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Alexander AY, Dhawan S, Venteicher AS. Role of immunotherapy in treatment refractory chordomas: review of current evidence. Front Surg 2024; 11:1375567. [PMID: 38881706 PMCID: PMC11177759 DOI: 10.3389/fsurg.2024.1375567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Chordomas are aggressive tumors that are thought to arise from remnants of the embryological notochord. They can arise along the ventromedial aspect of the sacrum, mobile spine, and clivus-with most cases occurring in the sacrum or skull base. Despite surgery and radiation, chordomas often progress and become refractory to further treatment. The high recurrence rate of chordomas has created an urgent need to develop new systemic treatment options. Recent case reports and clinical trials have highlighted the use of immunotherapy for refractory chordomas. In this review, we summarize the results of these studies and discuss the potential role of immunotherapy for chordomas. Methods The PUBMED database was queried for studies mentioning both "Chordoma" and "Immunotherapy." All case series and case reports that involved administration of an immunotherapy for chordoma were included. Additional studies that were found during literature review were added. ClinicalTrials.Gov was queried for studies mentioning both "Chordoma" and "Immunotherapy." The final cohort consisted of all clinical trials that utilized immunotherapy for chordomas of any location. Results Eight case reports and series detailing the use of immunotherapy for treatment refractory chordoma were identified. Most patients received immunotherapy targeting the PD-1/PD-L1 interaction, and two patients received therapy targeting this interaction along with the tyrosine kinase inhibitor pazopanib. One patient received a vaccine derived from autologous tumor cells, and one patient received a viral vector that downregulated the effect of TGF-beta. One clinical trial utilized a brachyury vaccine in conjunction with standard of care radiotherapy. Conclusions Immunotherapy for chordoma is a promising area of investigation with increasing, but small, numbers of case series and clinical trials. Despite challenges in patient accrual, future directions in chordoma immunotherapy may lie in vaccine-based therapies and immune checkpoint inhibitors. Understanding chordoma heterogeneity and microenvironment will likely elucidate important chordoma features that will inform future clinical trial design.
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Affiliation(s)
- A Yohan Alexander
- Department of Neurosurgery and Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Sanjay Dhawan
- Department of Neurosurgery and Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Andrew S Venteicher
- Department of Neurosurgery and Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN, United States
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2
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Desai R, Pelargos PE, Dunn IF. Chordoma: Genetics and Contemporary Management. Int J Mol Sci 2024; 25:5877. [PMID: 38892063 PMCID: PMC11172617 DOI: 10.3390/ijms25115877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Chordomas, arising from notochord remnants, are rare neoplasms with aggressive growth patterns despite their histologically low-grade nature. This review explores their embryological origins, molecular markers like brachyury, and genetic alterations driving pathogenesis. Diagnosis relies on advanced imaging and biopsy confirmation due to overlapping features with chondrosarcoma. The WHO classification distinguishes conventional, dedifferentiated, and poorly differentiated chordomas, each with distinct prognostic implications. Recent genomic analyses uncovered recurrent mutations in PI3K signaling pathways and chromatin remodeling genes, informing prognostic models. Surgery remains the cornerstone of treatment, though adjuvant radiation complements surgical resection. Although chordomas are generally considered refractory to medical therapy, emerging targeted molecular strategies show potential promise in ongoing trials. This review aims to provide a concise yet comprehensive overview of chordomas, guiding clinicians in diagnosis, treatment, and prognostication for improved patient outcomes.
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Affiliation(s)
| | | | - Ian F. Dunn
- Department of Neurological Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA; (R.D.); (P.E.P.)
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3
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Hoch CC, Knoedler L, Knoedler S, Bashiri Dezfouli A, Schmidl B, Trill A, Douglas JE, Adappa ND, Stögbauer F, Wollenberg B. Integrated Molecular and Histological Insights for Targeted Therapies in Mesenchymal Sinonasal Tract Tumors. Curr Oncol Rep 2024; 26:272-291. [PMID: 38376625 PMCID: PMC10920452 DOI: 10.1007/s11912-024-01506-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide a comprehensive overview of mesenchymal sinonasal tract tumors (STTs), a distinct subset of STTs. Despite their rarity, mesenchymal STTs represent a unique clinical challenge, characterized by their rarity, often slow progression, and frequently subtle or overlooked symptoms. The complex anatomy of the sinonasal area, which includes critical structures such as the orbit, brain, and cranial nerves, further complicates surgical treatment options. This underscores an urgent need for more advanced and specialized therapeutic approaches. RECENT FINDINGS Advancements in molecular diagnostics, particularly in next-generation sequencing, have significantly enhanced our understanding of STTs. Consequently, the World Health Organization has updated its tumor classification to better reflect the distinct histological and molecular profiles of these tumors, as well as to categorize mesenchymal STTs with greater accuracy. The growing understanding of the molecular characteristics of mesenchymal STTs opens new possibilities for targeted therapeutic interventions, marking a significant shift in treatment paradigms. This review article concentrates on mesenchymal STTs, specifically addressing sinonasal tract angiofibroma, sinonasal glomangiopericytoma, biphenotypic sinonasal sarcoma, and skull base chordoma. These entities are marked by unique histopathological and molecular features, which challenge conventional treatment approaches and simultaneously open avenues for novel targeted therapies. Our discussion is geared towards delineating the molecular underpinnings of mesenchymal STTs, with the objective of enhancing therapeutic strategies and addressing the existing shortcomings in the management of these intricate tumors.
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Affiliation(s)
- Cosima C Hoch
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel Knoedler
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum Munich, Munich, Germany
| | - Ali Bashiri Dezfouli
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
- Central Institute for Translational Cancer Research, Technical University of Munich (TranslaTUM), Department of Radiation Oncology, Klinikum rechts der Isar, Munich, Germany
| | - Benedikt Schmidl
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
| | - Anskar Trill
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
- Central Institute for Translational Cancer Research, Technical University of Munich (TranslaTUM), Department of Radiation Oncology, Klinikum rechts der Isar, Munich, Germany
| | - Jennifer E Douglas
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Fabian Stögbauer
- Institute of Pathology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
| | - Barbara Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany.
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Díaz-Alvarez L, López-Cortés GI, Pérez-Figueroa E. Immunomodulation exerted by galectins: a land of opportunity in rare cancers. Front Immunol 2023; 14:1301025. [PMID: 38022609 PMCID: PMC10663293 DOI: 10.3389/fimmu.2023.1301025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Rare cancers represent only 5% of newly diagnosed malignancies. However, in some cases, they account for up to 50% of the deaths attributed to cancer in their corresponding organ. Part of the reason is that treatment options are generally quite limited, non-specific, and very often, only palliative. Needless to say, research for tailored treatments is warranted. Molecules that exert immunomodulation of the tumor microenvironment are attractive drug targets. One such group is galectins. Thus, in this review we summarize the current knowledge about galectin-mediated immunomodulation in rare cancers, highlighting the research opportunities in each case.
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Affiliation(s)
- Laura Díaz-Alvarez
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Posgrado en Ciencias Biológicas, Unidad de Posgrado, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Erandi Pérez-Figueroa
- Unidad Periférica para el Estudio de la Neuroinflamación en Patologías Neurológicas, Instituto de Investigaciones Biomédicas e Instituto Nacional de Neurología y Neurocirugía, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Bioquímica, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Martinez Moreno M, Wang E, Schroeder C, Sullivan P, Gokaslan Z. Shedding light on emerging therapeutic targets for chordoma. Expert Opin Ther Targets 2023; 27:705-713. [PMID: 37647357 DOI: 10.1080/14728222.2023.2248382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Despite encouraging advances in radiation and surgical treatment, chordomas remain resistant to chemotherapy and local recurrence is common. Although the primary mechanism of recurrence is local, metastatic disease occurs in a small subset of patients. Recurrence may also occur along the surgical trajectory if care is not taken to fully excise the open biopsy pathway. There is increasing morbidity with reoperation upon disease recurrence, and radiation is an option for cytoreduction in primary disease or for recurrent disease, although toxicity may be observed with high-dose therapies. Given these challenges, targeted chemotherapeutic agents for postoperative adjuvant treatment are needed. AREAS COVERED In this review, we summarize the genetic drivers of chordoma and the state of the current research in chordoma immunotherapy and epigenetics. EXPERT OPINION Chordoma is a heterogenous tumor that should be targeted from different angles and the study of its characteristics, from molecular to immunological to epigenetic, is necessary. Combining different approaches, such as studying noninvasive patient methylation patterns with tissue-based molecular and drug screening, can transform patient care by guiding treatment decisions based on prognostic mechanisms from different sources, while helping individualize surgical planning and treatment.
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Affiliation(s)
| | - Elaina Wang
- Rhode Island Hospital, Brown University, Providence, USA
| | | | - Patricia Sullivan
- Rhode Island Hospital, Brown University, Providence, USA
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ziya Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Kesari S, Wang F, Juarez T, Ashili S, Patro CPK, Carrillo J, Nguyen M, Truong J, Levy J, Sommer J, Freed DM, Xiu J, Takasumi Y, Bouffet E, Gill JM. Activity of pemetrexed in pre-clinical chordoma models and humans. Sci Rep 2023; 13:7317. [PMID: 37147496 PMCID: PMC10163028 DOI: 10.1038/s41598-023-34404-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023] Open
Abstract
Chordomas are rare slow growing tumors, arising from embryonic remnants of notochord with a close predilection for the axial skeleton. Recurrence is common and no effective standard medical therapy exists. Thymidylate synthase (TS), an intracellular enzyme, is a key rate-limiting enzyme of DNA biosynthesis and repair which is primarily active in proliferating and metabolically active cells. Eighty-four percent of chordoma samples had loss of TS expression which may predict response to anti-folates. Pemetrexed suppresses tumor growth by inhibiting enzymes involved in folate metabolism, resulting in decreased availability of thymidine which is necessary for DNA synthesis. Pemetrexed inhibited growth in a preclinical mouse xenograft model of human chordoma. We report three cases of metastatic chordoma that had been heavily treated previously with a variety of standard therapies with poor response. In two cases, pemetrexed was added and objective responses were observed on imaging with one patient on continuous treatment for > 2 years with continued shrinkage. One case demonstrated tumor growth after treatment with pemetrexed. The two cases which had a favorable response had a loss of TS expression, whereas the one case with progressive disease had TS present. These results demonstrate the activity of pemetrexed in recurrent chordoma and warrant a prospective clinical trial which is ongoing (NCT03955042).
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Affiliation(s)
- Santosh Kesari
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA.
