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Castelli B, Tellini M, Guidi M, Di Nicola M, Giunti L, Buccoliero AM, Censullo ML, Iacono A, Desideri I, Genitori L, Sardi I, Fonte C. Case report: complete long-lasting response to multimodal third line treatment with neurosurgical resection, carmustine wafer implantation and dabrafenib plus trametinib in a BRAFV600E mutated high-grade glioma. Front Oncol 2024; 14:1359093. [PMID: 38774414 PMCID: PMC11106409 DOI: 10.3389/fonc.2024.1359093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/21/2024] [Indexed: 05/24/2024] Open
Abstract
Dabrafenib plus trametinib is a promising new therapy for patients affected by BRAFV600E-mutant glioma, with high overall response and manageable toxicity. We described a complete and long-lasting response in a case of recurrent anaplastic pleomorphic xanthoastrocytoma CNS WHO-grade 3 BRAFV600E mutated. Due to very poor prognosis, there are a few described cases of high-grade glioma (HGG) patients treated with the combined target therapy as third-line treatment. The emergence of optimized sequencing strategies and targeted agents, including multimodal and systemic therapy with dabrafenib plus trametinib, will continue to broaden personalized therapy in HGG improving patient outcomes.
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Affiliation(s)
- Barbara Castelli
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Marco Tellini
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Melina Guidi
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Marco Di Nicola
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Laura Giunti
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | | | | | - Alessandro Iacono
- Radiology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | | | - Lorenzo Genitori
- Neurosurgery Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Iacopo Sardi
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Carla Fonte
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
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Sharma S, Mathur K, Mittal A, Mukta M, Jindal A, Kumar M. Study of Surrogate Immunohistochemical Markers IDH1, ATRX, BRAF V600E, and p53 Mutation in Astrocytic and Oligodendroglial Tumors. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1743265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction In consonance with current the World Health Organization (WHO) classification of the central nervous system (CNS) tumors (2016), histological diagnosis of gliomas should be reinforced by molecular information. This study was performed to determine the frequency of isocitrate dehydrogenase 1 (IDH1), α thalassemia/intellectual disability syndrome X-linked (ATRX), p53, and BRAF V600E mutations in different grade astrocytomas and oligodendrogliomas.
Methods Seventy-seven cases of astrocytoma and oligodendroglioma (7 pilocytic astrocytomas, 15 diffuse astrocytomas [DA], 4 anaplastic astrocytomas [AA], 29 glioblastomas [GBM], and 22 oligodendrogliomas) were analyzed using immunohistochemistry for IDH1 mutant protein, ATRX, p53, and BRAF as well as their clinicopathological features assessed.
Results All pilocytic astrocytoma and primary glioblastoma cases were negative for an IDH1 mutation. IDH1 mutation was detected in 66.7% (10/15) of DA, 50% (2/4) of AA, 20.7% (6/29) of glioblastomas, and 81.8% (18/22) of oligodendroglioma cases. Loss of nuclear ATRX expression was found in 86.7% (13/15), 75% (3/4), and 34.5% (10/29) of DA, AA, and GBM cases, respectively. All oligodendroglioma cases showed retained ATRX expression. Both markers were found statistically significant in the above tumors (p <0.05). BRAF V600E mutation was detected in a single case of pilocytic astrocytoma and pleomorphic xanthoastrocytoma as well as both cases of epithelioid glioblastoma.
Conclusions IDH1 and ATRX mutations are very common in diffuse astrocytoma and anaplastic astrocytoma, while they are rare in pilocytic astrocytoma and glioblastoma. Immunohistochemistry for IDH1 and ATRX can successfully characterize the diffuse gliomas into molecularly defined groups in the majority of the cases. BRAF V600E mutation is rare in astrocytic tumors in the Indian population.
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Affiliation(s)
- Santosh Sharma
- SMS Medical College and Attached Hospital, Jaipur, Rajasthan, India
| | - Kusum Mathur
- SMS Medical College and Attached Hospital, Jaipur, Rajasthan, India
| | - Alka Mittal
- SMS Medical College and Attached Hospital, Jaipur, Rajasthan, India
| | - Meel Mukta
- SMS Medical College and Attached Hospital, Jaipur, Rajasthan, India
| | - Arpita Jindal
- SMS Medical College and Attached Hospital, Jaipur, Rajasthan, India
| | - Mukesh Kumar
- SMS Medical College and Attached Hospital, Jaipur, Rajasthan, India
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Dahmani C, Corre E, Dandou S, Mangé A, Radulescu O, Coopman PJ, Cuq P, Larive RM. La résistance aux inhibiteurs de BRAF. Med Sci (Paris) 2022; 38:570-578. [DOI: 10.1051/medsci/2022083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
La voie de signalisation MAPK/ERK est une voie centrale de la signalisation intracellulaire. Sa dérégulation participe à la transformation et la progression tumorales. Dans plusieurs cancers, la découverte de mutations activatrices de BRAF, à l’origine de l’activation de cette voie, a ouvert de nouvelles perspectives thérapeutiques avec le développement d’inhibiteurs spécifiques de la protéine. Selon les cancers, ces inhibiteurs ont cependant montré soit une efficacité insuffisante, due à la résistance primaire des cellules tumorales, soit une efficacité transitoire, due à l’apparition d’une résistance acquise. Dans cette revue, nous revenons sur les découvertes qui ont conduit au développement de ces inhibiteurs de BRAF. Nous détaillons également les mécanismes moléculaires et cellulaires de la résistance à ces inhibiteurs observée dans différents types de cancers. Comprendre ces mécanismes est en effet primordial pour développer des stratégies thérapeutiques qui soient plus efficaces.
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Barinfeld O, Zahavi A, Weiss S, Toledano H, Michowiz S, Goldenberg-Cohen N. Genetic Alteration Analysis of IDH1, IDH2, CDKN2A, MYB and MYBL1 in Pediatric Low-Grade Gliomas. Front Surg 2022; 9:880048. [PMID: 35574540 PMCID: PMC9096721 DOI: 10.3389/fsurg.2022.880048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate pediatric low-grade gliomas for alterations in IDH1, IDH2, CDKN2A, MYB, and MYBL1. Materials and Methods DNA and RNA were extracted from 62 pediatric gliomas. Molecular methods included PCR, RT-PCR, and RNA sequencing; Sanger sequencing was used for validation. Results Analysis for hotspot genetic alterations in IDH1 R132 and IDH2 R172 (45 and 33 samples) was negative in all cases. CDKN2A deletions were detected in exons 1 and 2 in 1 (pleomorphic xanthoastrocytoma) sample of 9 samples analyzed. Of 10 samples analyzed for MYB translocation, 4 each were positive for translocations with exon 2 and exon 3 of PCDHGA1. Six samples showed MYBL rearrangement. The lack of IDH1/2 genetic alterations is in accordance with the literature in pediatric tumors. Alterations in MYB, MYBL were recently reported to characterize diffuse grade II, but not grade I, gliomas. Conclusion We optimized methods for analyzing gene variations and correlated the findings to pathological grade. The high incidence of MYB and MYBL need further evaluation. We also compared DNA, RNA, and RNA sequencing results for fusion, translocation, and genetic alterations. More accurate identification of the underlying biology of pediatric gliomas has implications for the development of targeted treatment.
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Affiliation(s)
- Orit Barinfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alon Zahavi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Ophthalmology Department, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
| | - Shirel Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Helen Toledano
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Oncology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Shalom Michowiz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurosurgery, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Nitza Goldenberg-Cohen
- The Krieger Eye Research Laboratory, Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Ophthalmology, Bnai-Zion Medical Center of Israel, Haifa, Israel
- Correspondence: Nitza Goldenberg-Cohen
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Clinical and radiological findings of glioblastomas harboring a BRAF V600E mutation. Brain Tumor Pathol 2022; 39:162-170. [PMID: 35362874 DOI: 10.1007/s10014-022-00432-7] [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] [Received: 01/26/2022] [Accepted: 03/27/2022] [Indexed: 11/02/2022]
Abstract
The aim of this study was to analyze the clinical and radiological characteristics of glioblastomas (GBMs) harboring a BRAF mutation. Sequencing analysis of BRAF, IDH1/2, and TERT promoters was performed on GBM samples of patients older than 15 years. The clinical, pathological, and radiological data of patients were retrospectively reviewed. Patients were classified into three groups according to their BRAF and IDH1/2 status: BRAF group, IDH group, and BRAF/IDH-wild-type (WT) group. Among 179 GBM cases, we identified nine cases with a BRAF mutation and nine with IDH mutation. The WT group had 161 cases. Age at onset in the BRAF group was significantly lower compared to the WT group and was similar to the IDH group. In cases with negative IDH1-R132H staining and age < 55 years, 15.2% were BRAF-mutant cases. Similar to the IDH group, overall survival of the BRAF group was significantly longer compared with the WT group. Among nine cases in the BRAF group, three cases had hemorrhagic onset and prior lesions were observed in two cases. In conclusion, age < 55 years, being IDH1-R132H negative, with hemorrhagic onset or the presence of prior lesions are factors that signal recommendation of BRAF analysis for adult GBM patients.
