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Whaley RD, Agaimy A, Bridge JA, Stoehr R, Din NU, Gagan J, Rampisela D, Folpe AL, Bishop JA. Xanthogranulomatous epithelial tumors/keratin-positive giant cell-rich tumors involving the head and neck: report of seven cases and review of the literature. Virchows Arch 2024:10.1007/s00428-024-03892-8. [PMID: 39162814 DOI: 10.1007/s00428-024-03892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
Xanthogranulomatous epithelial tumor (XGET) and HMGA2::NCOR2 fusion keratin-positive giant cell-rich tumor (KPGCT) are recently described morphologically overlapping rare neoplastic entities characterized by HMGA2::NCOR2 fusions, low-grade biological behavior, and a strong predilection for young females. To date, 47 cases have been reported with only four occurring in head and neck anatomic locations. In this study, we describe the clinicopathologic, immunohistochemical, and molecular findings of seven XGET/KPGCTs occurring in the head and neck region. The patients were six females and one male, aged 3.5-59 years old (median, 25 years). The tumors involved the ear, vocal cord, skull, neck soft tissue, and sinonasal cavity. Tumor sizes ranged from 1.5 to 6.7 cm. Histologically, the tumors were characterized by xanthogranulomatous histiocytes, osteoclast-like giant cells, and keratin-positive epithelioid cells. The XGET/KPGCTs involving the ear was remarkable for more cytologic atypia than previously described. Four cases had the HMGA2::NCOR2 fusion identified by NGS and three had HMGA2 gene locus alterations by FISH. Follow-up information was available for 3 of 7 patients (range 6-46 months). The patient with a vocal cord XGET/KPGCTs developed a local recurrence treated with excision. This study illustrates that XGET/KPGCTs involves the head and neck region as well, where it may be unexpected and hence under-recognized, and expands the anatomic locations of involvement to include unreported sites (ear, vocal cord, and sinonasal tract).
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Affiliation(s)
- Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Abbas Agaimy
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Julia A Bridge
- ProPath, Division of Cytogenetic and Molecular Pathology, Dallas, TX, USA
- Department of Pathology, Microbiology and Immunology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert Stoehr
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Nasir Ud Din
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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2
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Evans D, Rothschild S, Tordella C, Chacón M. Leveraging Patient Engagement Through Collaboration for Improved Global Health Outcomes in Sarcoma. Am Soc Clin Oncol Educ Book 2024; 44:e438934. [PMID: 38862132 DOI: 10.1200/edbk_438934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
In the dynamic landscape of oncology, collaborative efforts between the medical community and patient advocacy groups are pivotal in shaping standards of care and advancing research. Nowhere is this collaboration more evident than in sarcoma, a group of rare cancers posing unique challenges to diagnosis, management, and treatment, which profoundly affect patient outcomes. Here, we explore the vital role of patient-centric collaboration in improving global health outcomes in sarcoma, emphasizing the transformative power of collective action and shared expertise. Challenges in sarcoma care, including diagnostic complexities, disparities in access to care, and genomic tumor heterogeneity, underscore the urgent need for collaborative solutions. Initiatives like the Sarcoma European and Latin American Network (SELNET) and The Life Raft Group (LRG) exemplify successful models of collaborative research and patient advocacy, driving advancements in diagnosis, treatment, and disease understanding. Stakeholders across disciplines are uniting to improve sarcoma care and outcomes through the development of clinical practice guidelines, continuous medical education, patient registries, virtual tumor boards, and consortium-driven research endeavors, all of which foster the growth of global collaborative groups. The success of these collaborative efforts serves as a model for other rare diseases, highlighting the potential of collective action to drive progress and innovation in health care.
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Affiliation(s)
| | | | | | - Matías Chacón
- Instituto Alexander Fleming, Buenos Aires, Argentina
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3
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Wilsher MJ, Venus M, Fisher C. Giant cell-rich tumour with keratin expression and HMGA2::NCOR2 fusion presenting at a rare location, on the scalp of a 29-year-old male. Pathology 2024; 56:609-612. [PMID: 38341304 DOI: 10.1016/j.pathol.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Mark James Wilsher
- North West London Pathology Imperial College Healthcare NHS Trust, London, United Kingdom; Unilabs IHS, London, United Kingdom.
| | - Matthew Venus
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Cyril Fisher
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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4
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Rungsiprakarn P, Ryan AL, Wong DD, Luo M, Kazahaya K, Arkader A, Lau LMS, Ajuyah P, Rudzinski E, Kreiger PA, Roebuck DJ, Surrey LF, Foo TSY. Keratin-Positive Giant Cell Tumor of Bone and Soft Tissue With HMGA2::NCOR2 Fusion in Children Under 10 With Response to Imatinib Therapy: A Case Series. JCO Precis Oncol 2024; 8:e2300659. [PMID: 38935896 DOI: 10.1200/po.23.00659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 06/29/2024] Open
Abstract
HMGA2::NCOR2 keratin-positive giant cell tumors in children with response to imatinib in an infant.
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Affiliation(s)
- Phassawan Rungsiprakarn
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Anne L Ryan
- Department of Hematology, Oncology and Bone Marrow Transplant, Perth Children's Hospital, Nedlands, Australia
- Telethon Kids Insitute, University of Western Australia, Nedlands, Australia
| | - Daniel D Wong
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Australia
| | - Minjie Luo
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alexandre Arkader
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Loretta M S Lau
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, Australia
| | | | - Erin Rudzinski
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA
| | - Portia A Kreiger
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Derek J Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, Australia
- Division of Pediatrics, Medical School, University of Western Australia, Crawley, Australia
| | - Lea F Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Tiffany S Y Foo
- PathWest Laboratory Medicine, Perth Children's Hospital, Nedlands, WA, Australia
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5
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Nishio J, Nakayama S, Koga K, Aoki M. Keratin-Positive Giant Cell-Rich Tumor: A Review and Update. Cancers (Basel) 2024; 16:1940. [PMID: 38792018 PMCID: PMC11120402 DOI: 10.3390/cancers16101940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
Keratin-positive giant cell-rich tumor (KPGCT) is an extremely rare and recently described mesenchymal neoplasm that occurs in both soft tissue and bone, frequently found in young women. It has locally recurrent potential if incompletely excised but low risk for metastasis. KPGCT is histologically similar to conventional giant cell tumors of soft tissue but shows the presence of keratin-positive mononuclear cells. Interestingly, KPGCT also shares some morphological features with xanthogranulomatous epithelial tumors. These two tumors have recently been shown to harbor an HMGA2-NCOR2 fusion, arguing in favor of a single entity. Surgery is the treatment of choice for localized KPGCT. Therapeutic options for advanced or metastatic disease are unknown. This review provides an overview of the current knowledge on the clinical presentation, pathogenesis, histopathology, and treatment of KPGCT. In addition, we will discuss the differential diagnosis of this emerging entity.
