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Tamura R, Yamanobe Y, Fujioka M, Morimoto Y, Fukumura M, Nakaya M, Oishi Y, Sato M, Ueda R, Fujiwara H, Hikichi T, Noji S, Oishi N, Ozawa H, Ogawa K, Kawakami Y, Ohira T, Yoshida K, Toda M. Phase I/II Study of a Vascular Endothelial Growth Factor Receptor Vaccine in Patients With NF2-Related Schwannomatosis. J Clin Oncol 2024; 42:2578-2587. [PMID: 38776485 DOI: 10.1200/jco.23.02376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/15/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE The humanized antivascular endothelial growth factor (VEGF) antibody bevacizumab (Bev) is efficacious for the treatment of NF2-related schwannomatosis (NF2), previously known as neurofibromatosis type 2. This study evaluated the safety and efficacy of a VEGF receptor (VEGFR) vaccine containing VEGFR1 and VEGFR2 peptides in patients with NF2 with progressive schwannomas (jRCTs031180184). MATERIALS AND METHODS VEGFR1 and VEGFR2 peptides were injected subcutaneously into infra-axillary and inguinal regions, once a week for 4 weeks and then once a month for 4 months. The primary end point was safety. Secondary end points included tolerability, hearing response, imaging response, and immunologic response. RESULTS Sixteen patients with NF2 with progressive schwannomas completed treatment and were assessed. No severe vaccine-related adverse events occurred. Among the 13 patients with assessable hearing, word recognition score improved in five patients at 6 months and two at 12 months. Progression of average hearing level of pure tone was 0.168 dB/mo during the year of treatment period, whereas long-term progression was 0.364 dB/mo. Among all 16 patients, a partial response was observed in more than one schwannoma in four (including one in which Bev had not been effective), minor response in 5, and stable disease in 4. Both VEGFR1-specific and VEGFR2-specific cytotoxic T lymphocytes (CTLs) were induced in 11 patients. Two years after vaccination, a radiologic response was achieved in nine of 20 assessable schwannomas. CONCLUSION This study demonstrated the safety and preliminary efficacy of VEGFR peptide vaccination in patients with NF2. Memory-induced CTLs after VEGFR vaccination may persistently suppress tumor progression.
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Affiliation(s)
- Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiharu Yamanobe
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masato Fujioka
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
- Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
- Department of Molecular Genetics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yukina Morimoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Fukumura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masato Nakaya
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yumiko Oishi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Mizuto Sato
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Ueda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirokazu Fujiwara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Shinobu Noji
- Division of Cellular Signaling Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
- Laboratory of Cell and Tissue Biology, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Oishi
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kawakami
- Division of Cellular Signaling Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
- Department of Immunology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Takayuki Ohira
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Kim BH, Chung YH, Woo TG, Kang SM, Park S, Kim M, Park BJ. NF2-Related Schwannomatosis (NF2): Molecular Insights and Therapeutic Avenues. Int J Mol Sci 2024; 25:6558. [PMID: 38928264 PMCID: PMC11204266 DOI: 10.3390/ijms25126558] [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: 05/04/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
NF2-related schwannomatosis (NF2) is a genetic syndrome characterized by the growth of benign tumors in the nervous system, particularly bilateral vestibular schwannomas, meningiomas, and ependymomas. This review consolidates the current knowledge on NF2 syndrome, emphasizing the molecular pathology associated with the mutations in the gene of the same name, the NF2 gene, and the subsequent dysfunction of its product, the Merlin protein. Merlin, a tumor suppressor, integrates multiple signaling pathways that regulate cell contact, proliferation, and motility, thereby influencing tumor growth. The loss of Merlin disrupts these pathways, leading to tumorigenesis. We discuss the roles of another two proteins potentially associated with NF2 deficiency as well as Merlin: Yes-associated protein 1 (YAP), which may promote tumor growth, and Raf kinase inhibitory protein (RKIP), which appears to suppress tumor development. Additionally, this review discusses the efficacy of various treatments, such as molecular therapies that target specific pathways or inhibit neomorphic protein-protein interaction caused by NF2 deficiency. This overview not only expands on the fundamental understanding of NF2 pathophysiology but also explores the potential of novel therapeutic targets that affect the clinical approach to NF2 syndrome.
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Affiliation(s)
- Bae-Hoon Kim
- Rare Disease R&D Center, PRG S&T Co., Ltd., Busan 46274, Republic of Korea; (B.-H.K.)
| | - Yeon-Ho Chung
- Rare Disease R&D Center, PRG S&T Co., Ltd., Busan 46274, Republic of Korea; (B.-H.K.)
| | - Tae-Gyun Woo
- Rare Disease R&D Center, PRG S&T Co., Ltd., Busan 46274, Republic of Korea; (B.-H.K.)
| | - So-mi Kang
- Department of Molecular Biology, College of Natural Science, Pusan National University, Busan 46241, Republic of Korea
| | - Soyoung Park
- Department of Molecular Biology, College of Natural Science, Pusan National University, Busan 46241, Republic of Korea
| | - Minju Kim
- Rare Disease R&D Center, PRG S&T Co., Ltd., Busan 46274, Republic of Korea; (B.-H.K.)
| | - Bum-Joon Park
- Rare Disease R&D Center, PRG S&T Co., Ltd., Busan 46274, Republic of Korea; (B.-H.K.)
- Department of Molecular Biology, College of Natural Science, Pusan National University, Busan 46241, Republic of Korea
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Shinya Y, Teranishi Y, Hasegawa H, Miyawaki S, Sugiyama T, Shin M, Kawashima M, Umekawa M, Katano A, Nakatomi H, Saito N. Long-term outcomes of stereotactic radiosurgery for intracranial schwannoma in neurofibromatosis type 2: a genetic analysis perspective. J Neurooncol 2024; 166:185-194. [PMID: 38151698 DOI: 10.1007/s11060-023-04530-0] [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] [Received: 11/08/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Neurofibromatosis type 2 (NF2) is intractable because of multiple tumors involving the nervous system and is clinically diverse and genotype-dependent. Stereotactic radiosurgery (SRS) for NF2-associated schwannomas remains controversial. We aimed to investigate the association between radiosurgical outcomes and mutation types in NF2-associated schwannomas. METHODS This single-institute retrospective study included consecutive NF2 patients with intracranial schwannomas treated with SRS. The patients' types of germline mutations ("Truncating," "Large deletion," "Splice site," "Missense," and "Mosaic") and Halliday's genetic severity scores were examined, and the associations with progression-free rate (PFR) and overall survival (OS) were analyzed. RESULTS The study enrolled 14 patients with NF2 with 22 associated intracranial schwannomas (median follow-up, 102 months). The PFRs in the entire cohort were 95% at 5 years and 90% at 10-20 years. The PFRs tended to be worse in patients with truncating mutation exons 2-13 than in those with other mutation types (91% at 5 years and 82% at 10-20 years vs. 100% at 10-20 years, P = 0.140). The OSs were 89% for patients aged 40 years and 74% for those aged 60 years in the entire cohort and significantly lower in genetic severity group 3 than in the other groups (100% vs. 50% for those aged 35 years; P = 0.016). CONCLUSION SRS achieved excellent PFR for NF2-associated intracranial schwannomas in the mild (group 2A) and moderate (group 2B) groups. SRS necessitates careful consideration for the severe group (group 3), especially in cases with NF2 truncating mutation exons 2-13.