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Predicting BRAF V600E mutation in glioblastoma: utility of radiographic features. Brain Tumor Pathol 2021; 38:228-233. [PMID: 34216310 DOI: 10.1007/s10014-021-00407-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/01/2021] [Indexed: 12/13/2022]
Abstract
Detection of BRAF V600E mutation in glioblastomas (GBMs) is important because of potential therapeutic implications. Still, the relative paucity of these mutations makes molecular detection in all GBMs controversial. In the present study, we analyzed clinical, radiographic and pathologic features of 12 BRAF V600E-mutant GBMs and 12 matched controls from 2 institutions. We found that a majority of BRAF V600E-mutant GBMs displayed a combination of well-circumscribed lesions, large cystic components with thin walls and solid cortical component on MRI, but with some overlap with matched BRAF wildtype controls (p = 0.069). BRAF V600E-mutant GBMs were also apt to gross total resection (83% vs 17%, p = 0.016) and morphologically displayed epithelioid features (83% vs 0%, p < 0.0001). Identification of these clinical, radiographic, and pathologic characteristics should prompt testing for BRAF V600E in IDH-wildtype GBM.
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Acharya S, Liu JF, Tatevossian RG, Chiang J, Qaddoumi I, Gajjar A, Walker D, Harreld JH, Merchant TE, Ellison DW. Risk stratification in pediatric low-grade glioma and glioneuronal tumor treated with radiation therapy: an integrated clinicopathologic and molecular analysis. Neuro Oncol 2021; 22:1203-1213. [PMID: 32052049 DOI: 10.1093/neuonc/noaa031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Management of unresectable pediatric low-grade glioma and glioneuronal tumor (LGG/LGGNT) is controversial. There are no validated prognostic features to guide use of radiation therapy (RT). Our study aimed to identify negative prognostic features in patients treated with RT using clinicopathologic and molecular data and validate these findings in an external dataset. METHODS Children with non-metastatic, biopsy-proven unresectable LGG/LGGNT treated with RT at a single institution between 1997 and 2017 were identified. Recursive partitioning analysis (RPA) was used to stratify patients into low- and high-risk prognostic groups based on overall survival (OS). CNS9702 data were used for validation. RESULTS One hundred and fifty patients met inclusion criteria. Median follow-up was 11.4 years. RPA yielded low- and high-risk groups with 10-year OS of 95.6% versus 76.4% (95% CI: 88.7%-98.4% vs 59.3%-87.1%, P = 0.003), respectively. These risk groups were validated using CNS9702 dataset (n = 48) (4-year OS: low-risk vs high-risk: 100% vs 64%, P < 0.001). High-risk tumors included diffuse astrocytoma or location within thalamus/midbrain. Low-risk tumors included pilocytic astrocytoma/ganglioglioma located outside of the thalamus/midbrain. In the subgroup with known BRAF status (n = 49), risk stratification remained prognostic independently of BRAF alteration (V600E or fusion). Within the high-risk group, delayed RT, defined as RT after at least one line of chemotherapy, was associated with a further decrement in overall survival (P = 0.021). CONCLUSION A high-risk subgroup of patients, defined by diffuse astrocytoma histology or midbrain/thalamus tumor location, have suboptimal long-term survival and might benefit from timely use of RT. These results require validation.
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Affiliation(s)
- Sahaja Acharya
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jo-Fen Liu
- Children's Brain Tumor Research Centre, University of Nottingham, Nottingham, UK
| | - Ruth G Tatevossian
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jason Chiang
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ibrahim Qaddoumi
- Division of Neuro-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amar Gajjar
- Division of Neuro-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David Walker
- Children's Brain Tumor Research Centre, University of Nottingham, Nottingham, UK
| | - Julie H Harreld
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David W Ellison
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Tan JY, Wijesinghe IVS, Alfarizal Kamarudin MN, Parhar I. Paediatric Gliomas: BRAF and Histone H3 as Biomarkers, Therapy and Perspective of Liquid Biopsies. Cancers (Basel) 2021; 13:cancers13040607. [PMID: 33557011 PMCID: PMC7913734 DOI: 10.3390/cancers13040607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Gliomas are major causes of worldwide cancer-associated deaths in children. Generally, paediatric gliomas can be classified into low-grade and high-grade gliomas. They differ significantly from adult gliomas in terms of prevalence, molecular alterations, molecular mechanisms and predominant histological types. The aims of this review article are: (i) to discuss the current updates of biomarkers in paediatric low-grade and high-grade gliomas including their diagnostic and prognostic values, and (ii) to discuss potential targeted therapies in treating paediatric low-grade and high-grade gliomas. Our findings revealed that liquid biopsy is less invasive than tissue biopsy in obtaining the samples for biomarker detections in children. In addition, future clinical trials should consider blood-brain barrier (BBB) penetration of therapeutic drugs in paediatric population. Abstract Paediatric gliomas categorised as low- or high-grade vary markedly from their adult counterparts, and denoted as the second most prevalent childhood cancers after leukaemia. As compared to adult gliomas, the studies of diagnostic and prognostic biomarkers, as well as the development of therapy in paediatric gliomas, are still in their infancy. A body of evidence demonstrates that B-Raf Proto-Oncogene or V-Raf Murine Sarcoma Viral Oncogene Homolog B (BRAF) and histone H3 mutations are valuable biomarkers for paediatric low-grade gliomas (pLGGs) and high-grade gliomas (pHGGs). Various diagnostic methods involving fluorescence in situ hybridisation, whole-genomic sequencing, PCR, next-generation sequencing and NanoString are currently used for detecting BRAF and histone H3 mutations. Additionally, liquid biopsies are gaining popularity as an alternative to tumour materials in detecting these biomarkers, but still, they cannot fully replace solid biopsies due to several limitations. Although histone H3 mutations are reliable prognosis biomarkers in pHGGs, children with these mutations have a dismal prognosis. Conversely, the role of BRAF alterations as prognostic biomarkers in pLGGs is still in doubt due to contradictory findings. The BRAF V600E mutation is seen in the majority of pLGGs (as seen in pleomorphic xanthoastrocytoma and gangliomas). By contrast, the H3K27M mutation is found in the majority of paediatric diffuse intrinsic pontine glioma and other midline gliomas in pHGGs. pLGG patients with a BRAF V600E mutation often have a lower progression-free survival rate in comparison to wild-type pLGGs when treated with conventional therapies. BRAF inhibitors (Dabrafenib and Vemurafenib), however, show higher overall survival and tumour response in BRAF V600E mutated pLGGs than conventional therapies in some studies. To date, targeted therapy and precision medicine are promising avenues for paediatric gliomas with BRAF V600E and diffuse intrinsic pontine glioma with the H3K27M mutations. Given these shortcomings in the current treatments of paediatric gliomas, there is a dire need for novel therapies that yield a better therapeutic response. The present review discusses the diagnostic tools and the perspective of liquid biopsies in the detection of BRAF V600E and H3K27M mutations. An in-depth understanding of these biomarkers and the therapeutics associated with the respective challenges will bridge the gap between paediatric glioma patients and the development of effective therapies.
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Affiliation(s)
| | | | | | - Ishwar Parhar
- Correspondence: ; Tel.: +603-5514-6304; Fax: +603-5515-6341
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Armas Melián K, Delgado López FJ, Medina Imbroda JM, Rodríguez Betancor D, Rodríguez Pons D. Intramedullary spinal cord ganglioglioma: Case report and comparative literature review. Neurocirugia (Astur) 2020; 32:124-133. [PMID: 33092982 DOI: 10.1016/j.neucir.2020.07.005] [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: 12/03/2019] [Revised: 04/20/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intramedullary spinal cord gangliogliomas (ISCGGs) account for 35-40% of all intramedullary tumors in children. These tumors have a different algorithm for treatment and prognosis than other medullary tumors, such as astrocytomas and spinal ependymomas. The objective of the study was to review the literature and examine an approach to diagnosing and treating this tumor based on a case report of ISCGG diagnosed at our center. METHOD An exhaustive review of cases of ISCGG published via the PubMed-NCBI platform between 1911 and 2018 was performed, and each patient's epidemiological characteristics, tumor location, symptoms, radiological diagnosis and treatment were appended. RESULTS A total of 167 cases of ISCGG were found, including our own. In our sample, 52% of patients were female and the most commonly affected age group was 0-9 years of age (35% of patients). Motor deficit has been found to be the main symptom in a larger proportion of adults patients versus pediatric patients. On X-ray, this tumor shows greater hyperintensity and contrast uptake than astrocytomas and ependymomas, as well as a higher percentage of intratumoral cysts. The BRAFV600E mutation is less common in spinal as opposed to supratentorial gangliogliomas. Surgery with complete resection is the treatment of choice. Only 19% of the patients in the sample received radiotherapy, and only 9% received chemotherapy as their only line of treatment. CONCLUSIONS ISCGGs are common in the pediatric population and require strong suspicion for proper diagnosis and treatment, as the risk of recurrence of ISCGGs is 3 times greater than that of supratentorial gangliogliomas.