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
| | - Feng Wang
- Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, Chengdu, China.
| | - Tiffany Juarez
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | | | - C Pawan K Patro
- CureScience, San Diego, CA, USA
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Jose Carrillo
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Minhdan Nguyen
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Judy Truong
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Joan Levy
- Chordoma Foundation, Durham, NC, USA
| | | | | | | | - Yuki Takasumi
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Eric Bouffet
- The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Canada
| | - Jaya M Gill
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
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Apps J, Gagen R, Neumann E, Solanki G, English M. A 13-year patient journey of infant giant clival chordoma: case report and literature review. Childs Nerv Syst 2023; 39:1077-1081. [PMID: 36414866 PMCID: PMC10159969 DOI: 10.1007/s00381-022-05749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022]
Abstract
Chordomas are rare malignant bone tumours that develop from the ectopic remnants of the embryonic notochord. In contrast to adults, the majority in children under 16 present intra-cranially (63%). In 2006, we reported the youngest case of a large clival chordoma, a 15-week old baby, the second case to present without skull base involvement and the fourth case of chordoma in a patient with tuberous sclerosis (TS) Kombogiorgas (Childs Nerv Syst 22(10):1369-1374, 2006). In this report, we provide an update on this patient's journey through a range of therapeutic options and summarize an update of the literature, since 2006, for this patient group.
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Affiliation(s)
- J Apps
- Department of Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Department of Neurosurgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - R Gagen
- Department of Neurosurgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Radiology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - E Neumann
- Department of Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Department of Neurosurgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - G Solanki
- Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - M English
- Department of Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- Department of Neurosurgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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8
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Aydemir E, Tüysüz EC, Bayrak ÖF, Tecimel D, Hızlı-Deniz AA, Şahin F. Impact of silencing eEF2K expression on the malignant properties of chordoma. Mol Biol Rep 2023; 50:3011-3022. [PMID: 36652154 DOI: 10.1007/s11033-023-08257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Eukaryotic elongation factor 2 kinase (eukaryotic elongation factor 2 kinase, eEF2K) is a calcium calmodulin dependent protein kinase that keeps the highest energy consuming cellular process of protein synthesis under check through negative regulation. eEF2K pauses global protein synthesis rates at the translational elongation step by phosphorylating its only kown substrate elongation factor 2 (eEF2), a unique translocase activity in ekaryotic cells enabling the polypeptide chain elongation. Therefore, eEF2K is thought to preserve cellular energy pools particularly upon acute development of cellular stress conditions such as nutrient deprivation, hypoxia, or infections. Recently, high expression of this enzyme has been associated with poor prognosis in an array of solid tumor types. Therefore, in a growing number of studies tremendous effort is being directed to the development of treatment methods aiming to suppress eEF2K as a novel therapeutic approach in the fight against cancer. METHODS In our study, we aimed to investigate the changes in the tumorigenicity of chordoma cells in presence of gene silencing for eEF2K. Taking a transient gene silencing approach using siRNA particles, eEF2K gene expression was suppressed in chordoma cells. RESULTS Silencing eEF2K expression was associated with a slight increase in cellular proliferation and a decrease in death rates. Furthermore, no alteration in the sensitivity of chordoma cells to chemotherapy was detected in response to the decrease in eEF2K expression which intriguingly promoted suppression of cell migratory and invasion related properties. CONCLUSION Our findings indicate that the loss of eEF2K expression in chordoma cell lines results in the reduction of metastatic capacity.
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Affiliation(s)
- Esra Aydemir
- Department of Biomedical Engineering, Faculty of Engineering and Natural Sciences, Biruni University, 10. Yil Cad, Protokol Yolu, No: 45 Topkapı, 34010, Istanbul, Turkey.
| | - Emre Can Tüysüz
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey.,Department of Medical Genetics, Yeditepe University Medical School and Yeditepe University Hospital, Istanbul, Turkey.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Ömer Faruk Bayrak
- Department of Medical Genetics, Yeditepe University Medical School and Yeditepe University Hospital, Istanbul, Turkey
| | - Didem Tecimel
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey.,Department of Medical Genetics, Yeditepe University Medical School and Yeditepe University Hospital, Istanbul, Turkey
| | - Ayşen Aslı Hızlı-Deniz
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey
| | - Fikrettin Şahin
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey
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Jae-Min Park A, McDowell S, Mesfin A. Management of Chordoma of the Sacrum and Mobile Spine. JBJS Rev 2022; 10:01874474-202212000-00004. [PMID: 36639876 DOI: 10.2106/jbjs.rvw.22.00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
➢ Chordomas account for 1% to 4% of primary tumors of the spine and sacrum. ➢ En bloc resection is the preferred surgical treatment for the management of chordomas. ➢ Proton beam radiation is increasingly being used as a postoperative radiation modality for the treatment of chordomas.
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Affiliation(s)
- Andrew Jae-Min Park
- Department of Orthopedic Surgery and Physical Performance, University of Rochester School of Medicine & Dentistry, Rochester, New York
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10
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Passeri T, Dahmani A, Masliah-Planchon J, El Botty R, Courtois L, Vacher S, Marangoni E, Nemati F, Roman-Roman S, Adle-Biassette H, Mammar H, Froelich S, Bièche I, Decaudin D. In vivo efficacy assessment of the CDK4/6 inhibitor palbociclib and the PLK1 inhibitor volasertib in human chordoma xenografts. Front Oncol 2022; 12:960720. [PMID: 36505864 PMCID: PMC9732546 DOI: 10.3389/fonc.2022.960720] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Management of advanced chordomas remains delicate considering their insensitivity to chemotherapy. Homozygous deletion of the regulatory gene CDKN2A has been described as the most frequent genetic alteration in chordomas and may be considered as a potential theranostic marker. Here, we evaluated the tumor efficacy of the CDK4/6 inhibitor palbociclib, as well as the PLK1 inhibitor volasertib, in three chordoma patient-derived xenograft (PDX) models to validate and identify novel therapeutic approaches. Methods From our chordoma xenograft panel, we selected three models, two of them harboring a homozygous deletion of CDKN2A/2B genes, and the last one a PBRM1 pathogenic variant (as control). For each model, we tested the palbociclib and volasertib drugs with pharmacodynamic studies together with RT-PCR and RNAseq analyses. Results For palbociclib, we observed a significant tumor response for one of two models harboring the deletion of CDKN2A/2B (p = 0.02), and no significant tumor response in the PBRM1-mutated PDX; for volasertib, we did not observe any response in the three tested models. RT-PCR and RNAseq analyses showed a correlation between cell cycle markers and responses to palbociclib; finally, RNAseq analyses showed a natural enrichment of the oxidative phosphorylation genes (OxPhos) in the palbociclib-resistant PDX (p = 0.02). Conclusion CDK4/6 inhibition appears as a promising strategy to manage advanced chordomas harboring a loss of CDKN2A/2B. However, further preclinical studies are strongly requested to confirm it and to understand acquired or de novo resistance to palbociclib, in the peculiar view of a targeting of the oxidative phosphorylation genes.
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Affiliation(s)
- Thibault Passeri
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France,Department of Genetics, Institut Curie, University of Paris Saclay, Paris, France,Department of Neurosurgery, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, Paris, France,*Correspondence: Thibault Passeri,
| | - Ahmed Dahmani
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
| | | | - Rania El Botty
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
| | - Laura Courtois
- Department of Genetics, Institut Curie, University of Paris Saclay, Paris, France
| | - Sophie Vacher
- Department of Genetics, Institut Curie, University of Paris Saclay, Paris, France
| | - Elisabetta Marangoni
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
| | - Fariba Nemati
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France
| | - Sergio Roman-Roman
- Department of Translational Research, Institut Curie, University of Paris Saclay, Paris, France
| | - Homa Adle-Biassette
- Department of Pathology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, Paris, France
| | - Hamid Mammar
- Department of Radiotherapy - Proton Therapy Center, Institut Curie, Paris-Saclay University, Orsay, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, Paris, France
| | - Ivan Bièche
- Department of Genetics, Institut Curie, University of Paris Saclay, Paris, France
| | - Didier Decaudin
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, University of Paris Saclay, Paris, France,Department of Medical Oncology, Institut Curie, Paris, France
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Receptor Tyrosine Kinase Inhibitors for the Treatment of Recurrent and Unresectable Bone Sarcomas. Int J Mol Sci 2022; 23:ijms232213784. [PMID: 36430263 PMCID: PMC9697271 DOI: 10.3390/ijms232213784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Bone sarcomas are a heterogeneous group of rare tumors with a predominance in the young population. Few options of systemic treatment are available once they become unresectable and resistant to conventional chemotherapy. A better knowledge of the key role that tyrosine kinase receptors (VEGFR, RET, MET, AXL, PDGFR, KIT, FGFR, IGF-1R) may play in the pathogenesis of these tumors has led to the development of multi-target inhibitors (TKIs) that are progressively being incorporated into our therapeutic arsenal. Osteosarcoma (OS) is the most frequent primary bone tumor and several TKIs have demonstrated clinical benefit in phase II clinical trials (cabozantinib, regorafenib, apatinib, sorafenib, and lenvatinib). Although the development of TKIs for other primary bone tumors is less advanced, preclinical data and early trials have begun to show their potential benefit in advanced Ewing sarcoma (ES) and rarer bone tumors (chondrosarcoma, chordoma, giant cell tumor of bone, and undifferentiated pleomorphic sarcoma). Previous reviews have mainly provided information on TKIs for OS and ES. We aim to summarize the existing knowledge regarding the use of TKIs in all bone sarcomas including the most recent studies as well as the potential synergistic effects of their combination with other systemic therapies.
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12
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Freed DM, Sommer J, Punturi N. Emerging target discovery and drug repurposing opportunities in chordoma. Front Oncol 2022; 12:1009193. [PMID: 36387127 PMCID: PMC9647139 DOI: 10.3389/fonc.2022.1009193] [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] [Received: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 09/01/2023] Open
Abstract
The development of effective and personalized treatment options for patients with rare cancers like chordoma is hampered by numerous challenges. Biomarker-guided repurposing of therapies approved in other indications remains the fastest path to redefining the treatment paradigm, but chordoma's low mutation burden limits the impact of genomics in target discovery and precision oncology efforts. As our knowledge of oncogenic mechanisms across various malignancies has matured, it's become increasingly clear that numerous properties of tumors transcend their genomes - leading to new and uncharted frontiers of therapeutic opportunity. In this review, we discuss how the implementation of cutting-edge tools and approaches is opening new windows into chordoma's vulnerabilities. We also note how a convergence of emerging observations in chordoma and other cancers is leading to the identification and evaluation of new therapeutic hypotheses for this rare cancer.
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Gao J, Huang R, Yin H, Song D, Meng T. Research hotspots and trends of chordoma: A bibliometric analysis. Front Oncol 2022; 12:946597. [PMID: 36185236 PMCID: PMC9523362 DOI: 10.3389/fonc.2022.946597] [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: 05/17/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chordoma is a type of mesenchymal malignancy with a high recurrence rate and poor prognosis. Due to its rarity, the tumorigenic mechanism and optimal therapeutic strategy are not well known. Methods All relevant articles of chordoma research from 1 January 2000 to 26 April 2022 were obtained from Web of Science Core Collection database. Blibliometrix was used to acquire basic publication data. Visualization and data table of collaboration network, dynamic analysis, trend topics, thematic map, and factorial analysis were acquired using Blibliometrix package. VOSviewer was used to generate a visualization map of co-citation analysis and co-occurrence. Results A total of 2,285 articles related to chordoma were identified. The most influential and productive country/region was the United States, and Capital Medical University has published the most articles. Among all high-impact authors, Adrienne M. Flanagan had the highest average citation rate. Neurosurgery was the important periodical for chordoma research with the highest total/average citation rate. We focused on four hotspots in recent chordoma research. The research on surgical treatment and radiotherapy was relatively mature. The molecular signaling pathway, targeted therapy and immunotherapy for chordoma are not yet mature, which will be the future trends of chordoma research. Conclusion This study indicates that chordoma studies are increasing. Surgery and radiotherapy are well reported and always play fundamental roles in chordoma treatment. The molecular signaling pathway, targeted therapy, and immunotherapy of chordoma are the latest research hotspots.