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Affiliation(s)
- Jun Nishio
- Section of Orthopaedic Surgery, Department of Medicine, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka 814-0193, Japan
| | - Shizuhide Nakayama
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan;
| | - Kaori Koga
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; (K.K.); (M.A.)
| | - Mikiko Aoki
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; (K.K.); (M.A.)
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Dehner CA, Lo YC, Chopra S, Demicco EG, He K, Hirbe AC, Folpe AL, Chrisinger JSA. CSF1 expression in xanthogranulomatous epithelial tumor/keratin-positive giant cell-rich tumor. Hum Pathol 2024; 143:1-4. [PMID: 37993023 DOI: 10.1016/j.humpath.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
"Xanthogranulomatous epithelial tumor" (XGET) and "keratin-positive giant cell-rich soft tissue tumor" (KPGCT), two recently described mesenchymal neoplasms, likely represent different aspects of a single entity. Both tumors are composed of only a small minority of tumor cells surrounded by large numbers of non-neoplastic inflammatory cells and histiocytes, suggesting production of a paracrine factor with resulting "landscape effect," as seen in tenosynovial giant cell tumor. Recent evidence suggests that the paracrine factor in XGET/KPGCT may be CSF1, as in tenosynovial giant cell tumor. We hypothesized that CSF1 is overexpressed in XGET/KPGCT. To test our hypothesis, we performed quantitative real time PCR (qPCR) for CSF1 expression and CSF1 RNAscope chromogenic in situ hybridization (CISH) on 6 cases of XGET/KPGCT. All cases were positive with CSF1 CISH and showed increased expression of CSF1 by qPCR. Our findings provide additional evidence that the CSF1/CSF1R pathway is involved in the pathogenesis of XGET/KPGCT. These findings suggest a possible role for CSF1R inhibition in the treatment of unresectable or metastatic XGET/KPGCT.
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Affiliation(s)
- Carina A Dehner
- Department of Anatomic Pathology and Laboratory Medicine, Indiana University, 635 Barnhill Drive, Indianapolis, IN, 46202, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Ying-Chun Lo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Shefali Chopra
- Department of Pathology, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Laboratory Medicine and Pathobiology, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Kevin He
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine and Siteman Cancer Center, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Angela C Hirbe
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine and Siteman Cancer Center, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | - John S A Chrisinger
- Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
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Kim RG, Maher AW, Karunaratne S, Stalley PD, Boyle RA. Tenosynovial giant cell tumours: experience at an Australian tertiary referral centre for musculoskeletal tumours with minimum two-year follow-up. Bone Jt Open 2023; 4:846-852. [PMID: 37935246 PMCID: PMC10629998 DOI: 10.1302/2633-1462.411.bjo-2023-0116.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Aims Tenosynovial giant cell tumour (TGCT) is a rare benign tumour of the musculoskeletal system. Surgical management is fraught with challenges due to high recurrence rates. The aim of this study was to describe surgical treatment and evaluate surgical outcomes of TGCT at an Australian tertiary referral centre for musculoskeletal tumours and to identify factors affecting recurrence rates. Methods A prospective database of all patients with TGCT surgically managed by two orthopaedic oncology surgeons was reviewed. All cases irrespective of previous treatment were included and patients without follow-up were excluded. Pertinent tumour characteristics and surgical outcomes were collected for analysis. Results There were 111 total cases included in the study; 71 (64%) were female, the mean age was 36 years (SD 13.6), and the knee (n = 64; 57.7%) was the most commonly affected joint. In all, 60 patients (54.1%) had diffuse-type (D-TGCT) disease, and 94 patients (84.7%) presented therapy-naïve as "primary cases" (PC). The overall recurrence rate was 46.8% for TGCT. There was a statistically significant difference in recurrence rates between D-TGCT and localized disease (75.0% vs 13.7%, relative risk (RR) 3.40, 95% confidence interval (CI) 2.17 to 5.34; p < 0.001), and for those who were referred in the "revision cases" (RC) group compared to the PC group (82.4% vs 48.9%, RR 1.68, 95% CI 1.24 to 2.28; p = 0.011). Age, sex, tumour volume, and mean duration of symptoms were not associated with recurrence (p > 0.05). Conclusion Recurrence rates remain high even at a tertiary referral hospital. Highest rates are seen in D-TGCT and "revision cases". Due to the risks of recurrence, the complexity of surgery, and the need for adjuvant therapy, this paper further supports the management of TGCT in a tertiary referral multi-disciplinary orthopaedic oncology service.
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Affiliation(s)
- Raymond G. Kim
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine, Sydney Campus, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Anthony W. Maher
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Paul D. Stalley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Richard A. Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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8
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Weigelt MA, Azzato EM, Habermehl GK, Billings SD, Ko JS, Fritchie KJ. Keratin-positive giant cell-rich tumors of soft tissue with HMGA2::NCOR2 fusions. J Cutan Pathol 2023; 50:977-982. [PMID: 37496152 DOI: 10.1111/cup.14497] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Giant cell tumor of soft tissue (GCT-ST) is a rare soft tissue neoplasm that is morphologically similar to but genetically distinct from giant cell tumor of bone. A novel keratin-positive GCT-ST (KPGCT-ST) harboring HMGA2::NCOR2 fusions was recently discovered. Fewer than 30 cases have been described; herein is reported an additional seven. METHODS Cases diagnosed as GCT-ST were retrieved from institutional archives and consultation files. The histopathologic characteristics were assessed, and the electronic medical record was reviewed. RESULTS Seven tumors were identified in six women and one man with a median age of 23 years. All patients underwent excision; no recurrences or metastases were noted during a median follow-up period of 7 months. Histopathologically, the tumors were characterized by a multinodular proliferation of keratin-positive mononuclear cells with evenly admixed osteoclast-like giant cells and absent neoplastic bone. A fibrous capsule with lymphoid cuffing was frequently seen. Foamy macrophages, inflammation, hemorrhage, and hemosiderin were variably present. The HMGA2::NCOR2 fusion was detected in all cases. CONCLUSIONS Our findings support previously reported hypotheses that KPGCT-ST is a spectrum of the same entity as the recently described xanthogranulomatous epithelial tumor. Although follow-up data are limited, to date, KPGCT-ST appears to follow an indolent course.
