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Majzner RG, Theruvath JL, Nellan A, Heitzeneder S, Cui Y, Mount CW, Rietberg SP, Linde MH, Xu P, Rota C, Sotillo E, Labanieh L, Lee DW, Orentas RJ, Dimitrov DS, Zhu Z, Croix BS, Delaidelli A, Sekunova A, Bonvini E, Mitra SS, Quezado MM, Majeti R, Monje M, Sorensen PHB, Maris JM, Mackall CL. CAR T Cells Targeting B7-H3, a Pan-Cancer Antigen, Demonstrate Potent Preclinical Activity Against Pediatric Solid Tumors and Brain Tumors. Clin Cancer Res 2019; 25:2560-2574. [PMID: 30655315 PMCID: PMC8456711 DOI: 10.1158/1078-0432.ccr-18-0432] [Citation(s) in RCA: 375] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 10/13/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients with relapsed pediatric solid tumors and CNS malignancies have few therapeutic options and frequently die of their disease. Chimeric antigen receptor (CAR) T cells have shown tremendous success in treating relapsed pediatric acute lymphoblastic leukemia, but this has not yet translated to treating solid tumors. This is partially due to a paucity of differentially expressed cell surface molecules on solid tumors that can be safely targeted. Here, we present B7-H3 (CD276) as a putative target for CAR T-cell therapy of pediatric solid tumors, including those arising in the central nervous system. EXPERIMENTAL DESIGN We developed a novel B7-H3 CAR whose binder is derived from a mAb that has been shown to preferentially bind tumor tissues and has been safely used in humans in early-phase clinical trials. We tested B7-H3 CAR T cells in a variety of pediatric cancer models. RESULTS B7-H3 CAR T cells mediate significant antitumor activity in vivo, causing regression of established solid tumors in xenograft models including osteosarcoma, medulloblastoma, and Ewing sarcoma. We demonstrate that B7-H3 CAR T-cell efficacy is largely dependent upon high surface target antigen density on tumor tissues and that activity is greatly diminished against target cells that express low levels of antigen, thus providing a possible therapeutic window despite low-level normal tissue expression of B7-H3. CONCLUSIONS B7-H3 CAR T cells could represent an exciting therapeutic option for patients with certain lethal relapsed or refractory pediatric malignancies, and should be tested in carefully designed clinical trials.
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Affiliation(s)
- Robbie G Majzner
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Johanna L Theruvath
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Anandani Nellan
- Department of Pediatrics, University of Colorado, Denver Anschutz Medical Center, Denver, Colorado
| | - Sabine Heitzeneder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Yongzhi Cui
- Pediatric Oncology Branch, NCI, Bethesda, Maryland
| | - Christopher W Mount
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California
| | - Skyler P Rietberg
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Miles H Linde
- Immunology Graduate Program, Stanford University School of Medicine, Palo Alto, California
- Institute for Stem Cell Biology and Regenerative Medicine, Palo Alto, California
| | - Peng Xu
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | | | - Elena Sotillo
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Louai Labanieh
- Department of Bioengineering, Stanford University School of Medicine, Palo Alto, California
| | - Daniel W Lee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Rimas J Orentas
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Dimiter S Dimitrov
- Center for Antibody Therapeutics, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - Zhongyu Zhu
- Cancer and Inflammation Program, NCI, NIH, Frederick, Maryland
| | - Brad St Croix
- Tumor Angiogenesis Unit, Mouse Cancer Genetics Program (MCGP), NCI, NIH, Frederick, Maryland
| | - Alberto Delaidelli
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Alla Sekunova
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Siddhartha S Mitra
- Department of Pediatrics, University of Colorado, Denver Anschutz Medical Center, Denver, Colorado
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California
| | - Martha M Quezado
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Ravindra Majeti
- Institute for Stem Cell Biology and Regenerative Medicine, Palo Alto, California
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California
| | - Michelle Monje
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California
| | - Poul H B Sorensen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - John M Maris
- Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Crystal L Mackall
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California
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Rege S, Patil H, Narayan S. Adult medulloblastoma. ROMANIAN NEUROSURGERY 2016. [DOI: 10.1515/romneu-2016-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Medulloblastoma is a highly malignant central nervous system (CNS) tumor that arises from the cerebellum. It is the most common primary malignant intracranial childhood neoplasm. In adults, medulloblastoma are much less common, accounting for < 1% of all adult brain tumors. Herein, author has described a rare case of cerebellar medulloblastoma in adult.
