RA but affecting a single joint. However, the monoclonality of some synoviocytes, the presence of translocations and rare metastases also suggest a neoplastic disease, with some features common with sarcoma. TGCT is more probably in an intermediate situation between an inflammatory and a neoplastic process, with a main involvement of the proinflammatory cytokine CSF-1/CSF1R signaling axis. The key treatment option is surgery. New treatments, derived from the RA and sarcoma fields, are emerging. The tyrosine kinase inhibitor pexidartinib was recently FDA-approved as the first drug for severe TGCT where surgery is not an option. Options directly targeting the excessive proliferation of synoviocytes are at a preclinical stage.
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Affiliation(s)
| | | | - Pierre Miossec
- Department of Clinical Immunology and Rheumatology, and Immunogenomics and Inflammation Research Unit, University of Lyon, Hôpital Edouard Herriot, Lyon, France
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11
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Dalla-Torre R, Crenn V, Menu P, Isidor B, Guillot P, Le Goff B, Geffroy L, Dauty M, Fouasson-Chailloux A. Imatinib, a New Adjuvant Medical Treatment for Multifocal Villonodular Synovitis Associated to Noonan Syndrome: A Case Report and Literature Review. Front Med (Lausanne) 2022; 8:817873. [PMID: 35111788 PMCID: PMC8802824 DOI: 10.3389/fmed.2021.817873] [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] [Received: 11/18/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Noonan syndrome (NS) is an autosomal dominant multisystem disorder caused by the dysregulation of the Rat Sarcoma/Mitogen-activated protein kinase (RAS/MAPK) pathway and characterized by short stature, heart defects, pectus excavatum, webbed neck, learning disabilities, cryptorchidism, and facial dysmorphia. Villonodular synovitis is a joint disorder most common in young adults characterized by an abnormal proliferation of the synovial membrane. Multifocal Villonodular synovitis is a rare disease whose recurrent nature can make its management particularly difficult. Currently, there is no systemic therapy recommended in diffuse and recurrent forms, especially because of the fear of long-term side effects in patients, who are usually young. Yet, tyrosine kinase inhibitors seem promising to reduce the effects of an aberrant colony stimulating factor-1 (CSF-1) production at the origin of the synovial nodule proliferation. We present here the case of a 21-year-old woman with NS associated to diffuse multifocal villonodular synovitis (DMVS). Our clinical case provides therapeutic experience in this very rare association. Indeed, in association with surgery, the patient improved considerably: she had complete daily life autonomy, knee joint amplitudes of 100° in flexion and 0° in extension and was able to walk for 10 min without any technical assistance. To our knowledge, this is the first case of a patient suffering from DMVS associated with a Noonan syndrome treated with Glivec® (oral administration at a dosage of 340 mg/m2 in children, until disease regression) on a long-term basis.
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Affiliation(s)
- Romain Dalla-Torre
- CHU Nantes, Service de Médecine Physique et de Réadaptation Locomotrice, University Hospital of Nantes, Nantes, France
- CHU Nantes, Service de Rhumatologie, University Hospital of Nantes, Nantes, France
| | - Vincent Crenn
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, Nantes, France
| | - Pierre Menu
- CHU Nantes, Service de Médecine Physique et de Réadaptation Locomotrice, University Hospital of Nantes, Nantes, France
- CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton – Nantes University, Nantes, France
- IRMS, Institut Régional de Médecine du Sport, Hôpital Saint Jacques, Nantes, France
| | - Bertrand Isidor
- CHU Nantes, Service de Génétique Médicale, University Hospital of Nantes, Nantes, France
| | - Pascale Guillot
- CHU Nantes, Service de Rhumatologie, University Hospital of Nantes, Nantes, France
| | - Benoit Le Goff
- CHU Nantes, Service de Rhumatologie, University Hospital of Nantes, Nantes, France
| | - Loic Geffroy
- Chirurgie Orthopédique, Santé Atlantique, Saint Herblain, France
| | - Marc Dauty
- CHU Nantes, Service de Médecine Physique et de Réadaptation Locomotrice, University Hospital of Nantes, Nantes, France
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, Nantes, France
- CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton – Nantes University, Nantes, France
| | - Alban Fouasson-Chailloux
- CHU Nantes, Service de Médecine Physique et de Réadaptation Locomotrice, University Hospital of Nantes, Nantes, France
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, Nantes, France
- CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton – Nantes University, Nantes, France
- *Correspondence: Alban Fouasson-Chailloux
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12
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Zheng K, Yu XC, Hu YC, Xu M, Zhang JY. A New Simple and Practical Clinical Classification for Tenosynovial Giant Cell Tumors of the Knee. Orthop Surg 2021; 14:290-297. [PMID: 34914180 PMCID: PMC8867407 DOI: 10.1111/os.13179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To propose a simple and practical clinical classification for tenosynovial giant cell tumor (TGCT) of the knee. Methods A retrospective study was conducted to verify the value and significance of this clinical classification. TGCT growth patterns, knee joint capsule, and bone erosion were applied to establish this novel clinical classification. Seventy‐eight patients who underwent surgery for TGCT from 2008 to 2016 were identified. This novel clinical classification was retrospectively applied to patients' existing classification, and patients with different TGCT types were statistically compared to verify the significance of the clinical classification. Results The clinical classification included three types and four subtypes. Type 1: localized TGCT, Subtype 1a: localized intra‐articular TGCT, Subtype 1b: localized extra‐articular TGCT. Type 2: diffuse TGCT, Subtype 2a: diffuse intra‐articular TGCT with bone normal, Subtype 2b: diffuse intra‐articular TGCT with bone destruction. Type 3: diffuse TGCT across the knee joint capsule. The mean follow‐up time for the 78 patients was 59.6 months. Twenty‐one patients were in Subtype 1a, four were Subtype 1b, 38 were Subtype 2a, seven were Subtype 2b, and eight were Type 3. Oncological results and surgical complications differed significantly (P = 0.000, P = 0.000). The mean Musculoskeletal Tumor Society functional scores differed significantly at 27.8 for Type 1 patients, 22.9 for Type 2 patients, and 17.0 for Type 3 patients (P = 0.000). Conclusions This clinical classification can be easily used to evaluate TGCT of all knees prior to surgery or other treatments and can help determine surgical options.
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Affiliation(s)
- Kai Zheng
- Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistice Support Force, Jinan, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistice Support Force, Jinan, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Ming Xu
- Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistice Support Force, Jinan, China
| | - Jing-Yu Zhang
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
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13
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Yuan J, Li X, Yu S. Molecular targeted therapy for advanced or metastatic soft tissue sarcoma. Cancer Control 2021; 28:10732748211038424. [PMID: 34844463 PMCID: PMC8727831 DOI: 10.1177/10732748211038424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Soft tissue sarcomas are a form of rare and heterogeneous neoplasms with high recurrence rate and mortality. Over the past decades, less progress has been achieved. Surgical management with or without adjuvant/neoadjuvant radiotherapy is still the first-line treatment for localized soft tissue sarcomas, and chemotherapy is the additional option for those with high-risk. However, not all patients with advanced or metastatic soft tissue sarcomas benefit from conventional chemotherapy, targeted therapy takes the most relevant role in the management of those resistant to or failed to conventional chemotherapy. Heterogeneous soft tissue sarcomas vary from biological behavior, genetic mutations, and clinical presentation with a low incidence, indicating the future direction of histotype-based even molecule-based personalized therapy. Furthermore, increasing preclinical studies were carried out to investigate the pathogenesis and potential therapeutic targets of soft tissue sarcomas and increasing new drugs have been developed in recent years, which had started opening new doors for clinical treatment for patients with advanced/metastatic soft tissue sarcomas. Here we sought to summarize the concise characteristics and advance in the targeted therapy for the most common subtypes of soft tissue sarcomas.