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Affiliation(s)
- Maximillian A Weigelt
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elizabeth M Azzato
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Steven D Billings
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer S Ko
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Karen J Fritchie
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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9
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Svantesson T, van Oudenaarde K, Fuchs B, Bode B, Vogetseder A. Xanthogranulomatous epithelial tumor: a novel entity of uncertain biologic potential. Arch Clin Cases 2023; 10:142-145. [PMID: 37809034 PMCID: PMC10551808 DOI: 10.22551/2023.40.1003.10261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Xanthogranulomatous epithelial tumor (XGET) is an extremely rare and recently described mesenchymal neoplasm characterized by a distinctive histological appearance and clinical presentation. This case report describes a unique case of XGET in a 66-year-old female patient who presented with a 5 cm mass in the dorsal distal left thigh. The clinical, radiological, and pathological findings, as well as the management and follow-up, are discussed.
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Affiliation(s)
| | | | - Bruno Fuchs
- Division of Orthopedics, Cantonal Hospital Lucerne, Switzerland
| | - Beata Bode
- Pathology Institute Enge and University of Zurich, Zurich, Switzerland
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10
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Perret R, Malaka Z, Velasco V, Llamas-Gutierrez F, Ropars M, Linck PA, Hostein I, Azmani R, Valo I, Galmiche L, Moreau A, de Pinieux G, Michot A, Bochaton D, Coindre JM, Le Loarer F. Giant Cell Tumors With HMGA2::NCOR2 Fusion : Clinicopathologic, Molecular, and Epigenetic Study of a Distinct Entity. Am J Surg Pathol 2023; 47:801-811. [PMID: 37170907 DOI: 10.1097/pas.0000000000002051] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Giant cell tumors (GCTs) with high mobility group AT-Hook 2 ( HMGA2 )::nuclear receptor corepressor 2 ( NCOR2 ) fusion are rare mesenchymal tumors of controversial nosology, which have been anecdotally reported to respond to CSFR1 inhibitors. Here, we performed a comprehensive study of 6 GCTs with HMGA2::NCOR2 fusion and explored their relationship with other giant cell-rich neoplasms. Tumors occurred in 4 females and 2 males ranging in age from 17 to 32 years old (median 24). Three lesions originated in subcutaneous soft tissue and 3 in bone. Tumor size ranged from 20 to 33 mm (median 27 mm). The lesions had a nodular/multinodular architecture and were composed of sheets of mononuclear "histiocytoid" cells with uniform nuclei intermingled with multinucleated giant cells. Mitotic activity was low and nuclear atypia and metaplastic bone were absent. Variable findings included necrosis, cystic degeneration, lymphocytic infiltrate (sometimes forming nodules), and xanthogranulomatous inflammation. On immunohistochemistry, all cases focally expressed pan-keratin and were negative with SATB2 and H3.3G34W. Whole RNA-sequencing was performed in all cases of GCT with HMGA2::NCOR2 fusion and a subset of giant cell-rich tumors (tenosynovial-GCT, n = 19 and "wild-type" GCT of soft tissue, n = 9). Hierarchical clustering of RNA-sequencing data showed that GCT with HMGA2::NCOR2 fusion formed a single cluster, independent of the other 2 entities. Methylome profiling showed similar results, but the distinction from "wild-type" GCT of soft tissue was less flagrant. Gene expression analysis showed similar levels of expression of the CSF1/CSFR1 axis between GCT with HMGA2::NCOR2 fusion and tenosynovial-GCT, supporting their potential sensitivity to CSFR1 inhibitors. Clinical follow-up was available for 5 patients (range: 10 to 64 mo; median 32 mo). Three patients (60%) experienced local recurrences, whereas none had distant metastases or died of disease. Overall, our study confirms and expands previous knowledge on GCT with HMGA2::NCOR2 fusion and supports its inclusion as an independent entity.
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Affiliation(s)
- Raul Perret
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
- Bordeaux Institute of Oncology, BRIC, INSERM, Bordeaux University, Bergonié Institute, Bordeaux, France
| | - Zaki Malaka
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
- University of Bordeaux, Talence, France
| | - Valérie Velasco
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | | | - Mickael Ropars
- Orthopedic surgery department, Rennes University Hospital, Rennes, France
| | - Pierre-Antoine Linck
- Department of Radiology, Bergonié Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Isabelle Hostein
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Rihab Azmani
- Department of Bioinformatics, Bergonie Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Isabelle Valo
- Department of Pathology, Institute of Cancerology of the West, Angers, France
| | - Louise Galmiche
- Department of Pathology, Nantes University Hospital, Nantes, France
| | - Anne Moreau
- Department of Pathology, Nantes University Hospital, Nantes, France
| | - Gonzague de Pinieux
- Department of Pathology, Trousseau Hospital-Tours University Hospital, Chambray-lés-Tours, France
| | - Audrey Michot
- Plastic and Reconstructive Surgery Department, Bergonié Institute, Bordeaux, France
| | | | - Jean-Michel Coindre
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - François Le Loarer
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
- Bordeaux Institute of Oncology, BRIC, INSERM, Bordeaux University, Bergonié Institute, Bordeaux, France
- University of Bordeaux, Talence, France
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11
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Stacchiotti S, Dürr HR, Schaefer IM, Woertler K, Haas R, Trama A, Caraceni A, Bajpai J, Baldi GG, Bernthal N, Blay JY, Boye K, Broto JM, Chen WWT, Dei Tos PA, Desai J, Emhofer S, Eriksson M, Gronchi A, Gelderblom H, Hardes J, Hartmann W, Healey J, Italiano A, Jones RL, Kawai A, Leithner A, Loong H, Mascard E, Morosi C, Otten N, Palmerini E, Patel SR, Reichardt P, Rubin B, Rutkowski P, Sangalli C, Schuster K, Seddon BM, Shkodra M, Staals EL, Tap W, van de Rijn M, van Langevelde K, Vanhoenacker FMM, Wagner A, Wiltink L, Stern S, Van de Sande VM, Bauer S. Best clinical management of tenosynovial giant cell tumour (TGCT): A consensus paper from the community of experts. Cancer Treat Rev 2023; 112:102491. [PMID: 36502615 DOI: 10.1016/j.ctrv.2022.102491] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
Tenosynovial giant cell tumour (TGCT) is a rare, locally aggressive, mesenchymal tumor arising from the joints, bursa and tendon sheaths. TGCT comprises a nodular- and a diffuse-type, with the former exhibiting mostly indolent course and the latter a locally aggressive behavior. Although usually not life-threatening, TGCT may cause chronic pain and adversely impact function and quality of life (QoL). CSFR1 inhibitors are effective with benefit on symptoms and QoL but are not available in most countries. The degree of uncertainty in selecting the most appropriate therapy and the lack of guidelines on the clinical management of TGCT make the adoption of new treatments inconsistent across the world, with suboptimal outcomes for patients. A global consensus meeting was organized in June 2022, involving experts from several disciplines and patient representatives from SPAGN to define the best evidence-based practice for the optimal approach to TGCT and generate the recommendations presented herein.