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Affiliation(s)
- Yuki Shinya
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yu Teranishi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, 162-8655, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Masahiro Shin
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mariko Kawashima
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Advances in Targeted Therapy for Neurofibromatosis Type 2 (NF2)-Associated Vestibular Schwannomas. Curr Oncol Rep 2023; 25:531-537. [PMID: 36933171 DOI: 10.1007/s11912-023-01388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE OF REVIEW Neurofibromatosis 2 (NF2) is an autosomal-dominant genetic disorder characterized by bilateral vestibular schwannomas (VS), meningiomas, ependymomas, spinal and peripheral schwannomas, optic gliomas, and juvenile cataracts. Ongoing studies provide new insight into the role of the NF2 gene and merlin in VS tumorigenesis. RECENT FINDINGS As NF2 tumor biology becomes increasingly understood, therapeutics targeting specific molecular pathways have been developed and evaluated in preclinical and clinical studies. NF2-associated VS are a source of significant morbidity with current treatments including surgery, radiation, and observation. Currently, there are no FDA-approved medical therapies for VS, and the development of selective therapeutics is a high priority. This manuscript reviews NF2 tumor biology and current therapeutics undergoing investigation for treatment of patients with VS.
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Wach J, Güresir Á, Borger V, Schuss P, Becker A, Coch C, Schmitz MT, Hölzel M, Toma M, Herrlinger U, Vatter H, Güresir E. Elevated baseline C-reactive protein levels predict poor progression-free survival in sporadic vestibular schwannoma. J Neurooncol 2021; 156:365-375. [PMID: 34882287 PMCID: PMC8816751 DOI: 10.1007/s11060-021-03918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 01/01/2023]
Abstract
Background Recent investigations showed emerging evidence of the role of inflammation in the growth of sporadic vestibular schwannoma (VS). The present retrospective study investigated the impact of systemic inflammation on tumor progression using serum C-reactive protein (CRP) levels in a series of 87 surgically treated sporadic VS patients. Methods The optimal cut-off value for CRP was defined as 3.14 mg/dl according to the receiver operating characteristic curve (AUC: 0.70, 95% CI 0.47–0.92). Patient cohort was dichotomized into normal (n = 66; < 3.14 mg/dl) and high baseline (n = 21; ≥ 3.14 mg/dl) CRP groups. Results No significant differences in age, sex, comorbidities influencing the systemic inflammatory state, Karnofsky performance status (KPS), tumor size, extent of resection, or MIB-1 index were identified between the two groups defined by the baseline CRP levels. Univariable analysis demonstrated that a high CRP level (≥ 3.14 mg/dl) is significantly associated with a shortened progression-free survival (PFS) (hazard ratio (HR): 6.05, 95% CI 1.15–31.95, p = 0.03). Multivariable Cox regression analysis considering age, extent of resection, KPS, tumor size, and baseline CRP confirmed that an elevated CRP level (≥ 3.14 mg/dl) is an independent predictor of shortened PFS (HR: 7.20, 95% CI 1.08–48.14, p = 0.04). Conclusions The baseline CRP level thus serves as an independent predictor of PFS. Further investigations of the role of inflammation and tumor inflammatory microenvironment in the prediction of prognosis in sporadic VS are needed. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03918-0.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany.
| | - Ági Güresir
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Marieta Toma
- Institute of Pathology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
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Lewis D, Donofrio CA, O'Leary C, Li KL, Zhu X, Williams R, Djoukhadar I, Agushi E, Hannan CJ, Stapleton E, Lloyd SK, Freeman SR, Wadeson A, Rutherford SA, Hammerbeck-Ward C, Evans DG, Jackson A, Pathmanaban ON, Roncaroli F, King AT, Coope DJ. The microenvironment in sporadic and neurofibromatosis type II-related vestibular schwannoma: the same tumor or different? A comparative imaging and neuropathology study. J Neurosurg 2020; 134:1419-1429. [PMID: 32470937 DOI: 10.3171/2020.3.jns193230] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Inflammation and angiogenesis may play a role in the growth of sporadic and neurofibromatosis type 2 (NF2)-related vestibular schwannoma (VS). The similarities in microvascular and inflammatory microenvironment have not been investigated. The authors sought to compare the tumor microenvironment (TME) in sporadic and NF2-related VSs using a combined imaging and tissue analysis approach. METHODS Diffusion MRI and high-temporal-resolution dynamic contrast-enhanced (DCE) MRI data sets were prospectively acquired in 20 NF2-related and 24 size-matched sporadic VSs. Diffusion metrics (mean diffusivity, fractional anisotropy) and DCE-MRI-derived microvascular biomarkers (transfer constant [Ktrans], fractional plasma volume, tissue extravascular-extracellular space [ve], longitudinal relaxation rate, tumoral blood flow) were compared across both VS groups, and regression analysis was used to evaluate the effect of tumor size, pretreatment tumor growth rate, and tumor NF2 status (sporadic vs NF2-related) on each imaging parameter. Tissues from 17 imaged sporadic VSs and a separate cohort of 12 NF2-related VSs were examined with immunohistochemistry markers for vessels (CD31), vessel permeability (fibrinogen), and macrophage density (Iba1). The expression of vascular endothelial growth factor (VEGF) and VEGF receptor 1 was evaluated using immunohistochemistry, Western blotting, and double immunofluorescence. RESULTS Imaging data demonstrated that DCE-MRI-derived microvascular characteristics were similar in sporadic and NF2-related VSs. Ktrans (p < 0.001), ve (p ≤ 0.004), and tumoral free water content (p ≤ 0.003) increased with increasing tumor size and pretreatment tumor growth rate. Regression analysis demonstrated that with the exception of mean diffusivity (p < 0.001), NF2 status had no statistically significant effect on any of the imaging parameters or the observed relationship between the imaging parameters and tumor size (p > 0.05). Tissue analysis confirmed the imaging metrics among resected sporadic VSs and demonstrated that across all VSs studied, there was a close association between vascularity and Iba1+ macrophage density (r = 0.55, p = 0.002). VEGF was expressed by Iba1+ macrophages. CONCLUSIONS The authors present the first in vivo comparative study of microvascular and inflammatory characteristics in sporadic and NF2-related VSs. The imaging and tissue analysis results indicate that inflammation is a key contributor to TME and should be viewed as a therapeutic target in both VS groups.
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Affiliation(s)
- Daniel Lewis
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre.,2Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre (WMIC), University of Manchester
| | - Carmine A Donofrio
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Claire O'Leary
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre.,3Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester
| | - Ka-Loh Li
- 2Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre (WMIC), University of Manchester
| | - Xiaoping Zhu
- 2Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre (WMIC), University of Manchester
| | - Ricky Williams
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Ibrahim Djoukhadar
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Erjon Agushi
- 2Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre (WMIC), University of Manchester
| | - Cathal J Hannan
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Emma Stapleton
- 4Department of Otolaryngology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Simon K Lloyd
- 4Department of Otolaryngology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Simon R Freeman
- 4Department of Otolaryngology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Andrea Wadeson
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Scott A Rutherford
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Charlotte Hammerbeck-Ward
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - D Gareth Evans
- 5Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester
| | - Alan Jackson
- 2Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre (WMIC), University of Manchester
| | - Omar N Pathmanaban
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre.,6Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester; and
| | - Federico Roncaroli
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre.,3Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester
| | - Andrew T King
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre.,7Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - David J Coope
- 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre.,3Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester
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Tripathi M, Deora H, Kumar N, Batish A, Dutta P, Gurnani J, Mohindra S, Hussain Shahid A, Kataria K, Agrahari A, Singh Kataria M, Ahuja CK, Singh P. Role of Bevacizumab as a prophylactic and rehabilitative treatment modality in cases of sporadic and syndromic vestibular schwannoma: Fifty shades of grey! INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
HYPOTHESIS Microsurgical implantation of mouse merlin-deficient Schwann cells (MD-SC) into the cerebellopontine angle of immunodeficient rats will initiate tumor formation, hearing loss, and vestibular dysfunction. BACKGROUND The progress in identifying effective drug therapies for treatment of Neurofibromatosis type II (NF2) is limited by the availability of animal models of VS that develop hearing loss and imbalance. METHODS A microsurgical technique for implanting MD-SCs onto the cochleovestibular nerve of rats was developed. Ten Rowett Nude rats were implanted with either ∼10 MD-SCs expressing luciferase (N = 5) or vehicle (N = 5). Rats received bioluminescence imaging, auditory brainstem response testing, and were observed for head tilt every 2 weeks after surgery, for a total of 6 weeks. Tumors were harvested and processed with hematoxylin & eosin staining and immunohistochemistry was performed for S100. RESULTS Rats implanted with MD-SCs developed significantly higher tumor bioluminescence measurements and hearing threshold shifts at multiple frequencies by the 4th and 6th weeks post-implantation, compared with control rats. Rats implanted with MD-SCs also developed gross tumor. The tumor volume was significantly greater than nerve volumes obtained from rats in the control group. All rats with tumors developed a head tilt, while control rats had no signs of vestibular dysfunction. Tumors demonstrated histological features of schwannoma and express S100. CONCLUSION Using this microsurgical technique, this xenograft rat model of VS develops tumors involving the cochleovestibular nerve, shifts in hearing thresholds, and vestibular dysfunction. This animal model can be used to investigate tumor-mediated hearing loss and perform preclinical drug studies for NF2.