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Affiliation(s)
- Jin Yuan
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Li
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengji Yu
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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14
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Sbaraglia M, Gambarotti M, Businello G, Righi A, Fassan M, Dei Tos AP. Intra-Articular Tumors. Surg Pathol Clin 2021; 14:665-677. [PMID: 34742486 DOI: 10.1016/j.path.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The intra-articular space is a relatively rare site of occurrence of neoplastic diseases. The 2 distinct groups of clinicopathologic entities that exhibit an almost exclusive tropism for the joints are represented by synovial chondromatosis and tenosynovial giant cell tumors (TGCT). Synovial chondromatosis is a locally aggressive chondrogenic neoplasm that very rarely can show malignant behavior. TGCT occur in 2 main variants, the localized variant and the more locally aggressive diffuse type. Malignant TCGT is exceedingly rare and is characterized by significant rates of both local recurrence and metastatic spread.
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Affiliation(s)
- Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy; Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Marco Gambarotti
- Unit of Surgical Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianluca Businello
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy; Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Alberto Righi
- Unit of Surgical Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Fassan
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy; Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Angelo P Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy; Department of Medicine, University of Padua School of Medicine, Padua, Italy.
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15
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Uncommon and peculiar soft tissue sarcomas: Multidisciplinary review and practical recommendations. Spanish Group for Sarcoma research (GEIS -GROUP). Part II. Cancer Treat Rev 2021; 99:102260. [PMID: 34340159 DOI: 10.1016/j.ctrv.2021.102260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Among all Soft Tissue sarcomas there are some subtypes with low incidence and/or peculiar clinical behaviour, that need to be consider separately. Most of them are orphan diseases, whose biological characteristics imply a clearly different diagnostic and therapeutic approach from other more common sarcoma tumors. We present a brief and updated multidiciplinary review, focused on practical issues, aimed at helping clinicians in decision making. In this second part we review these subtypes: Alveolar Soft Part Sarcoma, Epithelioid Sarcoma, Clear Cell Sarcoma, Desmoplastic Small Round Cell Tumor, Rhabdoid Tumor, Phyllodes Tumor, Tenosynovial Giant Cell Tumors, Myoepithelial Tumor, Perivascular Epithelioid Cell Neoplasms (PEComas), Extraskeletal Myxoid Chondrosarcoma, NTRK-fusions Sarcomas. Most of them present their own radiological and histopathological feautures, that are essential to know in order to achieve early diagnosis. In some of them, molecular diagnosis is mandatory, not only in the diagnosis, but also to plan the treatment. On the other hand, and despite the low incidence, a great scientific research effort has been made to achieve new treatment opportunities for these patients even with approved indications. These include new treatments with targeted therapies and immunotherapy, which today represent possible therapeutic options. It is especially important to be attentive to new and potential avenues of research, and to promote the conduct of specific clinical trials for rare sarcomas.
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16
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Zhu JH, Li M, Liang Y, Wu JH. Tenosynovial giant cell tumor involving the cervical spine: A case report. World J Clin Cases 2021; 9:3394-3402. [PMID: 34002150 PMCID: PMC8107909 DOI: 10.12998/wjcc.v9.i14.3394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/21/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tenosynovial giant cell tumors (TGCTs) are a frequent benign proliferative disease originating from the synovial membrane. However, TGCTs rarely occur in the spine. The purpose of this paper is to report a case of TGCT occurring in the cervical spine. Although the disease is rare, it is essential to consider the possibility of TGCT in axial skeletal lesions. Awareness of spinal TGCTs is important because their characteristics are similar to common spinal tumor lesions.
CASE SUMMARY A 49-year-old man with a 2-year history of neck pain and weakness in both lower extremities was referred to our ward. Imaging revealed a mass extending from the left epidural space to the C4-5 paravertebral muscles with uneven enhancement. The tumor originated in the synovium of the C4-5 lesser joint and eroded mainly the C4-5 vertebral arch and spine. Puncture biopsy was suggestive of a giant cell-rich lesion. The patient had pulmonary tuberculosis, and we first administered anti-tuberculosis treatment. After the preoperative requirements of the anti-tuberculosis treatment were met, we used a posterior cervical approach to completely remove the mass after fixation with eight pedicle screws. The mass was identified as a TGCT by postoperative immunohistochemical analysis. Recurrence was not detected after 1 year of follow-up.
CONCLUSION Spinal TGCTs are often misdiagnosed. The radiological changes are not specific. The ideal treatment comprises complete excision with proper internal fixation, which can significantly reduce postoperative recurrence.
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Affiliation(s)
- Jing-Hui Zhu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Miao Li
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Yan Liang
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jian-Huang Wu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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17
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Rationale for the use of tyrosine kinase inhibitors in the treatment of paediatric desmoid-type fibromatosis. Br J Cancer 2021; 124:1637-1646. [PMID: 33723397 PMCID: PMC8110972 DOI: 10.1038/s41416-021-01320-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
In children with desmoid-type fibromatosis (DTF) in whom disease progression occurs after an initial watch-and-wait strategy, prolonged low-dose chemotherapy using vinblastine and methotrexate (VBL-MTX) is currently the standard of care. These conventional drugs have been prospectively evaluated but their efficacy and safety profiles are limited, and alternative therapeutic options are therefore essential. Based on the results of clinical trials, the use of tyrosine kinase inhibitors (TKIs) in the treatment of DTF is currently considered only in adult patients. TKIs such as imatinib show superior therapeutic efficacy to VBL-MTX and tolerable short-term side effects for the treatment of adult DFT, supporting the concept of the use of TKIs for the treatment of paediatric DFT. Moreover, new-generation TKIs, such as pazopanib and sorafenib, have shown improved therapeutic efficacy compared to imatinib in adult non-comparative studies. A tolerable safety profile of TKI therapy in children with disease entities other than DTF, such as leukaemia, has been reported. However, the efficacy and, in particular, the long-term safety of TKIs, including childhood-specific aspects such as growth and fertility, for the treatment of children with DTF should be investigated prospectively, as DFT therapy requires long-term drug exposure.
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18
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Burdett N, Bae S, Hamilton A, Desai J. The Role of Systemic Therapies in the Management of Soft Tissue Sarcoma. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Koo J, Hayashi M, Verneris MR, Lee-Sherick AB. Targeting Tumor-Associated Macrophages in the Pediatric Sarcoma Tumor Microenvironment. Front Oncol 2020; 10:581107. [PMID: 33381449 PMCID: PMC7769312 DOI: 10.3389/fonc.2020.581107] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022] Open
Abstract
For many pediatric sarcoma patients, multi-modal therapy including chemotherapy, radiation, and surgery is sufficient to cure their disease. However, event-free and overall survival rates for patients with more advanced disease are grim, necessitating the development of novel therapeutic approaches. Within many pediatric sarcomas, the normal immune response, including recognition and destruction of cancer cells, is lost due to the highly immune suppressive tumor microenvironment (TME). In this setting, tumor cells evade immune detection and capitalize on the immune suppressed microenvironment, leading to unchecked proliferation and metastasis. Recent preclinical and clinical approaches are aimed at understanding this immune suppressive microenvironment and employing cancer immunotherapy in an attempt to overcome this, by renewing the ability of the immune system to recognize and destroy cancer cells. While there are several factors that drive the attenuation of immune responses in the sarcoma TME, one of the most remarkable are tumor associated macrophage (TAMs). TAMs suppress immune cytolytic function, promote tumor growth and metastases, and are generally associated with a poor prognosis in most pediatric sarcoma subtypes. In this review, we summarize the mechanisms underlying TAM-facilitated immune evasion and tumorigenesis and discuss the potential therapeutic application of TAM-focused drugs in the treatment of pediatric sarcomas.
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Affiliation(s)
- Jane Koo
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, United States
| | - Masanori Hayashi
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, United States
| | - Michael R Verneris
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, United States
| | - Alisa B Lee-Sherick
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, United States
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20
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Abstract
Tenosynovial giant cell tumour (TGCT) is a group of rare soft tissues neoplasia affecting synovial joints, bursae and tendon sheaths and is classified as localized type or diffuse type. The diffuse type (TGCT-D), also known as ‘pigmented villonodular (teno)synovitis’ is characterized by local aggressivity, with invasion and destruction of adjacent soft-tissue structures, and high local recurrence rate. Radical surgery remains the standard therapy while adjuvant radiotherapy may help to control local spread. Malignant TGCT is characterized by high rate of local recurrences and distant metastasis. Few cases of malignant TGCT and very few evidences on systemic therapies are described in the literature, so, to date, no systemic treatment is approved for this rare disease. We report the case of a malignant TGCT patient treated with many different systemic therapies, including chemotherapy and tyrosine-kinase inhibitors, and performed a review of the literature on the systemic treatment options of this rare tumour.