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Affiliation(s)
- Silvia Stacchiotti
- Department of cancer medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Hans Roland Dürr
- Department of Orthopaedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Inga-Marie Schaefer
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Klaus Woertler
- Department of Radiology, Technische Universität München, Munich, Germany
| | - Rick Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Jyoti Bajpai
- Department of Medical Oncology, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Jean-Yves Blay
- Department of Medical Oncology, Université Centre Léon Bérard, Lyon, France
| | - Kjetil Boye
- Department of Medical Oncology, Oslo University Hospital, Oslo, Norway
| | - Javier-Martin Broto
- Oncology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Wei-Wu Tom Chen
- Department of Medical Oncology, National Taiwan University Hospital and Cancer Center, Taiwan
| | | | - Jayesh Desai
- Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, Australia
| | | | - Mikael Eriksson
- Department of Medical Oncology, LUCC - Lund University Cancer Centre, Lund, Sweden
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jendrik Hardes
- Department of Orthopaedic Oncology, Uniklinik Essen, Essen, Germany
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute for Pathology, Uniklinik Münster, Münster, Germany
| | - John Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden, London, United Kingdom
| | - Akira Kawai
- Department of Muscoloskeletal Oncology, National Cancer Center Hospital (NCCH), Tokyo, Japan
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medizinische Universität Graz, Graz, Austria
| | - Herbert Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Eric Mascard
- Department of Paediatric Orthopaedic Surgery, Clinique Arago, Paris, France
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Emanuela Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Peter Reichardt
- Department of Medical Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Brian Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute and Department of Cancer Biology, Cleveland Clinic, Cleveland, USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Claudia Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Beatrice M Seddon
- Department of Oncology, University College Hospital London, London, United Kingdom
| | - Morena Shkodra
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Eric L Staals
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - William Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, USA
| | | | | | | | - Andrew Wagner
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Lisette Wiltink
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sydney Stern
- Patient Representative, Life Raft Group, and Pharmacokinetics, University of Maryland Baltimore, USA
| | | | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, Uniklinik Essen, Essen, Germany
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12
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Bernthal NM, Healey JH, Palmerini E, Bauer S, Schreuder H, Leithner A, Martin-Broto J, Gouin F, Lopez-Bastida J, Gelderblom H, Staals EL, Burke ZD, Geiger EJ, Spierenburg G, Laeis P, Beyerlein E, Ye X, van de Sande M. A prospective real-world study of the diffuse-type tenosynovial giant cell tumor patient journey: A 2-year observational analysis. J Surg Oncol 2022; 126:1520-1532. [PMID: 36006054 DOI: 10.1002/jso.27067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/18/2022] [Accepted: 08/06/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Diffuse-tenosynovial giant cell tumor (D-TGCT) is a rare, locally aggressive, typically benign neoplasm affecting mainly large joints, representing a wide clinical spectrum. We provide a picture of the treatment journey of D-TGCT patients as a 2-year observational follow-up. METHODS The TGCT Observational Platform Project registry was a multinational, multicenter, prospective observational study at tertiary sarcoma centers spanning seven European countries and two US sites. Histologically confirmed D-TGCT patients were categorized as either those who remained on initial treatment strategy (determined at baseline visit) or those who changed treatment strategy with specific changes documented (e.g., systemic treatment to surgery) at the 1-year and/or 2-year follow-up visits. RESULTS A total of 176 patients were assessed, mean diagnosis age was 38.4 (SD ± 14.6) years; most patients had a knee tumor (120/176, 68.2%). For the 2-year observation period, most patients (75.5%) remained on the baseline treatment strategy throughout, 54/79 patients (68.4%) remained no treatment, 30/45 patients (66.7%) remained systemic treatment, 39/39 patients (100%) remained surgery. Those who changed treatment strategy utilized multimodal treatment options. CONCLUSIONS This is the first prospectively collected analysis to describe D-TGCT patient treatments over an extended follow-up and demonstrates the need for multidisciplinary teams to determine an optimal treatment strategy.
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Affiliation(s)
- Nicholas M Bernthal
- Division of Musculoskeletal Oncology, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - John H Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innoviative Therapies Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Hendrik Schreuder
- Department of Orthopaedics, Radboud University, Nijmegen, The Netherlands
| | - Andreas Leithner
- Deptartment of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Javier Martin-Broto
- Oncology Department, Fundacíon Jiménez Díaz University Hospital, Madrid, Spain
| | - Francois Gouin
- Department of Surgery, Onco-Orthopedic, Centre Léon Bérard, Lyon, France
| | - Julio Lopez-Bastida
- Faculty of Health Sciences, University Castilla-La Mancha, Talavera de la Reina, Spain
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eric L Staals
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Zachary D Burke
- Division of Musculoskeletal Oncology, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Erik J Geiger
- Division of Musculoskeletal Oncology, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Geert Spierenburg
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra Laeis
- Clinical Operations, Daiichi Sankyo Europe GMbH, Munich, Germany
| | - Elisabeth Beyerlein
- Biostatistics & Data Management, Daiichi Sankyo Europe GMbH, Munich, Germany
| | - Xin Ye
- Global Specialty Value, Access & Pricing, Daiichi Sankyo, Inc., Basking Ridge, New Jersey, USA
| | - Michiel van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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13
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Gauduchon T, Vanacker H, Pissaloux D, Cassier P, Dufresne A, Karanian M, Meurgey A, Bouhamama A, Gouin F, Ray-Coquard I, Blay JY, Tirode F, Brahmi M. Expanding the molecular spectrum of tenosynovial giant cell tumors. Front Oncol 2022; 12:1012527. [PMID: 36439507 PMCID: PMC9691341 DOI: 10.3389/fonc.2022.1012527] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background While great advances in clinical and pathological description of tenosynovial giant cell tumors (TGCT) have been made, TGCT molecular heterogeneity represents an ongoing challenge. The canonical oncogenic fusion CSF1::COL6A3 is not systematically observed, suggesting that other oncogenic mechanisms are involved in tumorigenesis. This study aims to explore by RNA sequencing a retrospective series of tumors diagnosed as TGCT, in order to provide a better description of their molecular landscape and to correlate molecular features with clinical data. Methods We analyzed clinicopathological data and performed whole-exome RNA sequencing on 41 TGCT samples. Results RNAseq analysis showed significant higher CSF1 and CSF1-R expression than a control panel of 2642 solid tumors. RNA sequencing revealed fusion transcripts in 14 patients including 6 not involving CSF1 and some previously unreported fusions. Unsupervised clustering on the expression profiles issued from this series suggested two distinct subgroups: one composed of various molecular subtypes including CSF1 and FN1 rearranged samples and one composed of four tumors harboring an HMGA2::NCOR2 fusion, suggesting distinct tumor entities. Overall, 15 patients received at least one systemic anti-CSF1R treatment and clinical improvement was observed in 11 patients, including patients from both clusters. Discussion This study reported molecular heterogeneity in TGCT, contrasting with the clinical and pathological homogeneity and the ubiquitous high CSF1 and CSF1R expression levels. Whether molecular diversity may impact the efficacy of systemic treatments needs to be further investigated.