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Long-Term Outcomes of Stereotactic Radiosurgery for Vestibular Schwannoma Associated with Neurofibromatosis Type 2 in Comparison to Sporadic Schwannoma. Cancers (Basel) 2019; 11:cancers11101498. [PMID: 31591325 PMCID: PMC6827030 DOI: 10.3390/cancers11101498] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/17/2022] Open
Abstract
The efficacy of radiosurgery for neurofibromatosis type 2 (NF2)-associated vestibular schwannoma (VS) remains debatable. We retrospectively analyzed radiosurgical outcomes for NF2-associated VS compared to sporadic VS using our database of 422 consecutive VS patients. Twenty-five patients with 30 NF2-associated VSs with a mean follow-up of 121 months were identified. NF2-associated VSs exhibited excellent tumor control (10-year cumulative rate, 92% vs. 92% in sporadic VSs; p = 0.945) and worse overall survival (73% vs. 97%; p = 0.005), mainly due to tumor progression other than the treated VSs. The presence of NF2 was not associated with failed tumor control via multivariate Cox proportional hazard analyses. No difference in radiation-induced adverse events (RAEs) was confirmed between cohorts, and prescription dose (hazard ratio 8.30, 95% confidence interval 3.19-21.62, p < 0.001) was confirmed as a risk for cranial nerve injuries via multivariate analysis. Further analysis after propensity score matching using age, volume, and sex as covariates showed that NF2-associated VSs exhibited excellent local control (100% vs. 93%; p = 0.240) and worse overall survival (67% vs. 100%; p = 0.002) with no significant difference in RAEs. Excellent long-term tumor control and minimal invasiveness may make radiosurgery a favorable therapeutic option for NF2 patients with small to medium VS, preferably with non-functional hearing or deafness in combination with postoperative tumor growth or progressive non-operated tumors, or with functional hearing by patients' wish.
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Goutagny S, Kalamarides M. Medical treatment in neurofibromatosis type 2. Review of the literature and presentation of clinical reports. Neurochirurgie 2018; 64:370-374. [DOI: 10.1016/j.neuchi.2016.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/26/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
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Wagner J, Welzel T, Habermehl D, Debus J, Combs SE. Radiotherapy in Patients with Vestibular Schwannoma and Neurofibromatosis Type 2: Clinical Results and Review of the Literature. TUMORI JOURNAL 2018; 100:189-94. [DOI: 10.1177/030089161410000212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background To evaluate the long-term outcome of patients with vestibular schwannoma (VS) and neurofibromatosis type 2 (NF2) treated with fractionated stereotactic radiotherapy (FSRT) or stereotactic radiosurgery (SRS). Patients and Methods Sixteen VS in 14 patients with NF2 were treated with FSRT (n = 14) and SRS (n = 2). Patients with tumor progression and/or progression of clinical symptoms were selected for treatment. For patients treated with FSRT a median total dose of 57.6 Gy was prescribed with a median fractionation of 5 × 1.8 Gy per week. For patients who underwent SRS a median single dose of 17 Gy was prescribed to the 80% isodose. Results FSRT and SRS were well tolerated. Local control rate was 94% for a median follow-up time of 131 months; 2- and 5-year progression-free survival were 100%. The probability of maintaining the pretreatment hearing level was 44%. Useful hearing preservation was 33%. Cranial nerve toxicity was moderate. Trigeminal nerve function worsened in 2 patients (12%) and facial nerve function in 3 patients (19%). One patient developed a new tinnitus. Conclusion FSRT and SRS are both safe and effective noninvasive and minimally invasive treatment options for patients with VS in the setting of NF2. The long-term local control rates are excellent. Functional hearing preservation is worse in patients with VS and NF2 than in patients with sporadic VS.
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Affiliation(s)
- Johanna Wagner
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg
| | - Thomas Welzel
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg
| | - Daniel Habermehl
- Department of Radiation Oncology, Technical University Hospital of Munich, Munich, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University Hospital of Munich, Munich, Germany
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Rosahl S, Bohr C, Lell M, Hamm K, Iro H. Diagnostics and therapy of vestibular schwannomas - an interdisciplinary challenge. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2017; 16:Doc03. [PMID: 29279723 PMCID: PMC5738934 DOI: 10.3205/cto000142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vestibular schwannomas (VS) expand slowly in the internal auditory canal, in the cerebellopontine angle, inside the cochlear and the labyrinth. Larger tumors can displace and compress the brainstem. With an annual incidence of 1:100,000 vestibular schwannoma represent 6-7% of all intracranial tumors. In the cerebellopontine angle they are by far the most neoplasm with 90% of all lesions located in this region. Magnetic resonance imaging (MRI), audiometry, and vestibular diagnostics are the mainstays of the clinical workup for patients harboring tumors. The first part of this paper delivers an overview of tumor stages, the most common grading scales for facial nerve function and hearing as well as a short introduction to the examination of vestibular function. Upholding or improving quality of life is the central concern in counseling and treating a patient with vestibular schwannoma. Preservation of neuronal function is essential and the management options - watchful waiting, microsurgery and stereotactic radiation - should be custom-tailored to the individual situation of the patient. Continuing interdisciplinary exchange is important to monitor treatment quality and to improve treatment results. Recently, several articles and reviews have been published on the topic of vestibular schwannoma. On the occasion of the 88th annual meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck surgery a special volume of the journal "HNO" will be printed. Hence this presentation has been designed to deviate from the traditional standard which commonly consists of a pure literature review. The current paper was conceptually woven around a series of interdisciplinary cases that outline examples for every stage of the disease that show characteristic results for management options to date. Systematic clinical decision pathways have been deduced from our experience and from results reported in the literature. These pathways are graphically outlined after the case presentations. Important criteria for decision making are size and growth rate of the tumor, hearing of the patient and the probability of total tumor resection with preservation of hearing and facial nerve function, age and comorbidity of the patient, best possible control of vertigo and tinnitus and last but not least the patient's preference and choice. In addition to this, the experience and the results of a given center with each treatment modality will figure in the decision making process. We will discuss findings that are reported in the literature regarding facial nerve function, hearing, vertigo, tinnitus, and headache and reflect on recent studies on their influence on the patient's quality of life. Vertigo plays an essential role in this framework since it is an independent predictor of quality of life and a patient's dependence on social welfare. Pathognomonic bilateral vestibular schwannomas that occur in patients suffering from neurofibromatosis typ-2 (NF2) differ from spontaneous unilateral tumors in their biologic behavior. Treatment of neurofibromatosis type-2 patients requires a multidisciplinary team, especially because of the multitude of separate intracranial and spinal lesions. Off-label chemotherapy with Bevacizumab can stabilize tumor size of vestibular schwannomas and even improve hearing over longer periods of time. Hearing rehabilitation in NF2 patients can be achieved with cochlear and auditory brainstem implants.
