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Ercan AB, Aronson M, Fernandez NR, Chang Y, Levine A, Liu ZA, Negm L, Edwards M, Bianchi V, Stengs L, Chung J, Al-Battashi A, Reschke A, Lion A, Ahmad A, Lassaletta A, Reddy AT, Al-Darraji AF, Shah AC, Van Damme A, Bendel A, Rashid A, Margol AS, Kelly BL, Pencheva B, Heald B, Lemieux-Anglin B, Crooks B, Koschmann C, Gilpin C, Porter CC, Gass D, Samuel D, Ziegler DS, Blumenthal DT, Kuo DJ, Hamideh D, Basel D, Khuong-Quang DA, Stearns D, Opocher E, Carceller F, Baris Feldman H, Toledano H, Winer I, Scheers I, Fedorakova I, Su JM, Vengoechea J, Sterba J, Knipstein J, Hansford JR, Gonzales-Santos JR, Bhatia K, Bielamowicz KJ, Minhas K, Nichols KE, Cole KA, Penney L, Hjort MA, Sabel M, Gil-da-Costa MJ, Murray MJ, Miller M, Blundell ML, Massimino M, Al-Hussaini M, Al-Jadiry MF, Comito MA, Osborn M, Link MP, Zapotocky M, Ghalibafian M, Shaheen N, Mushtaq N, Waespe N, Hijiya N, Fuentes-Bolanos N, Ahmad O, Chamdine O, Roy P, Pichurin PN, Nyman P, Pearlman R, Auer RC, Sukumaran RK, Kebudi R, Dvir R, Raphael R, Elhasid R, McGee RB, Chami R, Noss R, Tanaka R, Raskin S, Sen S, Lindhorst S, Perreault S, Caspi S, Riaz S, Constantini S, Albert S, Chaleff S, Bielack S, Chiaravalli S, Cramer SL, Roy S, Cahn S, Penna S, Hamid SA, Ghafoor T, Imam U, Larouche V, Magimairajan Issai V, Foulkes WD, Lee YY, Nathan PC, Maruvka YE, Greer MLC, Durno C, Shlien A, Ertl-Wagner B, Villani A, Malkin D, Hawkins C, Bouffet E, Das A, Tabori U. Clinical and biological landscape of constitutional mismatch-repair deficiency syndrome: an International Replication Repair Deficiency Consortium cohort study. Lancet Oncol 2024; 25:668-682. [PMID: 38552658 DOI: 10.1016/s1470-2045(24)00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/29/2023] [Accepted: 01/14/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Constitutional mismatch repair deficiency (CMMRD) syndrome is a rare and aggressive cancer predisposition syndrome. Because a scarcity of data on this condition contributes to management challenges and poor outcomes, we aimed to describe the clinical spectrum, cancer biology, and impact of genetics on patient survival in CMMRD. METHODS In this cohort study, we collected cross-sectional and longitudinal data on all patients with CMMRD, with no age limits, registered with the International Replication Repair Deficiency Consortium (IRRDC) across more than 50 countries. Clinical data were extracted from the IRRDC database, medical records, and physician-completed case record forms. The primary objective was to describe the clinical features, cancer spectrum, and biology of the condition. Secondary objectives included estimations of cancer incidence and of the impact of the specific mismatch-repair gene and genotype on cancer onset and survival, including after cancer surveillance and immunotherapy interventions. FINDINGS We analysed data from 201 patients (103 males, 98 females) enrolled between June 5, 2007 and Sept 9, 2022. Median age at diagnosis of CMMRD or a related cancer was 8·9 years (IQR 5·9-12·6), and median follow-up from diagnosis was 7·2 years (3·6-14·8). Endogamy among minorities and closed communities contributed to high homozygosity within countries with low consanguinity. Frequent dermatological manifestations (117 [93%] of 126 patients with complete data) led to a clinical overlap with neurofibromatosis type 1 (35 [28%] of 126). 339 cancers were reported in 194 (97%) of 201 patients. The cumulative cancer incidence by age 18 years was 90% (95% CI 80-99). Median time between cancer diagnoses for patients with more than one cancer was 1·9 years (IQR 0·8-3·9). Neoplasms developed in 15 organs and included early-onset adult cancers. CNS tumours were the most frequent (173 [51%] cancers), followed by gastrointestinal (75 [22%]), haematological (61 [18%]), and other cancer types (30 [9%]). Patients with CNS tumours had the poorest overall survival rates (39% [95% CI 30-52] at 10 years from diagnosis; log-rank p<0·0001 across four cancer types), followed by those with haematological cancers (67% [55-82]), gastrointestinal cancers (89% [81-97]), and other solid tumours (96% [88-100]). All cancers showed high mutation and microsatellite indel burdens, and pathognomonic mutational signatures. MLH1 or MSH2 variants caused earlier cancer onset than PMS2 or MSH6 variants, and inferior survival (overall survival at age 15 years 63% [95% CI 55-73] for PMS2, 49% [35-68] for MSH6, 19% [6-66] for MLH1, and 0% for MSH2; p<0·0001). Frameshift or truncating variants within the same gene caused earlier cancers and inferior outcomes compared with missense variants (p<0·0001). The greater deleterious effects of MLH1 and MSH2 variants as compared with PMS2 and MSH6 variants persisted despite overall improvements in survival after surveillance or immune checkpoint inhibitor interventions. INTERPRETATION The very high cancer burden and unique genomic landscape of CMMRD highlight the benefit of comprehensive assays in timely diagnosis and precision approaches toward surveillance and immunotherapy. These data will guide the clinical management of children and patients who survive into adulthood with CMMRD. FUNDING The Canadian Institutes for Health Research, Stand Up to Cancer, Children's Oncology Group National Cancer Institute Community Oncology Research Program, Canadian Cancer Society, Brain Canada, The V Foundation for Cancer Research, BioCanRx, Harry and Agnieszka Hall, Meagan's Walk, BRAINchild Canada, The LivWise Foundation, St Baldrick Foundation, Hold'em for Life, and Garron Family Cancer Center.
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Affiliation(s)
- Ayse Bahar Ercan
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Sinai Health System, Toronto, ON, Canada
| | | | - Yuan Chang
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Adrian Levine
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Logine Negm
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Melissa Edwards
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Vanessa Bianchi
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Lucie Stengs
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Jiil Chung
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Abeer Al-Battashi
- Department of Pediatric Hematology and Oncology, The Royal Hospital, Muscat, Oman
| | - Agnes Reschke
- Division of Pediatric Hematology/Oncology, Stanford Medicine, Stanford, CA, USA
| | - Alex Lion
- Department of Pediatric Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alia Ahmad
- University of Child Health Sciences, Children's Hospital Lahore, Lahore, Pakistan
| | - Alvaro Lassaletta
- Department of Pediatric Hematology-Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | | | - Amir F Al-Darraji
- College of Medicine, University of Baghdad, Paediatric Oncology Unit, Baghdad, Iraq
| | - Amish C Shah
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - An Van Damme
- Division of Pediatric Hematology and Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Aqeela Rashid
- Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Ashley S Margol
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | | | - Bojana Pencheva
- Alfac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Brandie Heald
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brianna Lemieux-Anglin
- Departments of Oncology and Human Genetics, McGill University Health Centre, Cancer Genetics Program, Montreal, QC, Canada
| | - Bruce Crooks
- Division of Hematology-Oncology, IWK Health, Halifax, NS, Canada
| | - Carl Koschmann
- Department of Pediatric Hematology-Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Catherine Gilpin
- Children's Hospital of Eastern Ontario, Genetics, Ottawa, ON, Canada
| | - Christopher C Porter
- Alfac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - David Gass
- Department of Pediatric Hematology and Oncology, Atrium Health, Charlotte, NC, USA
| | | | - David S Ziegler
- Kid's Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Deborah T Blumenthal
- Neuro-Oncology Division, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Dennis John Kuo
- Division of Pediatric Hematology/Oncology, University of California, San Diego, CA, USA
| | - Dima Hamideh
- Division of Pediatric Hematology-Oncology, American University of Beirut, Beirut, Lebanon
| | - Donald Basel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Duncan Stearns
- UH Rainbow Babies and Children's Hospital Division of Pediatrics, Pediatric Neuro-oncology, Cleveland, OH, USA
| | - Enrico Opocher
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | - Fernando Carceller
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Helen Toledano
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ira Winer
- Wayne State University and Karmanos Cancer Institute, Detroit, MI, USA
| | - Isabelle Scheers
- Division of Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, IREC Universite Catholique de Louvain, Brussels, Belgium
| | - Ivana Fedorakova
- Clinic of Pediatric Oncology and Hematology, University Children's Hospital, Banská Bystrica, Slovakia
| | - Jack M Su
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX, USA
| | - Jaime Vengoechea
- Associate Professor of Human Genetics, Emory University, Atlanta, GA, USA
| | - Jaroslav Sterba
- Pediatric Oncology Department, University Hospital Brno, Masaryk Univerzity, Faculty of Medicine, Brno, Czech Republic
| | - Jeffrey Knipstein
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jordan R Hansford
- Michael Rice Children's Hematology and Oncology Centre, Women's and Children's Hospital, Adelaide, SA, Australia; South Australia Health and Medical Research Institute Adelaide, SA, Australia; South Australia Immunogenomics Cancer Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Kanika Bhatia
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kevin J Bielamowicz
- Department of Pediatrics, Division of Hematology/Oncology, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA
| | - Khurram Minhas
- Division of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Kim E Nichols
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristina A Cole
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lynette Penney
- Division of Medical Genetics, Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
| | | | - Magnus Sabel
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Matthew Miller
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA
| | | | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Mazin F Al-Jadiry
- College of Medicine, University of Baghdad, Paediatric Oncology Unit, Baghdad, Iraq
| | | | - Michael Osborn
- Michael Rice Children's Hematology and Oncology Centre, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Michael P Link
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Michal Zapotocky
- Department of Paediatric Haematology and Oncology, University Hospital Motol and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Najma Shaheen
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Nicolas Waespe
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nobuko Hijiya
- Pediatric Hematology Oncology and Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Olfat Ahmad
- Hopp Children's Cancer Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Omar Chamdine
- Department of Pediatric Hematology Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Paromita Roy
- Department of Pathology, Tata Medical Center, Rajarhat, Kolkata, India
| | - Pavel N Pichurin
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Per Nyman
- Crown Princess Victoria Children's Hospital, Linköping University Hospital, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Rachel Pearlman
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Reghu K Sukumaran
- Department of Pediatric Hemato-oncology, Tata Medical Center, Kolkata, India
| | - Rejin Kebudi
- Department of Pediatric Hematology-Oncology, Istanbul University, Oncology Institute, Istanbul, Türkiye
| | - Rina Dvir
- Department of Pediatric Hemato-Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Robert Raphael
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Ronit Elhasid
- Department of Pediatric Hemato-Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Rose B McGee
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rose Chami
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ryan Noss
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH, USA
| | - Ryuma Tanaka
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Salmo Raskin
- Department of Pediatrics, Federal University of Parana, Curitiba, Parana
| | - Santanu Sen
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Scott Lindhorst
- Department of Neurosurgery, Division of Neuro-Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Sebastien Perreault