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Affiliation(s)
- Jianxuan Gao
- Department of Spine Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Tongji University Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Runzhi Huang
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Huabin Yin
- Department of Spine Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dianwen Song
- Department of Spine Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Tong Meng, ; Dianwen Song,
| | - Tong Meng
- Department of Spine Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Tongji University Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Tong Meng, ; Dianwen Song,
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14
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Jabbar R, Jankowski J, Pawełczyk A, Szmyd B, Solek J, Pierzak O, Wojdyn M, Radek M. Cervical Paraspinal Chordoma: A Literature Review with a Novel Case Report. J Clin Med 2022; 11:jcm11144117. [PMID: 35887879 PMCID: PMC9325254 DOI: 10.3390/jcm11144117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Chordomas are rare malignant neoplasms, accounting for 1–4% of all primary bone tumors. Most spinal chordomas occur in the sacrococcygeal region and the base of the skull; however, 6% of chordomas are observed in the cervical spine. In these cases, the lesion is mainly located in the midline. These tumors slowly grow before becoming symptomatic and encase the surrounding vascular and nerve structures. Patients with advanced chordoma have a poor prognosis due to local recurrence with infiltration and destruction of adjacent bone and tissues. Systemic chemotherapy options have not been fully effective in these tumors, especially for recurrent chordomas. Thus, new combinations of currently available targeted molecular and biological therapies with radiotherapy have been proposed as potential treatment modalities. Here, the present paper describes the case of a 41-year-old male with a C2–C4 chordoma located paravertebrally, who underwent surgical resection with a debulking procedure for a cervical chordoma. Computed tomography angiography revealed a paraspinal mass with bone remodeling and the MRI showed a paravertebral mass penetrating to the spinal canal with a widening of the intervertebral C2–C3 foramen. Initially, the tumor was diagnosed as schwannoma based on its localization and imaging features; however, the histopathology specimen confirmed the diagnosis of chordoma. This case study highlights the effectivity of radical surgical resection as a mainstay treatment for chordomas, discusses neuroimaging, diagnosis, and the use of currently available targeted therapies and forthcoming treatment strategies, as alternative treatment options for chordoma.
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Affiliation(s)
- Redwan Jabbar
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Jakub Jankowski
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Agnieszka Pawełczyk
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Bartosz Szmyd
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Julia Solek
- Department of Pathology, Chair of Oncology, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Olaf Pierzak
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Maciej Wojdyn
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, 90-549 Lodz, Poland; (R.J.); (J.J.); (A.P.); (B.S.); (O.P.); (M.W.)
- Correspondence:
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15
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Xiao D, Huang Y, Huang S, Zhuang J, Chen P, Wang Y, Zhang L. Targeted delivery of cancer drug paclitaxel to chordomas tumor cells via an RNA nanoparticle harboring an EGFR aptamer. Colloids Surf B Biointerfaces 2022; 212:112366. [PMID: 35144131 DOI: 10.1016/j.colsurfb.2022.112366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/04/2022] [Accepted: 01/23/2022] [Indexed: 12/23/2022]
Abstract
Paclitaxel has been extensively used in clinics for cancer treatment. However, its limited solubility in aqueous solution and high occurrence of side effects have also been widely reported. In this study, we constructed a biocompatible RNA nanoparticle delivery system (3WJ-EGFRapt) that includes 3WJ (3-way junction) nanoparticle with a size of 4.85 ± 0.59 nm as a backbone and an EGFR (epidermal growth factor receptor) aptamer for specific targeting to chordomas cells, which owns the encapsulation ability of drug paclitaxel (PTX) for cancer therapy. Confocal microscopy and flow cytometry results confirmed 3WJ-EGFRapt nanoparticle exhibited excellent specific targeting to chordomas cell U-CH2 which is an EGFR(+) cell line; while the 3WJ nanoparticle lose the targeted ability. Both of the two nanoparticles own no sensitivity to lung cancer cell H520 which is an EGFR(-) cell line. Moreover, the 3WJ-EGFRapt nanoparticle encapsulated drug PTX could enhance the inhibition efficiency of chordomas tumor cells U-CH2 as compared to free PTX alone. This work demonstrates that RNA-3WJ constructed with a targeting aptamer provides a compromising targeted drug delivery ability on chordomas cells for therapeutics.
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Affiliation(s)
- Dan Xiao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Yongxiong Huang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Shuaihao Huang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Jianxiong Zhuang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - P Chen
- Advanced Materials Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, China; Department of Chemical Engineering and Waterloo Institute for Nanotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L3G1, Canada
| | - Yi Wang
- Nanopeptide (Qingdao) Biotechnology LTD, Qingdao, Shandong 266000, China.
| | - Lei Zhang
- Department of Chemical Engineering and Waterloo Institute for Nanotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L3G1, Canada.
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16
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Baldi GG, Lo Vullo S, Grignani G, Vincenzi B, Badalamenti G, Mastore M, Buonomenna C, Morosi C, Barisella M, Frezza AM, Provenzano S, Simeone N, Picozzi F, Mariani L, Casali PG, Stacchiotti S. Weekly cisplatin with or without imatinib in advanced chordoma: A retrospective case-series analysis from the Italian Rare Cancers Network. Cancer 2022; 128:1439-1448. [PMID: 35026050 DOI: 10.1002/cncr.34083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND To report on a retrospective case-series analysis of weekly cisplatin (wCDDP) as a single agent or combined with imatinib (wCDDP/I) in patients with advanced chordoma treated within the Italian Rare Cancer Network. METHODS Adult patients with a diagnosis of advanced, brachyury-positive chordoma, treated from April 2007 to October 2020 with wCDDP or wCDDP/I were retrospectively identified. Imatinib was withheld at the same time as wCDDP. Response according to Response Evaluation Criteria in Solid Tumors, overall survival (OS), and progression-free survival (PFS) were analyzed. RESULTS Thirty-three consecutive patients were identified (wCDDP as front-line n = 8 [24.2%]; wCDDP as a further line n = 25 [75.8%]; prior imatinib n = 25 [75.8%]; evidence of progression before starting wCDDP n = 33). Of 32 patients evaluable for response (wCDDP, n = 22 [68.8%]; wCDDP/I, n = 10 [31.3%]), best response was stable disease (SD) in 27 patients (84.3%) and progression in 5 patients (15.6%). At a median follow-up of 54 months, the median OS (m-OS) was 30.3 months (interquartile range [IQR], 18.1-56.6), the m-PFS was 8.0 months (IQR, 5.1-17.0), the 6-month PFS rate was 65.2%, and the 12-month PFS rate was 30.3%. Of 22 patients who received wCDDP, the best response was SD in 18 patients (81.8%) and progression in 4 patients (18.2%), and the m-PFS was 8.0 months (IQR, 5.1-17.0 months). Of 10 patients who received treatment with wCDDP/I, the best response was SD in 9 patients (90%) and progression in 1 patient (10%), and the m-PFS was 9.3 months (IQR, 4.9-26.5 months). CONCLUSIONS This series suggests that wCDDP, both as a single agent and combined with imatinib, has antitumor activity in chordoma. Although no dimensional responses were observed, 65% and 30% of previously progressive patients were progression-free at 6 and 12 months, respectively. A prospective study is warranted.
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Affiliation(s)
- Giacomo G Baldi
- Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Biomedico University of Rome, Rome, Italy
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological, and Oral Sciences - Section of Medical Oncology, University of Palermo, Palermo, Italy
| | | | - Ciriaco Buonomenna
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Barisella
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Anna Maria Frezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Provenzano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Noemi Simeone
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fernanda Picozzi
- Deparment of Medical Oncology, Azienda Ospedaliera di Rilievo Nazionale dei Colli Monaldi-Cotugno, Naples, Italy.,Department of Electrical Engineering and Information Technology, Federico II University of Naples, Naples, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paolo G Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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17
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Moukhlissi M, Sghier AB, Bensaid M, Mezouar L. [Sacrococcygeal chordoma: about a case]. Pan Afr Med J 2022; 40:164. [PMID: 34970406 PMCID: PMC8683457 DOI: 10.11604/pamj.2021.40.164.30316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022] Open
Abstract
Le chordome sacrococcygien est une entité pathologique rare, rapporté dans seulement moins de 3% des cas. Nous allons rapporter l´observation d´une patiente prise en charge au Centre Régional d'Oncologie d'Oujda au Maroc ayant présenté un chordome sacrococcygien localement avancé. Le traitement a consisté en une radiothérapie exclusive sur la tumeur, la chirurgie d´exérèse n´était pas possible. Actuellement la patiente est à 2 ans de recul, la tumeur est stable sur le plan clinique et radiologique avec un bon état général.
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Affiliation(s)
- Mohamed Moukhlissi
- Département de Radiothérapie, Centre Hospitalier Universitaire Mohammed VI, Faculté de Médecine et de Pharmacie, Université Mohammed 1er, Oujda, Maroc
| | - Ahmed Ben Sghier
- Département de Radiothérapie, Centre Hospitalier Universitaire Mohammed VI, Faculté de Médecine et de Pharmacie, Université Mohammed 1er, Oujda, Maroc
| | | | - Loubna Mezouar
- Département de Radiothérapie, Centre Hospitalier Universitaire Mohammed VI, Faculté de Médecine et de Pharmacie, Université Mohammed 1er, Oujda, Maroc
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18
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Scheipl S, Barnard M, Lohberger B, Zettl R, Brcic I, Liegl-Atzwanger B, Rinner B, Meindl C, Fröhlich E. Drug combination screening as a translational approach toward an improved drug therapy for chordoma. Cell Oncol (Dordr) 2021; 44:1231-1242. [PMID: 34550531 PMCID: PMC8648636 DOI: 10.1007/s13402-021-00632-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 02/01/2023] Open
Abstract
Purpose Drug screening programmes have revealed epidermal growth factor receptor inhibitors (EGFRis) as promising therapeutics for chordoma, an orphan malignant bone tumour, in the absence of a known genetic driver. Concurrently, the irreversible EGFRi afatinib (Giotrif®) is being evaluated in a multicentric Phase II trial. As tyrosine kinase inhibitor (TKI) monotherapies are invariably followed by resistance, we aimed to evaluate potential therapeutic combinations with EGFRis. Methods We screened 133 clinically approved anticancer drugs as single agents and in combination with two EGFRis (afatinib and erlotinib) in the clival chordoma cell line UM-Chor1. Synergistic combinations were analysed in a 7 × 7 matrix format. The most promising combination was further explored in clival (UM-Chor1, MUG-CC1) and sacral (MUG-Chor1, U-CH1) chordoma cell lines. Secretomes were analysed for receptor tyrosine kinase ligands (EGF, TGF-α, FGF-2 and VEGF-A) upon drug treatment. Results Drugs that were active as single agents (n = 45) included TKIs, HDAC and proteasome inhibitors, and cytostatic drugs. Six combinations were analysed in a matrix format: n = 4 resulted in a significantly increased cell killing (crizotinib, dabrafenib, panobinostat and doxorubicin), and n = 2 exhibited no or negligible effects (regorafenib, venetoclax). Clival chordoma cell lines were more responsive to combined EGFR-MET inhibition. EGFR-MET cross-talk (e.g. via TGF-α secretion) likely accounts for the synergistic effects of EGFR-MET inhibition. Conclusion Our screen revealed promising combinations with EGFRis, such as the ALK/MET-inhibitor crizotinib, the HDAC-inhibitor panobinostat or the topoisomerase-II-inhibitor doxorubicin, which are part of standard chemotherapy regimens for various bone and soft-tissue sarcomas. Supplementary Information The online version contains supplementary material available at 10.1007/s13402-021-00632-x.