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Affiliation(s)
- Kevin Armas Melián
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Francisco José Delgado López
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España
| | - Juan Manuel Medina Imbroda
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España
| | - Dailos Rodríguez Betancor
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España
| | - Daniel Rodríguez Pons
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España
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Detection of BRAF V600E Mutation in Ganglioglioma and Pilocytic Astrocytoma by Immunohistochemistry and Real-Time PCR-Based Idylla Test. DISEASE MARKERS 2020; 2020:8880548. [PMID: 32879641 PMCID: PMC7448243 DOI: 10.1155/2020/8880548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/21/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022]
Abstract
The BRAF V600E mutation is an important oncological target in certain central nervous system (CNS) tumors, for which a possible application of BRAF-targeted therapy grows continuously. In the present study, we aim to determine the prevalence of BRAF V600E mutations in a series of ganglioglioma (GG) and pilocytic astrocytoma (PA) cases. Simultaneously, we decided to verify whether the combination of fully automated tests—BRAF-VE1 immunohistochemistry (IHC) and Idylla BRAF mutation assay—may be useful to accurately predict it in the case of specified CNS tumors. The study included 49 formalin-fixed, paraffin-embedded tissues, of which 15 were GG and 34 PA. Immunohistochemistry with anti-BRAF V600E (VE1) antibody was performed on tissue sections using the VentanaBenchMark ULTRA platform. All positive or equivocal cases on IHC and selected negative ones were further assessed using the Idylla BRAF mutation assay coupled with the Idylla platform. The BRAF-VE1 IHC was positive in 6 (6/49; 12.3%) and negative in 39 samples (39/49; 79.6%). The interpretation of immunostaining results was complicated in 4 cases, of which 1 tested positive for the Idylla BRAF mutation assay. Therefore, the overall positivity rate was 14.3%. This included 2 cases of GG and 5 cases of PA. Our study found that BRAF V600E mutations are moderately frequent in PA and GG and that for these tumor entities, IHC VE1 is suitable for screening purposes, but all negative, equivocal, and weak positive cases should be further tested with molecular biology techniques, of which the Idylla system seems to be a promising tool.
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Hennani S, Dehbi H, Nadifi S, Karkouri M. Detection of KIAA1549/BRAF fusion in Moroccan patients with Pediatric Low-Grade Gliomas. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mustansir F, Mushtaq N, Darbar A. Dabrafenib in BRAFV600E mutant pilocytic astrocytoma in a pediatric patient. Childs Nerv Syst 2020; 36:203-207. [PMID: 31418082 DOI: 10.1007/s00381-019-04346-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/07/2019] [Indexed: 11/29/2022]
Abstract
Pilocytic astrocytomas (PAs) are the most common pediatric central nervous system tumors. They constitute around 30% of all primary central nervous tumors in the pediatric age group. Their clinical behavior may vary but most of them are indolent and do not undergo malignant transformations compared with their adult counterparts. PAs are primarily treated with surgery and in cases of progression; chemotherapy may be needed. They usually carry a good prognosis, with a 10-year survival rate of 90%. BRAFV600E mutations have been identified in approximately 9-15% of patients with PA. These relatively high mutation frequencies in PA open avenues for treatment using targeted therapies such as BRAFV600E inhibitors (e.g., dabrafenib). There have been a few published case reports and case series showing clinical benefits with BRAF inhibitors in BRAF-positive tumors. We report a case of successful treatment of BRAFV600E immunopositive optic pathway PA in a child with dabrafenib.
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Affiliation(s)
- F Mustansir
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan.
| | - N Mushtaq
- Department of Pediatrics, The Aga Khan University, Karachi, Sindh, Pakistan
| | - A Darbar
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
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Fearon C, Loftus T, Byrne AL, Heffernan J, Cooney M, Heeney C, Walsh A, Lorigan J, Beausang A, Cryan J, Farrell M, Brett F. Impact of the 2016 World Health Organization Classification of Tumours of the Central Nervous System: an Irish experience. Ir J Med Sci 2019; 189:799-803. [PMID: 31797204 DOI: 10.1007/s11845-019-02144-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/15/2019] [Indexed: 01/26/2023]
Abstract
The 2016 World Health Organization Classification of Tumours of the Central Nervous System Tumours represents the most significant update to neuro-oncological tumour classification to date, compared with previous updates. This update reflects the substantial advances in molecular and genetic understanding of both adult and childhood brain tumours which have occurred in recent years. These advances have meant that an increasing array of molecular tests are required to definitively classify a tumour, allowing for a more precise integrated pathological diagnosis, but at the expense of a more challenging pathology workup. We review the changes incorporated into the 2016 classification and describe the impact of these changes in an Irish neuropathology laboratory.
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Affiliation(s)
- Conor Fearon
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Teresa Loftus
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Amber Lynn Byrne
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | | | - Maeve Cooney
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Ciara Heeney
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Andrea Walsh
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Jennifer Lorigan
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Alan Beausang
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Jane Cryan
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Michael Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Francesca Brett
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland.
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14
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Kurani H, Gurav M, Shetty O, Chinnaswamy G, Moiyadi A, Gupta T, Jalali R, Epari S. Pilocytic astrocytomas: BRAFV600E and BRAF fusion expression patterns in pediatric and adult age groups. Childs Nerv Syst 2019; 35:1525-1536. [PMID: 31321520 DOI: 10.1007/s00381-019-04282-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Pilocytic astrocytomas (PCAs) are characterized by two dominant molecular alterations of the BRAF gene, i.e., BRAFV600E mutation and KIAA1549-BRAF fusions which show a differential pattern of frequency across different age-groups. METHODS Formalin-fixed paraffin-embedded tissues of 358 (pediatric 276 and adult 82) consecutive PCAs were evaluated for BRAFV600E mutation by Sanger sequencing and KIAA1549:BRAF fusion transcripts (KIAA1549:BRAF 16-9, KIAA1549:BRAF 15-9, and KIAA1549:BRAF 16-11) by reverse transcriptase polymerase chain reaction, which were correlated with different clinicopathological features. RESULTS BRAFV600E mutation was detected in 8.9% pediatric and 9.75% adult PCAs, whereas 41.1% and 25.7% of pediatric and adult cases showed KIAA1549-BRAF fusions respectively. BRAFV600E did not show any statistically significant correlation with any of the clinical parameters (age, location, and gender). KIAA1549:BRAF fusions showed a significant statistical association with the pediatric age group and cerebellar location. KIAA1549-BRAF 16-9 was the commonest variant and was predominantly associated with cerebellar location than non-cerebellar whereas fusion variant 15-9 negatively correlated with cerebellar locations. CONCLUSIONS The present study showed overall frequency of 53.5% and 37.3% BRAF alterations in pediatric and adult PCA cases respectively. BRAF fusion in PCA cases showed a different distribution pattern across age groups and locations; while no such differential pattern was observed for BRAFV600E.
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Affiliation(s)
- Hetakshi Kurani
- Division of Molecular Pathology, Department of Pathology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India
| | - Mamta Gurav
- Division of Molecular Pathology, Department of Pathology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India
| | - Omshree Shetty
- Division of Molecular Pathology, Department of Pathology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India
| | - Aliasagar Moiyadi
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Hospital and ACTREC, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India
| | - Sridhar Epari
- Division of Molecular Pathology, Department of Pathology, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India.
- Department of Pathology (& Division of Molecular Pathology), Tata Memorial Hospital and ACTREC, Tata Memorial Centre, Homi Baba National Institute, Mumbai, 400012, India.
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15
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Kristensen BW, Priesterbach-Ackley LP, Petersen JK, Wesseling P. Molecular pathology of tumors of the central nervous system. Ann Oncol 2019; 30:1265-1278. [PMID: 31124566 PMCID: PMC6683853 DOI: 10.1093/annonc/mdz164] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Since the update of the 4th edition of the WHO Classification of Central Nervous System (CNS) Tumors published in 2016, particular molecular characteristics are part of the definition of a subset of these neoplasms. This combined 'histo-molecular' approach allows for a much more precise diagnosis of especially diffuse gliomas and embryonal CNS tumors. This review provides an update of the most important diagnostic and prognostic markers for state-of-the-art diagnosis of primary CNS tumors. Defining molecular markers for diffuse gliomas are IDH1/IDH2 mutations, 1p/19q codeletion and mutations in histone H3 genes. Medulloblastomas, the most frequent embryonal CNS tumors, are divided into four molecularly defined groups according to the WHO 2016 Classification: wingless/integrated (WNT) signaling pathway activated, sonic hedgehog (SHH) signaling pathway activated and tumor protein p53 gene (TP53)-mutant, SHH-activated and TP53-wildtype, and non-WNT/non-SHH-activated. Molecular characteristics are also important for the diagnosis of several other CNS tumors, such as RELA fusion-positive subtype of ependymoma, atypical teratoid rhabdoid tumor (AT/RT), embryonal tumor with multilayered rosettes, and solitary fibrous tumor/hemangiopericytoma. Immunohistochemistry is a helpful alternative for further molecular characterization of several of these tumors. Additionally, genome-wide methylation profiling is a very promising new tool in CNS tumor diagnostics. Much progress has thus been made by translating the most relevant molecular knowledge into a more precise clinical diagnosis of CNS tumors. Hopefully, this will enable more specific and more effective therapeutic approaches for the patients suffering from these tumors.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Brain/pathology
- Brain Neoplasms/diagnosis
- Brain Neoplasms/drug therapy
- Brain Neoplasms/genetics
- Brain Neoplasms/mortality
- DNA Methylation
- Drug Resistance, Neoplasm/genetics
- Gene Expression Regulation, Neoplastic/drug effects
- Glioma/diagnosis
- Glioma/drug therapy
- Glioma/genetics
- Glioma/mortality
- Humans
- Immunohistochemistry
- Molecular Targeted Therapy/methods
- Mutation
- Neoplasms, Germ Cell and Embryonal/diagnosis
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Germ Cell and Embryonal/genetics
- Neoplasms, Germ Cell and Embryonal/mortality
- Prognosis
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- B W Kristensen
- Department of Pathology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | | | - J K Petersen
- Department of Pathology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P Wesseling
- Department of Pathology, University Medical Center Utrecht, Utrecht; Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pathology, Amsterdam University Medical Centers/VU Medical Center, Amsterdam, The Netherlands.