- Division of Child Neurology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Shani Caspi
- Sheba Medical Center, Cancer Research Center, Tel Hashomer, Israel
| | - Shazia Riaz
- Department of Hematology and Oncology, The Children's Hospital and University of Child Health Sciences, Lahore, Pakistan
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sophie Albert
- Cancer Axis, Lady Davis Institute, Jewish General Hospital, Montreal, QC Canada
| | | | - Stefan Bielack
- Padiatrie 5 (Onkologie, Hamatologie, Immunologie), Zentrum fur Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Stefano Chiaravalli
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stuart Louis Cramer
- Department of Pediatric Hematology/Oncology, Prisma Health, Columbia, SC, USA
| | - Sumita Roy
- Central Michigan University, Mount Pleasant, MI, USA; Division of Genetics, Genomic & Metabolic Disorders, Pediatric Cancer Genetics Clinic, Children's Hospital of Michigan, Detroit, MI, USA
| | - Suzanne Cahn
- Winship Cancer Institute, Emory University Hospital, Atlanta, GA, USA
| | - Suzanne Penna
- Division of Rehabilitation Neuropsychology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Tariq Ghafoor
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center, National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Uzma Imam
- Pediatric Oncology Department, National Institute of Child Health, Karachi, Pakistan
| | - Valerie Larouche
- Department of Hematology-Oncology, CHU de Quebec-Universite Laval, Quebec, QC, Canada
| | | | - William D Foulkes
- Departments of Oncology and Human Genetics, McGill University Health Centre, Cancer Genetics Program, Montreal, QC, Canada
| | - Yi Yen Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paul C Nathan
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yosef E Maruvka
- Faculty of Biotechnology and Food Engineering, The Lokey Center for Life Science and Engineering, TECHNION-Israel Institute of Technology, Haifa, Israel
| | - Mary-Louise C Greer
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carol Durno
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adam Shlien
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Anita Villani
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Malkin
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia Hawkins
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Bouffet
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anirban Das
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada; Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada; Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
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2
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Vasudevan HN, Payne E, Delley CL, John Liu S, Mirchia K, Sale MJ, Lastella S, Nunez MS, Lucas CHG, Eaton CD, Casey-Clyde T, Magill ST, Chen WC, Braunstein SE, Perry A, Jacques L, Reddy AT, Pekmezci M, Abate AR, McCormick F, Raleigh DR. Functional interactions between neurofibromatosis tumor suppressors underlie Schwann cell tumor de-differentiation and treatment resistance. Nat Commun 2024; 15:477. [PMID: 38216572 PMCID: PMC10786885 DOI: 10.1038/s41467-024-44755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/03/2024] [Indexed: 01/14/2024] Open
Abstract
Schwann cell tumors are the most common cancers of the peripheral nervous system and can arise in patients with neurofibromatosis type-1 (NF-1) or neurofibromatosis type-2 (NF-2). Functional interactions between NF1 and NF2 and broader mechanisms underlying malignant transformation of the Schwann lineage are unclear. Here we integrate bulk and single-cell genomics, biochemistry, and pharmacology across human samples, cell lines, and mouse allografts to identify cellular de-differentiation mechanisms driving malignant transformation and treatment resistance. We find DNA methylation groups of Schwann cell tumors can be distinguished by differentiation programs that correlate with response to the MEK inhibitor selumetinib. Functional genomic screening in NF1-mutant tumor cells reveals NF2 loss and PAK activation underlie selumetinib resistance, and we find that concurrent MEK and PAK inhibition is effective in vivo. These data support a de-differentiation paradigm underlying malignant transformation and treatment resistance of Schwann cell tumors and elucidate a functional link between NF1 and NF2.
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Affiliation(s)
- Harish N Vasudevan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Emily Payne
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Cyrille L Delley
- Department of Bioengineering, University of California San Francisco, San Francisco, CA, USA
| | - S John Liu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Kanish Mirchia
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Matthew J Sale
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Sydney Lastella
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Maria Sacconi Nunez
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Charlotte D Eaton
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Tim Casey-Clyde
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Arie Perry
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Line Jacques
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa T Reddy
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Melike Pekmezci
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Adam R Abate
- Department of Bioengineering, University of California San Francisco, San Francisco, CA, USA
| | - Frank McCormick
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.
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3
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Williams EA, Ravindranathan A, Gupta R, Stevers NO, Suwala AK, Hong C, Kim S, Yuan JB, Wu J, Barreto J, Lucas CHG, Chan E, Pekmezci M, LeBoit PE, Mully T, Perry A, Bollen A, Van Ziffle J, Devine WP, Reddy AT, Gupta N, Basnet KM, Macaulay RJB, Malafronte P, Lee H, Yong WH, Williams KJ, Juratli TA, Mata DA, Huang RSP, Hiemenz MC, Pavlick DC, Frampton GM, Janovitz T, Ross JS, Chang SM, Berger MS, Jacques L, Song JS, Costello JF, Solomon DA. Novel SOX10 indel mutations drive schwannomas through impaired transactivation of myelination gene programs. Neuro Oncol 2023; 25:2221-2236. [PMID: 37436963 PMCID: PMC10708934 DOI: 10.1093/neuonc/noad121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Schwannomas are common peripheral nerve sheath tumors that can cause severe morbidity given their stereotypic intracranial and paraspinal locations. Similar to many solid tumors, schwannomas and other nerve sheath tumors are primarily thought to arise due to aberrant hyperactivation of the RAS growth factor signaling pathway. Here, we sought to further define the molecular pathogenesis of schwannomas. METHODS We performed comprehensive genomic profiling on a cohort of 96 human schwannomas, as well as DNA methylation profiling on a subset. Functional studies including RNA sequencing, chromatin immunoprecipitation-DNA sequencing, electrophoretic mobility shift assay, and luciferase reporter assays were performed in a fetal glial cell model following transduction with wildtype and tumor-derived mutant isoforms of SOX10. RESULTS We identified that nearly one-third of sporadic schwannomas lack alterations in known nerve sheath tumor genes and instead harbor novel recurrent in-frame insertion/deletion mutations in SOX10, which encodes a transcription factor responsible for controlling Schwann cell differentiation and myelination. SOX10 indel mutations were highly enriched in schwannomas arising from nonvestibular cranial nerves (eg facial, trigeminal, vagus) and were absent from vestibular nerve schwannomas driven by NF2 mutation. Functional studies revealed these SOX10 indel mutations have retained DNA binding capacity but impaired transactivation of glial differentiation and myelination gene programs. CONCLUSIONS We thus speculate that SOX10 indel mutations drive a unique subtype of schwannomas by impeding proper differentiation of immature Schwann cells.
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Affiliation(s)
- Erik A Williams
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Ajay Ravindranathan
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Rohit Gupta
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Nicholas O Stevers
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Abigail K Suwala
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Chibo Hong
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Somang Kim
- Department of Physics and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Jimmy Bo Yuan
- Department of Physics and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Jasper Wu
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Jairo Barreto
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Calixto-Hope G Lucas
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Emily Chan
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Philip E LeBoit
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Thaddeus Mully
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Andrew Bollen
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Jessica Van Ziffle
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - W Patrick Devine
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Alyssa T Reddy
- Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Han Lee
- Department of Pathology, University of California, Davis, Sacramento, California, USA
| | - William H Yong
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, California, USA
| | - Kevin Jon Williams
- Departments of Physiology and Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Tareq A Juratli
- Department of Neurosurgery, Division of Neuro-Oncology, Faculty of Medicine and Carl Gustav Carus University Hospital, Dresden, Germany
| | - Douglas A Mata
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | | | | | - Dean C Pavlick
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | | | - Tyler Janovitz
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | - Jeffrey S Ross
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Line Jacques
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jun S Song
- Department of Physics and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Joseph F Costello
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
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4
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Mueller S, Kline C, Stoller S, Lundy S, Christopher L, Reddy AT, Banerjee A, Cooney TM, Raber S, Hoffman C, Luks T, Wembacher-Schroeder E, Lummel N, Zhang Y, Bonner ER, Nazarian J, Molinaro AM, Prados M, Villanueva-Meyer JE, Gupta N. PNOC015: Repeated convection-enhanced delivery of MTX110 (aqueous panobinostat) in children with newly diagnosed diffuse intrinsic pontine glioma. Neuro Oncol 2023; 25:2074-2086. [PMID: 37318058 PMCID: PMC10628948 DOI: 10.1093/neuonc/noad105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The objective of this study was to determine the safety, tolerability, and distribution of MTX110 (aqueous panobinostat) delivered by convection-enhanced delivery (CED) in patients with newly diagnosed diffuse intrinsic pontine glioma (DIPG) who completed focal radiation therapy (RT). METHODS Patients with DIPG (2-21 years) were enrolled after RT. CED of MTX110 combined with gadoteridol was completed across 7 dose levels (DL) (30-90 µM; volumes ranging from 3 mL to 2 consecutive doses of 6 mL). An accelerated dose escalation design was used. Distribution of infusate was monitored with real-time MR imaging. Repeat CED was performed every 4-8 weeks. Quality-of-life (QoL) assessments were obtained at baseline, every 3 months on therapy, and end of therapy. RESULTS Between May 2018 and March 2020, 7 patients who received a total of 48 CED infusions, were enrolled (median age 8 years, range 5-21). Three patients experienced dose-limited toxicities. Four grade 3 treatment-related adverse events were observed. Most toxicities were transient new or worsening neurologic function. Median overall survival (OS) was 26.1 months (95% confidence interval: 14.8-not reached). Progression-free survival was 4-14 months (median, 7). Cumulative percentage of tumor coverage for combined CED infusions per patient ranged from 35.6% to 81.0%. Increased CED infusions were negatively associated with self-reported QoL assessments. CONCLUSION Repeat CED of MTX110 with real-time imaging with gadoteridol is tolerable for patients with DIPG. Median OS of 26.1 months compares favorably with historical data for children with DIPG. The results support further investigation of this strategy in a larger cohort.