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Gultekin M, Cengiz M, Sezen D, Zorlu F, Yildiz F, Yazici G, Hurmuz P, Ozyigit G, Akyol F, Gurkaynak M. Reirradiation of Pediatric Tumors Using Hypofractionated Stereotactic Radiotherapy. Technol Cancer Res Treat 2016; 16:195-202. [PMID: 27352857 DOI: 10.1177/1533034616655952] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy and safety of hypofractionated stereotactic radiotherapy for reirradiation of recurrent pediatric tumors. METHODS AND MATERIALS The study included 23 pediatric patients who were reirradiated using hypofractionated stereotactic radiotherapy in the radiation oncology department between January 2008 and November 2013. In total, 33 tumors were treated-27 (82%) cranial and 6 (18%) extracranial. Hypofractionated stereotactic radiotherapy was administered due to recurrent disease in 31 (94%) tumors and residual disease in 2 (6%) tumors. The median total dose was 25 Gy (range: 15-40 Gy), and the median follow-up was 20 months (range: 2-68 months). RESULTS The 1-year and 2-year local control rates in the entire study population were 42% and 31%, respectively. The median local control time was 11 months (range: 0-54 months) following hypofractionated stereotactic radiotherapy. The patients with tumor response after hypofractionated stereotactic radiotherapy had significantly longer local control than the patients with post-hypofractionated stereotactic radiotherapy tumor progression (21 vs 3 months, P < .001). Tumor volume <1.58 cm3 was correlated (not significantly) with better local control (23 vs 7 months, P = .064). CONCLUSION Reirradiation of pediatric tumors using hypofractionated stereotactic radiotherapy is a safe and effective therapeutic approach. This treatment modality should be considered as a treatment option in selected pediatric patients.
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Affiliation(s)
- Melis Gultekin
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cengiz
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Duygu Sezen
- 2 Department of Radiation Oncology, School of Medicine, Koç University, Istanbul, Turkey
| | - Faruk Zorlu
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ferah Yildiz
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gozde Yazici
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Pervin Hurmuz
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokhan Ozyigit
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Fadil Akyol
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Gurkaynak
- 1 Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
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Targeting the Hedgehog Pathway in Pediatric Medulloblastoma. Cancers (Basel) 2015; 7:2110-23. [PMID: 26512695 PMCID: PMC4695880 DOI: 10.3390/cancers7040880] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/05/2015] [Accepted: 10/16/2015] [Indexed: 11/17/2022] Open
Abstract
Medulloblastoma (MB), a primitive neuroectomal tumor of the cerebellum, is the most common malignant pediatric brain tumor. The cause of MB is largely unknown, but aberrant activation of Hedgehog (Hh) pathway is responsible for ~30% of MB. Despite aggressive treatment with surgical resection, radiation and chemotherapy, 70%–80% of pediatric medulloblastoma cases can be controlled, but most treated patients suffer devastating side effects. Therefore, developing a new effective treatment strategy is urgently needed. Hh signaling controls transcription of target genes by regulating activities of the three Glioma-associated oncogene (Gli1-3) transcription factors. In this review, we will focus on current clinical treatment options of MB and discuss mechanisms of drug resistance. In addition, we will describe current known molecular pathways which crosstalk with the Hedgehog pathway both in the context of medulloblastoma and non-medulloblastoma cancer development. Finally, we will introduce post-translational modifications that modulate Gli1 activity and summarize the positive and negative regulations of the Hh/Gli1 pathway. Towards developing novel combination therapies for medulloblastoma treatment, current information on interacting pathways and direct regulation of Hh signaling should prove critical.
