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Paul MR, Zage PE. Overview and recent advances in the targeting of medulloblastoma cancer stem cells. Expert Rev Anticancer Ther 2021; 21:957-974. [PMID: 34047251 DOI: 10.1080/14737140.2021.1932472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Medulloblastoma, an embryonal small round blue cell tumor primarily arising in the posterior fossa, is the most common malignancy of the central nervous system in children and requires intensive multi-modality therapy for cure. Overall 5-year survival is approximately 75% in children with primary disease, but outcomes for relapsed disease are very poor. Recent advances have identified molecular subgroups with excellent prognosis, with 5-year overall survival rates >90%, and subgroups with very poor prognosis with overall survival rates <50%. Molecular subtyping has allowed for more sophisticated risk stratification of patients, but new treatments for the highest risk patients have not yet improved outcomes. Targeting cancer stem cells may improve outcomes, and several candidate targets and novel drugs are under investigation.Areas covered: We discuss medulloblastoma epidemiology, biology, treatment modalities, risk stratification, and molecular subgroup analysis, links between subgroup and developmental biology, cancer stem cell biology in medulloblastoma including previously described cancer stem cell markers and proposed targeted treatments in the current literature.Expert opinion: The understanding of cancer stem cells in medulloblastoma will advance therapies targeting the most treatment-resistant cells within the tumor and therefore reduce the incidence of treatment refractory and relapsed disease.
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Affiliation(s)
- Megan Rose Paul
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, California, USA (M.R.P., P.E.Z.); Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital-San Diego, San Diego, California, USA
| | - Peter E Zage
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, California, USA (M.R.P., P.E.Z.); Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital-San Diego, San Diego, California, USA
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Alves CAPF, Löbel U, Martin-Saavedra JS, Toescu S, Tsunemi MH, Teixeira SR, Mankad K, Hargrave D, Jacques TS, da Costa Leite C, Gonçalves FG, Vossough A, D'Arco F. A Diagnostic Algorithm for Posterior Fossa Tumors in Children: A Validation Study. AJNR Am J Neuroradiol 2021; 42:961-968. [PMID: 33664107 DOI: 10.3174/ajnr.a7057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Primary posterior fossa tumors comprise a large group of neoplasias with variable aggressiveness and short and long-term outcomes. This study aimed to validate the clinical usefulness of a radiologic decision flow chart based on previously published neuroradiologic knowledge for the diagnosis of posterior fossa tumors in children. MATERIALS AND METHODS A retrospective study was conducted (from January 2013 to October 2019) at 2 pediatric referral centers, Children's Hospital of Philadelphia, United States, and Great Ormond Street Hospital, United Kingdom. Inclusion criteria were younger than 18 years of age and histologically and molecularly confirmed posterior fossa tumors. Subjects with no available preoperative MR imaging and tumors located primarily in the brain stem were excluded. Imaging characteristics of the tumors were evaluated following a predesigned, step-by-step flow chart. Agreement between readers was tested with the Cohen κ, and each diagnosis was analyzed for accuracy. RESULTS A total of 148 cases were included, with a median age of 3.4 years (interquartile range, 2.1-6.1 years), and a male/female ratio of 1.24. The predesigned flow chart facilitated identification of pilocytic astrocytoma, ependymoma, and medulloblastoma sonic hedgehog tumors with high sensitivity and specificity. On the basis of the results, the flow chart was adjusted so that it would also be able to better discriminate atypical teratoid/rhabdoid tumors and medulloblastoma groups 3 or 4 (sensitivity = 75%-79%; specificity = 92%-99%). Moreover, our adjusted flow chart was useful in ruling out ependymoma, pilocytic astrocytomas, and medulloblastoma sonic hedgehog tumors. CONCLUSIONS The modified flow chart offers a structured tool to aid in the adjunct diagnosis of pediatric posterior fossa tumors. Our results also establish a useful starting point for prospective clinical studies and for the development of automated algorithms, which may provide precise and adequate diagnostic tools for these tumors in clinical practice.