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Affiliation(s)
- Sabine Mueller
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of Zurich, Zurich, Switzerland
| | - Cassie Kline
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Schuyler Stoller
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Shannon Lundy
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Lauren Christopher
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Alyssa T Reddy
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Anu Banerjee
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Tabitha M Cooney
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts, USA
| | - Shannon Raber
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Carly Hoffman
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Tracy Luks
- Department of Radiology, University of California, San Francisco, San Francisco, California, USA
| | | | | | - Yalan Zhang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Erin R Bonner
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, USA
| | - Javad Nazarian
- Department of Pediatrics, University of Zurich, Zurich, Switzerland
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, USA
| | - Annette M Molinaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael Prados
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Javier E Villanueva-Meyer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Nalin Gupta
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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5
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Lucas CHG, Sloan EA, Gupta R, Wu J, Pratt D, Vasudevan HN, Ravindranathan A, Barreto J, Williams EA, Shai A, Whipple NS, Bruggers CS, Maher O, Nabors B, Rodriguez M, Samuel D, Brown M, Carmichael J, Lu R, Mirchia K, Sullivan DV, Pekmezci M, Tihan T, Bollen AW, Perry A, Banerjee A, Mueller S, Gupta N, Hervey-Jumper SL, Oberheim Bush NA, Daras M, Taylor JW, Butowski NA, de Groot J, Clarke JL, Raleigh DR, Costello JF, Phillips JJ, Reddy AT, Chang SM, Berger MS, Solomon DA. Multiplatform molecular analyses refine classification of gliomas arising in patients with neurofibromatosis type 1. Acta Neuropathol 2022; 144:747-765. [PMID: 35945463 PMCID: PMC9468105 DOI: 10.1007/s00401-022-02478-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 01/28/2023]
Abstract
Gliomas arising in the setting of neurofibromatosis type 1 (NF1) are heterogeneous, occurring from childhood through adulthood, can be histologically low-grade or high-grade, and follow an indolent or aggressive clinical course. Comprehensive profiling of genetic alterations beyond NF1 inactivation and epigenetic classification of these tumors remain limited. Through next-generation sequencing, copy number analysis, and DNA methylation profiling of gliomas from 47 NF1 patients, we identified 2 molecular subgroups of NF1-associated gliomas. The first harbored biallelic NF1 inactivation only, occurred primarily during childhood, followed a more indolent clinical course, and had a unique epigenetic signature for which we propose the terminology "pilocytic astrocytoma, arising in the setting of NF1". The second subgroup harbored additional oncogenic alterations including CDKN2A homozygous deletion and ATRX mutation, occurred primarily during adulthood, followed a more aggressive clinical course, and was epigenetically diverse, with most tumors aligning with either high-grade astrocytoma with piloid features or various subclasses of IDH-wildtype glioblastoma. Several patients were treated with small molecule MEK inhibitors that resulted in stable disease or tumor regression when used as a single agent, but only in the context of those tumors with NF1 inactivation lacking additional oncogenic alterations. Together, these findings highlight recurrently altered pathways in NF1-associated gliomas and help inform targeted therapeutic strategies for this patient population.
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Affiliation(s)
- Calixto-Hope G Lucas
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily A Sloan
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Rohit Gupta
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Jasper Wu
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Drew Pratt
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Harish N Vasudevan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ajay Ravindranathan
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Jairo Barreto
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Erik A Williams
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Anny Shai
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nicholas S Whipple
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Carol S Bruggers
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Ossama Maher
- Department of Oncology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Burt Nabors
- Division of Neuro-Oncology, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - David Samuel
- Department of Hematology/Oncology, Valley Children's Hospital, Madera, CA, USA
| | - Melandee Brown
- Department of Neurosurgery, Valley Children's Hospital, Madera, CA, USA
| | - Jason Carmichael
- Department of Medical Genetics and Metabolism, Valley Children's Hospital, Madera, CA, USA
| | - Rufei Lu
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Kanish Mirchia
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Daniel V Sullivan
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Anuradha Banerjee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Sabine Mueller
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nancy Ann Oberheim Bush
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Mariza Daras
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jennie W Taylor
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nicholas A Butowski
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - John de Groot
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer L Clarke
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Joseph F Costello
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Joanna J Phillips
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa T Reddy
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Susan M Chang
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA.
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6
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Ullrich NJ, Prabhu SP, Reddy AT, Fisher MJ, Packer R, Goldman S, Robison NJ, Gutmann DH, Viskochil DH, Allen JC, Korf B, Cantor A, Cutter G, Thomas C, Perentesis JP, Mizuno T, Vinks AA, Manley PE, Chi SN, Kieran MW. A phase II study of continuous oral mTOR inhibitor everolimus for recurrent, radiographic-progressive neurofibromatosis type 1-associated pediatric low-grade glioma: a Neurofibromatosis Clinical Trials Consortium study. Neuro Oncol 2021; 22:1527-1535. [PMID: 32236425 DOI: 10.1093/neuonc/noaa071] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Activation of the mammalian target of rapamycin (mTOR) pathway is observed in neurofibromatosis type 1 (NF1) associated low-grade gliomas (LGGs), but agents that inhibit this pathway, including mTOR inhibitors, have not been studied in this population. We evaluate the efficacy of the orally administered mTOR inhibitor everolimus for radiographically progressive NF1-associated pediatric LGGs. METHODS Children with radiologic-progressive, NF1-associated LGG and prior treatment with a carboplatin-containing chemotherapy were prospectively enrolled on this phase II clinical trial to receive daily everolimus. Whole blood was analyzed for everolimus and markers of phosphatidylinositol-3 kinase (PI3K)/mTOR pathway inhibition. Serial MRIs were obtained during treatment. The primary endpoint was progression-free survival at 48 weeks. RESULTS Twenty-three participants (median age, 9.4 y; range, 3.2-21.6 y) were enrolled. All participants were initially evaluable for response; 1 patient was removed from study after development of a malignant peripheral nerve sheath tumor. Fifteen of 22 participants (68%) demonstrated a response, defined as either shrinkage (1 complete response, 2 partial response) or arrest of tumor growth (12 stable disease). Of these, 10/15 remained free of progression (median follow-up, 33 mo). All remaining 22 participants were alive at completion of therapy. Treatment was well tolerated; no patient discontinued therapy due to toxicity. Pharmacokinetic parameters and pre-dose concentrations showed substantial between-subject variability. PI3K/mTOR pathway inhibition markers demonstrating blood mononuclear cell mTOR pathway inactivation was achieved in most participants. CONCLUSION Individuals with recurrent/progressive NF1-associated LGG demonstrate significant disease stability/shrinkage during treatment with oral everolimus with a well-tolerated toxicity profile. Everolimus is well suited for future consideration as upfront or combination therapy in this patient population.