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Affiliation(s)
- Susanne Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Michelle Barnard
- Cancer Research UK - AstraZeneca Antibody Alliance Laboratory, Cambridge, UK
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
| | - Richard Zettl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Iva Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Beate Rinner
- Division of Biomedical Research, Medical University of Graz, Graz, Austria
| | - Claudia Meindl
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Eleonore Fröhlich
- Center for Medical Research, Medical University of Graz, Graz, Austria
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19
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Rekhi B, Michal M, Ergen FB, Roy P, Puls F, Haugland HK, Soylemezoglu F, Kosemehmetoglu K. Poorly differentiated chordoma showing loss of SMARCB1/INI1: Clinicopathological and radiological spectrum of nine cases, including uncommon features of a relatively under-recognized entity. Ann Diagn Pathol 2021; 55:151809. [PMID: 34482218 DOI: 10.1016/j.anndiagpath.2021.151809] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/17/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022]
Abstract
Poorly differentiated chordoma is a newly recognized entity in the recent World Health Organization (WHO) classification of tumors of soft tissue and bone. Slightly over 60 such cases have been documented. Herein, we present a clinicopathological profile, including radiological features, of nine cases, which occurred in five males and four females, with age varying from 1 to 29 years (median = 43), in the cervical spine (n = 2), skull base (n = 2), clivus (n = 2), thoracic spine (n = 1) lumbar spine (n = 1) and coccyx (n = 1) Average tumor size was 4.8 cm. None of the 6-referral cases was diagnosed as a poorly differentiated chordoma at the referring laboratory. Histopathologically, all cases displayed a cellular tumor comprising polygonal cells (n = 9) displaying moderate to marked nuclear pleomorphism with prominent nucleoli (n = 7), eosinophilic (n = 9) to vacuolated cytoplasm (n = 7), rhabdoid morphology (n = 4), interspersed mitotic figures (n = 5), focal necrosis (n = 6) and inflammatory cells (n = 9). A single tumor displayed areas resembling classic chordoma, transitioning into poorly differentiated areas. There were multinucleate giant cells and physaliphorous cells in two tumors, each, respectively. Immunohistochemically, tumor cells were positive for AE1/AE3 (7/7), EMA (7/7), cytokeratin (CK) MNF116 (1/1), OSCAR (1/1), brachyury (9/9, diffusely), S100P (4/7, mostly focally), and glypican 3(2/4). SMARCB1/INI1 was completely lost in all nine tumors. A single case tested by FISH showed homozygous deletion of the SMARCB1 gene. Therapeutically (n = 7), all patients were treated with surgical resection (invariably incomplete) (n = 5), followed by adjuvant radiation therapy (n = 4) and chemotherapy (n = 4). While a single patient partially responded to treatment and another patient is alive with no evidence of disease after 23 years, three patients died of disease, six, eight, and 11 months post-diagnosis, despite adjuvant treatments. A single patient presented with a metastatic lung nodule, while another developed widespread metastasis. Poorly differentiated chordomas display a spectrum of features, are associated with a lower index of suspicion for a diagnosis, and display aggressive outcomes. Critical analysis of radiological and histopathological features, including necessary immunostains (brachyury and SMARCB1/INI1), is necessary for their timely diagnosis. These tumors show loss of SMARCB1/INI1 immunostaining and homozygous deletion of INI1/SMARCB1 gene.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.
| | | | | | - Paromita Roy
- Department of Pathology, Tata Medical Centre, Rajarhat, Kolkata, West Bengal, India
| | - Florian Puls
- Department Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
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20
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Abstract
CONTEXT.— Chordomas are uncommon malignant neoplasms with notochordal differentiation encountered by neuropathologists, bone/soft tissue pathologists, and general surgical pathologists. These lesions most commonly arise in the axial skeleton. Optimal therapy typically involves complete surgical resection, which is often technically difficult owing to the anatomic location, leading to a high rate of recurrence. Lesions have been generally resistant to radiation and chemotherapy; however, experimental studies involving targeted therapy and immunotherapy are currently underway. OBJECTIVE.— To summarize the clinical and pathologic findings of the various types of chordoma (conventional chordoma, dedifferentiated chordoma, and poorly differentiated chordoma), the differential diagnosis, and recent advances in molecular pathogenesis and therapeutic modalities that are reliant on accurate diagnosis. DATA SOURCES.— Literature review based on PubMed searches containing the term "chordoma" that address novel targeted and immunomodulatory therapeutic modalities; ongoing clinical trials involved in treating chordoma with novel therapeutic modalities identified through the Chordoma Foundation and ClinicalTrials.gov; and the authors' practice experience combined with various authoritative texts concerning the subject. CONCLUSIONS.— Chordoma is a clinically and histologically unique malignant neoplasm, and numerous diagnostic considerations must be excluded to establish the correct diagnosis. Treatment options have largely been centered on surgical excision with marginal results; however, novel therapeutic options including targeted therapy and immunotherapy are promising means to improve prognosis.
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Affiliation(s)
- Veronica Ulici
- From the Department of Pathology and Laboratory Medicine, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Jesse Hart
- From the Department of Pathology and Laboratory Medicine, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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21
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Wedekind MF, Widemann BC, Cote G. Chordoma: Current status, problems, and future directions. Curr Probl Cancer 2021; 45:100771. [PMID: 34266694 DOI: 10.1016/j.currproblcancer.2021.100771] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Abstract
Chordoma is a rare tumor that occurs along the axial spine in pediatrics and adults, with an incidence of approximately 350 cases per year in the United States. While typically described as slow-growing, many patients will eventually develop loco-regional relapse or metastatic disease with few treatment options. Despite numerous efforts over the last 10+ years, effective treatments for patients are lacking. As subtypes of chordoma are identified and described in more detail, further knowledge regarding the natural history of each type, tumor location, age differences, genomic variability, and an overall better understanding of chordoma may be the key to developing meaningful clinical trials and effective therapies for patients with chordoma.
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Affiliation(s)
- Mary Frances Wedekind
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Gregory Cote
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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22
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Biological Treatments of Neurofibromatosis Type 2 and Other Skull Base Disorders. Otolaryngol Clin North Am 2021; 54:789-801. [PMID: 34120747 DOI: 10.1016/j.otc.2021.05.004] [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] [Indexed: 11/20/2022]
Abstract
Studies of genomic alterations that occur in skull base tumors have provided information regarding biological aberrations that are necessary for the growth and maintenance of these tumors. This has led to the development and initiation of clinical trials incorporating biological treatments for many skull base tumors. The exciting developments of molecularly targeted therapy for the treatment of skull base tumors may provide noninvasive therapeutic options for patients that can be used either alone or in combination with surgery and/or radiation therapy. Future analysis and continued scientific discovery of treatments for skull base tumors can lead to improved outcomes in patients.
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23
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Akinduro OO, Suarez-Meade P, Garcia D, Brown DA, Sarabia-Estrada R, Attia S, Gokaslan ZL, Quiñones-Hinojosa A. Targeted Therapy for Chordoma: Key Molecular Signaling Pathways and the Role of Multimodal Therapy. Target Oncol 2021; 16:325-337. [PMID: 33893940 DOI: 10.1007/s11523-021-00814-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chordoma is a rare but devastating tumor that arises in the cranial skull base or spine. There are currently no US Food and Drug Administration-approved targeted therapies for chordoma, and little understanding of whether using more than one therapy has benefit over monotherapy. OBJECTIVE The objective of this study was to systematically review the current status of clinical trials completed for patients with chordoma to determine if multimodal therapy offers a benefit in progression-free survival over monomodal therapy. METHODS We performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to review the available clinical trials of targeted therapy for chordoma. We compiled the clinical data to determine if there is a benefit of multimodal therapy over monotherapy. RESULTS Our search resulted in 11 clinical trials including 270 patients with advanced chordoma who were treated with targeted therapies. The most commonly employed targeted therapies acted within the following pathways: platelet-derived growth factor receptor (187 patients), vascular endothelial growth factor (66 patients), and mammalian target of rapamycin (43 patients). Reported progression-free survival for included studies ranged from 2.5 to 58 months, with the longest progression-free survival in a trial that included a platelet-derived growth factor receptor inhibitor, nilotinib, and concurrent radiotherapy (58.2 months). There was a higher range of progression-free survival for trials treating patients with multimodal therapy (10.2-14 months vs 2.5-9.2 months, except for a monotherapy trial published in 2020 with a progression-free survival of 18 months), and those published in 2018 or later (14-58.2 months vs 2.5-10.2 months). Only 23% of patients with chordoma in published clinical trials have been treated with multimodal therapy. CONCLUSIONS Progression-free survival may be enhanced by the use of targeted therapy with concurrent radiotherapy, use of multimodal therapy, and use of newer targeted therapy. Future clinical trials should consider use of concurrent radiotherapy and multimodal therapy for patients with advanced chordoma.
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Affiliation(s)
- Oluwaseun O Akinduro
- Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA
| | - Paola Suarez-Meade
- Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA
| | - Diogo Garcia
- Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA
| | | | - Rachel Sarabia-Estrada
- Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA
| | - Steven Attia
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alfredo Quiñones-Hinojosa
- Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA.
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Pennington Z, Ehresman J, McCarthy EF, Ahmed AK, Pittman PD, Lubelski D, Goodwin CR, Sciubba DM. Chordoma of the sacrum and mobile spine: a narrative review. Spine J 2021; 21:500-517. [PMID: 33589095 DOI: 10.1016/j.spinee.2020.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
Chordoma is a notochord-derived primary tumor of the skull base and vertebral column known to affect 0.08 to 0.5 per 100,000 persons worldwide. Patients commonly present with mechanical, midline pain with or without radicular features secondary to nerve root compression. Management of these lesions has classically revolved around oncologic resection, defined by en bloc resection of the lesion with negative margins as this was found to significantly improve both local control and overall survival. With advancement in radiation modalities, namely the increased availability of focused photon therapy and proton beam radiation, high-dose (>50 Gy) neoadjuvant or adjuvant radiotherapy is also becoming a standard of care. At present chemotherapy does not appear to have a role, but ongoing investigations into the ontogeny and molecular pathophysiology of chordoma promise to identify therapeutic targets that may further alter this paradigm. In this narrative review we describe the epidemiology, histopathology, diagnosis, and treatment of chordoma.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA.