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21
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Mastboom MJL, Lips W, van Langevelde K, Mifsud M, Ng C, McCarthy CL, Athanasou NA, Gibbons CLMH, van de Sande MAJ. The effect of Imatinib Mesylate in diffuse-type Tenosynovial Giant Cell Tumours on MR imaging and PET-CT. Surg Oncol 2020; 35:261-267. [PMID: 32932224 DOI: 10.1016/j.suronc.2020.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Recurrence rates remain high after surgical treatment of diffuse-type Tenosynovial Giant Cell Tumour (TGCT). Imatinib Mesylate (IM) blocks Colony Stimulating Factor1 Receptor (CSF1R), the driver mechanism in TGCT. The aim of this study was to determine if IM reduces the tumour metabolic activity evaluated by PET-CT and to compare this response with the response seen on MR imaging. MATERIALS AND METHODS 25 Consecutive patients treated with IM (off label use) for locally advanced (N = 12) or recurrent (N = 13) diffuse-type TGCT were included, 15 male and median age at diagnosis 39 (IQR 31-47) years. The knee was most frequently affected (n = 16; 64%). The effect of IM was assessed pre- and post-IM treatment by comparing MR scans and PET-CT. MR scans were assessed by Tumour Volume Score (TVS), an estimation of the tumour volume as a percentage of the total synovial cavity. PET-CT scans were evaluated based on maximum standardized uptake value (SUV-max). Partial response was defined as more than 50% tumour reduction with TVS and a decrease of at least 30% on SUV-max. RESULTS Median duration of IM treatment was 7.0 (IQR 4.2-11.5) months. Twenty patients (80%) discontinued IM treatment for poor response or intended surgery. Twenty patients experienced an adverse event grade 1-2, three patients grade 3 (creatinine increment, neutropenic sepsis, liver dysfunction). MR assessment of all joints showed 32% (6/19) partial response and 63% (12/19) stable disease, with a mean difference of 12% (P = 0.467; CI -22.4-46.0) TVS between pre- and post-IM and a significant mean difference of 23% (P = 0.021; CI 4.2-21.6) in all knee lesions. PET-CT, all joints, showed a significantly decreased mean difference of 5.3 (P = 0.004; CI 1.9-8.7) SUV-max between pre- and post-IM treatment (58% (11/19) partial response, 37% (7/19) stable disease). No correlation between MR imaging and PET-CT could be appreciated in 15 patients with complete radiological data. CONCLUSION This study confirms the moderate radiological response of IM in diffuse-type TGCT. PET-CT is a valuable additional diagnostic tool to quantify response to tyrosine kinase inhibitor treatment. Its value should be assessed further to validate its efficacy in the objective measurement of biological response in targeted systemic treatment of TGCT.
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Affiliation(s)
- M J L Mastboom
- Orthopaedics Oncology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - W Lips
- Orthopaedics Oncology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - K van Langevelde
- Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - M Mifsud
- Orthopaedic Department, Mater Dei Hospital, Triq Dun Karm, Msida, Malta.
| | - C Ng
- Orthopaedic Department, Mater Dei Hospital, Triq Dun Karm, Msida, Malta.
| | - C L McCarthy
- Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - N A Athanasou
- Histopathology, NDORMS, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - C L M H Gibbons
- Orthopaedics Oncology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - M A J van de Sande
- Orthopaedics Oncology, Leiden University Medical Centre, Leiden, the Netherlands.
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22
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Baldi GG, Gronchi A, Stacchiotti S. Pexidartinib for the treatment of adult symptomatic patients with tenosynovial giant cell tumors. Expert Rev Clin Pharmacol 2020; 13:571-576. [PMID: 32478598 DOI: 10.1080/17512433.2020.1771179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Tenosynovial giant cell tumor (TGCT) is a benign mesenchymal tumor arising from the synovium of tendon sheats and joints, driven by colony-stimulating factor 1 (CSF1) over-expression. Standard treatment is surgery, but local recurrences are frequent, especially in diffuse TGCT subtype, rarely cured with surgery. When TGCT becomes a chronic condition, which may severely compromise joint function and quality of life, patients may need a systemic therapy. Areas covered: We reviewed the drugs on clinical development in TGCT, focusing on the pharmacodynamics, pharmacokinetics, efficacy, and toxicity profile of pexidartinib, the first drug approved in the US for TGCT, and on the open questions about its optimal use in clinical practice. EXPERT OPINION CSFR1 inhibitors have opened a new avenue for treatment of TGCT patients. Pexidartinib is the first-in-class FDA approved agent for symptomatic locally advanced TGCT, based on a phase III study where pexidartinib showed high anti-tumor activity, improved patient symptoms, and functional outcome. A few cases of potentially life-threatening hepatic toxicity were observed. TGCT patients candidate to pexidartinib need to be carefully selected by the multidisciplinary board of center of expertise, balancing the expected risk-benefit ratio. Close monitoring of liver function and adequate education on the approved indication is warranted.
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Affiliation(s)
- Giacomo Giulio Baldi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato , Prato, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori , Milan, Italy
| | - Silvia Stacchiotti
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan, Italy
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23
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Brahmi M, Cassier P, Dufresne A, Chabaud S, Karanian M, Meurgey A, Bouhamama A, Gouin F, Vaz G, Garret J, Sunyach MP, Dupré A, Marec-Berard P, Corradini N, Perol D, Ray-Coquard I, Blay JY. Long term term follow-up of tyrosine kinase inhibitors treatments in inoperable or relapsing diffuse type tenosynovial giant cell tumors (dTGCT). PLoS One 2020; 15:e0233046. [PMID: 32433669 PMCID: PMC7239463 DOI: 10.1371/journal.pone.0233046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/27/2020] [Indexed: 12/21/2022] Open
Abstract
RATIONALE CSF1R tyrosine kinase inhibitors (TKI) and antibodies yield response rates and tumor control in patients with diffuse type tenosynovial giant cell tumors (dTGCT). The long term management of patients with dTGCT treated with TKI is however not known. PATIENTS AND METHODS We conducted a retrospective single center study on the 39 patients with advanced and/or inoperable dTGCT referred to the Centre Leon Berard for a medical treatment. The clinical characteristics and treatments of patients who had received at least one line of CSF1R TKI or Ab was collected from the electronic patient records and analyzed, after this study was approved by the Institutional Review Board of the Centre Leon Berard. Statistics were conducted using SPSS 23.0. RESULTS Thirty-nine patients received at least one line of TKI among the 101 patients with histologically confirmed dTGCT refered to this center. Imatinib, nilotinib, pexidartinib, emactuzumab were the most frequently used agents. First line treatment was given for a median duration of 7 months. With a median follow-up from the initiation of TKI of 30 months, the progression-free rate at 30 months is 56% for the 39 patients. 15 patients had recurrent disease after first line CSF1R inhibitor: 12 (80%) received a 2nd line treatment for a median duration of 6 months and a median time to progression (TTP) of 12 months. Six patients had afterwards a recurrent disease and 5 (83%) received a 3rd line treatment for a median duration of 5 months and a median TTP of 9 months. Progression-free rate at 30 months was observed in 3 of 12 (25%) after line 2 and 1 of 5 (20%) after line 3. None of the patients refered died with a median follow-up of 67 months. CONCLUSIONS CSF1R TKI or Ab provide prolonged tumor control and symptom relief for a majority of patients with inoperable or relapsing dTGCT, in first and subsequent lines. Multiple lines are required for close to 50% of patients with relapsing dTGCT.