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Affiliation(s)
- Thibault Gauduchon
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
- *Correspondence: Thibault Gauduchon,
| | - Helene Vanacker
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052-CNRS5286, Lyon, France
| | - Daniel Pissaloux
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
| | - Philippe Cassier
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
| | - Armelle Dufresne
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
| | - Marie Karanian
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
| | - Alexandra Meurgey
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
| | - Amine Bouhamama
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
| | - François Gouin
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
| | - Isabelle Ray-Coquard
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon, France
| | - Jean-Yves Blay
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon, France
| | - Franck Tirode
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052-CNRS5286, Lyon, France
| | - Mehdi Brahmi
- Département d’oncologie médicale, Centre de lutte contre le cancer Léon-Bérard, Lyon, France
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052-CNRS5286, Lyon, France
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14
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PANAGOPOULOS IOANNIS, HEIM SVERRE. Neoplasia-associated Chromosome Translocations Resulting in Gene Truncation. Cancer Genomics Proteomics 2022; 19:647-672. [PMID: 36316036 PMCID: PMC9620447 DOI: 10.21873/cgp.20349] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
Chromosomal translocations in cancer as well as benign neoplasias typically lead to the formation of fusion genes. Such genes may encode chimeric proteins when two protein-coding regions fuse in-frame, or they may result in deregulation of genes via promoter swapping or translocation of the gene into the vicinity of a highly active regulatory element. A less studied consequence of chromosomal translocations is the fusion of two breakpoint genes resulting in an out-of-frame chimera. The breaks then occur in one or both protein-coding regions forming a stop codon in the chimeric transcript shortly after the fusion point. Though the latter genetic events and mechanisms at first awoke little research interest, careful investigations have established them as neither rare nor inconsequential. In the present work, we review and discuss the truncation of genes in neoplastic cells resulting from chromosomal rearrangements, especially from seemingly balanced translocations.
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Affiliation(s)
- IOANNIS PANAGOPOULOS
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - SVERRE HEIM
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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15
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Dehner CA, Baker JC, Bell R, Dickson BC, Schmidt RE, Demicco EG, Chrisinger JSA. Xanthogranulomatous epithelial tumors and keratin-positive giant cell-rich soft tissue tumors: two aspects of a single entity with frequent HMGA2-NCOR2 fusions. Mod Pathol 2022; 35:1656-1666. [PMID: 35690644 DOI: 10.1038/s41379-022-01115-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
Xanthogranulomatous epithelial tumor (XGET) and keratin-positive giant cell-rich soft tissue tumor with HMGA2-NCOR2 fusion (KPGCT) are two recently described neoplasms with both distinct and overlapping clinical and histopathologic features. We hypothesized that XGET and KPGCT may be related and represent a histologic spectrum of a single entity. To test this, we sought to characterize the clinical, radiographic, immunohistochemical, ultrastructural and molecular features of additional tumors with features of XGET and/or KPGCT, which we refer to descriptively as keratin-positive xanthogranulomatous/giant cell-rich tumors (KPXG/GCT). The archives were searched for potential cases of KPXG/GCT. Clinical and imaging features were noted. Slides were assessed for histologic and immunohistochemical findings. Ultrastructural and next generation RNA sequencing-based analysis were also performed. Nine cases were identified arising in seven women and two men [median age of 33 years (range: 12-87)]. Median tumor size was 4 cm (range: 2.4-14.0 cm) and tumors presented in the thigh (2), buttock (1), forearm (2), groin (1), cranial fossa (1), ilium (1), and tibia (1). Morphologically, tumors were most frequently characterized by a fibrous capsule, with associated lymphoid reaction, enclosing a polymorphous proliferation of histiocytes, giant cells (Touton and osteoclast-types), mixed inflammatory infiltrate, hemorrhage and hemosiderin deposition, which imparted a variably xanthogranulomatous to giant cell tumor-like appearance. One case clearly showed mononuclear cells with eosinophilic cytoplasm characteristic of XGET. All cases expressed keratin and 7 of 9 were found to harbor HMGA2-NCOR2 fusions including cases with xanthogranulomatous appearance. One patient developed local recurrence and multifocal pulmonary lesions, which were radiographically suspicious for metastases. Shared clinical, histologic and immunohistochemical features, and the shared presence of HMGA2-NCOR2 fusions supports interpretation of KPXG/GCT as a single entity which includes XGET and KPGCT. Given limited clinical follow-up to date and rare cases with apparently aggressive findings, we provisionally regard these tumors as having uncertain biologic potential.
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Affiliation(s)
- Carina A Dehner
- Department of Pathology and Immunology, Division of Anatomic Pathology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert Bell
- Department of Pathology and Immunology, Division of Anatomic Pathology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital & Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Robert E Schmidt
- Department of Pathology and Immunology, Division of Neuropathology, Washington University School of Medicine, St. Louis, MO, USA
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital & Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - John S A Chrisinger
- Department of Pathology and Immunology, Division of Anatomic Pathology, Washington University School of Medicine, St. Louis, MO, USA.