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Affiliation(s)
- Steffen Rosahl
- Department of Neurosurgery, Helios Hospital of Erfurt, Germany
| | - Christopher Bohr
- Department of Otolaryngology, University Hospital of Erlangen, Germany
| | - Michael Lell
- Institute for Radiology and Nuclear Medicine, Hospital of Nuremberg, Germany
| | - Klaus Hamm
- Cyberknife Center of Central Germany, Erfurt, Germany
| | - Heinrich Iro
- Department of Neurosurgery, Helios Hospital of Erfurt, Germany
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Radiation-Induced Schwannomas and Neurofibromas: A Systematic Review. World Neurosurg 2017; 104:713-722. [PMID: 28532923 DOI: 10.1016/j.wneu.2017.05.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Radiation-induced benign peripheral nerve sheath tumors are uncommon late complications of irradiation. We conducted the largest systematic review of individual patient data. METHODS We performed a systematic search of PubMed databases and compiled a comprehensive literature review. Kaplan-Meier analysis was used to investigate survival, and statistical significance was assessed with a log-rank test. RESULTS We analyzed 40 cases of radiation-induced benign peripheral nerve sheath tumors. The histologic distributions were 28 schwannomas, 11 neurofibromas, and 1 ganglioneuroma. The average age of radiation exposure for development of primary lesions was 14.9 ± 15.5 years, and the latency period between radiotherapy to the onset of secondary tumors was 24.5 ± 12.7 years. The average irradiation dose delivered was 26.3 ± 20.3 Gy. The median overall survival for all cases was not reached (95% confidence interval, 22-not reached) months, with 10-year survival rates of 65.2%. Surgical negative margin was a positive prognostic factor for radiation-induced benign peripheral nerve sheath tumors. CONCLUSIONS The risk of incidence of secondary benign peripheral nerve sheath tumors in patients treated with radiotherapy should be considered in long-term follow-up periods. At present, complete surgical resection is the main stay for the treatment of radiation-induced benign peripheral nerve sheath tumors.
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Netto JP, Schwartz D, Varallyay C, Fu R, Hamilton B, Neuwelt EA. Misleading early blood volume changes obtained using ferumoxytol-based magnetic resonance imaging perfusion in high grade glial neoplasms treated with bevacizumab. Fluids Barriers CNS 2016; 13:23. [PMID: 27998280 PMCID: PMC5175388 DOI: 10.1186/s12987-016-0047-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neovascularization, a distinguishing trait of high-grade glioma, is a target for anti-angiogenic treatment with bevacizumab (BEV). This study sought to use ferumoxytol-based dynamic susceptibility contrast magnetic resonance imaging (MRI) to clarify perfusion and relative blood volume (rCBV) changes in glioma treated with BEV and to determine potential impact on clinical management. METHODS 16 high grade glioma patients who received BEV following post-chemoradiation radiographic or clinical progression were included. Ferumoxytol-based MRI perfusion measurements were taken before and after BEV. Lesions were defined at each timepoint by gadolinium-based contrast agent (GBCA)-enhancing area. Lesion volume and rCBV were compared pre and post-BEV in the lesion and rCBV "hot spot" (mean of the highest rCBV in a 1.08 cm2 area in the enhancing volume), as well as hypoperfused and hyperperfused subvolumes within the GBCA-enhancing lesion. RESULTS GBCA-enhancing lesion volumes decreased 39% (P = 0.01) after BEV. Mean rCBV in post-BEV GBCA-enhancing area did not decrease significantly (P = 0.227) but significantly decreased in the hot spot (P = 0.046). Mean and hot spot rCBV decreased (P = 0.039 and 0.007) when post-BEV rCBV was calculated over the pre-BEV GBCA-enhancing area. Hypoperfused pixel count increased from 24% to 38 (P = 0.007) and hyperperfused decreased from 39 to 28% (P = 0.017). Mean rCBV decreased in 7/16 (44%) patients from >1.75 to <1.75, the cutoff for pseudoprogression diagnosis. CONCLUSIONS Decreased perfusion after BEV significantly alters rCBV measurements when using ferumoxytol. BEV treatment response hinders efforts to differentiate true progression from pseudoprogression using blood volume measurements in malignant glioma, potentially impacting patient diagnosis and management.
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Affiliation(s)
- Joao Prola Netto
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
- Department of Neuroradiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Daniel Schwartz
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
- Advanced Imaging Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Csanad Varallyay
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
- Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Bronwyn Hamilton
- Department of Neuroradiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Edward A. Neuwelt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
- Department of Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239 USA
- Department of Neurosurgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR 97239 USA
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15
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Liu P, Yao Q, Li NA, Liu Y, Wang Y, Li M, Li Z, Li J, Li G. Low-dose bevacizumab induces radiographic regression of vestibular schwannomas in neurofibromatosis type 2: A case report and literature review. Oncol Lett 2016; 11:2981-2986. [PMID: 27123050 PMCID: PMC4840682 DOI: 10.3892/ol.2016.4347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/29/2016] [Indexed: 02/01/2023] Open
Abstract
The current case study aimed to explore the efficacy of a low-dose bevacizumab regimen in inhibiting tumor growth and minimizing adverse effects. A 55-year-old man with neurofibromatosis type 2 (NF2) suffered bilateral vestibular schwannomas (VS) measuring 5.25 and 2.54 cm3 on the left and right, respectively. His capacity for bilateral language recognition was impaired. However, the patient refused microsurgical tumor resection and gamma knife therapy. Low-dose bevacizumab regimen (3.3–2.2 mg/kg every 2–4 weeks) was administered by intravenous injection for ~1.5 years to inhibit tumor growth and avoid further deterioration of hearing. Compared with baseline measurements prior to treatment, the bilateral VS regressed to 3.59 cm3 (68%) and 2.08 cm3 (82%) on the left and right, respectively. No hearing improvement was detected; however, the patient subjectively experienced a significant hearing improvement as his ability to communicate with people and distinguish voices was restored. No adverse effects were observed. Bevacizumab provides an alternative treatment option for those who refuse surgical intervention. Given the adverse effects commonly induced by bevacizumab, the use of a low-dose regimen would appear to be promising with regard to tumor regression and hearing preservation for patients with VS in NF2. However, the minimum dose required to sustain a response to bevacizumab in NF2 patients remains unknown. Finding the minimum effective dose sufficient to sustain hearing and/or volumetric response for individual patients is required.