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Wang W, Macaulay RJB. Cell-Cycle Gene Expression in Lovastatin-Induced Medulloblastoma Apoptosis. Can J Neurol Sci 2014; 30:349-57. [PMID: 14672267 DOI: 10.1017/s0317167100003061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background:3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase is a key rate-limiting enzyme in the mevalonate pathway, which generates precursors both for cholesterol biosynthesis and for the production of nonsteroidal mevalonate derivatives that are involved in a number of growth-regulatory processes. We have reported that lovastatin, a competitive inhibitor of HMG-CoA reductase, not only inhibits medulloblastoma proliferation in vitro, but also induces near-complete cell death via apoptosis. The mechanism of this phenomenon is unclear. Possible involvement of changes in expression of certain cell-cycle related genes led us to study some of them in more detail.Methods:Medulloblastoma cell lines were exposed in vitro to lovastatin, and the effects of gene expression changes were studied using RT-PCR, antisense oligonucleotide, DNA electrophoresis and Western blotting analysis.Results:1) Levels of total Ras gene mRNA and individual Ras gene mRNA are stable in lovastatin treatment in all examined medulloblastoma cell lines. 2) Blocking c-myc gene over-expression does not enhance medulloblastoma cell sensitivity to lovastatin. 3) Following lovastatin treatment, p16 expression exhibits no change, but pronounced increases of p27KIP1 protein are observed in all examined cell lines. Lovastatin induces pronounced increases of p21WAF1 protein only in Daoy and UW228, but not in D283 Med and D341 Med. 4) Following lovastatin treatment, increased p53 protein is detected only in D341 Med, and bax protein is unchanged in all cell lines.Conclusion:Lovastatin-induced growth inhibition and apoptosis in medulloblastoma are not dependent on the regulation of Ras and c-myc gene expression, but may be mediated by p27KIP1 gene expression. Lovastatin-induced apoptosis in medulloblastoma is probably p53 independent, but p53 and p21WAF1 gene expression may also mediate anti-proliferative effects of lovastatin on specific medulloblastoma cell lines.
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Affiliation(s)
- Wei Wang
- Laboratory of Cellular Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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6
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Muzumdar D, Ventureyra ECG. Treatment of posterior fossa tumors in children. Expert Rev Neurother 2014; 10:525-46. [DOI: 10.1586/ern.10.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Pérez-Espejo MA, Tobarra-González BM, Piqueras-Pérez CJ, Sola-Pérez J, Torroba A, Sánchez-Salinas A, Moraleda-Jiménez JM, de la Fuente-Muñoz I, García-Fernández R, López-Soler F, Martínez-Lage JF, Fernández-Pérez J. [Radiosurgery as adjuvant treatment of a recurrent adult medulloblastoma. Ultra-early response]. Neurocirugia (Astur) 2011; 22:554-7. [PMID: 22167285 DOI: 10.1016/s1130-1473(11)70109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The role of radiosurgery after multimodality treatment of recurrent desmoplastic adult medulloblastoma is analyzed. The ultra-early clinical and pathological response of this tumor to adjunctive radiosurgery is stressed.
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Affiliation(s)
- M A Pérez-Espejo
- Servicios de Neurocirugía, Hospital Universitario Virgen Arrixaca, Murcia
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Reirradiation of relapsed brain tumors in children. Rep Pract Oncol Radiother 2011; 17:32-7. [PMID: 24376994 DOI: 10.1016/j.rpor.2011.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/06/2011] [Accepted: 10/07/2011] [Indexed: 11/21/2022] Open
Abstract
AIM The aim of this study was to evaluate toxicity and response to fractionated reirradiation (FR) of relapsed primary brain tumors in children. BACKGROUND The treatment options for recurrent brain tumors in children previously irradiated are limited. Reirradiation is performed with fear due to the cumulative late CNS toxicity and the lack of a significant chance of cure. MATERIALS AND METHODS Between 2008 and 2009, eight children with a median age of 14.5 years with a diagnosis of a recurrent brain tumor underwent reirradiation. Initially, all patients were treated with surgery, chemotherapy and radiotherapy. The median time to the first recurrence after the initial treatment was 19.5 months. Intervals between radiotherapy courses were in the range of 5-51 mos. All retreatments were carried out with 3D image-based conformal methods. The total prescription dose was 40 Gy in a fraction of 5 × 2 Gy/week. The total cumulative dose ranged from 65 to 95 Gy (median: 75 Gy). The median cumulative biologically effective dose was 144 Gy (range: 126-181 Gy). RESULTS The median overall survival and progression free survival measured from the beginning of reirradiation was 17.5 and 6.5 months, respectively. During the first evaluation, four patients showed a complete or partial response, two did not respond radiologically. Two children were progressive at the time of reirradiation. Among children with progression that occurred during the first year after reirradiation, only two progressed in the treatment area. The repeated irradiation was well tolerated by all patients. No late complications have been observed. CONCLUSION In the absence of other treatment possibilities, the fractionated reirradiation with highly conformal three-dimensional planning could be a therapeutic choice in case of recurrent brain tumors in children. The control of craniospinal dissemination remains to be the main problem.