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25
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Levine AB, Wong D, Fatehi M, Yip S. Ependymoma and Chordoma. Neurosurgery 2021; 87:860-870. [PMID: 33057707 DOI: 10.1093/neuros/nyaa329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/31/2020] [Indexed: 11/14/2022] Open
Abstract
Ependymoma and chordoma are 2 tumors that occur throughout the craniospinal axis, and for which the extent of neurosurgical resection has a key prognostic role. Both tumors have distinctive pathologic features, yet can present significant diagnostic challenges to pathologists in cases without classical histology. The molecular understanding of ependymoma has had significant advances in the past decade, with the identification of 9 molecular groups with significant prognostic and clinical implications, while a comprehensive study of chordoma further emphasized the key role of brachyury overexpression in its pathogenesis. In this review, we discuss the pathogenesis, radiology and gross pathology, histology, and molecular features of these 2 tumors, as well as active research into targeted therapies, with an emphasis on practical diagnostic challenges, and the use of immunohistochemical and molecular tests in routine diagnostic practice.
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Affiliation(s)
- Adrian B Levine
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek Wong
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mostafa Fatehi
- Department of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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26
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Apparent diffusion coefficient as a prognostic factor in clival chordoma. Sci Rep 2021; 11:486. [PMID: 33436803 PMCID: PMC7804259 DOI: 10.1038/s41598-020-79894-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
Clival chordoma is a rare disease with high recurrence rates even after a combination of surgical resection and radiotherapy. Apparent diffusion coefficient (ADC) has been used to evaluate aggressive features of chordoma, but its utility for clival chordoma has not been explored specifically. In this study, the utility of preoperative ADC values was analyzed for predicting tumor progression and recurrence in patients with clival chordoma. Between 2012 and 2019, a total of 30 operated cases were analyzed with available preoperative ADC data. Receiver operating characteristic (ROC) analysis was used to obtain ADC cutoff values for predicting tumor aggressiveness. The mean and minimum ADC values were significantly lower in the aggressive tumor group than in the stable tumor group (both P < 0.001). ROC analysis showed that a mean cutoff ADC value of 1198 × 10−6 mm2/s and minimum ADC value of 895.5 × 10–6 mm2/s could be used to predict aggressive features of clival chordoma. Subtotal resection, partial resection, and mean and minimum ADC values that were lower than cutoff values were negative predictors of overall survival and progression-free survival. In conclusion, mean and minimum ADC values could be useful in predicting aggressiveness of clival chordoma.
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27
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To YH, Orme L, Lewin J. The Role of Systemic Therapies in the Management of Bone Sarcoma. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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28
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Bai R, Zhao ZQ, Wang YX, Zhao W, Wu LS, Cui SX, Guo SB, Liang CL. Sacral and thoracic chordoma with pulmonary metastases: A case report and review of the literature. Mol Clin Oncol 2020; 14:17. [PMID: 33363727 PMCID: PMC7725214 DOI: 10.3892/mco.2020.2179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
Chordoma is a sporadic type of cancer that affects the spine and is particularly challenging to treat due to the paucity of reported cases and scientific literature. In particular, primary chordomas affecting both the sacral and thoracic vertebrae are extremely rare. We herein report a rare case of chordoma in the sacral and thoracic vertebrae with pulmonary metastasis, along with a literature review. The objective of the present study was to explore treatment options and long-term outcomes in patients with metastatic chordoma. Posterior decompression was performed for the thoracic tumor, followed by extended resection of the sacral tumor. The symptoms of the patient were relieved after surgery, and the postoperative Nurick score decreased from grade 3 to grade 2, while the postoperative McCormick score was I. Therefore, complete chordoma excision and internal spinal fixation may effectively reduce tumor recurrence and metastasis.
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Affiliation(s)
- Rui Bai
- Department of Orthopedic Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010030, P.R. China
| | - Zhen-Qun Zhao
- Department of Orthopedic Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010030, P.R. China
| | - Yu-Xin Wang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010030, P.R. China
| | - Wei Zhao
- Department of Orthopedic Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010030, P.R. China
| | - Li-Shuan Wu
- Department of Orthopedic Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010030, P.R. China
| | - Shu-Xia Cui
- Department of Orthopedic Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010030, P.R. China
| | - Shi-Bing Guo
- Department of Orthopedic Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010030, P.R. China
| | - Chen-Liang Liang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010030, P.R. China
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29
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Holley C, Breining T, Scheithauer M, Möller P, Barth TFE. [Primary extra-axial chondroid chordoma of the anterior nasal septum: case report of a rare chordoma with literature review]. HNO 2020; 69:221-228. [PMID: 33095325 DOI: 10.1007/s00106-020-00957-3] [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] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
An 87-year-old patient reported a nodular, progressively enlarging mass of the anterior nasal septum leading to partial obstruction of the nostrils. The tumor showed no infiltration of the subcutis, bone, or paranasal sinuses in imaging or intraoperatively. Histological examination revealed a chondroid tumor with lobular growth and physaliferous cell morphology. Immunohistochemistry revealed a brachyury-positive tumor without EWSR1 rearrangement, leading to the diagnosis of a chondroid chordoma. The reported case demonstrates the differential diagnostic considerations pertaining to this rare tumor, which can also have an untypical and very rare extra-axial location. Review of the literature identified 34 primary extraosseous chordomas of the nose, nasopharynx, and paranasal sinuses, and allowed the nasal chordoma presented herein to be included in this group of extra-axial chordomas.
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Affiliation(s)
- C Holley
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - T Breining
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - M Scheithauer
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T F E Barth
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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30
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Abstract
Chordoma is a rare cancer in children and understanding the genesis of this tumor may contribute to treatment approaches. Evidence has proposed VDC/IE (vincristine, doxorubicin, cyclophosphamide/ifosfamide, etoposide) as a treatment option for young patients with chordoma to avoid the long-term effects of radiation therapy. We present a case of acute myeloid leukemia developing during treatment of localized chordoma of the clivus in a 20-month-old male. We propose a genomic relationship that may have contributed to the development of clival chordoma and acute myeloid leukemia without a latency period and advocate for genomic sequencing in children with chordoma before the initiation of systemic therapies.
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31
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Hoffman SE, Al Abdulmohsen SA, Gupta S, Hauser BM, Meredith DM, Dunn IF, Bi WL. Translational Windows in Chordoma: A Target Appraisal. Front Neurol 2020; 11:657. [PMID: 32733369 PMCID: PMC7360834 DOI: 10.3389/fneur.2020.00657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Abstract
Chordomas are rare tumors that are notoriously refractory to chemotherapy and radiotherapy when radical surgical resection is not achieved or upon recurrence after maximally aggressive treatment. The study of chordomas has been complicated by small patient cohorts and few available model systems due to the rarity of these tumors. Emerging next-generation sequencing technologies have broadened understanding of this disease by implicating novel pathways for possible targeted therapy. Mutations in cell-cycle regulation and chromatin remodeling genes have been identified in chordomas, but their significance remains unknown. Investigation of the immune microenvironment of these tumors suggests that checkpoint protein expression may influence prognosis, and adjuvant immunotherapy may improve patient outcome. Finally, growing evidence supports aberrant growth factor signaling as potential pathogenic mechanisms in chordoma. In this review, we characterize the impact on treatment opportunities offered by the genomic and immunologic landscape of this tumor.
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Affiliation(s)
- Samantha E Hoffman
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Sally A Al Abdulmohsen
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Saksham Gupta
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Blake M Hauser
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - David M Meredith
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, United States
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
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32
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Scheipl S, Igrec J, Leithner A, Smolle M, Haybäck J, Liegl B. [Chordoma: is there a molecular basis for diagnosis and treatment?]. DER PATHOLOGE 2020; 41:153-162. [PMID: 32100085 DOI: 10.1007/s00292-020-00761-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chordomas are malignant bone tumours with a reported annual incidence of 0.08 per 100,000 cases. They show a notochordal differentiation and are characterised by their nuclear expression of brachyury (TBXT). Chordomas are localised in the axial skeleton, where they occur from the clivus to the sacrococcygeal region. They are slow growing, locally destructive tumours, and are often not diagnosed until they have reached an advanced stage. Putative precursor-lesions are benign notochordal cell lesions, which are microscopically small and intraosseous. Different histological chordoma subtypes exist, which differ in their prognosis. To date, there are no known recurrent genetic drivers for this disease. Brachyury seems to play a key role in the pathogenesis of chordoma, though the detailed mechanism still needs to be elucidated. Surgical en bloc resection with negative margins is the only curative treatment for this disease. High-dose irradiation, particularly with protons and carbon ions, is a therapeutic alternative in cases of inoperable tumours. Currently, there is no approved medical treatment for chordoma. Clinical trials exploring additional therapeutic modalities are ongoing.
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Affiliation(s)
- Susanne Scheipl
- Univ.-Klinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich.
| | - Jasminka Igrec
- Univ.-Klinik für Radiologie, Medizinische Universität Graz, Auenbruggerplatz 9, 8036, Graz, Österreich
| | - Andreas Leithner
- Univ.-Klinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - Maria Smolle
- Univ.-Klinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - Johannes Haybäck
- Institut für Pathologie, Neuropathologie und Molekularpathologie, Medizinische Universität Innsbruck, Müllerstraße 44, 6020, Innsbruck, Österreich
- Institut für Pathologie, Univ.-Klinikum Magdeburg A.ö.R., Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
- Diagnostik- und Forschungsinstitut für Pathologie, Medizinische Universität Graz, Neue Stiftingtalstraße 6, 8010, Graz, Österreich
| | - Bernadette Liegl
- Diagnostik- und Forschungsinstitut für Pathologie, Medizinische Universität Graz, Neue Stiftingtalstraße 6, 8010, Graz, Österreich
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Abstract
PURPOSE OF REVIEW Chordoma is an exceedingly rare subtype of bone sarcoma. This review aims to provide a comprehensive insight into chordoma epidemiology, and an update on the recent advances in disease, biology and medical therapies. RECENT FINDINGS The incidence of chordoma is approximately 0.08/100 000 and the 5-year overall age-adjusted relative survival is 72% in the United States and 61% in Europe. Over the last years, significant steps forwards have been done in the comprehension of chordoma complexity, with insights gained into the biology and morphology of this disease. New entities have been described and potentially druggable molecular targets identified. This is becoming all the more relevant today, as new potentially active agents are under development. SUMMARY Chordoma is a complex disease because of its rarity, biological heterogeneity and peculiar clinical behaviour. Despite the progress done, the outcome in this disease remains unsatisfactory and the identification of active systemic treatments remains an urgent, unmet medical need.