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Affiliation(s)
- Pengfei Liu
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China; Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Qingyu Yao
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - N A Li
- Department of Nuclear Medicine, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Yongliang Liu
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Yuguo Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Meng Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Jianmin Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Gang Li
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Aprile G, Giuliani F, Lutrino SE, Fontanella C, Bonotto M, Rihawi K, Fasola G. Maintenance Therapy in Colorectal Cancer: Moving the Artillery Down While Keeping an Eye on the Enemy. Clin Colorectal Cancer 2016; 15:7-15. [DOI: 10.1016/j.clcc.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/29/2015] [Accepted: 08/10/2015] [Indexed: 01/26/2023]
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Tumor Biology of Vestibular Schwannoma: A Review of Experimental Data on the Determinants of Tumor Genesis and Growth Characteristics. Otol Neurotol 2016; 36:1128-36. [PMID: 26049313 DOI: 10.1097/mao.0000000000000788] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Provide an overview of the literature on vestibular schwannoma biology with special attention to tumor behavior and targeted therapy. BACKGROUND Vestibular schwannomas are benign tumors originating from the eighth cranial nerve and arise due to inactivation of the NF2 gene and its product merlin. Unraveling the biology of these tumors helps to clarify their growth pattern and is essential in identifying therapeutic targets. METHODS PubMed search for English-language articles on vestibular schwannoma biology from 1994 to 2014. RESULTS Activation of merlin and its role in cell signaling seem as key aspects of vestibular schwannoma biology. Merlin is regulated by proteins such as CD44, Rac, and myosin phosphatase-targeting subunit 1. The tumor-suppressive functions of merlin are related to receptor tyrosine kinases, such as the platelet-derived growth factor receptor and vascular endothelial growth factor receptor. Merlin mediates the Hippo pathway and acts within the nucleus by binding E3 ubiquiting ligase CRL4. Angiogenesis is an important mechanism responsible for the progression of these tumors and is affected by processes such as hypoxia and inflammation. Inhibiting angiogenesis by targeting vascular endothelial growth factor receptor seems to be the most successful pharmacologic strategy, but additional therapeutic options are emerging. CONCLUSION Over the years, the knowledge on vestibular schwannoma biology has significantly increased. Future research should focus on identifying new therapeutic targets by investigating vestibular schwannoma (epi)genetics, merlin function, and tumor behavior. Besides identifying novel targets, testing new combinations of existing treatment strategies can further improve vestibular schwannoma therapy.
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18
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Furtner J, Schöpf V, Seystahl K, Le Rhun E, Rudà R, Roelcke U, Koeppen S, Berghoff AS, Marosi C, Clement P, Faedi M, Watts C, Wick W, Soffietti R, Weller M, Preusser M. Kinetics of tumor size and peritumoral brain edema before, during, and after systemic therapy in recurrent WHO grade II or III meningioma. Neuro Oncol 2015; 18:401-7. [PMID: 26354929 DOI: 10.1093/neuonc/nov183] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/04/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The efficacy of systemic antineoplastic therapy on recurrent World Health Organization (WHO) grades II and III meningiomas is unclear. METHODS We performed a retrospective multicenter analysis of serial cranial MRI in patients with recurrent WHO II and III meningiomas treated with antineoplastic systemic therapies. Growth rates for tumor volume and diameter, as well as change rates for edema size, were calculated for all lesions. RESULTS We identified a total of 34 patients (23 atypical, 11 anaplastic meningiomas) with a total of 57 meningioma lesions who had been treated at 6 European institutions. Systemic therapies included bevacizumab, cytotoxic chemotherapy, somatostatin analogues, and tyrosine kinase inhibitors. Overall, tumor growth rates decreased during systemic therapy by 51% for tumor diameter and 14% for tumor volume growth rates compared with the period before initiation of systemic therapy. The most pronounced decrease in meningioma growth rates during systemic therapy was evident in patients treated with bevacizumab, with a reduction of 80% in diameter and 59% in volume growth. Furthermore, a decrease in size of peritumoral edema after initiation of systemic therapy was exclusively observed in patients treated with bevacizumab (-107%). CONCLUSIONS Our data indicate that systemic therapy may inhibit growth of recurrent WHO grades II and III meningiomas to some extent. In our small cohort, bevacizumab had the most pronounced inhibitory effect on tumor growth, as well as some anti-edematous activity. Prospective studies are needed to better define the role of medical therapies in this tumor type.
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Affiliation(s)
- Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Veronika Schöpf
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Katharina Seystahl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Emilie Le Rhun
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Roberta Rudà
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Ulrich Roelcke
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Susanne Koeppen
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Anna Sophie Berghoff
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Christine Marosi
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Paul Clement
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Marina Faedi
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Colin Watts
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Wolfgang Wick
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Riccardo Soffietti
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Michael Weller
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Matthias Preusser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (J.F., V.S.); Department of Psychology, University of Graz, Graz, Austria (V.S.); BioTechMed, Graz, Austria (V.S.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (K.S., M.W.); Department of Neuro-oncology, University Hospital, Lille, France (E.L.R.); Breast Cancer Department, Oscar Lambret Center, Lille, France (E.L.R.); PRISM Inserm U1191, Villeneuve D'Ascq, France (E.L.R.); Department of Neuro-Oncology, University of Torino, Torino, Italy (R.R., R.S.); Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, Aarau, Switzerland (U.R.); Department of Neurology, University of Essen, Essen, Germany (S.K.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., C.M., M.P.); Department of Oncology, KU Leuven, Leuven, Belgium (P.C.); Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy (M.F.); Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, England (C.W.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
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Farschtschi S, Kollmann P, Dalchow C, Stein A, Mautner VF. Reduced dosage of bevacizumab in treatment of vestibular schwannomas in patients with neurofibromatosis type 2. Eur Arch Otorhinolaryngol 2015; 272:3857-60. [PMID: 25794543 DOI: 10.1007/s00405-015-3604-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/09/2015] [Indexed: 12/18/2022]
Abstract
Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome associated with vestibular schwannomas and other benign tumors of the central nervous system. Bevacizumab is used for treatment of progressive vestibular schwannomas, with the intent to reduce tumor size or preserve/improve hearing. Prolonged treatment can cause side effects such as hypertension and proteinuria, which can be cause for discontinuation of therapy. We report on 3 patients who were treated with bevacizumab for 66-76 months, with dose reductions that minimized side effects while sustaining the clinical effect of the antiangiogenic therapy. After dose reduction from 5 mg/kg bi- or tri-weekly to 2.5 mg bi- or tri-weekly, all patients appeared clinically stable and radiographic and audiologic follow-up showed sustained response. In conclusion, in some NF2 patients, dose reduction of bevacizumab seems to be an effective option for managing side effects.
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Affiliation(s)
- Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Philipp Kollmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Dalchow
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alexander Stein
- Department of Internal Medicine II and Clinic (Oncology Center), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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McCabe MG, Evans DG. Pathogenesis and management of type 2 neurofibromatosis. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1014800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kollár A, Hewer E, Kellner-Weldon F, Ochsenbein A. Complete pain relief after bevacizumab in a patient with neurofibromatosis type 2. Acta Oncol 2015; 54:280-3. [PMID: 25225117 DOI: 10.3109/0284186x.2014.956185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Attila Kollár
- Department of Medical Oncology, University Hospital of Bern , Switzerland
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Neurofibromatosis type 2 vestibular schwannoma treatment: a review of the literature, trends, and outcomes. Otol Neurotol 2015; 35:889-94. [PMID: 24675066 DOI: 10.1097/mao.0000000000000272] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Review the useful hearing preservation and tumor control outcomes of microsurgery (MS), stereotactic radiation (SR), conservative management (CM), and chemotherapy (ChT) for Neurofibromatosis type 2 vestibular schwannomas. DATA SOURCES Ovid MEDLINE was used to conduct a thorough search of English-language publications dating from 1948 to February 2013. STUDY SELECTION Patients must have had useful hearing at diagnosis and treated with one of the 4 treatments as their primary therapy. All sporadic vestibular schwannoma cases were excluded. DATA EXTRACTION A total of 19 articles were reviewed. Hearing preservation was defined as unchanged or improved useful hearing. Tumor control was defined as no change in size or tumor regression for SR, CM, and ChT-treated cases, and as no recurrence for MS treated cases. CONCLUSION Microsurgery seems to have the worse overall results, while SR has very good tumor control with poor useful hearing preservation. If a patient qualifies for CM, he is likely to show the most satisfactory results with the least treatment available. A close follow-up on ChT clinical trials and possible side-effects is warranted as preliminary short-term results are quite favorable. Additional long-term studies are required for a better understanding of this disease.