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16
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Toll SA, Tran HN, Cotter J, Judkins AR, Tamrazi B, Biegel JA, Dhall G, Robison NJ, Waters K, Patel P, Cooper R, Margol AS. Sustained response of three pediatric BRAF V600E mutated high-grade gliomas to combined BRAF and MEK inhibitor therapy. Oncotarget 2019; 10:551-557. [PMID: 30728904 PMCID: PMC6355184 DOI: 10.18632/oncotarget.26560] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/27/2018] [Indexed: 01/07/2023] Open
Abstract
Outcomes for children with high-grade gliomas (HGG) remain dismal despite aggressive treatment strategies. The use of targeted therapy for BRAFV600E mutated malignancies including HGG is being explored as a potentially well tolerated and effective therapeutic option. The results of adult melanoma studies demonstrating that combination therapy with BRAF inhibitors and MEK inhibitors results in prolonged survival led us to employ this treatment strategy in children with BRAFV600E mutated HGG. In this case series, we describe three pediatric patients with HGG with confirmed BRAFV600E mutation who demonstrated responses to combination therapy with dabrafenib and trametinib.
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Affiliation(s)
- Stephanie A Toll
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Hung N Tran
- Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Jennifer Cotter
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexander R Judkins
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Benita Tamrazi
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Radiology and Imaging, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaclyn A Biegel
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Girish Dhall
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Nathan J Robison
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kaaren Waters
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Palak Patel
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Robert Cooper
- Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Ashley S Margol
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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17
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Choi E, Kim SI, Won JK, Chung CK, Kim SK, Choi SH, Choi S, Han B, Ahn B, Im SW, Park SH. Clinicopathological and molecular analysis of multinodular and vacuolating neuronal tumors of the cerebrum. Hum Pathol 2018; 86:203-212. [PMID: 30550736 DOI: 10.1016/j.humpath.2018.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022]
Abstract
Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a recently recognized rare neuronal tumor, and its pathogenesis is unclear. We analyzed 7 cases of histologically typical MVNT: 6 were adults (mean age, 43.0 years [range, 23-56 years]) and 1 was a child (age, 10 years). The most common symptoms were seizures (n = 4) and headache (n = 2). The tumors were supratentorial (temporal, 5; frontal lobes, 2) in origin as reported. Vacuolated tumor cells were robustly positive for α-INA and Olig2 and at least partly positive for synaptophysin and MAP2, but negative for Neu-N, nestin and CD34. GFAP and vimentin were expressed in reactive astrocytes but not in tumor cells. Negative results were obtained for p53, IDH-1, BRAFV600E, H3 K27M, EGFR, Lin28A, and L1CAM. ATRX, BRG1, INI-1, and TMHH were retained. The Ki-67 labeling index was very low (<1%), and pHH3 revealed no mitotic figure. Ultrastructural features of tumor cells were comparable with those of immature neuronal cells, with several intracytoplasmic myelin-like autophagosomes and pericellular vacuolization. No IDH1/IDH2 and BRAFV600E mutations were found upon direct sequencing. Whole-exome sequencing revealed FGFR2-ZMYND11 gene fusion in 1 case. After gross total resection, all patients were alive without seizures. There was no tumor recurrence during an average period of 68 months (range, 23-101 months). The analysis of 7 typical cases of MVNT suggested that these lesions may be clonal tumors because FGFR2-ZMYND11 fusion was found (1 case).
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Affiliation(s)
- Euno Choi
- Department of Pathology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seonk-Ik Kim
- Department of Pathology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jae-Kyung Won
- Department of Pathology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seung Ki Kim
- Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seung-Hong Choi
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seongmin Choi
- Division of Clinical Bioinformatics, Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Bome Han
- Department of Bioinformatics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Bokyung Ahn
- Department of Pathology, Korea University Hospital, College of Medicine, Seoul 02842, Republic of Korea
| | - Sun-Wha Im
- Department of Biochemistry, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, Republic of Korea; Institute of Neuroscience, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
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18
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Sexton-Oates A, Dodgshun A, Hovestadt V, Jones DTW, Ashley DM, Sullivan M, MacGregor D, Saffery R. Methylation profiling of paediatric pilocytic astrocytoma reveals variants specifically associated with tumour location and predictive of recurrence. Mol Oncol 2018; 12:1219-1232. [PMID: 28388012 PMCID: PMC6068350 DOI: 10.1002/1878-0261.12062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/31/2022] Open
Abstract
Childhood pilocytic astrocytomas (PA) are low-grade tumours with an excellent prognosis. However, a minority, particularly those in surgically inaccessible locations, have poorer long-term outcome. At present, it is unclear whether anatomical location in isolation, or in combination with underlying biological variation, determines clinical behaviour. Here, we have tested the utility of DNA methylation profiling to inform tumour biology and to predict behaviour in paediatric PA. Genome-wide DNA methylation profiles were generated for 117 paediatric PAs. Using a combination of analyses, we identified DNA methylation variants specific to tumour location and predictive of behaviour. Receiver-operating characteristic analysis was used to test the predictive utility of clinical and/or DNA methylation features to classify tumour behaviour at diagnosis. Unsupervised analysis distinguished three methylation clusters associated with tumour location (cortical, midline and infratentorial). Differential methylation of 5404 sites identified enrichment of genes involved in 'embryonic nervous system development'. Specific hypermethylation of NEUROG1 and NR2E1 was identified as a feature of cortical tumours. A highly accurate method to classify tumours according to behaviour, which combined three clinical features (age, location and extent of resection) and methylation level at a single site, was identified. Our findings show location-specific epigenetic profiles for PAs, potentially reflecting their cell type of origin. This may account for differences in clinical behaviour according to location independent of histopathology. We also defined an accurate method to predict tumour behaviour at diagnosis. This warrants further testing in similar patient cohorts.
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Affiliation(s)
- Alexandra Sexton-Oates
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Andrew Dodgshun
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - David M Ashley
- School of Medicine, Deakin University, Waurn Ponds, Australia
| | - Michael Sullivan
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Children's Cancer Centre, The Royal Children's Hospital, Parkville, Australia
| | - Duncan MacGregor
- Department of Anatomical Pathology, The Royal Children's Hospital, Parkville, Australia.,Department of Pathology, The University of Melbourne, Parkville, Australia
| | - Richard Saffery
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
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19
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Li YX, Aibaidula A, Shi Z, Chen H, Li KKW, Chung NYF, Yang RR, Chan DTM, Poon WS, Lee KLR, Mao Y, Wu J, Chan AKY, Zhou L, Ng HK. Oligodendrogliomas in pediatric and teenage patients only rarely exhibit molecular markers and patients have excellent survivals. J Neurooncol 2018; 139:307-322. [DOI: 10.1007/s11060-018-2890-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
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20
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Chatterjee D, Radotra BD, Kumar N, Vasishta RK, Gupta SK. IDH1, ATRX, and BRAFV600E mutation in astrocytic tumors and their significance in patient outcome in north Indian population. Surg Neurol Int 2018. [PMID: 29527387 PMCID: PMC5838837 DOI: 10.4103/sni.sni_284_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: According to the current World Health Organization (WHO) classification of central nervous system (CNS) tumors (2016), histological diagnosis of gliomas should be supplemented by molecular information. This study was carried out to determine the frequency of isocitrate dehydrogenase 1 (IDH1), ATRX, and BRAF V600E mutations in different grade astrocytomas and their prognostic value. Methods: Eighty cases of astrocytoma (15 pilocytic astrocytoma, 25 diffuse astrocytoma, 15 anaplastic astrocytoma, and 25 glioblastoma) with follow-up information were analyzed using immunohistochemistry for IDH1 mutant protein, ATRX, p53, and BRAF. Sanger sequencing was carried out for IDH1 exon 4 and BRAF exon 15. Results: All pilocytic astrocytoma and primary glioblastoma cases were negative for IDH1 mutation. IDH1 mutation was detected in 80% (20/25) DA and 87% (13/15) AA cases. IDH1 R132H was the commonest IDH1 mutation (94.1%) and immunohistochemistry showed 100% sensitivity and specificity to detect this mutation. Loss of nuclear ATRX expression was found in 87% (20/23) and 100% (14/14) DA and AA cases, respectively. IDH1 mutant DA patients had longer overall survival than IDH1 wild cases, although this difference was not significant (79.5 months vs. 42.5 months, P value 0.417). BRAF V600E mutation was not detected in any astrocytic tumor. Conclusions: IDH1 and ATRX mutations are very common in diffuse astrocytoma and anaplastic astrocytoma, while they are rare in pilocytic astrocytoma and glioblastoma. Immunohistochemistry for IDH1 and ATRX can successfully characterize the diffuse gliomas into molecularly defined groups in majority of the cases. BRAF V600E mutation is rare in astrocytic tumors in Indian population.
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Affiliation(s)
- Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bishan Dass Radotra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kumar Vasishta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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21
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Abstract
Recent genome-wide studies of malignancies of the central nervous system (CNS) have revolutionized our understanding of the biology of these tumors. This newly gained knowledge provides a wealth of opportunity for biomarker driven clinical research. To date, however, only few of the available molecular markers truly influence clinical decision-making and treatment. The most widely validated markers in neuro-oncology presently are: 1) MGMT promoter methylation as a prognostic and predictive marker in glioblastoma, 2) co-deletion of 1p and 19q differentiating oligodendrogliomas from astrocytomas, 3) IDH1/2 mutations, and 4) select pathway-associated mutations. This article focuses on currently impactful biomarkers in adult and pediatric brain cancers and it provides a perspective on the direction of research in this field.