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Affiliation(s)
- Mehdi Brahmi
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Philippe Cassier
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Armelle Dufresne
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Sylvie Chabaud
- Department of Statistics, Léon Bérard Cancer Center, Lyon, France
| | - Marie Karanian
- Department of Biopathology, Léon Bérard Cancer Center, Lyon, France
| | | | - Amine Bouhamama
- Department of Radiology, Léon Bérard Cancer Center, Lyon, France
| | - Francois Gouin
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | - Gualter Vaz
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | - Jerome Garret
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | | | - Aurélien Dupré
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | | | - Nadège Corradini
- Institut d’Hematology Oncologie Pediatrique, Centre Leon Berard, Lyon, France
| | - David Perol
- Department of Statistics, Léon Bérard Cancer Center, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
- University Claude Bernard, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
- University Claude Bernard, Lyon, France
- * E-mail:
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24
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Abstract
This review examines the following aspects of tenosynovial giant cell tumors (TSGCTs): the use of multiple names, the complex relationship between tumor growth pattern and location, the high rate of postoperative recurrence, local invasiveness, use of nonsurgical therapy with molecularly targeted drugs, and best current treatments. This tumor has been referred to by various names, but is now most frequently referred to as TSGCT. TSGCT is classified as localized and diffuse, in accordance with its growth characteristics. Most TSGCTs of the fingers are localized. TSGCT is likely a neoplastic process arising from synovial lining cells, in which tumor cells express the colony stimulating factor 1 (CSF1) gene. The postoperative recurrence rate of TSGCT is approximately 15%. The intrinsic characteristics of recurrence are not clear, and complete resection of the lesion is still the treatment mainstay. Moreover, TSGCT commonly grows out of a pseudocapsule. Therefore, to perform complete resection of TSGCT, surgery must be performed cautiously after appropriate preparation, by using anesthesia, a tourniquet, surgical loupe, and surgical microscopy. After accurate preoperative diagnosis, meticulous planning by surgeons is necessary. The lesion should be resected along with approximately 1-mm of healthy tissue at the adhesion site. In addition, because satellite lesions might be present near the tumor, careful dissection and observation of the color of surrounding tissue are important. International clinical trials of CSF1 receptor inhibitors for TSGCT treatment are ongoing.
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Affiliation(s)
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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25
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Penel N, Lebellec L, Blay JY, Robin YM. Overview of « druggable » alterations by histological subtypes of sarcomas and connective tissue intermediate malignancies. Crit Rev Oncol Hematol 2020; 150:102960. [PMID: 32320927 DOI: 10.1016/j.critrevonc.2020.102960] [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: 12/18/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022] Open
Abstract
We summarize herein the literature data about molecular targeted therapies in sarcomas and conjunctive tissue intermediate malignancies. For each clinical setting, the level of evidence, the mechanism of action and the target are described. The two major axes include (i) identification of subgroups of tumors with druggable alteration irrespective of the histological diagnosis (e.g. NTRK), and (ii) druggable target of pathway related to the physiopathology of the tumor: denosumab and bone giant cell tumor, imatinib and soft tissue giant cell tumor, mTOR inhibitor and PECOMA.
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Affiliation(s)
- Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France; Lille University, Medical School, Lille, France.
| | - Loïc Lebellec
- Lille University, Medical School, Lille, France; Medical Oncology Unit, Dron Hospital, Tourcoing, France
| | - Jean-Yves Blay
- Department of Medicine, Centre Leon Bérard, Lyon, France; Claude Bernard University, Medical School Lyon, France
| | - Yves-Marie Robin
- Biopathology department, Centre Oscar Lambret, Lille, France; Lille University, Inserm U1192, Laboratoire « Protéomique, Réponse Inflammatoire et Spectrométrie de Masse » (PRISM), Villeneuve d'Ascq, France
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26
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Hamza A, Gidley PW, Learned KO, Hanna EY, Bell D. Uncommon tumors of temporomandibular joint: An institutional experience and review. Head Neck 2020; 42:1859-1873. [PMID: 32040228 DOI: 10.1002/hed.26106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/31/2019] [Accepted: 01/28/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The temporomandibular joint (TMJ) harbors a myriad of pathologic alterations including arthritides and benign and malignant neoplasms. METHODS Herein, we describe our institutional experience of some uncommon and unusual synovial pathologies of the TMJ along with a review of literature. We searched through the archives of department of pathology and institutional electronic medical record for specimens of TMJ between 1999 and 2019. Hematoxylin and eosin slides were reviewed and data (final diagnosis, age, gender, clinical presentation, tumor size, treatment modality, recurrence, and vital status) were collected. RESULTS A total of seven cases were identified including four cases of synovial chrondromatosis; and one case each of tenosynovial giant cell tumor, localized type, tenosynovial giant cell tumor, diffuse type, and synovial sarcoma. CONCLUSIONS The article emphasizes on the clinical, radiologic, pathologic, and molecular features of these uncommon entities. The differential diagnosis of each entity is also discussed. Current updates in the management are also reviewed.
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Affiliation(s)
- Ameer Hamza
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Paul W Gidley
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Kim O Learned
- Department of Neuroradiology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Diana Bell
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas.,Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Brahmi M, Alberti L, Tirode F, Karanian M, Eberst L, Pissaloux D, Cassier P, Blay JY. Complete response to CSF1R inhibitor in a translocation variant of teno-synovial giant cell tumor without genomic alteration of the CSF1 gene. Ann Oncol 2019; 29:1488-1489. [PMID: 29668829 DOI: 10.1093/annonc/mdy129] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- M Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
| | - L Alberti
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - F Tirode
- Centre de Recherche en Cancerologie de Lyon, Lyon, France
| | - M Karanian
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - L Eberst
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - D Pissaloux
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - P Cassier
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - J Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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28
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Fraser EJ, Sullivan M, Maclean F, Nesbitt A. Tenosynovial Giant-Cell Tumors of the Foot and Ankle: A Critical Analysis Review. JBJS Rev 2019; 5:01874474-201701000-00001. [PMID: 28135228 DOI: 10.2106/jbjs.rvw.16.00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Ethan J Fraser
- 1Department of Orthopaedic Surgery, St Vincent's Clinic, Sydney, Australia2Foot and Ankle Clinic, North Shore Private Hospital, Sydney, Australia3Douglass Hanly Moir Pathology, Macquarie Park, Australia4Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Australia
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29
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Dufresne A, Brahmi M, Karanian M, Blay JY. Using biology to guide the treatment of sarcomas and aggressive connective-tissue tumours. Nat Rev Clin Oncol 2019; 15:443-458. [PMID: 29666441 DOI: 10.1038/s41571-018-0012-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sarcomas are a heterogeneous group of malignancies that arise from cells of a mesenchymal origin. Surgery forms the mainstay of the treatment of most patients with localized sarcoma and might be followed or preceded by chemotherapy and/or radiotherapy. In the metastatic setting, systemic treatments tend to improve survival and control symptoms. However, the adverse events and sometimes disappointing outcomes associated with these empirical approaches to treatment indicate a need for new approaches. The advent of next-generation sequencing (NGS) has enabled more targeted treatment of many malignancies based on the presence of specific alterations. NGS analyses of sarcomas have revealed the presence of many alterations that can be targeted using therapies that are already used in patients with other forms of cancer. In this Review, we describe the genomic alterations considered to define specific nosological subgroups of sarcoma and whose contribution to oncogenesis provides a biological rationale for the use of a specific targeted therapy. We also report several less successful examples that should guide researchers and clinicians to better define the extent to which the identification of driver molecular alterations should influence the development of novel treatments.
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Affiliation(s)
- Armelle Dufresne
- Department of Medical Oncology, Centre Leon Berard, Lyon, France.