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Cakir B, Tarhan NC, Coskun M, Ozdemir BH, Bozkurt A, Ozyilkan O. Metastatic cerebellar medulloblastoma in the liver mimicking a complicated cyst: sonographic and MDCT findings. AJR Am J Roentgenol 2004; 183:1608-10. [PMID: 15547199 DOI: 10.2214/ajr.183.6.01831608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Banu Cakir
- Department of Radiology, Baskent University Faculty of Medicine, Fevzi Cakmak Cad. 10.sok., No: 45, Bahcelievler, Ankara 06490, Turkey.
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Vachon P, Girard C, Théorêt Y. Effects of basic fibroblastic growth factor on the growth of human medulloblastoma xenografts. J Neurooncol 2004; 67:139-46. [PMID: 15072461 DOI: 10.1023/b:neon.0000021824.41701.e5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to evaluate the effect of basic fibroblastic growth factor (bFGF) on the growth of human UM-MB1 medulloblastoma xenografts injected intracranially in nude mice. Under general anesthesia, a homogenous suspension of UM-MB1 cells (10(5)/10 microl) were injected in the caudoputamen nuclei of the right cerebral hemisphere using a stereotaxic apparatus. The treatment group (n = 9) received 10 microl of a bFGF solution (20 microg/ml) at 3 and 6 days following the inoculation of the cells at the injection site using the same stereotaxic coordinates. The control group (n = 9) were injected intracranially with a phosphate-buffered saline vehicle using a similar protocol. Mice were sacrificed 3 weeks following the xenograft surgery and the brains were prepared for histological observations as well as tumor volume evaluations. The mean volume of bFGF-treated tumors (mean volume +/- SD = 50.0 +/- 32.9 +/- mm3) was significantly smaller than for the non-treated xenografts (mean volume +/- SD = 199.0 +/- 42.1 mm3) (t-test, p < 0.001). Compared to non-treated tumor cells, bFGF-treated medulloblastoma cells had a greater cytoplasm volume and their nuclei contained more euchromatin suggesting that bFGF may initiate differentiation. In conclusion, our results suggest that bFGF may offer a new chemotherapeutic modality for the treatment of medulloblastoma.
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Affiliation(s)
- Pascal Vachon
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montreal, St-Hyacinthe, QC, Canada.
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Rustamzadeh E, Li C, Doumbia S, Hall WA, Vallera DA. Targeting the over-expressed urokinase-type plasminogen activator receptor on glioblastoma multiforme. J Neurooncol 2004; 65:63-75. [PMID: 14649886 DOI: 10.1023/a:1026238331739] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A recombinant fusion protein targeting the urokinase-type plasminogen activator receptor (uPAR) and delivering a potent catalytic toxin has the advantage of simultaneously targeting both over-expressed uPAR on glioblastoma cells and on the tumor neovasculature. Such a hybrid protein was synthesized consisting of the noninternalizing amino-terminal fragment (ATF) of urokinase-type plasminogen activator (uPA) for binding, and the catalytic portion of diphtheria toxin (DT) for killing, and the translocation enhancing region (TER) of DT for internalization. The protein was highly selective for human glioblastoma in vitro and in vivo. In vivo, this DT/ATF hybrid called DTAT caused the regression of small subcutaneous uPAR-expressing tumors with minimal toxicity to critical organs. In vitro, DTAT killed only uPAR-positive glioblastoma cell lines and human endothelial cells in the form of the HUVEC cell line. Killing was selective and blockable with specific antibody. DTAT was highly effective against tumor cells cultured from glioblastoma multiforme patients and in vitro mixing experiments combining DTAT with DTIL13 another highly effective anti-glioblastoma agent showed that the mixture was as toxic as the most potent immunotoxin. In this article, we review our progress to date with DTAT.