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22
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Ishi Y, Hatanaka KC, Yamaguchi S, Fujita H, Motegi H, Kobayashi H, Terasaka S, Houkin K. Diencephalic pediatric low-grade glioma harboring the BRAF V600E mutation presenting with various morphologies in sequential biopsy specimens. Brain Tumor Pathol 2017; 34:165-171. [DOI: 10.1007/s10014-017-0298-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 08/16/2017] [Indexed: 01/24/2023]
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23
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Pathak P, Kumar A, Jha P, Purkait S, Faruq M, Suri A, Suri V, Sharma MC, Sarkar C. Genetic alterations related to BRAF-FGFR genes and dysregulated MAPK/ERK/mTOR signaling in adult pilocytic astrocytoma. Brain Pathol 2017; 27:580-589. [PMID: 27608415 DOI: 10.1111/bpa.12444] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/05/2016] [Indexed: 01/05/2023] Open
Abstract
Pilocytic astrocytomas occur rarely in adults and show aggressive tumor behavior. However, their underlying molecular-genetic events are largely uncharacterized. Hence, 59 adult pilocytic astrocytoma (APA) cases of classical histology were studied (MIB-1 LI: 1%-5%). Analysis of BRAF alterations using qRT-PCR, confirmed KIAA1549-BRAF fusion in 11 (19%) and BRAF-gain in 2 (3.4%) cases. BRAF-V600E mutation was noted in 1 (1.7%) case by sequencing. FGFR1-mutation and FGFR-TKD duplication were seen in 7/59 (11.9%) and 3/59 (5%) cases, respectively. Overall 36% of APAs harbored BRAF and/or FGFR genetic alterations. Notably, FGFR related genetic alterations were enriched in tumors of supratentorial region (8/25, 32%) as compared with other locations (P = 0.01). The difference in age of cases with FGFR1-mutation (Mean age ± SD: 37.2 ± 15 years) vs. KIAA1549-BRAF fusion (Mean age ± SD: 25.1 ± 4.1 years) was statistically significant (P = 0.03). Combined BRAF and FGFR alterations were identified in 3 (5%) cases. Notably, the cases with more than one genetic alteration were in higher age group (Mean age ± SD: 50 ± 12 years) as compared with cases with single genetic alteration (Mean age ± SD: 29 ± 10; P = 0.003). Immunopositivity of p-MAPK/p-MEK1 was found in all the cases examined. The pS6-immunoreactivity, a marker of mTOR activation was observed in 34/39 (87%) cases. Interestingly, cases with BRAF and/or FGFR related alteration showed significantly lower pS6-immunostatining (3/12; 25%) as compared with those with wild-type BRAF and/or FGFR (16/27; 59%) (P = 0.04). Further, analysis of seven IDH wild-type adult diffuse astrocytomas (DA) showed FGFR related genetic alterations in 43% cases. These and previous results suggest that APAs are genetically similar to IDH wild-type adult DAs. APAs harbor infrequent BRAF alterations but more frequent FGFR alterations as compared with pediatric cases. KIAA1549-BRAF fusion inversely correlates with increasing age whereas FGFR1-mutation associates with older age. Activation of MAPK/ERK/mTOR signaling appears to be an important oncogenic event in APAs and may be underlying event of aggressive tumor behavior. The findings provided a rationale for potential therapeutic advantage of targeting MAPK/ERK/mTOR pathway in APAs.
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Affiliation(s)
- Pankaj Pathak
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prerana Jha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Suvendu Purkait
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine, Council of Scientific and Industrial Research - Institute of Genomics and Integrative Biology (CSIR- IGIB), New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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24
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Zanello M, Pages M, Tauziède-Espariat A, Saffroy R, Puget S, Lacroix L, Dezamis E, Devaux B, Chrétien F, Andreiuolo F, Sainte-Rose C, Zerah M, Dhermain F, Dumont S, Louvel G, Meder JF, Grill J, Dufour C, Pallud J, Varlet P. Clinical, Imaging, Histopathological and Molecular Characterization of Anaplastic Ganglioglioma. J Neuropathol Exp Neurol 2016; 75:971-980. [PMID: 27539475 DOI: 10.1093/jnen/nlw074] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Anaplastic ganglioglioma (AGG) is a rare and malignant variant of ganglioglioma. According to the World Health Organization classification version 2016, their histopathological grading criteria are still ill-defined. The aim of the present study was to assess the clinical, imaging, histopathological, and molecular characteristics and outcomes of AGGs in a large consecutive and retrospective adult and pediatric case series. Eighteen patients with AGGs (13 adults and 5 children) were identified (14 de novo and 4 secondary) from a cohort of 222 gangliogliomas (GG) (8%) treated at our institution between 2000 and 2015. AGGs represented a very aggressive disease with poor outcome (median progression-free survival, 10 months; median overall survival, 27 months). They were located in the temporal lobe only in 22% and presented with seizures (44%) or increased intracranial pressure (44%) at diagnosis. Concerning histopathological and molecular data, they shared morphological characteristics and BRAF V600E mutation (39%) with their benign counterparts but also showed hTERT promoter mutation (61%), p53 accumulation (39%), ATRX loss (17%), or p.K27M H3F3A mutation (17%). AGGs are malignant neoplasms requiring aggressive oncological treatment. In the perspective of targeted therapies, AGGs should be screened for BRAF V600E, hTERT, ATRX, and mutations of histone genes.
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Affiliation(s)
- Marc Zanello
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Mélanie Pages
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Arnault Tauziède-Espariat
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Raphael Saffroy
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Stéphanie Puget
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Ludovic Lacroix
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Edouard Dezamis
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Bertrand Devaux
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Fabrice Chrétien
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Felipe Andreiuolo
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Christian Sainte-Rose
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Michel Zerah
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Frédéric Dhermain
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Sarah Dumont
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Guillaume Louvel
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Jean-François Meder
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Jacques Grill
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Christelle Dufour
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Johan Pallud
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Pascale Varlet
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
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25
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Affiliation(s)
- Timothy P. Heffron
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
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26
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Brokinkel B, Peetz-Dienhart S, Ligges S, Brentrup A, Stummer W, Paulus W, Hasselblatt M. A comparative analysis of MAPK pathway hallmark alterations in pilocytic astrocytomas: age-related and mutually exclusive. [corrected]. Neuropathol Appl Neurobiol 2015; 41:258-61. [PMID: 24750136 DOI: 10.1111/nan.12145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/26/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany; Institute of Neuropathology, University Hospital Münster, Münster, Germany
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27
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Abstract
Thirteen adult patients with temozolomide, surgery and radiation refractory ganglioglioma were screened for the BRAF V600E mutation. Three (23%) were found positive for the presence of the BRAF mutation and were treated with the BRAF inhibitor dabrafenib. Dabrafenib was well tolerated with no grade 3 or higher toxicity. The median number of cycles was 7 (a cycle was defined as 1 month of daily dabrafenib) and best response was stable disease in two patients and a partial response in one patient. Median progression-free survival was 7 months with a range of 4-10 months.
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Affiliation(s)
- Marc C Chamberlain
- Department of Neurology/Division of Neuro-Oncology, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, 825 Eastlake Avenue E, POB 19023, MS G4940, Seattle, WA 98109-1023, USA
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28
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Preusser M, Bienkowski M, Birner P. BRAF inhibitors in BRAF-V600 mutated primary neuroepithelial brain tumors. Expert Opin Investig Drugs 2015; 25:7-14. [PMID: 26536389 DOI: 10.1517/13543784.2016.1110143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Primary neuroepithelial brain tumors encompass a wide variety of glial and glioneuronal neoplasms. Malignant tumors, tumors located in surgically inaccessible locations (e.g., eloquent brain areas, deep structures, brain stem) and recurrent or progressive tumors pose considerable treatment challenges and are candidates for novel therapeutics based on molecular insights. Small kinase inhibitors of v-RAF murine sarcoma viral oncogene homologue B1 (BRAF) have shown considerable antineoplastic activity in some tumor types harboring activating BRAF-V600 mutations (e.g., melanoma) and promising data are emerging on BRAF inhibitor therapy of mutation-bearing primary brain tumors. AREAS COVERED This review summarizes the available data on BRAF-V600 point mutations and the antineoplastic activity and toxicity profiles of BRAF inhibitors in neuroepithelial brain tumors including diffuse gliomas (glioblastomas, astrocytomas, oligodendrogliomas), pilocytic astrocytomas, pleomorphic xanthoastrocytomas and gangliogliomas. EXPERT OPINION Activating BRAF-V600 mutations are recurrently found in several glial and glioneuronal brain tumors and the available data indicate that BRAF inhibitors are active and well-tolerated in such tumors. Thus, BRAF inhibitors represent a novel and promising therapeutic opportunity that may alter the disease course of molecularly selected CNS neoplasms in a clinically meaningful way. However, so far the evidence is anecdotal and prospective clinical studies should be conducted.