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Affiliation(s)
- Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders, Dana-Farber Cancer Institution, Boston, Massachusetts
| | - Sanjay P Prabhu
- Departments of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Alyssa T Reddy
- Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, California
| | - Michael J Fisher
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Roger Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC
| | | | - Nathan J Robison
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | | | - Jeffrey C Allen
- Departments of Pediatrics and Neurology, NYU Cancer Institute, NYU Langone Medical Center, New York, New York
| | - Bruce Korf
- Department of Genetics, University of Utah, Salt Lake City, Utah.,Department of Medical Genetics, University of Alabama, Birmingham, Alabama
| | - Alan Cantor
- Department of Preventative Medicine, University of Alabama, Birmingham, Alabama.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gary Cutter
- School of Public Health, University of Alabama, Birmingham, Alabama.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Coretta Thomas
- School of Public Health, University of Alabama, Birmingham, Alabama.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - John P Perentesis
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tomoyuki Mizuno
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexander A Vinks
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Peter E Manley
- Department of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders, Dana-Farber Cancer Institution, Boston, Massachusetts
| | - Susan N Chi
- Department of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders, Dana-Farber Cancer Institution, Boston, Massachusetts
| | - Mark W Kieran
- Department of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders, Dana-Farber Cancer Institution, Boston, Massachusetts
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7
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Yue JK, Chang D, Oh T, Winkler EA, Lu AY, Hetts SW, Young EP, Reddy AT, Fox CK, Abla AA, Roland JL. Multiple Tumor-Associated Intracranial Aneurysms Adjacent to a Suprasellar Germ Cell Tumor: Case Report and Review of Literature. Pediatr Neurosurg 2021; 56:482-491. [PMID: 34320494 DOI: 10.1159/000517890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tumor-associated intracranial aneurysms are rare and not well understood. CASE PRESENTATION We describe a 4-year-old female with multiple intracranial aneurysms intimately associated with a suprasellar germ cell tumor (GCT). We provide the clinical history, medical, and surgical treatment course, as well as a comprehensive and concise synthesis of the literature on tumor-associated aneurysms. DISCUSSION We discuss mechanisms for aneurysm formation with relevance to the current case, including cellular and paracrine signaling pertinent to suprasellar GCTs and possible molecular pathways involved. We review the complex multidisciplinary treatment required for complex tumor and cerebrovascular interactions.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Diana Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Taemin Oh
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Alex Y Lu
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Department of Interventional Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth P Young
- Department of Pediatric Hematology/Oncology, University of California San Francisco, San Francisco, California, USA
| | - Alyssa T Reddy
- Department of Pediatric Hematology/Oncology, University of California San Francisco, San Francisco, California, USA
| | - Christine K Fox
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jarod L Roland
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
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8
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Chung J, Maruvka YE, Sudhaman S, Kelly J, Haradhvala NJ, Bianchi V, Edwards M, Forster VJ, Nunes NM, Galati MA, Komosa M, Deshmukh S, Cabric V, Davidson S, Zatzman M, Light N, Hayes R, Brunga L, Anderson ND, Ho B, Hodel KP, Siddaway R, Morrissy AS, Bowers DC, Larouche V, Bronsema A, Osborn M, Cole KA, Opocher E, Mason G, Thomas GA, George B, Ziegler DS, Lindhorst S, Vanan M, Yalon-Oren M, Reddy AT, Massimino M, Tomboc P, Van Damme A, Lossos A, Durno C, Aronson M, Morgenstern DA, Bouffet E, Huang A, Taylor MD, Villani A, Malkin D, Hawkins CE, Pursell ZF, Shlien A, Kunkel TA, Getz G, Tabori U. DNA Polymerase and Mismatch Repair Exert Distinct Microsatellite Instability Signatures in Normal and Malignant Human Cells. Cancer Discov 2020; 11:1176-1191. [PMID: 33355208 DOI: 10.1158/2159-8290.cd-20-0790] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/23/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022]
Abstract
Although replication repair deficiency, either by mismatch repair deficiency (MMRD) and/or loss of DNA polymerase proofreading, can cause hypermutation in cancer, microsatellite instability (MSI) is considered a hallmark of MMRD alone. By genome-wide analysis of tumors with germline and somatic deficiencies in replication repair, we reveal a novel association between loss of polymerase proofreading and MSI, especially when both components are lost. Analysis of indels in microsatellites (MS-indels) identified five distinct signatures (MS-sigs). MMRD MS-sigs are dominated by multibase losses, whereas mutant-polymerase MS-sigs contain primarily single-base gains. MS deletions in MMRD tumors depend on the original size of the MS and converge to a preferred length, providing mechanistic insight. Finally, we demonstrate that MS-sigs can be a powerful clinical tool for managing individuals with germline MMRD and replication repair-deficient cancers, as they can detect the replication repair deficiency in normal cells and predict their response to immunotherapy. SIGNIFICANCE: Exome- and genome-wide MSI analysis reveals novel signatures that are uniquely attributed to mismatch repair and DNA polymerase. This provides new mechanistic insight into MS maintenance and can be applied clinically for diagnosis of replication repair deficiency and immunotherapy response prediction.This article is highlighted in the In This Issue feature, p. 995.
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Affiliation(s)
- Jiil Chung
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yosef E Maruvka
- Massachusetts General Hospital Center for Cancer Research, Charlestown, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Sumedha Sudhaman
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacalyn Kelly
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas J Haradhvala
- Massachusetts General Hospital Center for Cancer Research, Charlestown, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Harvard Graduate Program in Biophysics, Harvard University, Cambridge, Massachusetts
| | - Vanessa Bianchi
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa Edwards
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Victoria J Forster
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nuno M Nunes
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa A Galati
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Komosa
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shriya Deshmukh
- Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,The Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Vanja Cabric
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Scott Davidson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthew Zatzman
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Light
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Reid Hayes
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ledia Brunga
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nathaniel D Anderson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ben Ho
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karl P Hodel
- Department of Biochemistry and Molecular Biology, Tulane Cancer Center, Tulane University of Medicine, New Orleans, Louisiana
| | - Robert Siddaway
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - A Sorana Morrissy
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Charbonneau Cancer Institute and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Daniel C Bowers
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas.,Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, Texas
| | - Valérie Larouche
- Department of Pediatrics, Centre Mere-enfant Soleil du CHU de Quebec, CRCHU de Quebec, Universite Laval, Quebec City, Quebec, Canada
| | - Annika Bronsema
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Osborn
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Kristina A Cole
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Enrico Opocher
- Pediatric Oncology and Hematology, Azienda Ospedaliera-Universita' degli Studi di Padova, Padova, Italy
| | - Gary Mason
- Department of Pediatric Hematology-Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Gregory A Thomas
- Division of Pediatric Hematology-Oncology, Oregon Health and Science University, Portland, Oregon
| | - Ben George
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Randwick, New South Wales, Australia
| | - Scott Lindhorst
- Neuro-Oncology, Department of Neurosurgery, and Department of Medicine, Division of Hematology/Medical Oncology, Medical University of South Carolina Charleston, South Carolina
| | - Magimairajan Vanan
- Department of Pediatric Hematology-Oncology, Cancer Care Manitoba; Research Institute in Oncology and Hematology (RIOH), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michal Yalon-Oren
- Pediatric Hemato-Oncology, Edmond and Lilly Safra Children's Hospital and Cancer Research Center, Sheba Medical Center, Tel Hashomer Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Alyssa T Reddy
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milano, Italy
| | - Patrick Tomboc
- Department of Pediatrics Section of Hematology-Oncology, WVU Medicine Children's, Morgantown, West Virginia
| | - An Van Damme
- Division of Hematology and Oncology, Department of Pediatrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alexander Lossos
- Department of Neurology, Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Carol Durno
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel A Morgenstern
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Eric Bouffet
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Huang
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anita Villani
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Malkin
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Program in Cell Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zachary F Pursell
- Department of Biochemistry and Molecular Biology, Tulane Cancer Center, Tulane University of Medicine, New Orleans, Louisiana
| | - Adam Shlien
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas A Kunkel
- Genome Integrity Structural Biology Laboratory, National Institute of Environmental Health Sciences, NIH, Durham, North Carolina
| | - Gad Getz
- Massachusetts General Hospital Center for Cancer Research, Charlestown, Massachusetts. .,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Uri Tabori
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada. .,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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9
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Mueller S, Reddy AT, Dombi E, Allen J, Packer R, Clapp W, Goldman S, Schorry E, Tonsgard J, Blakeley J, Ullrich NJ, Gross A, Walsh K, Thomas C, Edwards L, Prados M, Korf B, Fisher MJ. NFB-17. MEK INHIBITOR BINIMETINIB SHOWS CLINICAL ACTIVITY IN CHILDREN WITH NEUROFIBROMATOSIS TYPE 1- ASSOCIATED PLEXIFORM NEUROFIBROMAS: A REPORT FROM PNOC AND THE NF CLINICAL TRIALS CONSORTIUM. Neuro Oncol 2020. [PMCID: PMC7715338 DOI: 10.1093/neuonc/noaa222.619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Plexiform neurofibromas (PNs) can cause significant morbidity. In this phase 2 study, we assessed imaging and functional outcomes to the MEK-inhibitor Binimetinib in pediatric patients with PNs. METHODS Children (age 1–17 years) with PN that were progressive or causing significant morbidity were eligible. Binimetinib is dosed twice-daily (starting dose of 32mg/m2) for maximum of 24 four-week courses. Participants with partial response (PR; >20% decrease in PN volume on central MRI review) at cycle 12 may stay on therapy. Participants undergo MRI and functional assessments at baseline and after courses 4, 8, 12, 18 and 24. Functional assessments are based on PN location. RESULTS Here we present 1-year response data. Twenty participants (55% male) with median age 12 years (range 2–16 years) enrolled; 19 are evaluable for response. Median baseline tumor volume was 326 ml (range, 8-6661 ml). Fourteen participants (74%) met criteria for PR, with 11 achieving PR by course 5. Median maximal PN volume reduction was 25.5% (range, 9–54%). As of August 2020, 14 participants received at least 12 cycles of Binimetinib; 10 remain on therapy. Off study reasons include treatment associated toxicities (n=2), subject withdrawal (n=2), non-compliance (n=2), prolonged treatment delay (n=1), and lack of response (n=3). Thirteen participants underwent dose reduction. Institution-reported related grade 3 toxicities included dry skin, weight gain, muscle weakness, rash, paronychia, cellulitis, diarrhea, gastric hemorrhage and CPK increase. CONCLUSIONS Binimetinib appears reasonably well-tolerated and shows promising activity in children with NF1-associated PNs. Outcomes on functional improvement will be reported at the meeting.
