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Modzelewska K, Boer EF, Mosbruger TL, Picard D, Anderson D, Miles RR, Kroll M, Oslund W, Pysher TJ, Schiffman JD, Jensen R, Jette CA, Huang A, Stewart RA. MEK Inhibitors Reverse Growth of Embryonal Brain Tumors Derived from Oligoneural Precursor Cells. Cell Rep 2017; 17:1255-1264. [PMID: 27783941 DOI: 10.1016/j.celrep.2016.09.081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/04/2016] [Accepted: 09/23/2016] [Indexed: 12/18/2022] Open
Abstract
Malignant brain tumors are the leading cause of cancer-related deaths in children. Primitive neuroectodermal tumors of the CNS (CNS-PNETs) are particularly aggressive embryonal tumors of unknown cellular origin. Recent genomic studies have classified CNS-PNETs into molecularly distinct subgroups that promise to improve diagnosis and treatment; however, the lack of cell- or animal-based models for these subgroups prevents testing of rationally designed therapies. Here, we show that a subset of CNS-PNETs co-express oligoneural precursor cell (OPC) markers OLIG2 and SOX10 with coincident activation of the RAS/MAPK (mitogen-activated protein kinase) pathway. Modeling NRAS activation in embryonic OPCs generated malignant brain tumors in zebrafish that closely mimic the human oligoneural/NB-FOXR2 CNS-PNET subgroup by histology and comparative oncogenomics. The zebrafish CNS-PNET model was used to show that MEK inhibitors selectively eliminate Olig2+/Sox10+ CNS-PNET tumors in vivo without impacting normal brain development. Thus, MEK inhibitors represent a promising rationally designed therapy for children afflicted with oligoneural/NB-FOXR2 CNS-PNETs.
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Affiliation(s)
- Katarzyna Modzelewska
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Elena F Boer
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Timothy L Mosbruger
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Daniel Picard
- Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON M4N1X8, Canada
| | - Daniela Anderson
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Rodney R Miles
- Department of Pathology and ARUP Laboratories, University of Utah, 500 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Mitchell Kroll
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - William Oslund
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Theodore J Pysher
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; Primary Children's Hospital/Intermountain Healthcare, Salt Lake City, UT 84113, USA
| | - Joshua D Schiffman
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Randy Jensen
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Cicely A Jette
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Annie Huang
- Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON M4N1X8, Canada
| | - Rodney A Stewart
- Department of Oncological Sciences and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT 84112, USA.
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Rajagopal R, Abd-Ghafar S, Ganesan D, Bustam Mainudin AZ, Wong KT, Ramli N, Jawin V, Lum SH, Yap TY, Bouffet E, Qaddoumi I, Krishnan S, Ariffin H, Abdullah WA. Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia. J Glob Oncol 2016; 3:143-156. [PMID: 28717752 PMCID: PMC5493270 DOI: 10.1200/jgo.2015.002659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Pediatric medulloblastoma (MB) treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographics and outcome of pediatric MB treated at the University Malaya Medical Center between January 1994 and December 2013 and describe the challenges encountered. METHODS Fifty-one patients with childhood MB were seen at University Malaya Medical Center. Data from 43 patients were analyzed; eight patients were excluded because their families refused treatment after surgery. RESULTS Headache and vomiting were the most common presenting symptoms, and the mean interval between symptom onset and diagnosis was 4 weeks. Fourteen patients presented with metastatic disease. Five-year progression-free survival (± SE) for patients ≥ 3 years old was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) in the high-risk group and 68.6% ± 18.6% (95% CI, 40.3% to 100%) in the average-risk group, and 5-year overall survival (± SE) in these two groups was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) and 58.3% ± 18.6% (95% CI, 31.3% to 100%), respectively. Children younger than 3 years old had 5-year progression-free and overall survival rates (± SE) of 47.6% ± 12.1% (95% CI, 28.9% to 78.4%) and 45.6% ± 11.7% (95% CI, 27.6% to 75.5%), respectively. Time to relapse ranged from 4 to 132 months. Most patients who experienced relapse died within 1 year. Febrile neutropenia, hearing loss, and endocrinopathy were the most common treatment-related complications. CONCLUSION The survival rate of childhood MB in Malaysia is inferior to that usually reported in the literature. We postulate that the following factors contribute to this difference: lack of a multidisciplinary neuro-oncology team, limited health care facilities, inconsistent risk assessment, insufficient data in the National Cancer Registry and pathology reports, inadequate long-term follow-up, and cultural beliefs leading to treatment abandonment.
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Affiliation(s)
- Revathi Rajagopal
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Sayyidatul Abd-Ghafar
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Dharmendra Ganesan
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Anita Zarina Bustam Mainudin
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Kum Thong Wong
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Norlisah Ramli
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Vida Jawin
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Su Han Lum
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Tsiao Yi Yap
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Eric Bouffet
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Ibrahim Qaddoumi
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Shekhar Krishnan
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Hany Ariffin
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Wan Ariffin Abdullah
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
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