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Affiliation(s)
- Matthias Preusser
- a Department of Medicine I , Medical University of Vienna , Vienna , Austria.,b Comprehensive Cancer Center Vienna, CNS Unit , Medical University of Vienna , Vienna , Austria
| | - Michal Bienkowski
- c Institute of Neurology , Medical University of Vienna , Vienna , Austria.,d Department of Molecular Pathology and Neuropathology , Medical University of Lodz , Lodz , Poland
| | - Peter Birner
- b Comprehensive Cancer Center Vienna, CNS Unit , Medical University of Vienna , Vienna , Austria.,e Department of Pathology , Medical University of Vienna , Waehringer Guertel 18-20, 1090 Vienna , Austria
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29
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Gessi M, Dörner E, Dreschmann V, Antonelli M, Waha A, Giangaspero F, Gnekow A, Pietsch T. Intramedullary gangliogliomas: histopathologic and molecular features of 25 cases. Hum Pathol 2015; 49:107-13. [PMID: 26826417 DOI: 10.1016/j.humpath.2015.09.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/24/2015] [Accepted: 09/26/2015] [Indexed: 11/17/2022]
Abstract
Gangliogliomas are uncommon glioneuronal tumors, which usually arise in the cerebral hemispheres and occasionally in the brain stem. Gangliogliomas occurring in the spinal cord are extremely rare. In this study, we analyzed the clinical, histopathologic, and molecular features of 25 spinal gangliogliomas. The cases included in our series affected mostly children and young adults (15 males and 10 females; mean age, 20 years; median age, 14 years; age range, 1-72 years) and were predominantly localized in the cervical and thoracic spine. From the clinical point of view (detailed follow-up available for 9 pediatric cases; mean follow-up: 2 years 10 months; range, 3 months to 5 years 10 months), most patients showed stable disease after subtotal resection. Radiotherapy was rarely used as adjuvant treatment. Histologically, gangliogliomas (WHO grade I) (21 cases) showed features largely similar to their supratentorial counterparts. Anaplastic gangliogliomas (World Health Organization grade III) (4 cases) showed features of anaplasia (including high cellularity and increased mitotic and proliferation activity). From a molecular point of view, only 2 tumors (2/19, 11%) harbored a BRAF(V600E) mutation. In conclusion, although spinal gangliogliomas display histologic and clinical features similar to their supratentorial counterparts, they show a relatively low frequency of BRAF(V600E) mutations, alteration otherwise common in hemispheric and brain stem gangliogliomas.
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Affiliation(s)
- Marco Gessi
- Institute of Neuropathology, University of Bonn Medical Center, 53105 Bonn, Germany.
| | - Evelyn Dörner
- Institute of Neuropathology, University of Bonn Medical Center, 53105 Bonn, Germany
| | - Verena Dreschmann
- Institute of Neuropathology, University of Bonn Medical Center, 53105 Bonn, Germany
| | - Manila Antonelli
- Department of Radiological Oncological and Anatomo-Pathological Sciences, University of Rome-"La Sapienza", 00164 Rome, Italy
| | - Andreas Waha
- Institute of Neuropathology, University of Bonn Medical Center, 53105 Bonn, Germany
| | - Felice Giangaspero
- Department of Radiological Oncological and Anatomo-Pathological Sciences, University of Rome-"La Sapienza", 00164 Rome, Italy; IRCCS Neuromed, 86077 Pozzilli (IS), Italy
| | - Astrid Gnekow
- Department of Pediatric Oncology, Klinikum Augsburg, 86156 Augsburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn Medical Center, 53105 Bonn, Germany
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30
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Suzuki Y, Takahashi-Fujigasaki J, Akasaki Y, Matsushima S, Mori R, Karagiozov K, Joki T, Ikeuchi S, Ikegami M, Manome Y, Murayama Y. BRAF V600E-mutated diffuse glioma in an adult patient: a case report and review. Brain Tumor Pathol 2015; 33:40-9. [PMID: 26445861 DOI: 10.1007/s10014-015-0234-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/24/2015] [Indexed: 11/30/2022]
Abstract
Recent advances in genomic technology and genome-wide analysis have identified key molecular alterations that are relevant to the diagnosis and prognosis of brain tumors. Molecular information such as mutations in isocitrate dehydrogenase (IDH) genes or 1p/19q co-deletion status will be more actively incorporated into the histological classification of diffuse gliomas. BRAF V600E mutations are found frequently in circumscribed low-grade gliomas such as pleomorphic xanthoastrocytoma (PXA) and extra-cerebellar pilocytic astrocytoma, or epithelioid glioblastomas (E-GBM), a rare variant of GBM. This mutation is relatively rare in other types of diffuse gliomas, especially in adult onset cases. Here, we present an adult onset case of IDH wild-type/BRAF V600E-mutated diffuse glioma, evolving from grade III to grade IV. The tumor displayed atypical exophytic growth and had unusual histological features not fully compatible with, but indicative of PXA and E-GBM. We discuss differential diagnosis of the tumor, and review previously described diffuse gliomas with the BRAF V600E mutation.
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Affiliation(s)
- Yuta Suzuki
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Junko Takahashi-Fujigasaki
- Department of Neuropathology, Brain Bank for Aging Research, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Yasuharu Akasaki
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Matsushima
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryosuke Mori
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsuhiro Joki
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Ikeuchi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshinobu Manome
- Division of Molecular Cell Biology, Core Research Facilities for Basic Science, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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31
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Dasgupta T, Olow AK, Yang X, Hashizume R, Nicolaides TP, Tom M, Aoki Y, Berger MS, Weiss WA, Stalpers LJA, Prados M, James CD, Mueller S, Haas-Kogan DA. Survival advantage combining a BRAF inhibitor and radiation in BRAF V600E-mutant glioma. J Neurooncol 2015; 126:385-93. [PMID: 26384810 DOI: 10.1007/s11060-015-1939-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/12/2015] [Indexed: 01/05/2023]
Abstract
Radiation (RT) is critical to the treatment of high-grade gliomas (HGGs) but cures remain elusive. The BRAF mutation V600E is critical to the pathogenesis of 10-20% of pediatric gliomas, and a small proportion of adult HGGs. Here we aim to determine whether PLX4720, a specific BRAF V600E inhibitor, enhances the activity of RT in human HGGs in vitro and in vivo. Patient-derived HGG lines harboring wild-type BRAF or BRAF V600E were assessed in vitro to determine IC50 values, cell cycle arrest, apoptosis and senescence and elucidate mechanisms of combinatorial activity. A BRAF V600E HGG intracranial xenograft mouse model was used to evaluate in vivo combinatorial efficacy of PLX4720+RT. Tumors were harvested for immunohistochemistry to quantify cell cycle arrest and apoptosis. RT+PLX4720 exhibited greater anti-tumor effects than either monotherapy in BRAF V600E but not in BRAF WT lines. In vitro studies showed increased Annexin V and decreased S phase cells in BRAF V600E gliomas treated with PLX4720+RT, but no significant changes in β-galactosidase levels. In vivo, concurrent and sequential PLX4720+RT each significantly prolonged survival compared to monotherapies, in the BRAF V600E HGG model. Immunohistochemistry of in vivo tumors demonstrated that PLX4720+RT decreased Ki-67 and phospho-MAPK, and increased γH2AX and p21 compared to control mice. BRAF V600E inhibition enhances radiation-induced cytotoxicity in BRAF V600E-mutated HGGs, in vitro and in vivo, effects likely mediated by apoptosis and cell cycle, but not senescence. These studies provide the pre-clinical rationale for clinical trials of concurrent radiotherapy and BRAF V600E inhibitors.
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Affiliation(s)
- Tina Dasgupta
- Valley Radiotherapy Associates, 1500 Rosecrans Avenue, Manhattan Beach, CA, 90266, USA.
| | - Aleksandra K Olow
- Department of Laboratory Medicine, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
- Department of Radiation Oncology, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - Xiaodong Yang
- Department of Radiation Oncology, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - Rintaro Hashizume
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Theodore P Nicolaides
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Maxwell Tom
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - Yasuyuki Aoki
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - William A Weiss
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, 94143, USA
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - Lukas J A Stalpers
- Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Prados
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - C David James
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Sabine Mueller
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, 94143, USA
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, CA, 94143, USA
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32
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Watanabe Y, Shido K, Niihori T, Niizuma H, Katata Y, Iizuka C, Oba D, Moriya K, Saito-Nanjo Y, Onuma M, Rikiishi T, Sasahara Y, Watanabe M, Aiba S, Saito R, Sonoda Y, Tominaga T, Aoki Y, Kure S. Somatic BRAF c.1799T>A p.V600E Mosaicism syndrome characterized by a linear syringocystadenoma papilliferum, anaplastic astrocytoma, and ocular abnormalities. Am J Med Genet A 2015; 170A:189-94. [DOI: 10.1002/ajmg.a.37376] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/30/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Yuko Watanabe
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Kosuke Shido
- Department of Dermatology; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Tetsuya Niihori
- Department of Medical Genetics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Hidetaka Niizuma
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yu Katata
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Chie Iizuka
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Daiju Oba
- Department of Medical Genetics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Kunihiko Moriya
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yuka Saito-Nanjo
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Masaei Onuma
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Takeshi Rikiishi
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yoji Sasahara
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Mika Watanabe
- Department of Pathology; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Setsuya Aiba
- Department of Dermatology; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Ryuta Saito
- Department of Neurosurgery; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Teiji Tominaga
- Department of Neurosurgery; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yoko Aoki
- Department of Medical Genetics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Shigeo Kure
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
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Abstract
PURPOSE OF REVIEW To summarize the current knowledge on v-RAF murine sarcoma viral oncogene homologue B1 (BRAF) aberrations in tumours of the central nervous system. RECENT FINDINGS BRAF alterations are found in variable frequencies across a wide spectrum of diverse central nervous system neoplasms. BRAF V600 point mutations (most commonly of the V600E type) are most common in pleomorphic xanthoastrocytoma (approximately 60% of cases), gangliogliomas (50%), dysembryoplastic neuroepithelial tumours (30%), Langerhans cell histiocytosis (50%), melanoma brain metastases (50%) and papillary craniopharyngiomas (96%) and are also detectable in a fraction of glioblastomas (overall mutation rate of 2-12%, with a higher rate of approximately 50% in epithelioid glioblastomas). BRAF fusions (most commonly KIAA1549: BRAF) are typical for pilocytic astrocytomas and are almost absent from other tumour types. Clinical trials have established tyrosine-kinase inhibitors of BRAF as feasible treatment option in selected patients with mutation-bearing brain metastases of melanoma. Preclinical studies, some case reports and small patient series have documented tumour responses of primary brain tumours with BRAF aberrations to BRAF inhibition. SUMMARY Molecular testing for BRAF alterations in brain tumours may be of clinical relevance for differential diagnostic considerations in some situations or to guide selection of patients for targeted therapy with specific inhibitors. Prospective clinical trials evaluating the efficacy of BRAF inhibitors in central nervous system tumours are strongly supported by the available evidence.