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16
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Spierenburg G, Grimison P, Chevreau C, Stacchiotti S, Piperno-Neumann S, Le Cesne A, Ferraresi V, Italiano A, Duffaud F, Penel N, Metzger S, Chabaud S, van der Heijden L, Pérol D, van de Sande MAJ, Blay JY, Gelderblom H. Long-term follow-up of nilotinib in patients with advanced tenosynovial giant cell tumours: Long-term follow-up of nilotinib in TGCT. Eur J Cancer 2022; 173:219-228. [PMID: 35932628 DOI: 10.1016/j.ejca.2022.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diffuse-type tenosynovial giant cell tumour (D-TGCT) is a non-malignant but locally aggressive tumour driven by overexpression of colony-stimulating factor-1 (CSF1). CSF1R inhibitors are potential therapeutic strategies for patients not amenable to surgery. We report here the long-term outcome of nilotinib in patients with advanced D-TGCT treated within a phase II prospective international study (ClinicalTrials.gov: NCT01261429). METHODS Patients were enrolled between December 2010-September 2012 at 11 cancer centres. Eligible patients had histologically confirmed D-TGCT, not amenable to surgery. Patients received nilotinib until evidence of progression, toxicity or a maximum of one year. Long-term data were retrospectively collected after the completion of the phase II trial. Patients with nilotinib treatment ≥12 weeks and follow-up ≥12 months were included for long-term analysis. RESULTS Forty-eight of 56 enrolled patients were included. Median treatment duration was 11 months; 31 (65%) patients completed the treatment protocol. After 102 months of follow-up (median; range 12-129), 25 patients (52%) had progression. The median progression-free survival (PFS) was 77 months. The five-year PFS rate was 53%. Fifteen patients (n = 15/46; 33%) experienced clinical worsening after 11 months (median). Twenty-seven patients (58%) received additional treatment, after which eleven patients (n = 11/27; 41%) had a second relapse. Nine patients required a subsequent treatment, primarily other CSF1R inhibitors (n = 6/9; 67%). No unfavourable long-term effects were observed. CONCLUSION This long-term analysis of nilotinib for advanced D-TGCT showed that about half of the patients had progression and underwent additional treatment after 8.5 years follow-up. Contrarily, several patients had ongoing disease control after limited treatment duration, demonstrating the mixed effect of nilotinib.
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Affiliation(s)
- Geert Spierenburg
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, Netherlands.
| | - Peter Grimison
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire Du Cander de Toulouse, Toulouse, France
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sophie Piperno-Neumann
- Department of Medical Oncology, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Axel Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Departmental Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Florence Duffaud
- Department of Medical Oncology, Hôpital de La Timone, Aix-Marseille Université, Marseille, France
| | - Nicolas Penel
- Department of Medical Oncology, Center Oscar Lambret, Lille University Lille, France
| | - Severine Metzger
- Department of Clinical Research and Innovation, Léon Bérard Cancer Center, Lyon, France
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Léon Bérard Cancer Center, Lyon, France
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - David Pérol
- Department of Clinical Research and Innovation, Léon Bérard Cancer Center, Lyon, France
| | | | - Jean-Yves Blay
- Department of Medical Oncology, Center Léon Bérard Cancer Center, Lyon, France
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
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17
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Spierenburg G, van der Heijden L, van Langevelde K, Szuhai K, Bovée JVGM, van de Sande MAJ, Gelderblom H. Tenosynovial giant cell tumors (TGCT): molecular biology, drug targets and non-surgical pharmacological approaches. Expert Opin Ther Targets 2022; 26:333-345. [PMID: 35443852 DOI: 10.1080/14728222.2022.2067040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Tenosynovial giant cell tumor (TGCT) is a mono-articular, benign or locally aggressive and often debilitating neoplasm. Systemic therapies are becoming part of the multimodal armamentarium when surgery alone will not confer improvements. Since TGCT is characterized by colony-stimulating factor-1 (CSF1) rearrangements, the most studied molecular pathway is the CSF1 and CSF1 receptor (CSF1R) axis. Inhibiting CSF1-CSF1R interaction often yields considerable radiological and clinical responses; however, adverse events may cause treatment discontinuation because of an unfavorable risk-benefit ratio in benign disease. Only Pexidartinib is approved by the US FDA; however, the European Medicines Agency has not approved it due to uncertainties on the risk-benefit ratio. Thus, there is a need for safer and effective therapies. AREAS COVERED Light is shed on disease mechanisms and potential drug targets. The safety and efficacy of different systemic therapies are evaluated. EXPERT OPINION The CSF1-CSF1R axis is the principal drug target; however, the effect of CSF1R inhibition on angiogenesis and the role of macrophages, which are essential in the postoperative course, needs further elucidation. Systemic therapies have a promising role in treating mainly diffuse-type, TGCT patients who are not expected to clinically improve from surgery. Future drug development should focus on targeting neoplastic TGCT cells.
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Affiliation(s)
- Geert Spierenburg
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Karoly Szuhai
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith V G M Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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18
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Panagopoulos I, Andersen K, Gorunova L, Lund-Iversen M, Lobmaier I, Heim S. Recurrent Fusion of the Genes for High-mobility Group AT-hook 2 ( HMGA2) and Nuclear Receptor Co-repressor 2 ( NCOR2) in Osteoclastic Giant Cell-rich Tumors of Bone. Cancer Genomics Proteomics 2022; 19:163-177. [PMID: 35181586 DOI: 10.21873/cgp.20312] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIM Chimeras involving the high-mobility group AT-hook 2 gene (HMGA2 in 12q14.3) have been found in lipomas and other benign mesenchymal tumors. We report here a fusion of HMGA2 with the nuclear receptor co-repressor 2 gene (NCOR2 in 12q24.31) repeatedly found in tumors of bone and the first cytogenetic investigation of this fusion. MATERIALS AND METHODS Six osteoclastic giant cell-rich tumors were investigated using G-banding, RNA sequencing, reverse transcription polymerase chain reaction, Sanger sequencing, and fluorescence in situ hybridization. RESULTS Four tumors had structural chromosomal aberrations of 12q. The pathogenic variant c.103_104GG>AT (p.Gly35Met) in the H3.3 histone A gene was found in a tumor without 12q aberration. In-frame HMGA2-NCOR2 fusion transcripts were found in all tumors. In two cases, the presence of an HMGA2-NCOR2 fusion gene was confirmed by FISH on metaphase spreads. CONCLUSION Our results demonstrate that a subset of osteoclastic giant cell-rich tumors of bone are characterized by an HMGA2-NCOR2 fusion gene.