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Noor A, Bindal P, Ramirez M, Vredenburgh J. Chordoma: A Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e918927. [PMID: 31969553 PMCID: PMC6998794 DOI: 10.12659/ajcr.918927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Female, 68-year-old Final Diagnosis: Chordoma Symptoms: Hoarseness • neck pain • weakness Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Arish Noor
- Internal Medicine, University of Connecticut, Farmington, CT, USA
| | - Poorva Bindal
- Internal Medicine, University of Connecticut, Farmington, CT, USA
| | - Miguel Ramirez
- Department of Radiology, St. Francis Hospital, Hartford, CT, USA
| | - James Vredenburgh
- Department of Hematology Oncology, St. Francis Hospital, Hartford, CT, USA
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35
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Kremenevski N, Schlaffer SM, Coras R, Kinfe TM, Graillon T, Buchfelder M. Skull Base Chordomas and Chondrosarcomas. Neuroendocrinology 2020; 110:836-847. [PMID: 32541136 DOI: 10.1159/000509386] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 11/19/2022]
Abstract
Skull base chordomas account for less than 0.2% and chondrosarcomas for less than 0.15% of all intracranial tumors. Although their clinical and imaging presentations are similar, they derive from different origins. Chordomas arise from embryonic remnants of the primitive notochord and chondrosarcomas from primitive mesenchymal cells or from the embryonic rest of the cranial cartilaginous matrix. Both entities are characterized by infiltration and destruction of the surrounding bone and soft tissue and a high locoregional recurrence rate. Chondrosarcomas, when treated with similar complex strategies, display a much better prognosis than chordomas. The overall survival is approximately 65% for chordomas and 80% for chondrosarcomas at 5 years and 30 and 50%, respectively, at 10 years. Chordomas are divided into the following 3 histological types: classical (conventional), chondroid, and dedifferentiated. Chondrosarcomas have conventional, mesenchymal, clear cell, and dedifferentiated subgroups. Both tumor entities often present with nonspecific symptoms, and headaches are the most reported initial symptom. Computed tomography and magnetic resonance imaging are required to determine the tumor localization and the extent of tumor growth. The treatment philosophy is to maximize tumor resection, minimize morbidity, and preserve function. Neurosurgical approaches commonly used for the resection of intracranial chordomas and chondrosarcomas are transsphenoidal, transbasal, cranio-orbitozygomatic, transzygomatic extended middle fossa, transcondylar, and transmaxillary approaches. Chordomas and chondrosarcomas are not sensitive to chemotherapy and there are no approved drugs for their treatment. The present treatment concept is a combination of surgical resection with a maximal excision and preserving patients' quality of life by adjuvant radiotherapy for both chordomas and chondrosarcomas.
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Affiliation(s)
- Natalia Kremenevski
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany,
| | | | - Roland Coras
- Institute of Neuropathology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Mehari Kinfe
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Graillon
- Department of Neurosurgery, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Brito da Silva H, Straus D, Barber JK, Rostomily RC, Ferreira M, Sekhar LN. Cranial Chordoma: A New Preoperative Grading System. Neurosurgery 2019; 83:403-415. [PMID: 29126120 PMCID: PMC6140779 DOI: 10.1093/neuros/nyx423] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/16/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chordomas are rare but challenging neoplasms involving the skull base. A preoperative
grading system will be useful to identify both areas for treatment and risk factors, and
correlate to the degree of resection, complications, and recurrence. OBJECTIVE To propose a new grading system for cranial chordomas designed by the senior author.
Its purpose is to enable comparison of different tumors with a similar pathology to
clivus chordoma, and statistically correlate with postoperative outcomes. METHODS The numerical grading system included tumor size, site of the tumor, vascular
encasement, intradural extension, brainstem invasion, and recurrence of the tumor either
after surgery or radiotherapy with a range of 2 to 25 points; it was used in 42 patients
with cranial chordoma. The grading system was correlated with number of operations for
resection, degree of resection, number and type of complications, recurrence, and
survival. RESULTS We found 3 groups: low-risk 0 to 7 points, intermediate-risk 8 to 12 points, and
high-risk ≥13 points in the grading system. The 3 groups were correlated with the
following: extent of resection (partial, subtotal, or complete; P <
.002); number of operative stages to achieve removal (P < .014);
tumor recurrence (P = .03); postoperative Karnofsky Performance Status
(P < .001); and with successful outcome (P =
.005). The grading system itself correlated with the outcome (P =
.005). CONCLUSION The proposed chordoma grading system can help surgeons to predict the difficulty of the
case and know which areas of the skull base will need attention to plan further
therapy.
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Affiliation(s)
- Harley Brito da Silva
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
| | - David Straus
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
| | - Jason K Barber
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
| | - Robert C Rostomily
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| | - Manuel Ferreira
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
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La Corte E, Dei Cas M, Raggi A, Patanè M, Broggi M, Schiavolin S, Calatozzolo C, Pollo B, Pipolo C, Bruzzone MG, Campisi G, Paroni R, Ghidoni R, Ferroli P. Long and Very-Long-Chain Ceramides Correlate with A More Aggressive Behavior in Skull Base Chordoma Patients. Int J Mol Sci 2019; 20:ijms20184480. [PMID: 31514293 PMCID: PMC6769603 DOI: 10.3390/ijms20184480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Skull base chordomas are rare tumors arising from notochord. Sphingolipids analysis is a promising approach in molecular oncology, and it has never been applied in chordomas. Our aim is to investigate chordoma behavior and the role of ceramides. METHODS Ceramides were extracted and evaluated by liquid chromatography and mass spectrometry in a cohort of patients with a skull base chordoma. Clinical data were also collected and correlated with ceramide levels. Linear regression and correlation analyses were conducted. RESULTS Analyzing the association between ceramides level and MIB-1, total ceramides and dihydroceramides showed a strong association (r = 0.7257 and r = 0.6733, respectively) with MIB-1 staining (p = 0.0033 and p = 0.0083, respectively). Among the single ceramide species, Cer C24:1 (r = 0.8814, p ≤ 0.0001), DHCer C24:1 (r = 0.8429, p = 0.0002) and DHCer C18:0 (r = 0.9426, p ≤ 0.0001) showed a significant correlation with MIB-1. CONCLUSION Our lipid analysis showed ceramides to be promising tumoral biomarkers in skull base chordomas. Long- and very-long-chain ceramides, such as Cer C24:1 and DHCer C24:1, may be related to a prolonged tumor survival and aggressiveness, and the understanding of their effective biological role will hopefully shed light on the mechanisms of chordoma radio-resistance, tendency to recur, and use of agents targeting ceramide metabolism.
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Affiliation(s)
- Emanuele La Corte
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Michele Dei Cas
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Monica Patanè
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Chiara Calatozzolo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Giuseppe Campisi
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Rita Paroni
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Riccardo Ghidoni
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
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Hulou MM, Garcia CR, Slone SA, Dugan A, Lei F, Huang B, Pittman T, Villano JL. Comprehensive Review of Cranial Chordomas Using National Databases in the USA. Clin Oncol (R Coll Radiol) 2019; 31:e149-e159. [PMID: 31303332 PMCID: PMC11106723 DOI: 10.1016/j.clon.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/01/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
AIMS The management of cranial chordomas is controversial. We provide a comprehensive review of the evolving patterns of care of cranial chordomas in the USA. MATERIALS AND METHODS We analysed the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2014 for clinical characteristics and long-term survival, and the National Surgical Quality Improvement Program (NSQIP) dataset between 2005 and 2016 for perioperative characteristics and surgical morbidity. RESULTS In total, 936 patients were identified from the NCDB, 405 patients from SEER and 64 patients from the NSQIP. Most patients were men (56.2, 54.8 and 57.8% in NCDB, SEER and NSQIP, respectively) and White (80.9 and 83.2% in NCDB and SEER, respectively). Surgery was the preferred treatment modality (87.3% in NCDB and 86.2% in SEER). Surgery was carried out alone (41.8% in NCDB and 40.7% in SEER) or in combination with radiation (42.1% in NCDB and 45.4% in SEER). Proton therapy was the most common type of radiation (32.2% in NCDB), particularly after 2011. The median operative time, median hospital length and postoperative morbidity were significantly higher in chordoma patients compared with patients who underwent other skull-base procedures. The 5-year survival rate was 79.8% in NCDB and 76.9% in SEER. There was a trend towards longer survival in patients receiving surgery and radiation, which has been increasingly used since 2004. Patients younger than 60 years had a decreased risk of mortality. CONCLUSIONS Our analysis reflects patterns of care in the USA. The use of surgery and radiation is increasing, with a trend towards longer survival. Surgery is complicated with long operative time, hospital stay and a higher rate of complications.
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Affiliation(s)
- M M Hulou
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - C R Garcia
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - S A Slone
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - A Dugan
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - F Lei
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - B Huang
- Division of Cancer Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - T Pittman
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - J L Villano
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Medicine, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.
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Meng T, Jin J, Jiang C, Huang R, Yin H, Song D, Cheng L. Molecular Targeted Therapy in the Treatment of Chordoma: A Systematic Review. Front Oncol 2019; 9:30. [PMID: 30775316 PMCID: PMC6367227 DOI: 10.3389/fonc.2019.00030] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/10/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives: Chordoma is a rare bone malignancy that affects the spine and skull base. Treatment dilemma leads to a high rate of local relapse and distant metastases. Molecular targeted therapy (MTT) is an option for advanced chordoma, but its therapeutic efficacy and safety have not been investigated systematically. Therefore, a systematic review was conducted on studies reporting MTT regimens for chordoma. Methods: Clinical trials, case series and case reports on chordoma MTT were identified using MEDLINE, Cochrane library and EMBASE, and systematically reviewed. Data on clinical outcomes, such as median overall survival, progression-free survival, response rate and adverse events (AEs) were extracted and analyzed. Results: Thirty-three eligible studies were selected for the systematic review, which indicated that imatinib and erlotinib were the most frequently used molecular targeted inhibitors (MTIs) for chordoma. For PDGFR-positive and/or EGFR-positive chordoma, clinical benefits were achieved with acceptable AEs. Monotherapy is preferred as the first-line of treatment, and combined drug therapy as the second-line treatment. In addition, the brachyury vaccine has shown promising results. Conclusions: The selection of MTIs for patients with advanced or relapsed chordoma should be based on gene mutation screening and immunohistochemistry (IHC). Monotherapy of TKIs is recommended as the first-line management, and combination therapy (two TKIs or TKI plus mTOR inhibitor) may be the choice for drug-resistant chordoma. Brachyury vaccine is a promising therapeutic strategy and requires more clinical trials to evaluate its safety and efficacy.