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Goutagny S, Raymond E, Esposito-Farese M, Trunet S, Mawrin C, Bernardeschi D, Larroque B, Sterkers O, Giovannini M, Kalamarides M. Phase II study of mTORC1 inhibition by everolimus in neurofibromatosis type 2 patients with growing vestibular schwannomas. J Neurooncol 2015; 122:313-20. [PMID: 25567352 DOI: 10.1007/s11060-014-1710-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Abstract
Neurofibromatosis type 2 (NF2) is a genetic disorder with bilateral vestibular schwannomas (VS) as the most frequent manifestation. Merlin, the NF2 tumor suppressor, was identified as a negative regulator of mammalian target of rapamycin complex 1. Pre-clinical data in mice showed that mTORC1 inhibition delayed growth of NF2-schwannomas. We conducted a prospective single-institution open-label phase II study to evaluate the effects of everolimus in ten NF2 patients with progressive VS. Drug activity was monitored every 3 months. Everolimus was administered orally for 12 months and, if the decrease in tumor volume was >20 % from baseline, treatment was continued for 12 additional months. Other patients stopped when completed 12 months of everolimus but were allowed to resume treatment when VS volume was >20 % during 1 year follow-up. Nine patients were evaluable. Safety was evaluated using CTCAE 3.0 criteria. After 12 months of everolimus, no reduction in volume ≥20 % was observed. Four patients had progressive disease, and five patients had stable disease with a median annual growth rate decreasing from 67 %/year before treatment to 0.5 %/year during treatment. In these patients, tumor growth resumed within 3-6 months after treatment discontinuation. Everolimus was then reintroduced and VS decreased by a median 6.8 % at 24 months. Time to tumor progression increased threefold from 4.2 months before treatment to > 12 months. Hearing was stable under treatment. The safety of everolimus was manageable. Although the primary endpoint was not reached, further studies are required to confirm the potential for stabilization of everolimus.
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Affiliation(s)
- Stéphane Goutagny
- Neurochirurgie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, 100 boulevard du General Leclerc, 92100, Clichy, France
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Poveda A, Ray-Coquard I, Romero I, Lopez-Guerrero JA, Colombo N. Emerging treatment strategies in recurrent platinum-sensitive ovarian cancer: Focus on trabectedin. Cancer Treat Rev 2014; 40:366-75. [DOI: 10.1016/j.ctrv.2013.08.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
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Passot G, Bakrin N, Garnier L, Roux A, Vaudoyer D, Wallet F, Gilly F, Glehen O, Cotte E. Intraperitoneal vascular endothelial growth factor burden in peritoneal surface malignancies treated with curative intent: The first step before intraperitoneal anti-vascular endothelial growth factor treatment? Eur J Cancer 2014; 50:722-30. [DOI: 10.1016/j.ejca.2013.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/28/2013] [Accepted: 11/02/2013] [Indexed: 12/21/2022]
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Miyahara K, Nouso K, Morimoto Y, Takeuchi Y, Hagihara H, Kuwaki K, Onishi H, Ikeda F, Miyake Y, Nakamura S, Shiraha H, Takaki A, Iwadou S, Kobayashi Y, Takaguchi K, Takuma Y, Takabatake H, Sakaguchi K, Yamamoto K. Efficacy of sorafenib beyond first progression in patients with metastatic hepatocellular carcinoma. Hepatol Res 2014; 44:296-301. [PMID: 23607549 DOI: 10.1111/hepr.12123] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 02/08/2023]
Abstract
AIM We investigated whether continuous sorafenib administration keeps suppressing the growth of hepatocellular carcinoma (HCC) after first progressive disease (PD), and whether it prolongs patients' survival. METHODS The size of metastatic lesions was measured in 36 patients with advanced HCC treated with sorafenib. The tumor growth rates before and after radiological PD as well as survival were compared between the patients who continued (n = 23) and stopped (n = 13) sorafenib at first radiological PD. RESULTS The growth rate did not differ between before and after PD in patients who continued sorafenib, while it increased after PD in patients who stopped sorafenib at PD (P = 0.002). Survival beyond first progression was longer in patients who continued sorafenib than in those who stopped it at PD (P = 0.012), and this tendency was observed even when the analysis was limited to Child-Pugh class A patients (P = 0.085). CONCLUSION Sorafenib administration beyond first radiological PD could continuously suppress HCC growth and may have survival benefit.
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Affiliation(s)
- Koji Miyahara
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Hilton DA, Hanemann CO. Schwannomas and their pathogenesis. Brain Pathol 2014; 24:205-20. [PMID: 24450866 DOI: 10.1111/bpa.12125] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/16/2014] [Indexed: 12/18/2022] Open
Abstract
Schwannomas may occur spontaneously, or in the context of a familial tumor syndrome such as neurofibromatosis type 2 (NF2), schwannomatosis and Carney's complex. Schwannomas have a variety of morphological appearances, but they behave as World Health Organization (WHO) grade I tumors, and only very rarely undergo malignant transformation. Central to the pathogenesis of these tumors is loss of function of merlin, either by direct genetic change involving the NF2 gene on chromosome 22 or secondarily to merlin inactivation. The genetic pathways and morphological features of schwannomas associated with different genetic syndromes will be discussed. Merlin has multiple functions, including within the nucleus and at the cell membrane, and this review summarizes our current understanding of the mechanisms by which merlin loss is involved in schwannoma pathogenesis, highlighting potential areas for therapeutic intervention.
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Affiliation(s)
- David A Hilton
- Department of Cellular and Anatomical Pathology, Derriford Hospital, Plymouth, UK
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Hawasli AH, Rubin JB, Tran DD, Adkins DR, Waheed S, Hullar TE, Gutmann DH, Evans J, Leonard JR, Zipfel GJ, Chicoine MR. Antiangiogenic agents for nonmalignant brain tumors. J Neurol Surg B Skull Base 2013; 74:136-41. [PMID: 24436903 DOI: 10.1055/s-0033-1338262] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/13/2012] [Indexed: 01/14/2023] Open
Abstract
Objective To assess the treatment response and side effects for the use of antiangiogenic agents such as vascular endothelial growth factor (VEGF) inhibitors for patients with vestibular schwannomas and meningiomas. Design and Methods Retrospective review of eight male and two female patients (ages 14 to 70, mean 36 years), treated with bevacizumab (9) or pazopanib (1). Six patients had neurofibromatosis type 2 (NF2) with bilateral vestibular schwannomas and meningiomas, and the four others had aggressive recurrent meningiomas. Results During treatment (range 4 to 21 months, mean 9.1) with antiangiogenic agents, two patients with an atypical meningioma and radiation necrosis had dramatic partial response, the six NF2 patients had stable or slightly improved disease, and two meningioma patients had disease progression. Hearing was stable in three of the NF2 patients and was improved in three NF2 patients (one of whom received a cochlear implant). Minor toxicities included epistaxis, nausea, diarrhea, weight loss, and abdominal pain. No grade 3 or 4 toxicities were observed. Conclusion Antiangiogenic agents appear to be safe for the treatment of patients with nonmalignant brain tumors, and in select cases may be efficacious.