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - Marie Karanian
- Department of Pathology, Centre Leon Berard, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
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30
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Skubitz KM, Wilson JD, Cheng EY, Lindgren BR, Boylan KLM, Skubitz APN. Effect of chemotherapy on cancer stem cells and tumor-associated macrophages in a prospective study of preoperative chemotherapy in soft tissue sarcoma. J Transl Med 2019; 17:130. [PMID: 30999901 PMCID: PMC6471853 DOI: 10.1186/s12967-019-1883-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background Cancer stem cells (CSC) may respond to chemotherapy differently from other tumor cells. Methods This study examined the expression of the putative cancer stem cell markers ALDH1, CD44, and CD133; the angiogenesis marker CD31; and the macrophage marker CD68 in soft tissue sarcomas (STS) before and after 4 cycles of chemotherapy with doxorubicin and ifosfamide in 31 patients with high-grade soft tissue sarcoma in a prospective clinical trial. Results None of the markers clearly identified CSCs in STS samples. Macrophages represented a prominent component in viable tumor areas in pre-treatment STS biopsies, ranging from < 5 to > 50%. Furthermore, macrophages expressed CD44 and ALDH1. Macrophage density correlated with baseline maximum standardized uptake value (SUVmax) on fluoro-deoxyglucose positron emission tomography (PET) imaging. Pre-chemotherapy CD68 staining correlated positively with the baseline SUVmax, and negatively with the percent of viable tumor cells in post-chemotherapy resection samples. In particular, cases with more CD68-positive cells at biopsy had fewer viable tumor cells at resection, suggesting a better response to chemotherapy. Conclusions In conclusion, ALDH1, CD44, and CD133 are not likely to be useful markers of CSCs in STS. However, our observation of infiltrating macrophages in STS specimens indicates that these immune cells may contribute significantly to STS biology and response to chemotherapy, and could provide a potential target of therapy. Future studies should investigate macrophage contribution to STS pathophysiology by cytokine signaling. Electronic supplementary material The online version of this article (10.1186/s12967-019-1883-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keith M Skubitz
- Department of Medicine, University of Minnesota Medical School, Box 286 University Hospital, Minneapolis, MN, 55455, USA. .,Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Jon D Wilson
- Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA.,Arkana Laboratories, Little Rock, AR, USA
| | - Edward Y Cheng
- Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Bruce R Lindgren
- Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA.,Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kristin L M Boylan
- Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Amy P N Skubitz
- Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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31
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Furuhata R, Iwanami A, Tsuji O, Nagoshi N, Suzuki S, Okada E, Fujita N, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Tenosynovial giant cell tumor of the cervical spine: a case report. Spinal Cord Ser Cases 2019; 5:23. [PMID: 31240119 PMCID: PMC6461752 DOI: 10.1038/s41394-019-0172-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Tenosynovial giant cell tumors (TSGCTs) generally occur in the limb joints, and only rarely in the spine. This case report describes a patient with TSGCT of the spine at C1-C2, which was treated surgically and diagnosed as TSGCT. Case presentation A 32-year-old woman with a 4-month history of neck pain and numbness in both upper extremities was referred to our department. Magnetic resonance imaging (MRI) revealed a neoplastic lesion extending from the left epidural space to the erector spinae muscles at the C1-C2 vertebral level, which was isointense on T1-weighted images, heterogeneously hypointense on T2-weighted images, and showed heterogeneous enhancement on gadopentetate dimeglumine (Gd-DTPA)-enhanced T1-weighted images. Computed tomography showed no findings suggestive of bone destruction of the vertebral body. Because the neurological symptoms were progressive, total macroscopic resection of the tumor was performed via a posterior approach. Histopathological examination of the resected specimen revealed the diagnosis of TSGCT. Improvement of the both the neck pain and upper-extremity numbness was noted postoperatively. An MRI obtained 6 months after the surgery revealed no evidence of tumor recurrence and the postoperative course was uneventful. Discussion TSGCT of the upper cervical spine (C1-C2) is rare, and this is the tenth reported case. If a tumor is heterogeneously hypointense on T2-weighted MRI, which reflects hemosiderosis, the possibility of this tumor should be considered in the differential diagnosis.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Akio Iwanami
- Department of Orthopaedic Surgery, Spine Center, Koga Hospital, Ibaraki, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Abstract
OPINION STATEMENT Soft tissue sarcomas are rare cancers with an expected incidence of about 14,000 new cases in 2018, and account for less than 1% of all cancers. It includes in excess of 75 heterogeneous subtypes with varying biology, molecular aberrations, and variable response to treatment. Because of the rarity of these tumors and the many different subtypes, there is no large-scale data to guide treatment, and hence the need for a multidisciplinary individualized approach to treatment, preferably at a high-volume tertiary referral center. For localized disease, surgery with or without radiation is the preferred treatment. In metastatic disease, the longest track record is with use of anthracyclines, either alone or in combination with ifosfamide, but the median overall survival even with combination was just over a year. There have been recent advances in understanding the heterogeneity of these tumors and the need for an individualized approach. With that new knowledge, recent approvals of trabectedin, eribulin, and pazopanib have been limited to some select histologic subtypes with improved outcomes. More recently, immunotherapy has been tested in select histotypes of sarcoma with encouraging activity and has led to further evaluation in combination with immunotherapeutic agents, as well as with chemotherapy and radiation treatments. Here, in this article, we summarize the data of the currently approved therapies in metastatic soft tissue sarcoma, with the principal focus on first-line therapies. We also review the recent encouraging data with PDGFR-targeted antibody (olaratumab) with doxorubicin which showed an impressive improvement in overall survival in phase II study. Molecular characterization of sarcoma subtypes will likely improve understanding of these very diverse tumors and improve target characterization. The ongoing efforts in better understanding these rare tumors hold the key to make a difference in the outcome of these patients.
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Affiliation(s)
- Megan Meyer
- Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Mahesh Seetharam
- Hematology and Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA.
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33
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Nakayama R, Jagannathan JP, Ramaiya N, Ferrone ML, Raut CP, Ready JE, Hornick JL, Wagner AJ. Clinical characteristics and treatment outcomes in six cases of malignant tenosynovial giant cell tumor: initial experience of molecularly targeted therapy. BMC Cancer 2018; 18:1296. [PMID: 30594158 PMCID: PMC6311045 DOI: 10.1186/s12885-018-5188-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/05/2018] [Indexed: 01/08/2023] Open
Abstract
Background Although tenosynovial giant cell tumor (TGCT) is classified as a benign tumor, it may undergo malignant transformation and metastasize in extremely rare occasions. High aberrant expression of CSF1 has been implicated in the development of TGCT and recent studies have shown promising activity of several CSF1R inhibitors against benign diffuse-type TGCT; however, little is known about their effects in malignant TGCT. Case presentation Information from six consenting patients (3 men, 3 women) with malignant TGCT presenting to Dana-Farber Cancer Institute for initial or subsequent consultation was collected. Median age at initial diagnosis of TGCT was 49.5 years (range 12–55), and median age at diagnosis of malignant TGCT was 50 years (range 34–55). Two patients developed malignant TGCT de novo, while four other cases showed metachronous malignant transformation. All tumors arose in the lower extremities (3 knee, 2 thigh, 1 hip). Five patients underwent surgery for the primary tumors, and four developed local recurrence. All six patients developed lung metastases, and four of five evaluable tumors developed inguinal and pelvic lymph node metastases. All six patients received systemic therapy. Five patients were treated with at least one tyrosine kinase inhibitor with inhibitory activity against CSF1R; however, only one patient showed clinical benefit (SD or PR). Five patients were treated with conventional cytotoxic agents. Doxorubicin-based treatment showed clinical benefit in all four evaluable patients, and gemcitabine/docetaxel showed clinical benefit in two patients. All six patients died of disease after a median of 21.5 months from diagnosis of malignant TGCT. Conclusions This study confirms that TGCT may transform into an aggressive malignant tumor. Lymph node and pulmonary metastases are common. Local recurrence rates are exceedingly high. Conventional cytotoxic chemotherapy showed clinical benefit, whereas tyrosine kinase inhibitors against CSF1R showed limited activity. Given its rarity, a prospective registry of malignant TGCT patients is needed to further understand the entity and to develop effective strategies for systemic treatment.