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Affiliation(s)
- Edward Rustamzadeh
- Department of Neurosurgery, University of Minnesota Cancer Center, Minneapolis, MN 55455, USA
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Abstract
Surgery, chemotherapy, and radiation therapy have become standard of practice in treating malignant brain tumors. Unfortunately, the prognosis of these malignant tumors still remains poor. Immunotoxins are a relatively new adjuvant treatment for brain tumors. Within the last few years an increased amount of clinically-oriented research involving immunotoxins has been published. This has led to numerous clinical trials which although encouraging have not yet born out the "magic bullet" concept envisioned for immunotoxins. In this review article the history, design, toxicity, and pharmokinetics of immunotoxins will be discussed in detail.
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Affiliation(s)
- Edward Rustamzadeh
- Department of Neurosurgery, Graduate School, University of Minnesota, Minneapolis, MN, USA.
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13
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Dyer SM, Keating J, Ewing PJ, Orcutt CJ. A Primitive Neuroectodermal Tumor in the Cerebellum of an Umbrella Cockatoo (Cacatua alba). J Avian Med Surg 2003. [DOI: 10.1647/1082-6742(2003)017[0020:apntit]2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McNeil DE, Coté TR, Clegg L, Rorke LB. Incidence and trends in pediatric malignancies medulloblastoma/primitive neuroectodermal tumor: a SEER update. Surveillance Epidemiology and End Results. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 39:190-4. [PMID: 12210449 DOI: 10.1002/mpo.10121] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It has been suggested that cerebellar medulloblastoma (M) and primitive neuroectodermal tumors (PNET) arising elsewhere in the nervous system, represent a single entity (M/PNET), although this concept is controversial. Cancer registries permit population-based description of cases reported as medulloblastoma, those reported as PNET and description of the aggregate, M/PNET. PROCEDURE We reviewed the 768 cases of M/PNET (633 diagnosed medulloblastoma and 135 diagnosed PNET) among persons under 20 years of age in the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database. RESULTS The incidence of M/PNET rose 23%, from 4 per 10(6) person-years in 1973-77 to 4.9 per 10(6) person-years in 1993-98. Cases reported as PNET were more likely than those reported as medulloblastoma to be supratentorial (30.4% vs. 1.9%, P < 0.001) and to be female (42.2% vs. 35.4%, P = 0.13). The difference in 5-year survival between the 600 children with infratentorial medulloblastoma vs. the 49 children with infratentorial PNET was not statistically significant (55% vs. 43%). Regardless of reporting diagnosis, survival was poorer among children age 0-3 years and those with supratentorial tumors. Children diagnosed in the more recent period from 1985-1998 had a longer median survival than children diagnosed in 1973-84 (4.9 years vs. 10 years, P < 0.05). Rates were 42% higher among Whites compared to Blacks (4.5/10(6) person-years vs. 3.1/10(6) person-years, P < 0.01). CONCLUSIONS We found M/PNET is increasing in incidence and more frequent among Whites. Given that medulloblastoma and PNET are histologically identical and have similar epidemiologic profiles, future studies should provide analyses that combine these entities.
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Affiliation(s)
- Dawn Elizabeth McNeil
- Division of Cancer Epidemiology and Genetics, NCI/NIH/EPS, Rockville, Maryland 20892-7236, USA.
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15
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Wang W, Macaulay RJ. Mevalonate prevents lovastatin-induced apoptosis in medulloblastoma cell lines. Can J Neurol Sci 1999; 26:305-10. [PMID: 10563217 DOI: 10.1017/s0317167100000433] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase) is a key rate-limiting enzyme in the mevalonate pathway, which generates precursors for cholesterol biosynthesis and the production of non-steroidal mevalonate derivatives that are involved in a number of growth-regulatory processes. We have reported that lovastatin, a competitive inhibitor of HMG-CoA reductase, not only inhibits medulloblastoma proliferation in vitro, but also induces near-complete cell death via apoptosis. The present study explores some of the pathways which may be involved in lovastatin-induced apoptosis. METHODS Medulloblastoma cell lines were exposed in vitro to lovastatin with or without mevalonate, and document the effects using morphology, flow cytometry. DNA electrophoresis and Northern analysis. RESULTS 1) Mevalonate prevents apoptosis when co-incubated with lovastatin, or when administered to lovastatin-pretreated cells. 2) Mevalonate restores the lovastatin-arrested cell cycle, allowing S phase entry. 3) Mevalonate does not prevent lovastatin-induced apoptosis after a critical duration of lovastatin pretreatment. For cell lines Daoy and UW228 this was 24 hours, and for D283 Med and D341 Med it was 48 hours. 4) Increases in HMG-CoA reductase mRNA levels induced by lovastatin are abrogated by co-incubation with lovastatin and mevalonate. CONCLUSIONS These results confirm that lovastatin inhibition of this enzyme results in blockage of the mevalonate pathway, and that such a block is a critical step in the mechanism of lovastatin-induced apoptosis.