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Affiliation(s)
- Ammar H Hawasli
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Joshua B Rubin
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA ; Department of Anatomy and Neurobiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - David D Tran
- Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Douglas R Adkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Shahid Waheed
- J. B. & Greeta B. Arthur Cancer Center, Mexico, Missouri, USA
| | - Timothy E Hullar
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, Missouri, USA ; Department of Anatomy and Neurobiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - John Evans
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jeffrey R Leonard
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Gregory J Zipfel
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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Development of drug treatments for neurofibromatosis type 2-associated vestibular schwannoma. Curr Opin Otolaryngol Head Neck Surg 2013; 20:372-9. [PMID: 22931905 DOI: 10.1097/moo.0b013e328357d2ee] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the discoveries in molecular pathophysiology contributing to the development of neurofibromatosis type 2 (NF2)-associated vestibular schwannomas and the recent experiences with drug therapies for these tumors. The review includes discussion of diagnostic criteria for NF2, populations to clinically consider for drug therapy and drug targets currently under consideration for NF2. RECENT FINDINGS Increased insight into the complex pathways that underlie both the genetic syndrome of NF2 and the specific pathogenesis of vestibular schwannomas has highlighted multiple potential therapeutic targets. These discoveries have been translated into clinical trials with some early promising results. Inhibition of angiogenesis as well as regulation of mammalian target of rapamycin and the epidermal growth factor receptor family of receptors are the focus of current clinical investigations. SUMMARY Although a great deal of work is ongoing to understand the multiple effects of the lack of the regulating protein Merlin on tumorgenesis in patients with NF2, advances are ongoing with clinical therapeutics. There is cause for enthusiasm based on recent results with antiangiogenesis therapy in select patients with NF2 and progressive vestibular schwannomas; however, awareness of the notable risks and limitations of therapies currently in development is required.
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Koutsimpelas D, Bjelopavlovic M, Yetis R, Frauenknecht K, Adryan B, Schmidtmann I, Gouveris H, Fruth K, Heinrich UR, Stauber RH, Mann WJ, Brieger J. The VEGF/VEGF-R axis in sporadic vestibular schwannomas correlates with irradiation and disease recurrence. ORL J Otorhinolaryngol Relat Spec 2013; 74:330-8. [PMID: 23344215 DOI: 10.1159/000346238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 11/19/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The molecular mechanisms downstream of mutated neurofibromatosis type 2 (NF2) gene resulting in the growth and development of vestibular schwannoma (VS) are controversial. Several lines of evidence suggest the involvement of the vascular endothelial growth factor (VEGF) pathway in VS development. Given that recent studies of VEGF blockade in patients with NF2-associated VS showed positive effects on VS growth control, we initiated this comprehensive study of the VEGF pathway in sporadic VS. METHODS A tissue microarray analysis of 182 sporadic VS was conducted. The expression of VEGF and its receptors as well as the proliferative activity of the tumors were quantified. The expression data were correlated to tumor volumes and diameters as well as to tumor recurrence and previous irradiation. RESULTS All studied tumors expressed VEGF and its receptors. Proliferative activity was related to the growth characteristics of the tumors. Moreover, we found significantly higher VEGF levels in recurrent tumors (p = 0.0387) and in preoperatively irradiated tumors (p = 0.0213). CONCLUSION Our data suggest a relevant role of the VEGF pathway in VS growth and therapy outcome. Therefore, targeting this pathway using antiangiogenic compounds might be beneficial for patients with sporadic VS, especially those with recurrent or irradiated tumors.
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Affiliation(s)
- D Koutsimpelas
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Bevacizumab for progressive vestibular schwannoma in neurofibromatosis type 2: a retrospective review of 31 patients. Otol Neurotol 2012; 33:1046-52. [PMID: 22805104 DOI: 10.1097/mao.0b013e31825e73f5] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Early studies suggest that bevacizumab treatment can result in tumor shrinkage and hearing improvement for some patients with neurofibromatosis type 2 (NF2). The aim of this study was to report extended follow-up in a larger cohort of similarly treated patients. STUDY DESIGN Retrospective study. SETTING Tertiary referral center PATIENTS Thirty-one consecutive NF2 patients who received bevacizumab for progressive vestibular schwannomas. MAIN OUTCOME MEASURE Hearing improvement, defined as an improvement in word recognition score above the 95% critical difference compared with baseline, and radiographic response, defined as a 20% or greater decrease in tumor volume compared with baseline. RESULTS The median age was 26 years (range, 12-73 yr). The median volumetric tumor growth rate before treatment was 64% per year. At the time of analysis, the median duration of treatment was 14 months (range, 6-41 mo) with a total of 47 patient-years of follow-up. A hearing response occurred in 57% (13/23) of evaluable patients and a radiographic response in 55% (17/31) of target vestibular schwannomas. The median time to response was 3 months for both end points. The only clinical or radiographic feature at baseline that correlated with change in tumor volume at 3 months was the mean apparent diffusion coefficient value, a radiologic marker of edema (p = 0.036). Ninety percent of patients had stable or improved hearing after 1 year of treatment and 61% at 3 years; 88% of patients had stable or decreased tumor size after 1 year of treatment and 54% at 3 years. Overall, treatment was well tolerated. CONCLUSION Bevacizumab treatment was followed by hearing improvement and tumor shrinkage in more than 50% of progressive vestibular schwannomas in NF2 patients. Stable or improved hearing was retained in the majority of patients.
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Karajannis MA, Legault G, Hagiwara M, Ballas MS, Brown K, Nusbaum AO, Hochman T, Goldberg JD, Koch KM, Golfinos JG, Roland JT, Allen JC. Phase II trial of lapatinib in adult and pediatric patients with neurofibromatosis type 2 and progressive vestibular schwannomas. Neuro Oncol 2012; 14:1163-70. [PMID: 22844108 DOI: 10.1093/neuonc/nos146] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This single-institution phase II study was performed to estimate the response rate to lapatinib in neurofibromatosis type 2 (NF2) patients with progressive vestibular schwannoma (VS). Twenty-one eligible patients were enrolled. Brain and spine MRIs, including 3-dimensional volumetric tumor analysis, and audiograms were performed once at baseline and again every 12 weeks. The primary response end point was evaluable in 17 patients and defined as ≥15% decrease in VS volume. Hearing was evaluable as a secondary end point in 13 patients, with responses defined as an improvement in the pure tone average of at least 10 dB or a statistically significant increase in word recognition scores. Four of 17 evaluable patients experienced an objective volumetric response (23.5%; 95% confidence interval [CI], 10%-47%), with median time to response of 4.5 months (range, 3-12). In responders, reduction in VS volumes ranged from -15.7% to -23.9%. Four of 13 patients evaluable for hearing met hearing criteria for response (30.8%; 95% CI, 13%-58%). One sustained response exceeded 9 months in duration. Median time to overall progression (ie, volumetric progression or hearing loss) was 14 months. The estimated overall progression-free survival and volumetric progression-free survival at 12 months were 64.2% (95% CI, 36.9%-82.1%) and 70.6% (95% CI, 43.1%-86.6%), respectively. Toxicity was generally minor, and no permanent dose modifications were required. Lapatinib carries minor toxicity and has objective activity in NF2 patients with progressive VS, including volumetric and hearing responses. Future studies could explore combination therapy with other molecular targeted agents such as bevacizumab.