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34
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Brandner S, von Deimling A. Diagnostic, prognostic and predictive relevance of molecular markers in gliomas. Neuropathol Appl Neurobiol 2015; 41:694-720. [PMID: 25944653 DOI: 10.1111/nan.12246] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 04/15/2015] [Indexed: 12/18/2022]
Abstract
The advances of genome-wide 'discovery platforms' and the increasing affordability of the analysis of significant sample sizes have led to the identification of novel mutations in brain tumours that became diagnostically and prognostically relevant. The development of mutation-specific antibodies has facilitated the introduction of these convenient biomarkers into most neuropathology laboratories and has changed our approach to brain tumour diagnostics. However, tissue diagnosis will remain an essential first step for the correct stratification for subsequent molecular tests, and the combined interpretation of the molecular and tissue diagnosis ideally remains with the neuropathologist. This overview will help our understanding of the pathobiology of common intrinsic brain tumours in adults and help guiding which molecular tests can supplement and refine the tissue diagnosis of the most common adult intrinsic brain tumours. This article will discuss the relevance of 1p/19q codeletions, IDH1/2 mutations, BRAF V600E and BRAF fusion mutations, more recently discovered mutations in ATRX, H3F3A, TERT, CIC and FUBP1, for diagnosis, prognostication and predictive testing. In a tumour-specific topic, the role of mitogen-activated protein kinase pathway mutations in the pathogenesis of pilocytic astrocytomas will be covered.
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Affiliation(s)
- Sebastian Brandner
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK.,Department of Neurodegeneration, UCL Institute of Neurology, London, UK
| | - Andreas von Deimling
- Department of Neuropathology, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center, DKFZ and DKTK, Heidelberg, Germany
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35
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Penman CL, Faulkner C, Lowis SP, Kurian KM. Current Understanding of BRAF Alterations in Diagnosis, Prognosis, and Therapeutic Targeting in Pediatric Low-Grade Gliomas. Front Oncol 2015; 5:54. [PMID: 25785246 PMCID: PMC4347423 DOI: 10.3389/fonc.2015.00054] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/16/2015] [Indexed: 12/19/2022] Open
Abstract
The mitogen-activated protein kinase (MAPK) pathway is known to play a key role in the initiation and maintenance of many tumors as well as normal development. This often occurs through mutation of the genes encoding RAS and RAF proteins which are involved in signal transduction in this pathway. BRAF is one of three RAF kinases which act as downstream effectors of growth factor signaling leading to cell cycle progression, proliferation, and survival. Initially reported as a point mutation (V600E) in the majority of metastatic melanomas, other alterations in the BRAF gene have now been reported in a variety of human cancers including papillary thyroid cancer, colon carcinomas, hairy cell leukemia, and more recently in gliomas. The identification of oncogenic mutations in the BRAF gene have led to a revolution in the treatment of metastatic melanoma using targeted molecular therapies that affect the MAPK pathway either directly through BRAF inhibition or downstream through inhibition of MEK. This review describes the molecular biology of BRAF in the context of pediatric low-grade gliomas, the role of BRAF as a diagnostic marker, the prognostic implications of BRAF, and evidence for therapeutic targeting of BRAF.
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Affiliation(s)
- Catherine Louise Penman
- Brain Tumour Research Group, Institute of Clinical Neurosciences, University of Bristol , Bristol , UK
| | - Claire Faulkner
- Bristol Genetics Laboratory, Pathology Sciences Southmead Hospital, Westbury on Trym , Bristol , UK
| | - Stephen P Lowis
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Upper Maudlin Street , Bristol , UK
| | - Kathreena M Kurian
- Brain Tumour Research Group, Institute of Clinical Neurosciences, University of Bristol , Bristol , UK
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36
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Park CK, Lee SH, Kim JY, Kim JE, Kim TM, Lee ST, Choi SH, Park SH, Kim IH. Expression level of hTERT is regulated by somatic mutation and common single nucleotide polymorphism at promoter region in glioblastoma. Oncotarget 2015; 5:3399-407. [PMID: 24930669 PMCID: PMC4102818 DOI: 10.18632/oncotarget.1975] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We investigated the role of somatic mutations and a common single nucleotide polymorphism (SNP) in the hTERT promoter region on hTERT expression and clinical outcomes. The hTERT promoter region was sequenced from 48 glioblastomas. hTERT expression was analyzed by quantitative real time-PCR. The association between hTERT promoter genetic changes and other genomic events and clinical variables common in gliomas were examined. C228T and C250T somatic mutations were found in 60.4% of glioblastomas, and a common SNP (T349C) was found in 66.6%. Somatic mutations and the SNP likely have opposing effects on hTERT expression. hTERT expression was significantly higher in the C228T or C250T mutated tumors. Tumors with the T349C genotype showed lower hTERT expression when C228T or C250T mutations were present. However, no significant survival differences were observed among the groups with or without hTERT promoter mutations and SNP. There was a significant association between genetic changes in the hTERT promoter and patient age as well as MGMT promoter methylation and EGFR amplification. hTERT expression is modulated by somatic mutations in the hTERT promoter as well as a common polymorphism. However, hTERT related genomic changes have limited value as an independent prognostic factor for clinical outcomes in glioblastomas.
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Affiliation(s)
- Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea;Department of Biomedical Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | | | | | | | | | | | | | | | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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37
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Myung JK, Cho HJ, Kim H, Park CK, Lee SH, Choi SH, Park P, Yoon JM, Park SH. Prognosis of Glioblastoma With Oligodendroglioma Component is Associated With the IDH1 Mutation and MGMT Methylation Status. Transl Oncol 2014; 7:712-9. [PMID: 25500080 PMCID: PMC4311043 DOI: 10.1016/j.tranon.2014.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 11/15/2022] Open
Abstract
Glioblastoma (GBM) with oligodendroglioma component (GBMO) is a newly described GBM subtype in the 2007 World Health Organization classification. However, its biological and genetic characteristics are largely unknown. We investigated the clinicopathological and molecular features of 34 GBMOs and compared the survival rate of these patients with those of patients with astrocytoma, oligodendroglioma, anaplastic oligoastrocytoma (AOA), and conventional GBMs in our hospital. GBMO could be divided into two groups based on the presence of an IDH1 mutation. The IDH1 mutation was more frequently found in secondary GBMO, which had lower frequencies of EGFR amplification but higher MGMT methylation than the wild type IDH1 group, and patients with mutant IDH1 GBMO were on average younger than those with wild-type IDH1. Therefore, GBMO is a clinically and molecularly heterogeneous subtype, largely belonging to a proneural and classical subtype of GBM. The survival rate of GBMO patients itself was worse than that of AOA patients but not significantly better than that of conventional GBM patients. GBMO survival was independent of the dominant histopathological subtype i.e., astrocyte-dominant or oligodendroglioma -dominant, but it was significantly associated with the IDH1 mutation and MGMT methylation status. Therefore, GBMO should be regarded as a separate entity from AOA and must be classified as a subtype of GBM. However, further study is needed to determine whether it is a pathologic variant or a pattern of GBM because GBMO has a similar prognosis to conventional GBMs.
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Affiliation(s)
- Jae Kyung Myung
- Department of Pathology, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea
| | - Hwa Jin Cho
- Department of Pathology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Hanna Kim
- Department of Pathology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Peom Park
- Department of Industrial Engineering, Ajou University, Suwon, Republic of Korea
| | - Jung Min Yoon
- Department of Industrial Engineering, Ajou University, Suwon, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea; Neuroscience Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea.
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38
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Koh J, Cho H, Kim H, Kim SI, Yun S, Park CK, Lee SH, Choi SH, Park SH. IDH2 mutation in gliomas including novel mutation. Neuropathology 2014; 35:236-44. [PMID: 25495392 DOI: 10.1111/neup.12187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/25/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022]
Abstract
Glioblastomas (GBMs) are the most aggressive type of primary brain tumors and provide a dismal prognosis. Thus far, several key genes have been identified in GBMs as prognostic and therapeutic targets. Mutations in two isocitrate dehydrogenase (IDH) genes, IDH1 and IDH2, commonly occur in low-grade gliomas and secondary high-grade gliomas, but are rare in primary GBMs. These mutations alter the catalytic activity of IDH proteins, promoting gliomagenesis. Gliomas with IDH1 or IDH2 mutation have better outcomes than do gliomas with wild-type IDH. The hot spots of IDH1 mutations (R132) and IDH2 mutations (R140 and R172) are well known and are considered as a possible biochemical explanation for the differing clinical characteristics of primary and secondary GBMs. We sought to find the incidence of IDH2 mutation and the characteristics of the gliomas with IDH2 mutation. Among 134 gliomas, which were operated in our hospital consecutively, we studied IDH1 and IDH2 mutations by Sanger sequencing and IDH2 mutation was identified in seven cases (5.2%, four oligodendrogliomas and three GBMs). IDH2 mutation was found in 3.3% of GBMs (3/90 cases) and 9.0% (4/44) of grades II to III gliomas. Here, we report the clinicopathological characteristics of the gliomas with IDH2 mutations including two cases of primary GBM carrying a novel missense IDH2 mutation (c. 484C>T, p. P162S).