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Affiliation(s)
- C A P F Alves
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology (C.d.C.L.), Hospital das Clinicas, Faculdade de Medicina de Sao Paulo, Sao Paulo
| | - U Löbel
- Radiology Department (U.L., K.M., F.D.), UCL Great Ormond Street Hospital for Children, London, UK
| | - J S Martin-Saavedra
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S Toescu
- Department of Neurosurgery (S.T.), UCL Great Ormond Street Hospital for Children, London, UK
| | - M H Tsunemi
- Department of Biostatistics (M.H.T.), Instituto de Biociências, São Paulo State University, São Paul, Brazil
| | - S R Teixeira
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - K Mankad
- Radiology Department (U.L., K.M., F.D.), UCL Great Ormond Street Hospital for Children, London, UK
| | - D Hargrave
- Pediatric Oncology Unit (D.H.), UCL Great Ormond Street Institute of Child Health, London, UK
| | - T S Jacques
- Developmental Biology and Cancer Programme (T.S.J.), UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - C da Costa Leite
- Department of Radiology (C.d.C.L.), Hospital das Clinicas, Faculdade de Medicina de Sao Paulo, Sao Paulo
| | - F G Gonçalves
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A Vossough
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - F D'Arco
- Radiology Department (U.L., K.M., F.D.), UCL Great Ormond Street Hospital for Children, London, UK
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Paul MR, Huo Y, Liu A, Lesperance J, Garancher A, Wechsler-Reya RJ, Zage PE. Characterization of G-CSF receptor expression in medulloblastoma. Neurooncol Adv 2020; 2:vdaa062. [PMID: 32642714 PMCID: PMC7316203 DOI: 10.1093/noajnl/vdaa062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Identifying mechanisms of medulloblastoma recurrence is a key to improving patient survival, and targeting treatment-resistant subpopulations within tumors could reduce disease recurrence. Expression of the granulocyte colony-stimulating factor receptor (G-CSF-R, CD114) is a potential marker of cancer stem cells, and therefore we hypothesized that a subpopulation of medulloblastoma cells would also express CD114 and would demonstrate chemoresistance and responsiveness to G-CSF. Methods Prevalence of CD114-positive (CD114+) cells in medulloblastoma cell lines, patient-derived xenograft (PDX) tumors, and primary patient tumor samples were assessed by flow cytometry. Growth rates, chemoresistance, and responses to G-CSF of CD114+ and CD114-negative (CD114−) cells were characterized in vitro using continuous live cell imaging and flow cytometry. Gene expression profiles were compared between CD114+ and CD114− medulloblastoma cells using quantitative RT-PCR. Results CD114+ cells were identifiable in medulloblastoma cell lines, PDX tumors, and primary patient tumors and have slower growth rates than CD114− or mixed populations. G-CSF accelerates the growth of CD114+ cells, and CD114+ cells are more chemoresistant. The CD114+ population is enriched when G-CSF treatment follows chemotherapy. The CD114+ population also has higher expression of the CSF3R, NRP-1, TWIST1, and MYCN genes. Conclusions Our data demonstrate that a subpopulation of CD114+ medulloblastoma cells exists in cell lines and tumors, which may evade traditional chemotherapy and respond to exogenous G-CSF. These properties invite further investigation into the role of G-CSF in medulloblastoma therapy and methods to specifically target these cells.
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Affiliation(s)
- Megan Rose Paul
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, California, USA.,Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital-San Diego, San Diego, California, USA
| | - Yuchen Huo
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, California, USA
| | - Andrea Liu
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, California, USA
| | - Jacqueline Lesperance
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, California, USA
| | - Alexandra Garancher
- Tumor Initiation and Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California, USA
| | - Robert J Wechsler-Reya
- Tumor Initiation and Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California, USA
| | - Peter E Zage
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, California, USA.,Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital-San Diego, San Diego, California, USA
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