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Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway;
| | - Kristin Andersen
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Marius Lund-Iversen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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19
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Macagno N, Pissaloux D, de la Fouchardière A, Karanian M, Lantuejoul S, Galateau Salle F, Meurgey A, Chassagne-Clement C, Treilleux I, Renard C, Roussel J, Gervasoni J, Cockenpot V, Crozes C, Baltres A, Houlier A, Paindavoine S, Alberti L, Duc A, Loarer FL, Dufresne A, Brahmi M, Corradini N, Blay JY, Tirode F. Wholistic approach - transcriptomic analysis and beyond using archival material for molecular diagnosis. Genes Chromosomes Cancer 2022; 61:382-393. [PMID: 35080790 DOI: 10.1002/gcc.23026] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 11/07/2022] Open
Abstract
Many neoplasms remain unclassified after histopathological examination, which requires further molecular analysis. To this regard, mesenchymal neoplasms are particularly challenging due to the combination of their rarity and the large number of subtypes, and many entities still lack robust diagnostic hallmarks. RNA transcriptomic profiles have proven to be a reliable basis for the classification of previously unclassified tumors and notably for mesenchymal neoplasms. Using exome-based RNA capture sequencing on more than 5000 samples of archival material (FFPE), the combination of expression profiles analyzes (including several clustering methods), fusion genes, and small nucleotide variations has been developed at the Centre Léon Bérard (CLB) in Lyon for the molecular diagnosis of challenging neoplasms and the discovery of new entities. The molecular basis of the technique, the protocol, and the bioinformatics algorithms used are described herein, as well as its advantages and limitations.
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Affiliation(s)
- Nicolas Macagno
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,Aix-Marseille University, Marmara institute, INSERM, U1251, MMG, DOD-CET, Marseille, France.,NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,CARADERM, French network of rare skin cancers, France
| | - Daniel Pissaloux
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Arnaud de la Fouchardière
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Marie Karanian
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Department of Biopathology, UNICANCER, Bergonié Institute, Bordeaux, France
| | - Sylvie Lantuejoul
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Grenoble Alpes University, Grenoble, France.,MESOPATH, MESOBANK, French network of mesothelioma, France
| | - Françoise Galateau Salle
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,MESOPATH, MESOBANK, French network of mesothelioma, France
| | - Alexandra Meurgey
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,NETSARC+, French Sarcoma Group (GSF-GETO) network, France
| | | | | | - Caroline Renard
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Juliette Roussel
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Julie Gervasoni
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Vincent Cockenpot
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Carole Crozes
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Aline Baltres
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Aurélie Houlier
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | | | - Laurent Alberti
- INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Adeline Duc
- INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Francois Le Loarer
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,Department of Biopathology, UNICANCER, Bergonié Institute, Bordeaux, France
| | - Armelle Dufresne
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Department of Oncology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Mehdi Brahmi
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Department of Oncology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Nadège Corradini
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Institute of pediatric oncology, IHOPe, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,Department of Oncology, UNICANCER, Centre Léon Bérard, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon I, Lyon, France.,Headquarters, UNICANCER, Paris, France
| | - Franck Tirode
- INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Department of Biopathology, UNICANCER, Bergonié Institute, Bordeaux, France.,Univ Lyon, Université Claude Bernard Lyon I, Lyon, France
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20
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Bernthal NM, Spierenburg G, Healey JH, Palmerini E, Bauer S, Gelderblom H, Staals EL, Lopez-Bastida J, Fronk EM, Ye X, Laeis P, van de Sande MAJ. The diffuse-type tenosynovial giant cell tumor (dt-TGCT) patient journey: a prospective multicenter study. Orphanet J Rare Dis 2021; 16:191. [PMID: 33926503 PMCID: PMC8086070 DOI: 10.1186/s13023-021-01820-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/19/2021] [Indexed: 02/06/2023] Open
Abstract
Background Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive neoplasm arising from the synovium of joints, bursae, and tendon sheaths affecting small and large joints. It represents a wide spectrum ranging from minimally symptomatic to massively debilitating. Most findings to date are mainly from small, retrospective case series, and thus the morbidity and actual impact of this rare disease remain to be elucidated. This study prospectively explores the management of TGCT in tertiary sarcoma centers. Methods The TGCT Observational Platform Project registry was a multinational, multicenter, prospective observational study involving 12 tertiary sarcoma centers in 7 European countries, and 2 US sites. This study enrolled for 2 years all consecutive ≥ 18 years old patients, with histologically diagnosed primary or recurrent cases of diffuse-type TGCT. Patient demographic and clinical characteristics were collected at baseline and every 6 months for 24 months. Quality of life questionnaires (PROMIS-PF and EQ-5D) were also administered at the same time-points. Here we report baseline patient characteristics. Results 166 patients were enrolled between November 2016 and March 2019. Baseline characteristics were: mean age 44 years (mean age at disease onset: 39 years), 139/166 (83.7%) had prior treatment, 71/166 patients (42.8%) had ≥ 1 recurrence after treatment of their primary tumor, 76/136 (55.9%) visited a medical specialist ≥ 5 times, 66/116 (56.9%) missed work in the 24 months prior to baseline, and 17/166 (11.6%) changed employment status or retired prematurely due to disease burden. Prior treatment consisted of surgery (i.e., arthroscopic, open synovectomy) (128/166; 77.1%) and systemic treatments (52/166; 31.3%) with imatinib (19/52; 36.5%) or pexidartinib (27/52; 51.9%). Treatment strategies at baseline visits consisted mainly of watchful waiting (81/166; 48.8%), surgery (41/166; 24.7%), or targeted systemic therapy (37/166; 22.3%). Patients indicated for treatment reported more impairment compared to patients indicated for watchful waiting: worst stiffness NRS 5.16/3.44, worst pain NRS 6.13/5.03, PROMIS-PF 39.48/43.85, and EQ-5D VAS 66.54/71.85.
Conclusion This study confirms that diffuse-type TGCT can highly impact quality of life. A prospective observational registry in rare disease is feasible and can be a tool to collect curated-population reflective data in orphan diseases.
Name of registry: Tenosynovial Giant Cell Tumors (TGCT) Observational Platform Project (TOPP). Trial registration number: NCT02948088. Date of registration: 10 October 2016. URL of Trial registry record: https://clinicaltrials.gov/ct2/show/NCT02948088?term=NCT02948088&draw=2. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01820-6.
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Affiliation(s)
- Nicholas M Bernthal
- Division of Musculoskeletal Oncology, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA.