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Affiliation(s)
- Jaemoon Koh
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hwajin Cho
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hannah Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Ik Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Sumi Yun
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Institute, Seoul National University College of Medicine, Seoul, Korea
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39
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40
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Abstract
Brain tumors are the most common solid tumor diagnosed in childhood that account for significant morbidity and mortality. New therapies are urgently needed; hence, we conducted the first ever prospective open-label phase II trials of the biological response modifier, poly-ICLC, in children with brain tumors. Poly-ICLC is a synthetic double-stranded RNA that has direct antiviral, antineoplastic, and immune adjuvant effects. A total of 47 children representing a variety of brain tumor histopathologic subtypes were treated with poly-ICLC. On the basis of the results of the initial phase II trial, an expanded prospective phase II trial in low-grade glioma (LGG) has been initiated. MRI was used to acquire volume-based measures of tumor response. No dose-limiting toxicities have been observed. In the initial study 3 of 12 subjects with progressive high-grade gliomas (HGGs) responded, and 2 of 4 children with progressive LGG experienced stable disease for 18 to 24 months. In the follow-up LGG phase II study, 2 of 5 LGG patients were stable over 18 months, with 1 stable for 6 months. Overall 5 of 10 LGG patients have responded. On the basis of low toxicity and the promising LGG response, poly-ICLC may be effective for childhood LGG, and the results justify biomarker studies for personalization of poly-ICLC as a single agent or adjuvant.
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41
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Lindsay AJ, Rush SZ, Fenton LZ. Pediatric posterior fossa ganglioglioma: unique MRI features and correlation with BRAF V600E mutation status. J Neurooncol 2014; 118:395-404. [DOI: 10.1007/s11060-014-1450-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
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42
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Robinson GW, Orr BA, Gajjar A. Complete clinical regression of a BRAF V600E-mutant pediatric glioblastoma multiforme after BRAF inhibitor therapy. BMC Cancer 2014; 14:258. [PMID: 24725538 PMCID: PMC3996187 DOI: 10.1186/1471-2407-14-258] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/08/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Standard therapies for high grade glioma have failed to substantially improve survival and are associated with significant morbidity. At relapse, high grade gliomas, such as glioblastoma multiforme, are refractory to therapy and universally fatal. BRAF V600E-mutations have been described in a modest 6% to 7% of primary central nervous system (CNS) tumors, but with increased prevalence in the pediatric population and in certain brain tumor subtypes. The use of BRAF inhibitors have transformed melanoma therapy however their use in brain tumors remains unproven. CASE PRESENTATION We describe the pediatric case of a now 12 year old Caucasian male who originally presented at age 9 with a right fronto-parietal glioblastoma multiforme that recurred 2 ½ years from diagnosis. Molecular analysis of the primary tumor revealed a BRAF V600E mutation and the patient was placed on the BRAF inhibitor vemurafenib. A complete response was observed after 4 months of therapy and remains sustained at 6 months. CONCLUSION This is the first report of a complete response of relapsed glioblastoma multiforme to targeted BRAF inhibitor therapy. While not a predominant mutation in glioblastoma multiforme, the increased prevalence of BRAF V600 mutations in pediatric CNS tumors and certain subtypes marks a population to whom this therapy could be applied. Response to this therapy suggests that BRAF inhibitors can affect primary CNS lesions when a documented and targetable mutation is present.
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Affiliation(s)
- Giles W Robinson
- Division of Neuro-Oncology, Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.
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43
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Byeon SJ, Cho HJ, Baek HW, Park CK, Choi SH, Kim SH, Kim HK, Park SH. Rhabdoid glioblastoma is distinguishable from classical glioblastoma by cytogenetics and molecular genetics. Hum Pathol 2014; 45:611-20. [DOI: 10.1016/j.humpath.2013.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/31/2013] [Accepted: 08/02/2013] [Indexed: 02/09/2023]
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44
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Genome-wide DNA copy number analysis of desmoplastic infantile astrocytomas and desmoplastic infantile gangliogliomas. J Neuropathol Exp Neurol 2013; 72:807-15. [PMID: 23965740 DOI: 10.1097/nen.0b013e3182a033a0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Little is known about the molecular features of desmoplastic infantile ganglioglioma (DIG) and desmoplastic infantile astrocytoma (DIA). We performed a genome-wide DNA copy number analysis in combination with a multiplex ligation-dependent probe amplification-based analysis of copy number changes of candidate genes in 4 DIAs and 10 DIGs. Molecular inversion probe (MIP) assay showed that large chromosomal alterations were rare among DIG and DIA. Focal recurrent genomic losses were observed in chromosome regions such as 5q13.3, 21q22.11, and 10q21.3 in both DIA and DIG. Principal component analysis did not show any significant differences between the molecular profiles of DIG and DIA, and a hierarchical cluster analysis did not clearly separate the 2 tumor groups according to their molecular profiles. In 6 cases, gain of genomic material at 7q31 (corresponding to MET gene) was found in multiplex ligation-dependent probe amplification (MLPA) analysis. Furthermore, two cases showed gain at 4q12, and a single case showed BRAF mutation. In agreement with previous analyses, this study demonstrates the absence of consistent recurrent chromosomal alterations in DIA and DIG and overall rarity of the BRAF mutation in these tumors. Notably, these results suggest that DIA and DIG represent a histologic spectrum of the same tumor rather than 2 separate entities.
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45
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Salvage therapy with BRAF inhibitors for recurrent pleomorphic xanthoastrocytoma: a retrospective case series. J Neurooncol 2013; 114:237-40. [DOI: 10.1007/s11060-013-1176-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/02/2013] [Indexed: 10/26/2022]
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46
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Gessi M, Pietsch T. The diagnostic role and clinical relevance of determination of BRAF status in brain tumors. Per Med 2013; 10:405-412. [PMID: 29783415 DOI: 10.2217/pme.13.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BRAF protein is a serine/threonine kinase that serves as an immediate downstream effector of the MAPK signaling cascade, a signal transduction pathway that modulates cell proliferation and survival. BRAF alterations leading to MAPK pathway activation have been identified in gliomas and glioneuronal tumors of the CNS. Whereas BRAF mutations have been found in a wide spectrum of CNS tumors, BRAF fusions have been almost exclusively found in pilocytic astrocytomas. BRAF fusion identification provides an additional help in the differential diagnosis of supratentorial gliomas. Although the prognostic significance of BRAF alterations in different CNS tumors is still under investigation, the evidence of BRAF-dependent MAPK-pathway activation in gliomas has moreover drawn attention to the potential use of MEK1/2 and RAF inhibitors in clinical neuro-oncology. Given the promising results of the therapeutic management of several cancer types, clinical studies investigating the suitability of such inhibitors for the therapy of gliomas are ongoing.
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Affiliation(s)
- Marco Gessi
- Institute of Neuropathology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, D-53105, Bonn, Germany.
| | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, D-53105, Bonn, Germany
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47
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Ida CM, Vrana JA, Rodriguez FJ, Jentoft ME, Caron AA, Jenkins SM, Giannini C. Immunohistochemistry is highly sensitive and specific for detection of BRAF V600E mutation in pleomorphic xanthoastrocytoma. Acta Neuropathol Commun 2013; 1:20. [PMID: 24252190 PMCID: PMC3893490 DOI: 10.1186/2051-5960-1-20] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/07/2013] [Indexed: 11/11/2022] Open
Abstract
Background High frequencies of the BRAF V600E mutation have been reported in pleomorphic xanthoastrocytoma (PXA). Recently, a BRAF V600E mutation-specific antibody has been developed and validated. We evaluated the immunohistochemical (IHC) detection of BRAF V600E mutation in PXA by comparing to gold standard molecular analysis and investigating the interobserver variability of the IHC scoring. We performed BRAF V600E IHC in 46 cases, of which 37 (80%) cases had sufficient tumor tissue for molecular analysis. IHC detection was performed using monoclonal mouse antibody VE1 (Spring Bioscience). IHC slides were scored independently by four reviewers blind to molecular data, including a primary (gold standard) and three additional reviewers. BRAF V600E mutation status was assessed by allele-specific polymerase chain reaction (PCR) with fragment analysis. Results All 46 cases showed interpretable BRAF V600E IHC results: 27 (59%) were positive (strong cytoplasmic staining), 19 (41%) were negative (6 of these cases with focal/diffuse weak cytoplasmic staining, interpreted as nonspecific by the primary reviewer). By molecular analysis, all 37 cases that could be tested had evaluable results: 22 (59%) cases were positive for BRAF V600E mutation and were scored as “IHC-positive”, and 15 (41%) were negative (including 11 cases scored as “IHC-negative” and 4 cases scored as negative with minimal nonspecific staining). IHC detection of BRAF V600E mutant protein was congruent in all 37 cases that were successfully evaluated by molecular testing (sensitivity and specificity of 100%). Agreement for IHC scoring among the 4 reviewers was almost perfect (kappa 0.92) when cases were scored as “positive/negative” and substantial (kappa 0.78) when minimal nonspecific staining was taken into account. Conclusions We conclude that detection of BRAF V600E mutation by immunohistochemistry is highly sensitive and specific. BRAF V600E IHC interpretation is usually straightforward, but awareness of possible nonspecific staining is necessary and training is recommended. It is a practical rapid method that may avoid the need of labor-intensive molecular testing and may be most valuable in small biopsies unsuitable for molecular analysis.
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