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Affiliation(s)
- Sabine Mueller
- University of California, San Francisco, San Francisco, CA, USA
- Children’s Hospital Zurich, Zurich, Switzerland
| | - Alyssa T Reddy
- University of California, San Francisco, San Francisco, CA, USA
| | - Eva Dombi
- National Cancer Institute, Center for Cancer Research, Bethesda, MD, USA
| | | | | | - Wade Clapp
- Indiana University, School of Medicine, Indianapolis, IN, USA
| | - Stewart Goldman
- Ann & Robert H, Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | - James Tonsgard
- The University of Chicago, Dept, of Pediatrics, Chicago, IL, USA
| | | | | | - Andrea Gross
- National Cancer Institute, Center for Cancer Research, Bethesda, MD, USA
| | | | - Coretta Thomas
- The University of Alabama, School of Public Health, Birmingham, AL, USA
| | - Lloyd Edwards
- The University of Alabama, School of Public Health, Birmingham, AL, USA
| | - Michael Prados
- University of California, San Francisco, San Francisco, CA, USA
| | - Bruce Korf
- The University of Alabama, School of Public Health, Birmingham, AL, USA
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10
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Reddy AT, Krailo MD, Buxton AB, Strother DR, Huang A, Zhou T, Judkins AR, Burger PC, Pollack IF, Williams-Hughes C, Fouladi M, Ho B, Mazewski CM, Lewis VA, Vezina LG, Booth TN, Mahajan A. Reply to S.A. Upadhyaya. J Clin Oncol 2020; 38:3353-3354. [PMID: 32730180 DOI: 10.1200/jco.20.01573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alyssa T Reddy
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Mark D Krailo
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Allen B Buxton
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Douglas R Strother
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Annie Huang
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Tianni Zhou
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Alexander R Judkins
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Peter C Burger
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Ian F Pollack
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Chris Williams-Hughes
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Maryam Fouladi
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Ben Ho
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Claire M Mazewski
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Victor A Lewis
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Louis-Gilbert Vezina
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Timothy N Booth
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
| | - Anita Mahajan
- Alyssa T. Reddy, MD, University of California San Francisco, CA; Mark D. Krailo, PhD, Keck School of Medicine, University of Southern California, Los Angeles, CA; Allen B. Buxton, MS, Children's Oncology Group, Monrovia, CA; Douglas R. Strother, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Annie Huang, MD, PhD, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Tianni Zhou, PhD, California State University at Long Beach, Long Beach, CA; Alexander R. Judkins, MD, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; Peter C. Burger, MD, Johns Hopkins University, Baltimore, MD; Ian F. Pollack, MD, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; Chris Williams-Hughes, BS, Children's Oncology Group, Monrovia, CA; Maryam Fouladi, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Ben Ho, MSc, Hospital for Sick Children, Toronto, ON, Canada; Claire M. Mazewski, MD, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Victor A. Lewis, MD, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Louis-Gilbert Vezina, MD, The George Washington University School Medicine and Health Sciences, Washington, DC; Timothy N. Booth, MD, University of Texas Southwestern, Dallas, TX; and Anita Mahajan, MD, Mayo Clinic, Rochester, MN
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11
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Bernstock JD, Alva E, Cohen JL, Lobbous M, Chagoya G, Elsayed GA, Orr BA, Rozzelle C, Rocque B, Blount J, Johnston JM, Li R, Fiveash JB, Dhall G, Reddy AT, Friedman GK. Treatment of pediatric high-grade central nervous system tumors with high-dose methotrexate in combination with multiagent chemotherapy: A single-institution experience. Pediatr Blood Cancer 2020; 67:e28119. [PMID: 31850678 DOI: 10.1002/pbc.28119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Effective treatment for pediatric embryonal brain tumors includes dose-intensive multiagent chemotherapy (DIMAC) followed by high-dose chemotherapy with stem cell rescue (HDCSCR). Use of repeated cycles of DIMAC including high-dose methotrexate (HDMTX) without HDCSCR has not been described. PROCEDURE We retrospectively reviewed the responses/toxicities in 13 patients (aged 2-155 months, median 22 months) with central nervous system (CNS) tumors (atypical teratoid rhabdoid tumors, CNS embryonal tumors not otherwise specified, pineoblastoma, embryonal tumor with multilayered rosettes, and CNS sarcoma) treated over a 12-year period with repeated cycles of HDMTX followed by etoposide, cisplatin, cyclophosphamide, and vincristine. RESULTS Six patients (46.2%) had disseminated disease at presentation and five (38.5%) had gross total resection. A total of 64 courses of therapy were administered with a median of five courses per patient. Eight patients (61.5%) received radiation therapy (one at relapse). By completion of therapy, 11 patients (84.6%) achieved a response (six complete, five partial). Six of the 13 patients (46.2%) remain alive with a median follow-up of 48 months (6-146). Acute toxicities included fever/neutropenia (70.3%), bacteremia (15.6%), and grade 3 mucositis (18.8%). Long-term complications included learning disability, seizure disorder, and brain necrosis, without treatment-related deaths. CONCLUSIONS DIMAC with HDMTX without HDCSCR may be an effective treatment option for selected patients with embryonal or high-grade CNS tumors.
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Affiliation(s)
- Joshua D Bernstock
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurosurgery, Brigham and Women's, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Alva
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joshua L Cohen
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mina Lobbous
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Galal A Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brent A Orr
- Pathology Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Curtis Rozzelle
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brandon Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rong Li
- Department of Pathology, Children's of Alabama, Birmingham, Alabama
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Girish Dhall
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alyssa T Reddy
- Department of Neurology, University of California at San Francisco, San Francisco, California
| | - Gregory K Friedman
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
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12
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Reddy AT, Strother DR, Judkins AR, Burger PC, Pollack IF, Krailo MD, Buxton AB, Williams-Hughes C, Fouladi M, Mahajan A, Merchant TE, Ho B, Mazewski CM, Lewis VA, Gajjar A, Vezina LG, Booth TN, Parsons KW, Poss VL, Zhou T, Biegel JA, Huang A. Efficacy of High-Dose Chemotherapy and Three-Dimensional Conformal Radiation for Atypical Teratoid/Rhabdoid Tumor: A Report From the Children's Oncology Group Trial ACNS0333. J Clin Oncol 2020; 38:1175-1185. [PMID: 32105509 DOI: 10.1200/jco.19.01776] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Atypical teratoid/rhabdoid tumor (AT/RT) is an aggressive, early-childhood brain tumor without standard effective treatment. To our knowledge, we conducted the first AT/RT-specific cooperative group trial, ACNS0333, to examine the efficacy and safety of intensive postoperative chemotherapy and focal radiation to treat AT/RT. PATIENTS AND METHODS Patients from birth to 22 years of age with AT/RT were eligible. After surgery, they received 2 courses of multiagent chemotherapy, followed by 3 courses of high-dose chemotherapy with peripheral blood stem cell rescue and involved-field radiation therapy. Timing of radiation was based on patient age and disease location and extent. Central testing of tumor and blood for SMARCB1 status was mandated. Tumor molecular subclassification was performed retrospectively. The primary analysis was event-free survival (EFS) for patients < 36 months of age compared with a cooperative groups' historical cohort. Although accrual was based on the therapeutic question, potential prognostic factors, including age, tumor location, M stage, surgical resection, order of therapy, germline status, and molecular subtype, were explored. RESULTS Of 65 evaluable patients, 54 were < 36 months of age. ACNS0333 therapy significantly reduced the risk of EFS events in patients < 36 months of age compared with the historical cohort (P < .0005; hazard rate, 0.43; 95% CI, 0.28 to 0.66). Four-year EFS and overall survival for the entire cohort were 37% (95% CI, 25% to 49%) and 43% (95% CI, 31% to 55%), respectively. Timing of radiation did not affect survival, and 91% of relapses occurred by 2 years from enrollment. Treatment-related deaths occurred in 4 patients. CONCLUSION The ACNS0333 regimen dramatically improved survival compared with historical therapies for patients with AT/RT. Clinical characteristics and molecular subgrouping suggest prognostic differences. ACNS0333 results lay a foundation on which to build future studies and incorporate testing of new therapeutic agents.
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Affiliation(s)
- Alyssa T Reddy
- Departments of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA
| | - Douglas R Strother
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander R Judkins
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Peter C Burger
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Ian F Pollack
- Department Neurosurgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Mark D Krailo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Maryam Fouladi
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Thomas E Merchant
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Ben Ho
- Department of Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire M Mazewski
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Victor A Lewis
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amar Gajjar
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Louis-Gilbert Vezina
- Department of Radiology, The George Washington University School Medicine and Health Sciences, Washington, DC
| | - Timothy N Booth
- Department of Radiology, University of Texas Southwestern, Dallas, TX
| | | | - Vicky L Poss
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Tianni Zhou
- Department of Mathematics and Statistics, California State University at Long Beach, Long Beach, CA
| | - Jaclyn A Biegel
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Annie Huang
- Department of Pediatrics, Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, Ontario, Canada
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13
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Sorge C, Li R, Singh S, Reddy AT, Solomon DA, Perry A, Friedman GK. Complete durable response of a pediatric anaplastic oligodendroglioma to temozolomide alone: Case report and review of literature. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26708. [PMID: 28696020 PMCID: PMC8408833 DOI: 10.1002/pbc.26708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 06/04/2017] [Indexed: 01/08/2023]
Abstract
Anaplastic oligodendroglioma (AO) is rare in children. Treatment typically consists of varying combinations of surgery, chemotherapy, and radiotherapy. We present a pediatric case of frontal lobe AO with periventricular subcallosal extension and local leptomeningeal involvement. The isocitrate dehydrogenase (IDH) wild-type tumor was MGMT methylated and contained an ATRX mutation, BRAF alteration, and 1p/19q co-deletion; a combination of alterations mostly encountered in pediatric oligodendrogliomas. The patient underwent a near total resection and had a complete, durable response to temozolomide alone, suggesting that conservative management without radiation may be appropriate in some cases. We review the literature of this uncommon subtype of glioma in children.
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Affiliation(s)
- Caryn Sorge
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rong Li
- Department of Pathology, Children’s of Alabama, Birmingham, Alabama
| | - Sumit Singh
- Department of Radiology, Children’s of Alabama, Birmingham, Alabama
| | - Alyssa T. Reddy
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - David A. Solomon
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Arie Perry
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Gregory K. Friedman
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Waters AM, Johnston JM, Reddy AT, Fiveash J, Madan-Swain A, Kachurak K, Bag AK, Gillespie GY, Markert JM, Friedman GK. Rationale and Design of a Phase 1 Clinical Trial to Evaluate HSV G207 Alone or with a Single Radiation Dose in Children with Progressive or Recurrent Malignant Supratentorial Brain Tumors. HUM GENE THER CL DEV 2017; 28:7-16. [PMID: 28319448 DOI: 10.1089/humc.2017.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Primary central nervous system tumors are the most common solid neoplasm of childhood and the leading cause of cancer-related death in pediatric patients. Survival rates for children with malignant supratentorial brain tumors are poor despite aggressive treatment with combinations of surgery, radiation, and chemotherapy, and survivors often suffer from damaging lifelong sequelae from current therapies. Novel innovative treatments are greatly needed. One promising new approach is the use of a genetically engineered, conditionally replicating herpes simplex virus (HSV) that has shown tumor-specific tropism and potential efficacy in the treatment of malignant brain tumors. G207 is a genetically engineered HSV-1 lacking genes essential for replication in normal brain cells. Safety has been established in preclinical investigations involving intracranial inoculation in the highly HSV-sensitive owl monkey (Aotus nancymai), and in three adult phase 1 trials in recurrent/progressive high-grade gliomas. No dose-limiting toxicities were seen in the adult studies and a maximum tolerated dose was not reached. Approximately half of the 35 treated adults had radiographic or neuropathologic evidence of response at a minimum of one time point. Preclinical studies in pediatric brain tumor models indicate that a variety of pediatric tumor types are highly sensitive to killing by G207. This clinical protocol outlines a first in human children study of intratumoral inoculation of an oncolytic virus via catheters placed directly into recurrent or progressive supratentorial malignant tumors.