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Affiliation(s)
- Robert Nakayama
- Ludwig Center at Dana-Farber/Harvard and Center for Sarcoma and Bone Oncology, Department of Medical Oncology, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | | | - Nikhil Ramaiya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Marco L Ferrone
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John E Ready
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Wagner
- Ludwig Center at Dana-Farber/Harvard and Center for Sarcoma and Bone Oncology, Department of Medical Oncology, Harvard Medical School, Boston, MA, USA.
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Palmerini E, Longhi A, Donati D, Staals EL. Advances in treatment for tenosynovial giant cell tumors. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1549481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric L. Staals
- Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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35
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Sansone V, Longhino V. What's in a name? A call for consistency in the classification of tenosynovial giant cell tumour. Knee 2018; 25:1322-1323. [PMID: 30482642 DOI: 10.1016/j.knee.2018.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/03/2018] [Accepted: 09/30/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Valerio Sansone
- Department of Orthopaedics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.
| | - Valentina Longhino
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
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36
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Stephan SR, Shallop B, Lackman R, Kim TWB, Mulcahey MK. Pigmented Villonodular Synovitis: A Comprehensive Review and Proposed Treatment Algorithm. JBJS Rev 2018; 4:01874474-201607000-00003. [PMID: 27509331 DOI: 10.2106/jbjs.rvw.15.00086] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Evidence now exists suggesting a neoplastic origin for pigmented villonodular synovitis, including a thorough description of the translocations involved. Arthroscopic excision for localized pigmented villonodular synovitis allows for both minimal recurrence and morbidity when compared with open excision; however, open excision still plays an important role in treating posterior compartment nodules. The optimal surgical treatment for diffuse pigmented villonodular synovitis is still a matter for debate, with combined anterior arthroscopic and open posterior excision being considered the preferred method. Radiation therapy has re-emerged as an additional treatment method for pigmented villonodular synovitis; however, the potential for serious toxicity makes it a questionable option, especially for such a benign condition. Small molecule and monoclonal antibody targeted therapies are being investigated as novel treatment methods for pigmented villonodular synovitis, with promising results.
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Affiliation(s)
- Stephen R Stephan
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Brandon Shallop
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | | | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
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37
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Gelderblom H, Cropet C, Chevreau C, Boyle R, Tattersall M, Stacchiotti S, Italiano A, Piperno-Neumann S, Le Cesne A, Ferraresi V, Penel N, Duffaud F, Cassier P, Toulmonde M, Casali P, Taieb S, Guillemaut S, Metzger S, Pérol D, Blay JY. Nilotinib in locally advanced pigmented villonodular synovitis: a multicentre, open-label, single-arm, phase 2 trial. Lancet Oncol 2018; 19:639-648. [DOI: 10.1016/s1470-2045(18)30143-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 12/19/2022]
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Gong J, Yan J, Forscher C, Hendifar A. Aldoxorubicin: a tumor-targeted doxorubicin conjugate for relapsed or refractory soft tissue sarcomas. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:777-786. [PMID: 29670334 PMCID: PMC5896668 DOI: 10.2147/dddt.s140638] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite available therapies after initial systemic therapy, prognosis remains poor in relapsed or refractory soft tissue sarcomas (STS). The rational and clinical development of novel agents to improve outcomes in this area of high unmet need is desperately warranted. Aldoxorubicin is a prodrug of doxorubicin that binds to serum albumin immediately after administration through an acid-sensitive hydrazone linker and is subsequently transported to tumor tissues where the acidic environment cleaves the linker and facilitates delivery of a tumor-targeted drug payload. In clinical studies to date, there has been evidence of efficacy and mitigated cardiac toxicity. In this review, we comprehensively detail the clinical development of aldoxorubicin in STS to date. Specifically, we highlight available data on the pharmacokinetics and efficacy from Phase I, Phase II, and Phase III trials in advanced or metastatic STS. We conclude with considerations for future directions of investigation for this promising antitumor agent.
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Affiliation(s)
- Jun Gong
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jessica Yan
- Department of Hematology and Oncology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Charles Forscher
- Sarcoma Program, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Hendifar
- Gastrointestinal and Neuroendocrine Malignancies, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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39
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Burton TM, Ye X, Parker ED, Bancroft T, Healey J. Burden of Illness Associated with Tenosynovial Giant Cell Tumors. Clin Ther 2018; 40:593-602.e1. [PMID: 29580718 DOI: 10.1016/j.clinthera.2018.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Little is known about the burden of illness in patients with tenosynovial giant cell tumors (TGCT), which are rare, typically benign, lesions of the synovial tissue including giant cell tumor of the tendon sheath (GCT-TS) and pigmented villonodular synovitis (PVNS). The objective of this study was to describe health care resource use and costs for patients with GCT-TS and PVNS, which are rare and typically benign TGCT. METHODS A retrospective cohort study design was used to analyze administrative claims for adult commercial and Medicare Advantage health plan enrollees with evidence of GCT-TS and PVNS from January 1, 2006 through March 31, 2015. Participants were continuously enrolled for 12 months before (pre-index period) and 12 months after (post-index period) the date of the first tenosynovial giant cell tumor (TGCT) claim (index date). Preindex and postindex measures were compared using the McNemar test and Wilcoxon signed-rank test. Results were stratified by TGCT type. FINDINGS The study identified 4664 patients with TGCT, 284 with GCT-TS, and 4380 with PVNS. Mean age (GCT-TS group: 50 years; PVNS group: 51 years) and sex distributions (GCT-TS group: 60.2% female; PVNS group: 59.5% female) were similar for each group. Most patients with GCT-TS (78.2%) had at least one postindex surgery, compared with 38.7% of patients with PVNS. Mean total health care costs increased from $8943 in the preindex period to $14,880 in the postindex period (P < 0.001) for GCT-TS and from $13,221 in the preindex period to $17,728 in the postindex period (P < 0.001) for PVNS. Preindex to postindex ambulatory costs increased nearly 120% for patients with GCT-TS ($4340 to $9570, P < 0.001) and 50% for patients with PVNS ($6782 to $10,278, P < 0.001), and physical therapy use increased significantly during the same period (GCT-TS: 18% to 40%, P < 0.001; PVNS: 38% to 60%, P < 0.001). IMPLICATIONS Costs increased substantially 1 year after the first TGCT claim, with more than half the costs covering ambulatory care. These results suggest a high health care burden once TGCT is identified.
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Affiliation(s)
| | - Xin Ye
- Daiichi Sankyo, Parsippany, NJ
| | | | | | - John Healey
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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40
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Abstract
In this review, we highlight the complexities of the natural history, biology, and clinical management of three intermediate connective tissue tumors: desmoid tumor (DT) or aggressive fibromatosis, tenosynovial giant cell tumor (TGCT) or diffuse-type pigmented villonodular synovitis (dtPVNS), and giant cell tumor of bone (GCTB). Intermediate histologies include tumors of both soft tissue and bone origin and are locally aggressive and rarely metastatic. Some common aspects to these tumors are that they can be locally infiltrative and/or impinge on critical organs, which leads to disfigurement, pain, loss of function and mobility, neurovascular compromise, and occasionally life-threatening consequences, such as mesenteric, bowel, ureteral, and/or bladder obstruction. DT, PVNS, and GCTB have few and recurrent molecular aberrations but, paradoxically, can have variable natural histories. A multidisciplinary approach is recommended for optimal management. In DT and PVNS, a course of observation may be appropriate, and any intervention should be guided by symptoms and/or disease progression. A surgical approach should take into consideration the infiltrative nature, difficulty in obtaining wide margins, high recurrence rates, acute and chronic surgical morbidities, and impact on quality of life. There are similar concerns with radiation, which especially relate to optimal field and transformation to high-grade radiation-associated sarcomas. Systemic therapies must be considered carefully in light of acute and chronic toxicities. Although standard and novel therapies are promising, many unanswered questions, such as duration of therapy and optimal end points to evaluate efficacy of drugs in clinical practice and trials, exist. Predictive biomarkers and novel clinical trial end points, such as volumetric measurement, magnetic resonance imaging T2 weighted mapping, nuclear imaging, and patient-reported outcomes, are in development and will require validation in prospective trials.