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Antiangiogenic therapy in the management of brain tumors: a clinical overview. Cancer Chemother Pharmacol 2012; 70:353-63. [DOI: 10.1007/s00280-012-1926-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 07/05/2012] [Indexed: 12/15/2022]
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Riina HA, Burkhardt JK, Santillan A, Bassani L, Patsalides A, Boockvar JA. Short-term clinico-radiographic response to super-selective intra-arterial cerebral infusion of Bevacizumab for the treatment of vestibular schwannomas in Neurofibromatosis type 2. Interv Neuroradiol 2012; 18:127-32. [PMID: 22681725 DOI: 10.1177/159101991201800201] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 12/11/2011] [Indexed: 11/16/2022] Open
Abstract
Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome with a prevalence of approximately 1 in 30,000. NF 2 is characterized by bilateral vestibular schwannomas, as well as meningiomas, ependymomas and gliomas. Currently, surgical resection and radiotherapy represent the mainstay of treatment, although new studies suggest a role for certain chemotherapeutic agents. Intravenous administration of Bevacizumab (Avastin, Genetech Pharmaceuticals) has been shown to be active in the treatment of vestibular schwannomas. The IV route of administration, however, carries a risk of known systemic side-effects such as bowel perforation, wound dehiscence and pulmonary embolism. In addition, the percentage of drug that reaches the tumor site may be restricted by the blood tumor barrier. This report describes the super-selective intra-arterial infusion of Bevacizumab following blood brain barrier disruption for the treatment of vestibular schwannomas in three patients with Neurofibromatosis type 2. It represents the first time such a technique has been performed for this disease. Additionally, this method of drug delivery may have important implications in the treatment of patients with vestibular schwannomas associated with Neurofibromatosis type 2.
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Affiliation(s)
- H A Riina
- Department of Neurosurgery, New York University Langone Medical Center, New York, NY 10016, USA.
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Roser F, Honegger J, Schuhmann MU, Tatagiba MS. Meningiomas, nerve sheath tumors, and pituitary tumors: diagnosis and treatment. Hematol Oncol Clin North Am 2012; 26:855-79. [PMID: 22794287 DOI: 10.1016/j.hoc.2012.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article gives an overview of meningiomas, pituitary tumors, and intracranial nerve sheath tumors as regards epidemiology, diagnosis, and treatment. Discussion includes the definition of these tumors and their symptomatology, diagnostic procedures, treatment options, surgical techniques, and outcomes.
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Affiliation(s)
- Florian Roser
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.
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Molecular Pathogenesis of Vestibular Schwannomas: Insights for the Development of Novel Medical Therapies. Otolaryngol Pol 2012; 66:84-95. [DOI: 10.1016/s0030-6657(12)70754-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 02/13/2012] [Indexed: 11/21/2022]
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Blakeley JO, Evans DG, Adler J, Brackmann D, Chen R, Ferner RE, Hanemann CO, Harris G, Huson SM, Jacob A, Kalamarides M, Karajannis MA, Korf BR, Mautner VF, McClatchey AI, Miao H, Plotkin SR, Slattery W, Stemmer-Rachamimov AO, Welling DB, Wen PY, Widemann B, Hunter-Schaedle K, Giovannini M. Consensus recommendations for current treatments and accelerating clinical trials for patients with neurofibromatosis type 2. Am J Med Genet A 2011; 158A:24-41. [PMID: 22140088 DOI: 10.1002/ajmg.a.34359] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 09/23/2011] [Indexed: 12/24/2022]
Abstract
Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome characterized by bilateral vestibular schwannomas (VS) which often result in deafness despite aggressive management. Meningiomas, ependymomas, and other cranial nerve and peripheral schwannomas are also commonly found in NF2 and collectively lead to major neurologic morbidity and mortality. Traditionally, the overall survival rate in patients with NF2 is estimated to be 38% at 20 years from diagnosis. Hence, there is a desperate need for new, effective therapies. Recent progress in understanding the molecular basis of NF2 related tumors has aided in the identification of potential therapeutic targets and emerging clinical therapies. In June 2010, representatives of the international NF2 research and clinical community convened under the leadership of Drs. D. Gareth Evans (University of Manchester) and Marco Giovannini (House Research Institute) to review the state of NF2 treatment and clinical trials. This manuscript summarizes the expert opinions about current treatments for NF2 associated tumors and recommendations for advancing therapies emerging from that meeting. The development of effective therapies for NF2 associated tumors has the potential for significant clinical advancement not only for patients with NF2 but for thousands of neuro-oncology patients afflicted with these tumors.
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Abstract
PURPOSE Four sets of clinical diagnostic criteria have been proposed for neurofibromatosis 2, but all have low sensitivity at the time of initial clinical assessment for the disease among patients with a negative family history who do not present with bilateral vestibular schwannomas. We have empirically developed and tested an improved set of diagnostic criteria that uses current understanding of the natural history and genetic characteristics of neurofibromatosis 2 to increase sensitivity while maintaining very high specificity. METHODS We used data from the UK Neurofibromatosis 2 Registry and Kaplan-Meier curves to estimate frequencies of clinical features at various ages among patients with or without unequivocal neurofibromatosis 2. On the basis of this analysis, we developed the Baser criteria, a new diagnostic system that incorporates genetic testing and gives more weight to the most characteristic features and to those that occur before 30 years of age. RESULTS In an independent validation subset of patients with unequivocal neurofibromatosis 2, the Baser criteria increased diagnostic sensitivity to 79% (9-15% greater than previous sets of criteria) while maintaining 100% specificity at the age at onset of the first characteristic sign of neurofibromatosis 2. CONCLUSION The Baser criteria permit early diagnosis in a greater proportion of patients with neurofibromatosis 2 than previous sets of diagnostic criteria.
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Goutagny S, Raymond E, Sterkers O, Colombani J, Kalamarides M. Radiographic regression of cranial meningioma in a NF2 patient treated by bevacizumab. Ann Oncol 2011; 22:990-991. [DOI: 10.1093/annonc/mdr012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Riediger T, Bothe C, Becskei C, Lutz TA. Peptide YY directly inhibits ghrelin-activated neurons of the arcuate nucleus and reverses fasting-induced c-Fos expression. Neuroendocrinology 2004; 79:317-26. [PMID: 15256809 DOI: 10.1159/000079842] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 05/24/2004] [Indexed: 01/27/2023]
Abstract
The hypothalamic arcuate nucleus (Arc) monitors and integrates hormonal and metabolic signals involved in the maintenance of energy homeostasis. The orexigenic peptide ghrelin is secreted from the stomach during negative status of energy intake and directly activates neurons of the medial arcuate nucleus (ArcM) in rats. In contrast to ghrelin, peptide YY (PYY) is released postprandially from the gut and reduces food intake when applied peripherally. Neurons in the ArcM express ghrelin receptors and neuropeptide Y receptors. Thus, PYY may inhibit feeding by acting on ghrelin-sensitive Arc neurons. Using extracellular recordings, we (1) characterized the effects of PYY on the electrical activity of ghrelin-sensitive neurons in the ArcM of rats. In order to correlate the effect of PYY on neuronal activity with the energy status, we (2) investigated the ability of PYY to reverse fasting-induced c-Fos expression in Arc neurons of mice. In addition, we (3) sought to confirm that PYY reduces food intake under our experimental conditions. Superfusion of PYY reversibly inhibited 94% of all ArcM neurons by a direct postsynaptic mechanism. The PYY-induced inhibition was dose-dependent and occurred at a threshold concentration of 10(-8)M. Consistent with the opposite effects of ghrelin and PYY on food intake, a high percentage (50%) of Arc neurons was activated by ghrelin and inhibited by PYY. In line with this inhibitory action, peripherally injected PYY partly reversed the fasting-induced c-Fos expression in Arc neurons of mice. Similarly, refeeding of food-deprived mice reversed the fasting-induced activation in the Arc. Furthermore, peripherally injected PYY reduced food intake in 12-hour fasted mice. Thus the activity of Arc neurons correlated with the feeding status and was not only reduced by feeding but also by administration of PYY in non-refed mice. In conclusion, our current observations suggest that PYY may contribute to signaling a positive status of energy intake by inhibiting Arc neurons, which are activated under a negative status of energy intake by signals such as ghrelin.
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Affiliation(s)
- Thomas Riediger
- Institute of Veterinary Physiology, University of Zurich, CH-8057 Zurich, Switzerland.
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