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Affiliation(s)
- Alicia M Waters
- 1 Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - James M Johnston
- 2 Department of Neurosurgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - Alyssa T Reddy
- 3 Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham , Birmingham, Alabama
| | - John Fiveash
- 4 Department of Radiation Oncology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Avi Madan-Swain
- 3 Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Kara Kachurak
- 5 Division of Hematology/Oncology, Children's of Alabama , Birmingham, Alabama
| | - Asim K Bag
- 6 Department of Radiology, University of Alabama at Birmingham , Birmingham, Alabama
| | - G Yancey Gillespie
- 2 Department of Neurosurgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - James M Markert
- 2 Department of Neurosurgery, University of Alabama at Birmingham , Birmingham, Alabama.,3 Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Gregory K Friedman
- 3 Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham , Birmingham, Alabama
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15
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Waters AM, Johnston JM, Reddy AT, Fiveash J, Madan-Swain A, Kachurak K, Bag AK, Gillespie GY, Markert JM, Friedman GK. Rationale and Design of a Phase I Clinical Trial to Evaluate HSV G207 Alone or with a Single Radiation Dose in Children with Progressive or Recurrent Malignant Supratentorial Brain Tumors. HUM GENE THER CL DEV 2017. [DOI: 10.1089/hum.2017.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alicia M Waters
- University of Alabama at Birmingham, Surgery, Birmingham, Alabama, United States
| | - James M Johnston
- University of Alabama at Birmingham, Neurosurgery, Birmingham, Alabama, United States
| | - Alyssa T Reddy
- University of Alabama at Birmingham, Pediatrics, Birmingham, Alabama, United States
| | - John Fiveash
- University of Alabama at Birmingham, Radiation Oncology, Birmingham, Alabama, United States
| | - Avi Madan-Swain
- University of Alabama at Birmingham, Pediatrics, Birmingham, Alabama, United States
| | - Kara Kachurak
- Benjamin Russell Hospital for Children, 22078, Birmingham, Alabama, United States
| | - Asim K Bag
- University of Alabama at Birmingham, Radiology, Birmingham, Alabama, United States
| | - G. Yancey Gillespie
- University of Alabama at Birmingham, Cell Biology and Anatomy, Birmingham, Alabama, United States
| | - James M Markert
- University of Alabama at Birmingham, Neurosurgery, Birmingham, Alabama, United States
| | - Gregory K Friedman
- University of Alabama at Birmingham, Pediatrics, 1600 7th Avenue South, Lowder 512, Birmingham, Alabama, United States, 35233
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16
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Torchia J, Golbourn B, Feng S, Ho KC, Sin-Chan P, Vasiljevic A, Norman JD, Guilhamon P, Garzia L, Agamez NR, Lu M, Chan TS, Picard D, de Antonellis P, Khuong-Quang DA, Planello AC, Zeller C, Barsyte-Lovejoy D, Lafay-Cousin L, Letourneau L, Bourgey M, Yu M, Gendoo DMA, Dzamba M, Barszczyk M, Medina T, Riemenschneider AN, Morrissy AS, Ra YS, Ramaswamy V, Remke M, Dunham CP, Yip S, Ng HK, Lu JQ, Mehta V, Albrecht S, Pimentel J, Chan JA, Somers GR, Faria CC, Roque L, Fouladi M, Hoffman LM, Moore AS, Wang Y, Choi SA, Hansford JR, Catchpoole D, Birks DK, Foreman NK, Strother D, Klekner A, Bognár L, Garami M, Hauser P, Hortobágyi T, Wilson B, Hukin J, Carret AS, Van Meter TE, Hwang EI, Gajjar A, Chiou SH, Nakamura H, Toledano H, Fried I, Fults D, Wataya T, Fryer C, Eisenstat DD, Scheinemann K, Fleming AJ, Johnston DL, Michaud J, Zelcer S, Hammond R, Afzal S, Ramsay DA, Sirachainan N, Hongeng S, Larbcharoensub N, Grundy RG, Lulla RR, Fangusaro JR, Druker H, Bartels U, Grant R, Malkin D, McGlade CJ, Nicolaides T, Tihan T, Phillips J, Majewski J, Montpetit A, Bourque G, Bader GD, Reddy AT, Gillespie GY, Warmuth-Metz M, Rutkowski S, Tabori U, Lupien M, Brudno M, Schüller U, Pietsch T, Judkins AR, Hawkins CE, Bouffet E, Kim SK, Dirks PB, Taylor MD, Erdreich-Epstein A, Arrowsmith CH, De Carvalho DD, Rutka JT, Jabado N, Huang A. Integrated (epi)-Genomic Analyses Identify Subgroup-Specific Therapeutic Targets in CNS Rhabdoid Tumors. Cancer Cell 2016; 30:891-908. [PMID: 27960086 PMCID: PMC5500911 DOI: 10.1016/j.ccell.2016.11.003] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 09/19/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
We recently reported that atypical teratoid rhabdoid tumors (ATRTs) comprise at least two transcriptional subtypes with different clinical outcomes; however, the mechanisms underlying therapeutic heterogeneity remained unclear. In this study, we analyzed 191 primary ATRTs and 10 ATRT cell lines to define the genomic and epigenomic landscape of ATRTs and identify subgroup-specific therapeutic targets. We found ATRTs segregated into three epigenetic subgroups with distinct genomic profiles, SMARCB1 genotypes, and chromatin landscape that correlated with differential cellular responses to a panel of signaling and epigenetic inhibitors. Significantly, we discovered that differential methylation of a PDGFRB-associated enhancer confers specific sensitivity of group 2 ATRT cells to dasatinib and nilotinib, and suggest that these are promising therapies for this highly lethal ATRT subtype.
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Affiliation(s)
- Jonathon Torchia
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Brian Golbourn
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Shengrui Feng
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - King Ching Ho
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Patrick Sin-Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Alexandre Vasiljevic
- Department of Pathology, Groupement Hospitalier Est, CHU de Lyon, Lyon-Bron 69677, France
| | - Joseph D Norman
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Paul Guilhamon
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Livia Garzia
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Natalia R Agamez
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Mei Lu
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Tiffany S Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Daniel Picard
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Pasqualino de Antonellis
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Dong-Anh Khuong-Quang
- Department of Pediatrics, McGill University, Montreal, QC H3Z2Z3, Canada; Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada
| | - Aline C Planello
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Constanze Zeller
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Dalia Barsyte-Lovejoy
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Lucie Lafay-Cousin
- Division of Pediatric Hematology/Oncology, Alberta Children's Hospital, AB T3B6A8, Canada
| | - Louis Letourneau
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Mathieu Bourgey
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Man Yu
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Deena M A Gendoo
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Misko Dzamba
- Department of Computer Science, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Mark Barszczyk
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Tiago Medina
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Alexandra N Riemenschneider
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - A Sorana Morrissy
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Seoul 138-736, Korea
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Marc Remke
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Christopher P Dunham
- Division of Anatomic Pathology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, University of British Columbia, V6T1Z3, Canada
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Qiang Lu
- Laboratory Medicine and Pathology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Vivek Mehta
- Division of Neurosurgery, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Steffen Albrecht
- Department of Pathology, McGill University, Montreal, QC H3Z2Z3, Canada
| | - Jose Pimentel
- Divison of Pathology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon 1649-035, Portugal
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N1N4, Canada
| | - Gino R Somers
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Claudia C Faria
- Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon 1649-035, Portugal
| | - Lucia Roque
- Cytometry and Cytogenetic Laboratory, CIPM, Portuguese Cancer Institute, Lisbon 1099-023, Portugal
| | - Maryam Fouladi
- Division of Oncology, Department of Cancer and Blood Diseases, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Lindsey M Hoffman
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | - Andrew S Moore
- Oncology Service, Children's Health Queensland Hospital; University of Queensland Diamantina Institute, Brisbane, QLD 4102, Australia
| | - Yin Wang
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China
| | - Seung Ah Choi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Jordan R Hansford
- Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Daniel Catchpoole
- Children's Cancer Research Unit, Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Diane K Birks
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | | | - Doug Strother
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Almos Klekner
- Department of Neurosurgery, University of Debrecen, Debrecen 4032, Hungary
| | - Laszló Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen 4032, Hungary
| | - Miklós Garami
- Second Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Péter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Tibor Hortobágyi
- Department of Histopathology, University of Szeged, Szeged 6720, Hungary
| | - Beverly Wilson
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Juliette Hukin
- Division of Hematology and Oncology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Anne-Sophie Carret
- Department of Pediatrics, Division of Hematology-Oncology, Université de Montréal/CHU Sainte-Justine, Montreal, QC H3T1C5, Canada
| | - Timothy E Van Meter
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA 23298-0631, USA
| | - Eugene I Hwang
- Department of Oncology, Children's National Medical Center, Washington, DC 20010, USA
| | - Amar Gajjar
- Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Shih-Hwa Chiou
- Department of Medical Research, Taipei Veterans General Hospital and National Yang-Ming University, Taipei 112, Taiwan
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University, Kumamoto 860-8556, Japan
| | - Helen Toledano
- Department of Pediatric Hematology Oncology, Children's Medical Center of Israel, Petach Tikva 49202, Isreal
| | - Iris Fried
- Department of Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Daniel Fults
- Department of Neurosurgery, University of Utah, School of Medicine, Salt Lake City, UT 84132, USA
| | - Takafumi Wataya
- Department of Neurosurgery, Shizuoka Children's Hospital, Shizuoka 420-8660, Japan
| | - Chris Fryer
- Division of Hematology and Oncology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - David D Eisenstat
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Katrin Scheinemann
- Department of Pediatrics, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Adam J Fleming
- Department of Pediatrics, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Donna L Johnston
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H8L1, Canada
| | - Jean Michaud
- Pathology and Laboratory Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H8L1, Canada
| | - Shayna Zelcer
- Division of Pediatric Hematology/Oncology, Children's Hospital, London Health Sciences Center, London, ON N6A5A5, Canada
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, Children's Hospital of Western Ontario, University of Western Ontario, London, ON N6A5W9, Canada
| | - Samina Afzal
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H4R2, Canada
| | - David A Ramsay
- Department of Pathology and Laboratory Medicine, Children's Hospital of Western Ontario, University of Western Ontario, London, ON N6A5W9, Canada
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10300, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10300, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham NG72RD, England
| | - Rishi R Lulla
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Jason R Fangusaro
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Harriet Druker
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ronald Grant
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - David Malkin
- Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - C Jane McGlade
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Theodore Nicolaides
- Department of Pediatrics (Hematology/Oncology), University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Tarik Tihan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Joanna Phillips
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada; Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Alexandre Montpetit
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Guillaume Bourque
- Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada; Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Gary D Bader
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Alyssa T Reddy
- Department of Pediatric Hematology and Oncology, University of Alabama, Birmingham, AL 35233, USA
| | - G Yancey Gillespie
- Department of Neurosurgery, University of Alabama, Birmingham, AL 35233, USA
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University of Würzburg, Würzburg 97070, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Uri Tabori
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Mathieu Lupien
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, Toronto, ON M5G0A4, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ulrich Schüller
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Torsten Pietsch
- Institute for Neuropathology, University of Bonn Medical Center, Bonn 53105, Germany
| | - Alexander R Judkins
- Department of Pathology & Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA
| | - Cynthia E Hawkins
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Pathology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Peter B Dirks
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Anat Erdreich-Epstein
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Cheryl H Arrowsmith
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Daniel D De Carvalho
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada.