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Affiliation(s)
- Mrinal M. Gounder
- Mrinal M. Gounder and William D. Tap, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical School, New York, NY; and David M. Thomas, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - David M. Thomas
- Mrinal M. Gounder and William D. Tap, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical School, New York, NY; and David M. Thomas, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - William D. Tap
- Mrinal M. Gounder and William D. Tap, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical School, New York, NY; and David M. Thomas, Garvan Institute of Medical Research, Darlinghurst, Australia
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41
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Tremble LF, Forde PF, Soden DM. Clinical evaluation of macrophages in cancer: role in treatment, modulation and challenges. Cancer Immunol Immunother 2017; 66:1509-1527. [PMID: 28948324 PMCID: PMC11028704 DOI: 10.1007/s00262-017-2065-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/13/2017] [Indexed: 12/22/2022]
Abstract
The focus of immunotherapeutics has been placed firmly on anti-tumour T cell responses. Significant progress has been made in the treatment of both local and systemic malignancies, but low response rates and rising toxicities are limiting this approach. Advancements in the understanding of tumour immunology are opening up a new range of therapeutic targets, including immunosuppressive factors in the tumour microenvironment. Macrophages are a heterogeneous group of cells that have roles in innate and adaptive immunity and tissue repair, but become co-opted by tumours to support tumour growth, survival, metastasis and immunosuppression. Macrophages also support tumour resistance to conventional therapy. In preclinical models, interference with macrophage migration, macrophage depletion and macrophage re-education have all been shown to reduce tumour growth and support anti-tumour immune responses. Here we discuss the role of macrophages in prognosis and sensitivity to therapy, while examining the significant progress which has been made in modulating the behaviour of these cells in cancer patients.
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Affiliation(s)
- Liam Friel Tremble
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Western Road, Cork, Ireland.
| | - Patrick F Forde
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Western Road, Cork, Ireland
| | - Declan M Soden
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Western Road, Cork, Ireland
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42
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Falster C, Stockmann Poulsen S, Joergensen U. A rare case of localised pigmented villonodular synovitis in the knee of a 24-year-old female soccer player: diagnosis, management and summary of tenosynovial giant cell tumours. BMJ Case Rep 2017; 2017:bcr-2017-219549. [PMID: 28978573 DOI: 10.1136/bcr-2017-219549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Localised pigmented villonodular synovitis (PVNS) of the knee is a rare diagnosis, with clinical signs and symptoms mimicking meniscal damage or other common knee injuries.We report the case of a 24-year-old female soccer player, seeking treatment after 7 months of persisting knee pain. Additionally, we present an overview of tenosynovial giant cell tumours.On examination, the patient was found to have tenderness in the medial joint space of the knee. MRI revealed a heterogeneous formation in the central part of the knee. The formation was completely enucleated arthroscopically, histological analyses confirmed the diagnosis of localised PVNS. The patient was subsequently free of symptoms with no signs of recurrence on MRI and had resumed soccer practice at the 1-year follow-up appointment.
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Affiliation(s)
- Casper Falster
- Department of Molecular Endocrinology and Stem Cell Research Unit (KMEB), Odense University Hospital, Odense, Denmark
| | - Simon Stockmann Poulsen
- Department of Orthopedic Surgery and Sports Traumatology, Odense University Hospital, Odense, Denmark
| | - Uffe Joergensen
- Department of Orthopedic Surgery and Sports Traumatology, Odense University Hospital, Odense, Denmark
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Abstract
PURPOSE OF REVIEW Colony-stimulating factor 1 receptor (CSF-1R) and its ligands, CSF-1 and interleukin 34 (IL-34), regulate the function and survival of tumor-associated macrophages, which are involved in tumorigenesis and in the suppression of antitumor immunity. Moreover, the CSF-1R/CSF-1 axis has been implicated in the pathogenesis of pigmented villonodular synovitis (PVNS), a benign tumor of the synovium. As advanced or metastatic malignant solid tumors and relapsed/refractory PVNS remain unresolved therapeutic problems, new approaches are needed to improve the outcome of patients with these conditions. RECENT FINDINGS In solid tumors, targeting CSF-1R via either small molecules or antibodies has shown interesting results in vitro but limited antitumor activity in vivo. Concerning PVNS, clinical trials assessing CSF-1R inhibitors have revealed promising initial outcomes. Blocking CSF-1/CSF-1R signaling represents a promising immunotherapy approach and several new potential combination therapies for future clinical testing.
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Cannarile MA, Weisser M, Jacob W, Jegg AM, Ries CH, Rüttinger D. Colony-stimulating factor 1 receptor (CSF1R) inhibitors in cancer therapy. J Immunother Cancer 2017; 5:53. [PMID: 28716061 PMCID: PMC5514481 DOI: 10.1186/s40425-017-0257-y] [Citation(s) in RCA: 675] [Impact Index Per Article: 96.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/05/2017] [Indexed: 12/26/2022] Open
Abstract
The tumor-permissive and immunosuppressive characteristics of tumor-associated macrophages (TAM) have fueled interest in therapeutically targeting these cells. In this context, the colony-stimulating factor 1 (CSF1)/colony-stimulating factor 1 receptor (CSF1R) axis has gained the most attention, and various approaches targeting either the ligands or the receptor are currently in clinical development. Emerging data on the tolerability of CSF1/CSF1R-targeting agents suggest a favorable safety profile, making them attractive combination partners for both standard treatment modalities and immunotherapeutic agents. The specificity of these agents and their potent blocking activity has been substantiated by impressive response rates in diffuse-type tenosynovial giant cell tumors, a benign connective tissue disorder driven by CSF1 in an autocrine fashion. In the malignant disease setting, data on the clinical activity of immunotherapy combinations with CSF1/CSF1R-targeting agents are pending. As our knowledge of macrophage biology expands, it becomes apparent that the complex phenotypic and functional properties of macrophages are heavily influenced by a continuum of survival, differentiation, recruitment, and polarization signals within their specific tissue environment. Thus, the role of macrophages in regulating tumorigenesis and the impact of depleting and/or reprogramming TAM as therapeutic approaches for cancer patients may vary greatly depending on organ-specific characteristics of these cells. We review the currently available clinical safety and efficacy data with CSF1/CSF1R-targeting agents and provide a comprehensive overview of ongoing clinical studies. Furthermore, we discuss the local tissue macrophage and tumor-type specificities and their potential impact on CSF1/CSF1R-targeting treatment strategies for the future.
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Affiliation(s)
- Michael A. Cannarile
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Nonnenwald 2, Penzberg, 82377 Germany
| | - Martin Weisser
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Nonnenwald 2, Penzberg, 82377 Germany
| | - Wolfgang Jacob
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Nonnenwald 2, Penzberg, 82377 Germany
| | - Anna-Maria Jegg
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Nonnenwald 2, Penzberg, 82377 Germany
| | - Carola H. Ries
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Nonnenwald 2, Penzberg, 82377 Germany
| | - Dominik Rüttinger
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Nonnenwald 2, Penzberg, 82377 Germany
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45
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Lung metastases of diffuse giant cell tumour of the fibular tendon sheath at the ankle: A case report. Orthop Traumatol Surg Res 2017; 103:399-402. [PMID: 27940251 DOI: 10.1016/j.otsr.2016.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 02/02/2023]
Abstract
Diffuse giant cell tumours of the tendon sheaths are described in the literature as locally aggressive soft-tissue tumours. We report the case of a 56-year-old male with a history of multiple surgical procedures for a giant cell tumour of the fibular tendon sheath at the right ankle. The multiple recurrences prompted monitoring by positron-emission tomography, which showed lung tumours. Biopsies confirmed that the tumours were metastases from the giant cell tumour of the tendon sheath. In patients with recurrent and/or diffuse giant cell tumour, positron-emission tomography is an effective monitoring tool.