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Affiliation(s)
- Tong Meng
- Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Shanghai Bone Tumor Institution, Shanghai, China.,Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiali Jin
- Department of Central Laboratory, Shanghai Tenth People's Hospital of Tongji University, School of Medicine, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Cong Jiang
- Beth Israel Deaconess Medical Center, BIDMC Cancer Center, Harvard Medical School, Cancer Research Institute, Boston, MA, United States
| | - Runzhi Huang
- Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Huabin Yin
- Shanghai Bone Tumor Institution, Shanghai, China.,Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dianwen Song
- Shanghai Bone Tumor Institution, Shanghai, China.,Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Liming Cheng
- Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji University, Shanghai, China
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Stacchiotti S, Morosi C, Lo Vullo S, Casale A, Palassini E, Frezza AM, Dinoi G, Messina A, Gronchi A, Cavalleri A, Venturelli E, Morelli D, Pilotti S, Collini P, Brich S, Tamborini E, Mariani L, Casali PG. Imatinib and everolimus in patients with progressing advanced chordoma: A phase 2 clinical study. Cancer 2018; 124:4056-4063. [PMID: 30216418 DOI: 10.1002/cncr.31685] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND We present the results of an academic phase 2 study on imatinib plus everolimus in patients who have progressive advanced chordoma. METHODS In January 2011, 43 adult chordoma patients were enrolled in the study and received imatinib 400 mg/day and everolimus 2.5 mg/day until progression or limiting toxicity. Eligible patients had progressed in the 6 months before study entry. PDGFRB, S6, and 4EBP1 expression and phosphorylation were evaluated by way of immunohistochemistry and/or western blotting. The primary endpoint was the overall response rate (ORR) according to Choi criteria. Secondary endpoints were RECIST 1.1 response, progression-free survival (PFS), overall survival (OS), correlation between S6/4EBP1 phosphorylation and response. RESULTS Thirteen of 43 patients were pretreated with imatinib. Among 40 of the 43 patients who were evaluable by Choi criteria, the best responses were 9 with partial response (ORR, 20.9%), 24 with stable disease (SD) (ORR, 55.8%), and 7 with progressive disease (ORR, 16.3%). Forty-two patients were evaluable by RECIST criteria, with 1 partial response (ORR, 2.3%), 37 stable disease (ORR, 86%), and 4 progressive disease (ORR, 9.3%). The median PFS according to Choi criteria was 11.5 months (range, 4.6-17.6 months), and 58.8% and 48.1% of patients were progression-free at 9 and 12 months, respectively. The median PFS by RECIST criteria was 14 months; the median OS was 47.1 months. When assessable, S6/4EBP1 was phosphorylated in a high and moderate/low proportion of tumor cells in responsive and nonresponsive patients, respectively. Toxicity caused a temporary and definitive treatment discontinuation in 60.5% and 30.2% of patients, respectively. CONCLUSIONS Imatinib plus everolimus showed a limited activity in progressing advanced chordoma. Interestingly, the amount of tumor cells activated for mammalian target of rapamycin effectors correlated with the response. Toxicity was not negligible.
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Affiliation(s)
- Silvia Stacchiotti
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Casale
- Radiology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Elena Palassini
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Anna Maria Frezza
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Gabriella Dinoi
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Antonella Messina
- Radiology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Adalberto Cavalleri
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Daniele Morelli
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvana Pilotti
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paola Collini
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvia Brich
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elena Tamborini
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo G Casali
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
- Oncolgy and Hemato-Oncology Department, University of Milan, Milan, Italy
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Kim JW, Hong CK, Cha YJ, Kim SH, Suh CO, Lee KS. Cardiac Metastasis from Clivus Chordoma. World Neurosurg 2018; 113:103-107. [DOI: 10.1016/j.wneu.2018.02.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
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Tumor Reduction with Pazopanib in a Patient with Recurrent Lumbar Chordoma. Case Rep Oncol Med 2018; 2018:4290131. [PMID: 29850323 PMCID: PMC5914121 DOI: 10.1155/2018/4290131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/20/2018] [Accepted: 03/13/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction Chordomas are rare malignancies of bone origin that occur in the axial skeleton, typically the skull base and lumbar/sacral regions. Although often classified as low-grade neoplasms, its locally infiltrative behavior may result in significant morbidity and mortality. Optimal surgical resection may be curative, but up to 50% of the cases relapse within 5 years, and currently there are no systemic treatments approved in this setting. A large proportion of these tumors express stem-cell factor receptor (c-KIT) and platelet-derived growth factor receptors (PDGFRs), providing a rationale for the use of tyrosine-kinase inhibitors (TKIs). Case report A 27-year-old male presented with recurrent chordoma of the lumbar spine 4 years after initial diagnosis. Salvage therapies in the interval included repeat resections and radiation therapy. He ultimately developed multifocal recurrence not amenable to complete excision or reirradiation. A comprehensive genomic profiling assay was performed and revealed nondrugable alterations. Decision was made to proceed with systemic treatment with pazopanib 800 mg/day, resulting in tumor reduction (-23.1% reduction in size) and prolonged disease control. Conclusion For this patient with a multiple recurrent chordoma and limited treatment options, pazopanib resulted in sustained clinical benefit following initial tumor reduction.
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Rekhi B, Kosemehmetoglu K, Rane S, Soylemezoglu F, Bulut E. Poorly Differentiated Chordomas Showing Loss of INI1/SMARCB1: A Report of 2 Rare Cases With Diagnostic Implications. Int J Surg Pathol 2018; 26:637-643. [PMID: 29623728 DOI: 10.1177/1066896918768043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Poorly differentiated chordomas are rare musculoskeletal tumors. Case 1. A 42-year-old lady presented with quadriparesis of 2 months' duration. Radiologic imaging disclosed a soft tissue mass in her left prevertebral- and paravertebral cervical region. Case 2. A 4-year-old male child presented with neck pain and restricted head movements of 1-year duration. Radiologic imaging revealed a contrast enhancing, paraspinal soft tissue mass in his cervical region. Microscopic examination in both the cases revealed a cellular malignant tumor composed of moderate to markedly pleomorphic cells with interspersed mitotic figures, along with focal myxoid change and necrosis. By immunohistochemistry, tumor cells in both cases were diffusely positive for pan cytokeratin (AE1/AE3) and brachyury, whereas these were negative for INI1/SMARCB1. Tumor cells in the second case were also positive for glypican3. The first case developed pulmonary metastasis, while the second case developed recurrence. Poorly differentiated chordomas are uncommon tumors, invariably characterized by loss of INI1. These tumors can be rarely seen in adults and need to be differentiated from their diagnostic mimics, in view of treatment implications and their relatively aggressive clinical outcomes.
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Stacchiotti S, Gronchi A, Fossati P, Akiyama T, Alapetite C, Baumann M, Blay JY, Bolle S, Boriani S, Bruzzi P, Capanna R, Caraceni A, Casadei R, Colia V, Debus J, Delaney T, Desai A, Dileo P, Dijkstra S, Doglietto F, Flanagan A, Froelich S, Gardner PA, Gelderblom H, Gokaslan ZL, Haas R, Heery C, Hindi N, Hohenberger P, Hornicek F, Imai R, Jeys L, Jones RL, Kasper B, Kawai A, Krengli M, Leithner A, Logowska I, Martin Broto J, Mazzatenta D, Morosi C, Nicolai P, Norum OJ, Patel S, Penel N, Picci P, Pilotti S, Radaelli S, Ricchini F, Rutkowski P, Scheipl S, Sen C, Tamborini E, Thornton KA, Timmermann B, Torri V, Tunn PU, Uhl M, Yamada Y, Weber DC, Vanel D, Varga PP, Vleggeert-Lankamp CLA, Casali PG, Sommer J. Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group. Ann Oncol 2018; 28:1230-1242. [PMID: 28184416 PMCID: PMC5452071 DOI: 10.1093/annonc/mdx054] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper.
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Affiliation(s)
| | - A Gronchi
- Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Fossati
- CNAO National Center for Oncological Hadrontherapy, Pavia.,Department of Radiotherapy, IEO-European Institute of Oncology, Milan, Italy
| | - T Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - C Alapetite
- Department of Radiotherapy, Institut Curie, Paris.,Institut Curie-Centre de Protonthérapie d'Orsay (ICPO), Orsay, France
| | - M Baumann
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Y Blay
- Cancer Medicine Department, Centre Léon Bérard, Lyon
| | - S Bolle
- Department of Radiotherapy, Gustave Roussy, Villejuif Cedex, France
| | - S Boriani
- Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Bologna
| | - P Bruzzi
- Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova
| | - R Capanna
- University Clinic of Orthopedics and Traumatology AO Pisa, Pisa
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - R Casadei
- Orthopedic Department, Rizzoli Institute Bologna, Bologna, Italy
| | - V Colia
- Departments of Cancer Medicine
| | - J Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - T Delaney
- Department of Radiation Oncology, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, USA
| | - A Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Birmingham
| | - P Dileo
- Department of Oncology, University College London Hospitals (UCLH), London, UK
| | - S Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Doglietto
- Institute of Neurosurgery, University of Brescia, Brescia, Italy
| | - A Flanagan
- University College London Cancer Institute, London.,Histopathology Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - S Froelich
- Department of Neurosurgery, Paris Diderot University, Hôpital Lariboisière, Paris, France
| | - P A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Z L Gokaslan
- Department of Neurosurgery, Brown University School of Medicine, Providence, USA
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Heery
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, USA
| | - N Hindi
- Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - P Hohenberger
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - F Hornicek
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - R Imai
- National Institute of Radiological Sciences, Research Center Hospital for Charged Particle Therapy, Chiba, Japan
| | - L Jeys
- Department of Orthopaedics, Royal Orthopaedic Hospital Birmingham, Birmingham
| | - R L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - B Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - A Kawai
- Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center, Tokio, Japan
| | - M Krengli
- Radiotherapy Department, University of Piemonte Orientale, Novara, Italy
| | - A Leithner
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria
| | - I Logowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - J Martin Broto
- Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - D Mazzatenta
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna
| | - C Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - O J Norum
- Department of Tumor Orthopedic Surgery, The Norwegian Radium Hospital, Oslo, Norway
| | - S Patel
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, USA
| | - N Penel
- Cencer Medicine Department, Oscar Lambret Cancer Centre, Lille, France
| | - P Picci
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna
| | - S Pilotti
- Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Radaelli
- Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - F Ricchini
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - S Scheipl
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria
| | - C Sen
- Department of Neurosurgery, NYU Langone Medical Center, New York
| | - E Tamborini
- Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - K A Thornton
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - B Timmermann
- Particle Therapy Department, West German Proton Therapy Centre Essen, University Hospital Essen, Essen, Germany
| | - V Torri
- Oncology Unit, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - P U Tunn
- Department of Orthopaedic Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - M Uhl
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Y Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D C Weber
- Paul Scherrer Institut PSI, Villigen, Switzerland
| | - D Vanel
- Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P P Varga
- National Center for Spinal Disorders, Budapest, Hungary
| | | | | | - J Sommer
- Chordoma Foundation, Durham, USA
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Magnaghi P, Salom B, Cozzi L, Amboldi N, Ballinari D, Tamborini E, Gasparri F, Montagnoli A, Raddrizzani L, Somaschini A, Bosotti R, Orrenius C, Bozzi F, Pilotti S, Galvani A, Sommer J, Stacchiotti S, Isacchi A. Afatinib Is a New Therapeutic Approach in Chordoma with a Unique Ability to Target EGFR and Brachyury. Mol Cancer Ther 2017; 17:603-613. [DOI: 10.1158/1535-7163.mct-17-0324] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/31/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022]
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46
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Khawaja AM, Venkatraman A, Mirza M. Clival Chordoma: Case Report and Review of Recent Developments in Surgical and Adjuvant Treatments. Pol J Radiol 2017; 82:670-675. [PMID: 29662593 PMCID: PMC5894024 DOI: 10.12659/pjr.902008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/23/2017] [Indexed: 12/31/2022] Open
Abstract
Chordomas are rare tumors that can develop anywhere along the craniospinal axis. These tumors present challenges with respect to diagnosis and treatment due to a high rate of recurrence, even after multiple surgeries, and the propensity to involve any region within the craniospinal axis. New developments in radiation therapy have improved recurrence-free survival in patients with chordomas. Different regimens of chemotherapy and molecularly-targeted therapies, as adjuvants to surgery, have been described in individual case reports and case series. The purpose of this paper is to describe a case of clival chordoma and review recent developments in diagnostic and therapeutic options. A 77-year-old female was referred because of diplopia and progressively worsening headaches. Head imaging revealed a large expansile and erosive mass in the skull base. The patient underwent a successful endoscopic endonasal trans-sphenoidal resection of the mass, with biopsy confirming the diagnosis of chordoma. Postoperatively, the patient experienced an improvement in neurological symptoms. Chordomas can present a diagnostic challenge due to the rare occurrence and a tendency to involve any region within the craniospinal axis.