| | - James T Rutka
- Department of Surgery, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
| | - Nada Jabado
- Department of Pediatrics, McGill University, Montreal, QC H3Z2Z3, Canada; Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada.
| | - Annie Huang
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
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Wolfe KR, Madan-Swain A, Hunter GR, Reddy AT, Baños J, Kana RK. An fMRI investigation of working memory and its relationship with cardiorespiratory fitness in pediatric posterior fossa tumor survivors who received cranial radiation therapy. Pediatr Blood Cancer 2013; 60:669-75. [PMID: 23042746 PMCID: PMC3541446 DOI: 10.1002/pbc.24331] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/27/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present study investigated the relationship between cardiorespiratory fitness and executive functioning in pediatric brain tumor survivors who received cranial radiation. This population is known to show executive dysfunction and lower rates of aerobic exercise compared to peers. PROCEDURE Nine adolescent survivors of pediatric posterior fossa tumor completed an n-back working memory task during a functional MRI scan, as well as cardiorespiratory fitness testing on a cycle ergometer. RESULTS Neuroimaging findings indicated typical activation patterns associated with working memory, mainly in the frontal-parietal network. Higher cardiorespiratory fitness was related to better performance on a behavioral measure of working memory and more efficient neural functioning. CONCLUSIONS This study provides preliminary evidence that cardiorespiratory fitness may be related to executive functioning, particularly working memory, in pediatric brain tumor survivors. Descriptions of the brain regions recruited for working memory by pediatric brain tumor survivors may be used to inform future interventions or indicators of treatment efficacy.
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Affiliation(s)
- Kelly R. Wolfe
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, AL 35233
| | - Avi Madan-Swain
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7 Avenue S., ACC 512, Birmingham, AL 35233
| | - Gary R. Hunter
- School of Education, University of Alabama at Birmingham, 901 13 Street S., Birmingham, AL 35294
| | - Alyssa T. Reddy
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7 Avenue S., ACC 512, Birmingham, AL 35233
| | - James Baños
- Department of Physical Medicine and Rehabilitation (Adjunct), University of Alabama at Birmingham, Spain Rehabilitation Center, Suite 190, 1717 6 Avenue S, Birmingham, AL 35294
| | - Rajesh K. Kana
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, AL 35233
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Wolfe KR, Walsh KS, Reynolds NC, Mitchell F, Reddy AT, Paltin I, Madan-Swain A. Executive functions and social skills in survivors of pediatric brain tumor. Child Neuropsychol 2012; 19:370-84. [PMID: 22420326 DOI: 10.1080/09297049.2012.669470] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Medical advances have resulted in increased survival rates for children with brain tumors. Consequently, issues related to survivorship have become more critical. The use of multimodal treatment, in particular cranial radiation therapy, has been associated with subsequent cognitive decline. Specifically, deficits in executive functions have been reported in survivors of various types of pediatric brain tumor. Survivors are left with difficulties, particularly in self-monitoring, initiation, inhibition, and planning, to name a few. Another domain in which survivors of pediatric brain tumor have been reported to show difficulty is that of social skills. Parents, teachers, and survivors themselves have reported decreased social functioning following treatment. Deficits in executive functions and social skills are likely interrelated in this population, as executive skills are needed to navigate various aspects of social interaction; however, this has yet to be studied empirically. Twenty-four survivors of pediatric brain tumor were assessed using a computerized task of executive functions, as well as paper-and-pencil measures of social skills and real-world executive skills. Social functioning was related to a specific aspect of executive functions, that is, the survivors' variability in response time, such that inconsistent responding was associated with better parent-reported and survivor-reported social skills, independent of intellectual abilities. Additionally, parent-reported real-world global executive abilities predicted parent-reported social skills. The implications of these findings for social skills interventions and future research are discussed.
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Affiliation(s)
- Kelly R Wolfe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
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19
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Walsh AM, Fiveash JB, Reddy AT, Friedman GK. Response to radiation in renal medullary carcinoma. Rare Tumors 2011; 3:e32. [PMID: 22066039 PMCID: PMC3208419 DOI: 10.4081/rt.2011.e32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 11/23/2022] Open
Abstract
Renal medullary carcinoma (RMC) is a rare and highly aggressive malignancy arising from the renal medulla and found mostly in patients with sickle cell trait. RMC usually presents with widely metastatic disease. We describe a young man diagnosed with metastatic RMC who sustained a complete response to systemic chemotherapy but developed brain metastases with leptomeningeal involvement and subsequently had a partial response to brain irradiation. The use of radiation in the management of RMC is reviewed. Due to the apparent propensity for RMC to spread to the central nervous system, prophylactic treatment such as craniospinal irradiation should be considered along with chemotherapy in patients with metastatic RMC to potentially improve the progression-free interval.
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Affiliation(s)
- Alexandra M Walsh
- Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL
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20
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Shah AC, Kelly DR, Nabors LB, Oakes WJ, Hilliard LM, Reddy AT. Treatment of primary CNS lymphoma with high-dose methotrexate in immunocompetent pediatric patients. Pediatr Blood Cancer 2010; 55:1227-30. [PMID: 20882580 DOI: 10.1002/pbc.22752] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report two cases of primary CNS lymphoma (PCNSL) treated with high-dose methotrexate. Though standard adult treatment of PCNSL incorporates whole-brain radiotherapy, the literature suggests it may be possible to delay or avoid radiotherapy and the associated increased risk of neurologic sequelae in pediatric patients. Studies in adults indicate methotrexate therapy can be effective against PCNSL and has advantages over the current standard of treatment. Both patients have no evidence of disease 9 and 7 years after treatment, suggesting high-dose methotrexate may lead to disease control in pediatric patients with PCNSL while avoiding the effects of radiotherapy.
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Affiliation(s)
- Amish C Shah
- Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
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21
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Abstract
Despite improving survival rates for children with cancer, a subset of patients exist with disease resistant to traditional therapies such as surgery, chemotherapy, and radiation. These patients require newer, targeted treatments used alone or in combination with more traditional approaches. Oncolytic herpes simplex virus (HSV) is one of these newer therapies that offer promise for several difficult to treat pediatric malignancies. The potential benefit of HSV therapy in pediatric solid tumors including brain tumors, neuroblastomas, and sarcomas is reviewed along with the many challenges that need to be addressed prior to moving oncolytic HSV therapy from the laboratory to the beside in the pediatric population.
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Affiliation(s)
- Gregory K Friedman
- Department of Pediatrics, Children's Hospital of Alabama, University of Alabama at Birmingham, USA.
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22
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Radbill AE, Reddy AT, Markert JM, Wyss JM, Pike MM, Akella NS, Bharara N, Gillespie GY. Effects of G207, a conditionally replication-competent oncolytic herpes simplex virus, on the developing mammalian brain. J Neurovirol 2007; 13:118-29. [PMID: 17505980 DOI: 10.1080/13550280601187177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Viral oncolytic therapy for malignant brain tumors involves local intratumoral delivery of a genetically engineered virus with tumor cell-specific lytic activity. Promising preliminary results have been achieved in preclinical models with G207, a replication-competent herpes simplex virus type 1 constructed with multiple directed mutations. Although the safety of G207 has been demonstrated in adults, application of viral oncolytic therapy to children with brain tumors has been delayed because of previous lack of data concerning the impact of a replication-competent oncolytic virus on the developing mammalian brain. In this study there was no significant difference in long-term physical development, cognitive performance, or exploratory behaviors between mice that received intracerebral inoculation of G207 or control saline at 4 days of age. However, histological examination and magnetic resonance imaging revealed frequent unilateral ventriculomegaly ipsilateral to the site of injection in only the G207 group. These results suggest that although it is unlikely that G207 will have significant adverse effects on neurodevelopmental outcomes of pediatric patients with brain tumors, an initial study of G207 in children should exclude those patients with tumors in or near the ventricular system as well as patients less than 2 years of age. Furthermore, patients in such a study will need to be closely monitored for the development of hydrocephalus.