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46
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Is It Reasonable for Orthopedic Surgeons to Do Chemotherapy for Patients with High-Grade Bone Sarcoma? A Paradigm for Treatment Individualization. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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47
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Osanai T, Suzuki H, Hiraga H, Soma T, Nojima T. Extra-articular diffuse-type tenosynovial giant cell tumor with benign histological features resulting in fatal pulmonary metastases. J Orthop Surg (Hong Kong) 2017; 25:2309499017690323. [PMID: 28219303 DOI: 10.1177/2309499017690323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Diffuse-type tenosynovial giant cell tumor (TS-GCT) is categorized as a locally aggressive but non-metastasizing neoplasm according to the WHO classification. Herein, we report an extremely rare case of a 41-year-old woman who developed multiple metastases from diffuse TS-GCT with benign histological features. The patient complained of a painful buttock mass and imaging studies revealed a soft tissue tumor of the buttock and multiple pulmonary nodules. The buttock tumor was excised and the final diagnosis was extra-articular diffuse-type TS-GCT. By video-assisted thoracic surgery, pulmonary nodules were pathologically identical to the primary tumor. Residual pulmonary nodules progressively grew, and she developed a muscle metastasis and a subcutis metastasis. She died of respiratory dysfunction due to multiple pulmonary metastases 1 year after primary surgery. Very few reports on histologically benign metastases from TS-GCT have been published, and the natural course of this rare condition remains unclarified. This rare case could provide important information for further clinical evaluation of this tumor.
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Affiliation(s)
- Toshihisa Osanai
- 1 Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Hiroaki Suzuki
- 2 Department of Diagnostic Pathology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Hiroaki Hiraga
- 1 Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Tamotsu Soma
- 1 Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Takayuki Nojima
- 3 Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
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Verspoor FGM, Scholte A, van der Geest ICM, Hannink G, Schreuder HWB. Cryosurgery as Additional Treatment in Tenosynovial Giant Cell Tumors. Sarcoma 2016; 2016:3072135. [PMID: 28115910 PMCID: PMC5221269 DOI: 10.1155/2016/3072135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/01/2016] [Accepted: 12/04/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction. Tenosynovial giant cell tumors (TGCT) emerge from the synovium and can behave aggressively. Surgical resection is the standard treatment. However, up to half of the patients with diffuse type show recurrences. Several additional treatments have been applied to reduce recurrences; none of these treatments was proven to be superior to surgical resection solely. This article describes the results of additional cryosurgery to surgical resection. Materials and Methods. We retrospectively evaluated 141 TGCT patients, between 1999 and 2007. Twelve patients had additional cryosurgery. The knee (n = 8), hip (n = 2), ankle (n = 1), and elbow (n = 1) were affected. Primary outcome variables were treatment indications, recurrences, and complications. Results. Indications for additional cryosurgery were extended disease, bone involvement, and locations that are difficult to surgically get disease-free such as cruciate ligaments. Five patients had recurrent disease, all of which had prior treatments. None of the primary treated patients had recurrent disease. One patient had a deep infection. Discussion. Cryosurgery may serve as an additional treatment for diffuse TCGT in selected cases. However, because of the small number of patients and the heterogeneous group we could not prove an advantage of additional cryosurgery over surgical resection only. Cryosurgery should be considered for further evaluation in a prospective study. If there is any effect it would be helpful, especially in patients with multiple TGCT recurrences.
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Affiliation(s)
- F. G. M. Verspoor
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | - A. Scholte
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - G. Hannink
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | - H. W. B. Schreuder
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
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Dangoor A, Seddon B, Gerrand C, Grimer R, Whelan J, Judson I. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6:20. [PMID: 27891213 PMCID: PMC5109663 DOI: 10.1186/s13569-016-0060-4] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/01/2016] [Indexed: 01/18/2023] Open
Abstract
Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues, and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location means that developing evidence-based guidelines is complicated by the limitations of the data available. However, this makes it more important that STS are managed by teams, expert in such cases, to ensure consistent and optimal treatment, as well as recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous version published in 2010 (Grimer et al. in Sarcoma 2010:506182, 2010). The original guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This current version has been updated and amended with reference to other European and US guidance. There are specific recommendations for the management of selected subtypes of disease including retroperitoneal and uterine sarcomas, as well as aggressive fibromatosis (desmoid tumours) and other borderline tumours commonly managed by sarcoma services. An important aim in sarcoma management is early diagnosis and prompt referral. In the UK, any patient with a suspected soft tissue sarcoma should be referred to one of the specialist regional soft tissues sarcoma services, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging, plus a biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon. In tumours at higher risk of recurrence or metastasis pre- or post-operative radiotherapy should be considered. Systemic anti-cancer therapy (SACT) may be utilized in some cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late-effects of treatment. For local recurrence, and more rarely in selected cases of metastatic disease, surgical resection would be considered. Treatment for metastases may include radiotherapy, or systemic therapy guided by the sarcoma subtype. In some cases, symptom control and palliative care support alone will be appropriate.
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Affiliation(s)
- Adam Dangoor
- Bristol Cancer Institute, Bristol Haematology & Oncology Centre, University Hospitals Bristol NHS Trust, Bristol, BS2 8ED UK
| | - Beatrice Seddon
- Department of Oncology, University College London Hospital NHS Trust, London, NW1 2PG UK
| | - Craig Gerrand
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, NE7 7DN UK
| | - Robert Grimer
- Royal Orthopaedic Hospital NHS Trust, Birmingham, B31 2AP UK
| | - Jeremy Whelan
- Department of Oncology, University College London Hospital NHS Trust, London, NW1 2PG UK
| | - Ian Judson
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ UK
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50
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Current Systemic Treatment Options for Tenosynovial Giant Cell Tumor/Pigmented Villonodular Synovitis: Targeting the CSF1/CSF1R Axis. Curr Treat Options Oncol 2016; 17:10. [PMID: 26820289 DOI: 10.1007/s11864-015-0385-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OPINION STATEMENT Adequate surgical resection remains the treatment of choice for tenosyovial giant cell tumor (TGCT). However, diffuse type TGCT (D-TGCT) is more difficult to resect and has a higher rate of recurrence (up to 50 %), which is often multiple. D-TGCT is rarely lethal and only rare cases of metastases have been described. Nevertheless, patients might have a significant decline in their quality of life due to multiple operations, which may sometimes result in a partial loss of function of the affected joint and may also be associated with perioperative morbidity and secondary arthrosis. As of today, no systemic treatment is approved for this rare disease. The aims of systemic therapy in the context of a non-lethal tumor are to reduce surgical morbidity and to preserve function and patient quality of life. Because TGCT is associated with characteristic cytogenetic abnormalities resulting in the overexpression of CSF1, systemic therapies targeting the CSF1/CSF1R axis (imatinib, nilotinib, emactuzumab, and PLX3397) have been tested in patients with locally advanced or relapsed D-TGCT. The more recent and more specific CSF1R inhibitors have shown a very interesting clinical activity with acceptable toxicity in early phase trials. These results will need to be confirmed in larger, ideally randomized, trials. But the high rate of clinical and functional improvement seen in some patients with advanced D-TGCT, often after multiple operations, suggests that these inhibitors will likely have a role in the management of patients with an inoperable disease; the definition of "inoperable TGCT" still requires refinement to reach a consensus. Another point that will need to be addressed is that of "the optimal duration of therapy" for these patients. Indeed, we and others have observed often prolonged clinical benefit and symptomatic relief even after treatment was stopped, with both monoclonal antibodies and tyrosine kinase inhibitors. Responses were observed very early on with emactuzumab and PLX3397, and patients experienced significant symptom improvement within a few weeks of starting therapy (2-4 weeks). Another possible application of CSF1R inhibitors could be used either as a preoperative or postoperative therapy for patients with operable TGCT. However, we currently lack sufficient follow-up to adequately address these questions which will each require specific trial designs. Overall, the striking clinical activity of CSF1R specific inhibitors in TGCT has created great enthusiasm among clinicians, and further development of these agents is clearly medically needed. Nevertheless, further investigations are necessary to validate those treatments and assess how to best incorporate them among other treatment modalities into the overall therapeutic strategy for a given patient.
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