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Affiliation(s)
- Ayaz M Khawaja
- Department of Neurology, Massachusetts General Hospital, Boston, MA, U.S.A
| | - Anand Venkatraman
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - Maira Mirza
- Department of Internal Medicine, Sinai-Grace Hospital/Detroit Medical Center, Detroit, MI, U.S.A
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Tarpey PS, Behjati S, Young MD, Martincorena I, Alexandrov LB, Farndon SJ, Guzzo C, Hardy C, Latimer C, Butler AP, Teague JW, Shlien A, Futreal PA, Shah S, Bashashati A, Jamshidi F, Nielsen TO, Huntsman D, Baumhoer D, Brandner S, Wunder J, Dickson B, Cogswell P, Sommer J, Phillips JJ, Amary MF, Tirabosco R, Pillay N, Yip S, Stratton MR, Flanagan AM, Campbell PJ. The driver landscape of sporadic chordoma. Nat Commun 2017; 8:890. [PMID: 29026114 PMCID: PMC5638846 DOI: 10.1038/s41467-017-01026-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 08/14/2017] [Indexed: 12/16/2022] Open
Abstract
Chordoma is a malignant, often incurable bone tumour showing notochordal differentiation. Here, we defined the somatic driver landscape of 104 cases of sporadic chordoma. We reveal somatic duplications of the notochordal transcription factor brachyury (T) in up to 27% of cases. These variants recapitulate the rearrangement architecture of the pathogenic germline duplications of T that underlie familial chordoma. In addition, we find potentially clinically actionable PI3K signalling mutations in 16% of cases. Intriguingly, one of the most frequently altered genes, mutated exclusively by inactivating mutation, was LYST (10%), which may represent a novel cancer gene in chordoma.Chordoma is a rare often incurable malignant bone tumour. Here, the authors investigate driver mutations of sporadic chordoma in 104 cases, revealing duplications in notochordal transcription factor brachyury (T), PI3K signalling mutations, and mutations in LYST, a potential novel cancer gene in chordoma.
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Affiliation(s)
- Patrick S Tarpey
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Sam Behjati
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
- Department of Paediatrics, University of Cambridge, Cambridge, CB2 0QQ, UK
- Corpus Christi College, Cambridge, CB2 1RH, UK
| | - Matthew D Young
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Inigo Martincorena
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | | | - Sarah J Farndon
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
- UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Charlotte Guzzo
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Claire Hardy
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Calli Latimer
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Adam P Butler
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Jon W Teague
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Adam Shlien
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada, M5G 1X8
| | - P Andrew Futreal
- Department of Genomic Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX, 77030, USA
| | - Sohrab Shah
- University of British Columbia, Vancouver, BC, Canada, V6T 1Z4
| | - Ali Bashashati
- University of British Columbia, Vancouver, BC, Canada, V6T 1Z4
| | - Farzad Jamshidi
- University of British Columbia, Vancouver, BC, Canada, V6T 1Z4
| | | | - David Huntsman
- University of British Columbia, Vancouver, BC, Canada, V6T 1Z4
| | - Daniel Baumhoer
- Bone Tumour Reference Centre, Institute of Pathology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Sebastian Brandner
- Division of Neuropathology and Department of Neurodegenerative Disease, The National Hospital for Neurology and Neurosurgery, University College Hospital NHS Foundation Trust and UCL Institute of Neurology, London, WC1N 3BG, UK
| | - Jay Wunder
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada, M5G 1X5
| | - Brendan Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada, M5G 1X5
| | | | - Josh Sommer
- Chordoma Foundation, PO Box 2127, Durham, NC, 27702, USA
| | - Joanna J Phillips
- Department of Neurosurgery, University of California, San Francisco, CA, 94143, USA
| | - M Fernanda Amary
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Middlesex, Stanmore, HA7 4LP, UK
| | - Roberto Tirabosco
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Middlesex, Stanmore, HA7 4LP, UK
| | - Nischalan Pillay
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Middlesex, Stanmore, HA7 4LP, UK
- University College London Cancer Institute, London, WC1E 6BT, UK
| | - Stephen Yip
- University of British Columbia, Vancouver, BC, Canada, V6T 1Z4
| | - Michael R Stratton
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Adrienne M Flanagan
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Middlesex, Stanmore, HA7 4LP, UK
- University College London Cancer Institute, London, WC1E 6BT, UK
| | - Peter J Campbell
- Cancer Genome Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK.
- Department of Haematology, University of Cambridge, Cambridge, CB2 2XY, UK.
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Multicentric Chordoma : An Uncommon and Incompletely Understood Presentation. Clin Neuroradiol 2017; 28:283-288. [PMID: 28766007 DOI: 10.1007/s00062-017-0610-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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Dahl NA, Luebbert T, Loi M, Neuberger I, Handler MH, Kleinschmidt-DeMasters BK, Mulcahy Levy JM. Chordoma Occurs in Young Children With Tuberous Sclerosis. J Neuropathol Exp Neurol 2017; 76:418-423. [PMID: 28498973 DOI: 10.1093/jnen/nlx032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chordomas are rare bony neoplasms usually unassociated with a familial tumor predisposition syndrome. The peak incidence of this midline axial skeletal tumor is in adulthood but when very young children are affected, consideration should be given to occurrence within the tuberous sclerosis (TS) complex, especially when presenting in neonates <3 months of age. To call attention to this association, we present a brachyury-immunopositive chordoma occurring in the skull base of a 2-month-old male infant who was later realized to have metastases to the subcutaneous tissues and lungs, as well as rhabdomyoma of the heart and renal cysts/angiomyolipomas, that is, characteristic features of the TS complex. We review the limited literature on this topic.
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Affiliation(s)
- Nathan A Dahl
- From the Department of Pediatrics, University of Colorado Denver, Aurora, Colorado (NAD, TL, ML, JMM-L); Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado (NAD, JMM-L); Department of Neurology (TL, BKK-D); Department of Radiology (IN); Department of Neurosurgery (MHH, BKK-D); and Department of Pathology, University of Colorado Denver, Aurora, Colorado (BKK-D)
| | - Timothy Luebbert
- From the Department of Pediatrics, University of Colorado Denver, Aurora, Colorado (NAD, TL, ML, JMM-L); Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado (NAD, JMM-L); Department of Neurology (TL, BKK-D); Department of Radiology (IN); Department of Neurosurgery (MHH, BKK-D); and Department of Pathology, University of Colorado Denver, Aurora, Colorado (BKK-D)
| | - Michele Loi
- From the Department of Pediatrics, University of Colorado Denver, Aurora, Colorado (NAD, TL, ML, JMM-L); Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado (NAD, JMM-L); Department of Neurology (TL, BKK-D); Department of Radiology (IN); Department of Neurosurgery (MHH, BKK-D); and Department of Pathology, University of Colorado Denver, Aurora, Colorado (BKK-D)
| | - Ilana Neuberger
- From the Department of Pediatrics, University of Colorado Denver, Aurora, Colorado (NAD, TL, ML, JMM-L); Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado (NAD, JMM-L); Department of Neurology (TL, BKK-D); Department of Radiology (IN); Department of Neurosurgery (MHH, BKK-D); and Department of Pathology, University of Colorado Denver, Aurora, Colorado (BKK-D)
| | - Michael H Handler
- From the Department of Pediatrics, University of Colorado Denver, Aurora, Colorado (NAD, TL, ML, JMM-L); Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado (NAD, JMM-L); Department of Neurology (TL, BKK-D); Department of Radiology (IN); Department of Neurosurgery (MHH, BKK-D); and Department of Pathology, University of Colorado Denver, Aurora, Colorado (BKK-D)
| | - Bette Kay Kleinschmidt-DeMasters
- From the Department of Pediatrics, University of Colorado Denver, Aurora, Colorado (NAD, TL, ML, JMM-L); Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado (NAD, JMM-L); Department of Neurology (TL, BKK-D); Department of Radiology (IN); Department of Neurosurgery (MHH, BKK-D); and Department of Pathology, University of Colorado Denver, Aurora, Colorado (BKK-D)
| | - Jean M Mulcahy Levy
- From the Department of Pediatrics, University of Colorado Denver, Aurora, Colorado (NAD, TL, ML, JMM-L); Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado (NAD, JMM-L); Department of Neurology (TL, BKK-D); Department of Radiology (IN); Department of Neurosurgery (MHH, BKK-D); and Department of Pathology, University of Colorado Denver, Aurora, Colorado (BKK-D)
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Colia V, Stacchiotti S. Medical treatment of advanced chordomas. Eur J Cancer 2017; 83:220-228. [PMID: 28750274 DOI: 10.1016/j.ejca.2017.06.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/23/2017] [Accepted: 06/28/2017] [Indexed: 12/27/2022]
Abstract
Chordoma is a very rare bone sarcoma that can arise from any site along the spine and from the skull base. En bloc resection is the gold standard for treatment while radiation therapy has been shown to provide both curative and palliative benefit. Unfortunately, local recurrences are common, even after a complete surgical resection, and up to 40% of patients suffer from distant metastases, while salvage treatments are challenging. Patients carrying an advanced disease need a systemic treatment. Unluckily, conventional chordoma are insensitive to cytotoxic chemotherapy that is considered the standard treatment option in patients with metastatic sarcoma. In the last decade, innovative therapies have been introduced, positively impacting disease control and patients' quality of life. In addition, a better understanding of the molecular characteristics of chordoma allowed to detect new potential targets. This review is focused on the pharmacological management of patients affected by an advanced disease, starting with a summary of data available on conventional chemotherapy, then moving to a deeper analysis of available data on molecular agents and immunotherapy, and finally providing an update on ongoing clinical trials and future prospective.
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Affiliation(s)
- Vittoria Colia
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy.
| | - Silvia Stacchiotti
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy.
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