| | - Geert Spierenburg
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - John H Healey
- Department of Surgery, Orthopaedic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emanuela Palmerini
- Medical Oncology, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eric L Staals
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Julio Lopez-Bastida
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Toledo, Spain
| | | | - Xin Ye
- Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
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21
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Recurrent novel HMGA2-NCOR2 fusions characterize a subset of keratin-positive giant cell-rich soft tissue tumors. Mod Pathol 2021; 34:1507-1520. [PMID: 33742141 PMCID: PMC8295036 DOI: 10.1038/s41379-021-00789-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
Giant cell tumors of soft tissue (GCT-ST) are rare low-grade neoplasms that were at one time thought to represent the soft tissue counterparts of GCT of bone (GCT-B) but are now known to lack the H3F3 mutations characteristic of osseous GCT. We present six distinctive giant cell-rich soft tissue neoplasms that expressed keratins and carried a recurrent HMGA2-NCOR2 gene fusion. Patients were five females and one male aged 14-60 years (median, 29). All presented with superficial (subcutaneous) masses that were removed by conservative marginal (3) or wide (2) local excision. The tumors originated in the upper extremity (2), lower extremity (2), head/neck (1), and trunk (1). Five patients with follow-up (median, 21 months; range, 14-168) remained disease-free. Grossly, all tumors were well-demarcated but not encapsulated with variable lobulation. Histologically, they were composed of bland plump epithelioid or ovoid to spindled mononuclear cells admixed with evenly distributed multinucleated osteoclast-type giant cells. Foci of stromal hemorrhage and hemosiderin were seen in all cases. The mitotic activity ranged from 2 to 14/10 high power fields (median: 10). Foci of necrosis and vascular invasion were seen in one case each. The mononuclear cells were immunoreactive with the AE1/AE3 keratin cocktail and less frequently/less diffusely for K7 and K19 but lacked expression of other lineage-associated markers. RNA-based next-generation sequencing revealed an HMGA2-NCOR2 fusion in all tumors. None of the keratin-negative conventional GCT-ST showed the HMGA2-NCOR2 fusion (0/7). Metaplastic bone (4/9) and SATB2 expression (3/4) were frequent in keratin-negative conventional GCT-ST but were lacking in keratin-positive HMGA2-NCOR2 fusion-positive tumors. The distinctive immunophenotype and genotype of these tumors strongly suggest that they represent a discrete entity, differing from conventional GCT-ST and other osteoclast-rich morphologic mimics. Their natural history appears favorable, although a study of additional cases and longer follow-up are warranted.
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22
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Baldi GG, Gronchi A, Stacchiotti S. Pexidartinib for the treatment of adult symptomatic patients with tenosynovial giant cell tumors. Expert Rev Clin Pharmacol 2020; 13:571-576. [PMID: 32478598 DOI: 10.1080/17512433.2020.1771179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Tenosynovial giant cell tumor (TGCT) is a benign mesenchymal tumor arising from the synovium of tendon sheats and joints, driven by colony-stimulating factor 1 (CSF1) over-expression. Standard treatment is surgery, but local recurrences are frequent, especially in diffuse TGCT subtype, rarely cured with surgery. When TGCT becomes a chronic condition, which may severely compromise joint function and quality of life, patients may need a systemic therapy. Areas covered: We reviewed the drugs on clinical development in TGCT, focusing on the pharmacodynamics, pharmacokinetics, efficacy, and toxicity profile of pexidartinib, the first drug approved in the US for TGCT, and on the open questions about its optimal use in clinical practice. EXPERT OPINION CSFR1 inhibitors have opened a new avenue for treatment of TGCT patients. Pexidartinib is the first-in-class FDA approved agent for symptomatic locally advanced TGCT, based on a phase III study where pexidartinib showed high anti-tumor activity, improved patient symptoms, and functional outcome. A few cases of potentially life-threatening hepatic toxicity were observed. TGCT patients candidate to pexidartinib need to be carefully selected by the multidisciplinary board of center of expertise, balancing the expected risk-benefit ratio. Close monitoring of liver function and adequate education on the approved indication is warranted.
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Affiliation(s)
- Giacomo Giulio Baldi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato , Prato, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori , Milan, Italy
| | - Silvia Stacchiotti
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan, Italy
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23
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Brahmi M, Cassier P, Dufresne A, Chabaud S, Karanian M, Meurgey A, Bouhamama A, Gouin F, Vaz G, Garret J, Sunyach MP, Dupré A, Marec-Berard P, Corradini N, Perol D, Ray-Coquard I, Blay JY. Long term term follow-up of tyrosine kinase inhibitors treatments in inoperable or relapsing diffuse type tenosynovial giant cell tumors (dTGCT). PLoS One 2020; 15:e0233046. [PMID: 32433669 PMCID: PMC7239463 DOI: 10.1371/journal.pone.0233046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/27/2020] [Indexed: 12/21/2022] Open
Abstract
RATIONALE CSF1R tyrosine kinase inhibitors (TKI) and antibodies yield response rates and tumor control in patients with diffuse type tenosynovial giant cell tumors (dTGCT). The long term management of patients with dTGCT treated with TKI is however not known. PATIENTS AND METHODS We conducted a retrospective single center study on the 39 patients with advanced and/or inoperable dTGCT referred to the Centre Leon Berard for a medical treatment. The clinical characteristics and treatments of patients who had received at least one line of CSF1R TKI or Ab was collected from the electronic patient records and analyzed, after this study was approved by the Institutional Review Board of the Centre Leon Berard. Statistics were conducted using SPSS 23.0. RESULTS Thirty-nine patients received at least one line of TKI among the 101 patients with histologically confirmed dTGCT refered to this center. Imatinib, nilotinib, pexidartinib, emactuzumab were the most frequently used agents. First line treatment was given for a median duration of 7 months. With a median follow-up from the initiation of TKI of 30 months, the progression-free rate at 30 months is 56% for the 39 patients. 15 patients had recurrent disease after first line CSF1R inhibitor: 12 (80%) received a 2nd line treatment for a median duration of 6 months and a median time to progression (TTP) of 12 months. Six patients had afterwards a recurrent disease and 5 (83%) received a 3rd line treatment for a median duration of 5 months and a median TTP of 9 months. Progression-free rate at 30 months was observed in 3 of 12 (25%) after line 2 and 1 of 5 (20%) after line 3. None of the patients refered died with a median follow-up of 67 months. CONCLUSIONS CSF1R TKI or Ab provide prolonged tumor control and symptom relief for a majority of patients with inoperable or relapsing dTGCT, in first and subsequent lines. Multiple lines are required for close to 50% of patients with relapsing dTGCT.
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Affiliation(s)
- Mehdi Brahmi
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Philippe Cassier
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Armelle Dufresne
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Sylvie Chabaud
- Department of Statistics, Léon Bérard Cancer Center, Lyon, France
| | - Marie Karanian
- Department of Biopathology, Léon Bérard Cancer Center, Lyon, France
| | | | - Amine Bouhamama
- Department of Radiology, Léon Bérard Cancer Center, Lyon, France
| | - Francois Gouin
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | - Gualter Vaz
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | - Jerome Garret
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | | | - Aurélien Dupré
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | | | - Nadège Corradini
- Institut d’Hematology Oncologie Pediatrique, Centre Leon Berard, Lyon, France
| | - David Perol
- Department of Statistics, Léon Bérard Cancer Center, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
- University Claude Bernard, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
- University Claude Bernard, Lyon, France
- * E-mail:
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