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Affiliation(s)
- W Wang
- Department of Pathology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Russo C, Pellarin M, Tingby O, Bollen AW, Lamborn KR, Mohapatra G, Collins VP, Feuerstein BG. Comparative genomic hybridization in patients with supratentorial and infratentorial primitive neuroectodermal tumors. Cancer 1999; 86:331-9. [PMID: 10421270 DOI: 10.1002/(sici)1097-0142(19990715)86:2<331::aid-cncr18>3.0.co;2-#] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intracranial primitive neuroectodermal tumors (PNETs) occur in the supratentorial and infratentorial regions of the brain. Although histologically similar, the natural history of the tumor at each site differs. The study goal was to determine whether there was evidence of a genetic difference between supratentorial and infratentorial PNETs. METHODS Using comparative genomic hybridization (CGH), 53 PNETs were analyzed to determine copy number aberrations. Forty-three tumors were located in the cerebellum (IPNETs), and ten were supratentorial PNETs (SPNETs). All samples were reviewed to confirm the diagnosis. Each specimen had at least 50% tumor. RESULTS Six of the 43 cases of IPNET had no copy number aberrations. In contrast, each case of SPNET had copy number aberrations detected by CGH. Statistically significant differences in copy number aberrations of chromosomes 14, 17, and 19 were detected in the two groups. The most common copy number aberration in the IPNETs was gain of chromosome 17q, which was observed in 16 of 43 cases (37%). However, no case of SPNET had gain of 17q. Loss of 14q was detected in four of ten SPNETs but was not detected in any of the IPNET cases. Loss of 19q was detected in 4 of 10 SPNETs and in only 1 of 43 IPNETs. CONCLUSIONS These results indicate that the genetic aberrations of IPNETs differ from the genetic aberrations of SPNETs. Although they are similar histologically, SPNETs and IPNETs appear to be biologically distinct entities.
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Affiliation(s)
- C Russo
- Brain Tumor Research Center of the Department of Neurological Surgery, School of Medicine, University of California, San Francisco 94143-0372, USA
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Bethune C, Blum A, Geyer JR, Silber JR, Ho RJ. Lipid association increases the potency against primary medulloblastoma cells and systemic exposure of 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) in rats. Pharm Res 1999; 16:896-903. [PMID: 10397611 DOI: 10.1023/a:1018886321917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To reduce the systemic toxicity and prolong the systemic presence of 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), a lipid-based drug carrier was designed and characterized. METHODS The degree of CCNU association with lipid vesicles composed of 1, 2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) and 1,2-dimyristoyl-sn-glycero-3-phosphoglycerol (DMPG) (1:1, m/m) was characterized and the drug decomposition rates of lipid-drug complexes were monitored. Effects of lipid association on drug potency against medulloblastoma cells and total systemic drug exposure in rats were determined. RESULTS At a CCNU:lipid molar ratio greater than 1:5, more than 90% of the drug was associated with the lipid vesicles. In aqueous suspensions, lipid association significantly reduced the first-order drug decomposition rate. In addition, lipid-associated CCNU exhibited a 4-fold increase in drug sensitivity with medulloblastoma cells. IC50 values for CCNU admixed and encapsulated with lipid vesicles were 18+/-4.9 and 14.0+/-2.2 microM, respectively, compared to 83+/-11.0 microM for free CCNU. When administered to rats, lipid-associated CCNU increased the AUC (area under the concentration-time curve) of CCNU by approximately 2-fold (20.46+/-2.15 compared to 39.59+/-1.87 microg x min/ml), and the terminal half-life (t1/2beta) by almost 9-fold (17+/-9 compared to 147+/-48 min) over free CCNU. Despite the increase in total systemic drug exposure, rats treated with lipid-associated CCNU exhibited a significantly lower frequency of acute neurotoxicity. CONCLUSIONS These data indicate that CCNU associated with lipid vesicles may increase drug stability, potency, and systemic exposure in rats.
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Affiliation(s)
- C Bethune
- Department of Pharmaceutics, University of Washington, Seattle 98195, USA
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Abstract
A 4-year-old female, spayed Border Collie Dog was brought to the Veterinary Medical Teaching Hospital for evaluation of a progressive head tilt and ataxia that were unresponsive to therapy. Neurologic examination localized a right-sided lesion. The owner refused additional diagnostic tests, and necropsy was performed after euthanasia. Gross findings included atrophy of the temporal muscles and a moderately well delineated, 2.5- x 1.5- x 1.0-cm, gray soft-tissue mass compressing the right cerebellar hemisphere and dorsal hindbrain, resulting in massive dilatation of the lateral, third, and fourth ventricles and hydrocephalus. Histologic examination revealed two distinct features: undifferentiated, primitive, polygonal to fusiform cells with typical morphologic characteristics of medulloblastoma and interspersed areas containing myelinated axons and cells with glial and neuronal differentiation. Immunohistochemical examination confirmed the presence of primitive neuroepithelium and cells with glial and neuronal differentiation.
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Affiliation(s)
- H Steinberg
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison 53706-1102, USA.
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Abstract
Chronic oral VP-16 (Etoposide) is a chemotherapy regimen with wide application in oncology and documented efficacy against germ cell tumors, lymphomas, Kaposi sarcoma, and glial brain tumors. Eight patients ranging in age from 4 to 36 years (median 7.5 years) with locally recurrent medulloblastoma were treated with VP-16. No patient displayed evidence of cerebrospinal fluid dissemination, distant brain or spine parenchymal metastases, or extraneural metastatic disease. All patients had previously been treated with surgery (gross total resection, 5; subtotal resection, 3), craniospinal radiotherapy, and platinum-based chemotherapy (adjuvant, 3; salvage, 8). Each cycle of therapy consisted of 21 days of VP-16 (50 mg/m2/day) followed by a 7 to 14 day rest followed by an additional 21 days of VP-16 (50 mg/m2/day). Complete blood counts were obtained weekly. Neurologic examination and brain magnetic resonance imaging scan with contrast were performed prior to each cycle of therapy. Treatment-related complications included: partial alopecia (5 patients); diarrhea (4); weight loss (3); anemia (2); neutropenia (4); and thrombocytopenia (4). Two patients required transfusion and 1 patient received antibiotics for neutropenic fever. All patients were evaluable for response: 3 demonstrated progressive disease after the first cycle of VP-16, 3 had stable disease (range 4 to 6 months) and 2 had partial neuroradiographic responses (8 and 10 months). Median duration of response and stable disease was 6 months (range: 4 to 10 months) in 5 of 8 (62.5%) patients. Chronic oral VP-16 is a well-tolerated and relatively non-toxic chemotherapeutic agent with demonstrated activity in locally recurrent medulloblastoma.
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Affiliation(s)
- M C Chamberlain
- Department of Neurosciences, University of California, San Diego, 92103-8421, USA
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Abstract
Medulloblastoma is a malignant embryonal tumor predominantly of childhood. It occurs principally in the midline cerebellar region but is prone to invade the meninges and cerebrospinal fluid spaces. It is the principal posterior fossa tumor in children and represents 20% of all brain tumors in this age group. Considerable advances have been made in characterizing the morphologic subtypes, immunophenotypes, and in vitro behavior of cell lines. However, the cell of origin and its relationship to other related primitive neuroectodermal tumors remains uncertain. Although recent advances in the application of proliferation markers and the use of apoptosis in situ labelling have been applied, a prognostically relevant marker applicable to surgical neuropathology remains to be developed. The fundamental molecular pathogenesis of tumor development remains unknown, although recent exciting advances have shown alterations in some members of the PAX family of genes as well as increased expression of neurotrophin receptors. These may prove to be of prognostic significance.
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Affiliation(s)
- J P Provias
- Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
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