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Affiliation(s)
- Andrew E Radbill
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a highly malignant central nervous system neoplasm that usually affects very young children and is typically deadly despite very aggressive treatment. Considered rare, the tumor was not recognized as a distinct entity until the 80's, due to its similar features with other primitive tumors. Although AT/RT has become increasingly recognized, published data has been based on small series and are retrospective. Based on these data, there are occasional long-term survivors, most of whom received intensive multi-modal therapy. AT/RT is the first pediatric brain tumor for which a candidate tumor suppressor gene has been identified. A mutation or deletion in the INI1 gene occurs in the majority of AT/RT tumors. The function of the gene is not yet understood. Prospective clinical and biologic trials are greatly needed to understand the efficacy of therapeutic interventions, as well as the role of the gene.
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Affiliation(s)
- Alyssa T Reddy
- University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Prabhakaran P, Reddy AT, Oakes WJ, King WD, Winkler MK, Givens TG. A pilot trial comparing cerebral perfusion pressure-targeted therapy to intracranial pressure-targeted therapy in children with severe traumatic brain injury. J Neurosurg 2004; 100:454-9. [PMID: 15287454 DOI: 10.3171/ped.2004.100.5.0454] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors sought to compare cerebral perfusion pressure (CPP)- with intracranial pressure (ICP)-targeted therapy in children with severe traumatic brain injury (TBI). METHODS A randomized controlled trial was developed to assess CPP and ICP therapies in 17 children (range 15 months-15 years of age) with poststabilization Glasgow Coma Scale (GCS) scores of less than or equal to 8 who were admitted to a pediatric intensive care unit at a Level I trauma center. Goals in the ICP group were to maintain ICP lower than 20 mm Hg and CPP higher than 50 mm Hg. In the CPP group, goals were to maintain CPP higher than 70 mm Hg for patients at least 2 years old and higher than 60 mm Hg for patients younger than 2 years of age. The study outcomes were death or functional outcome at 1 year postinjury. The median GCS scores in the CPP group (12 patients) and the ICP group (five patients) were 6 and 7, respectively. In the CPP group, two patients died, one was lost to follow up, four were unimpaired, and five had mild impairment. In the ICP group, all patients survived; one was lost to follow up, two had mild impairment, and two had hemiparesis and moderate impairment. There were four unimpaired survivors in the CPP arm compared with none in the ICP arm (p = 0.08). CONCLUSIONS The CPP method appears to be safe, although this feasibility study does not establish that the CPP therapy is superior to ICP therapy.
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Affiliation(s)
- Priya Prabhakaran
- Departments of Pediatrics and Surgery, University of Alabama at Birmingham, Alabama, USA
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Wellons JC, Reddy AT, Tubbs RS, Abdullatif H, Oakes WJ, Blount JP, Grabb PA. Neuroendoscopic findings in patients with intracranial germinomas correlating with diabetes insipidus. J Neurosurg 2004; 100:430-6. [PMID: 15287450 DOI: 10.3171/ped.2004.100.5.0430] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intracranial germinomas commonly occur in the pineal region, the floor of the third ventricle (hypothalamus), or both, and they are often associated with diabetes insipidus (DI). The authors conducted a study to correlate preoperative DI with the endoscopic and magnetic resonance (MR) imaging evidence of tumor on the third ventricle floor. METHODS The authors reviewed hospital records, office charts, and MR imaging studies obtained in patients in whom a biopsy sampling procedure was performed with or without endoscopic third ventriculostomy (ETV) at Children's Hospital, Birmingham, Alabama between May 1998 and July 2002. Ten patients with the pathological diagnosis of pure germinoma were identified. Preoperative MR imaging findings and presenting symptoms were correlated with intraoperative neuroendoscopic findings. Seven patients presented with symptomatic hydrocephalus and underwent concomitant ETV. Six patients presented with DI and MR imaging evidence of involvement of the third ventricle floor. Two patients presented with DI and no initial MR imaging evidence of neoplastic involvement of the third ventricle floor; in both there was endoscopic evidence of neoplastic involvement of the floor of the third ventricle. In two children without DI, neither MR imaging nor endoscopic evidence of involvement of the third ventricle floor was observed. CONCLUSIONS In the authors' experience with intracranial germinoma, endoscopic tumor biopsy sampling, and ETV provide an effective, safe, and minimally invasive means of obtaining diagnostic tissue and treating any concomitant hydrocephalus. The authors found that preoperative DI is an absolute predictor of neoplastic involvement of the hypothalamus regardless of MR imaging findings. Therefore, in the setting of DI and intracranial germinoma without neuroimaging evidence of hypothalamic involvement, germinomatous involvement of the hypothalamus should be assumed present, if not confirmed endoscopically at the time of biopsy sampling or third ventriculostomy, when devising adjuvant treatment plans for such patients.
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Affiliation(s)
- John C Wellons
- Section of Pediatric Neurosurgery, and Divisions of Pediatric Hematology/Oncology and Pediatric Endocrinology, Children's Hospital, Birmingham, Alabama 35233, USA
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Reddy AT, Wellons JC, Allen JC, Fiveash JB, Abdullatif H, Braune KW, Grabb PA. Refining the staging evaluation of pineal region germinoma using neuroendoscopy and the presence of preoperative diabetes insipidus. Neuro Oncol 2004; 6:127-33. [PMID: 15134627 PMCID: PMC1871986 DOI: 10.1215/s1152851703000243] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 12/03/2003] [Indexed: 11/19/2022] Open
Abstract
Treatment strategies for CNS germinoma are currently evolving. Current approaches include reducing the volume and dose of radiation by adding pre-irradiation chemotherapy. Very accurate staging is necessary with such an approach to prevent failures. Eight consecutive patients with pineal germinoma at one institution underwent endoscopic surgery for tumor biopsy, direct visualization of the third ventricular region, and third ventriculostomy for those with hydrocephalus. All patients were treated with 4 cycles of chemotherapy. Conformal field radiation therapy followed, with the dose to the tumor bed dependent on the response to chemotherapy. Patients who had MRI, endoscopic, or cerebrospinal fluid evidence of multicentric or disseminated disease also received craniospinal radiation. Six patients had diabetes insipidus (DI) at presentation. All 6 had tumor studding the floor of the third ventricle on endoscopic visualization, while only 4 of those patients had MRI evidence of disease in that region. All patients have completed therapy and are alive, with no evidence of disease at median follow-up of 31.5 months from diagnosis. Direct endoscopic visualization of the third ventricular region may be more sensitive than MRI for evaluating the presence of suprasellar disease and appears to add important information. This parameter should be added to the staging evaluation when feasible. In this series, the presence of DI was 100% predictive of suprasellar disease, even when the MRI was negative for involvement of that region. Patients should be evaluated for DI as part of the initial staging, and if it is present, the patients should be treated for suprasellar disease regardless of MRI findings.
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Affiliation(s)
- Alyssa T Reddy
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Abstract
High-grade gliomas, including glioblastoma multiforme, anaplastic astrocytoma, and intrinsic pontine, are very difficult to treat in children. Despite aggressive treatment with multimodal therapy, most children with these diseases do not survive. Data from published series support aggressive surgical resection when clinically feasible. Patients who have had aggressive resections tend to have a longer survival than those who have undergone only biopsies or partial resections. Almost all patients with high-grade gliomas respond to radiation therapy, and it is the current mainstay of adjuvant therapy. Radiation therapy also tends to prolong survival, but it is rarely curative. Although responses to chemotherapy have been demonstrated, there are no compelling data indicating that it prolongs survival for this group of patients. Current and proposed studies are combining radiation therapy and/or chemotherapy with agents that have shown preclinical promise as radiosensitizers, anti-angiogenesis factors, growth factor receptor inhibitors, and free radical inducers. Other biologic therapies, including gene therapy, are also being investigated. Improved survival for these patients will likely require combined therapy that includes novel treatment.
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Affiliation(s)
- Alyssa T Reddy
- Department of Pediatrics, University of Alabama at Birmingham, The Children's Hospital of Alabama, Birmingham, Alabama 35233, USA
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Abstract
Survival rates for children with cancer have increased dramatically over the past few decades. Development of new chemotherapeutic agents and the expanded use of older agents have had a major impact on this celebrated improvement. Chemotherapy can have, however, significant toxicity on the nervous system. The most common neurologic complications involve acute alterations in consciousness, leukoencephalopathy, seizures, cerebral infarctions, paralysis, neuropathy, and ototoxicity. Most of the information on toxicity comes from prospective reports and the adult patient population. Methotrexate, cyclosporin, and platinum compounds are the most frequently cited. No prospective studies have been done to evaluate chemotherapy-induced neurotoxicity in the pediatric population, and the exact incidence of such complications is unknown. Such investigation is greatly needed, as it may lead to a better understanding of how chemotherapy affects the nervous system and ultimately help develop more strategies to prevent drug-related neurotoxicity in pediatric cancer patients.
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Affiliation(s)
- Alyssa T Reddy
- The Children's Hospital of Alabama, 1600 7th Avenue South, Suite 512 ACC, Birmingham, AL 35233, USA.
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Morrison DG, Phuah HK, Reddy AT, Dure LS, Kline LB. Ophthalmologic involvement in the syndrome of headache, neurologic deficits, and cerebrospinal fluid lymphocytosis. Ophthalmology 2003; 110:115-8. [PMID: 12511355 DOI: 10.1016/s0161-6420(02)01444-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To emphasize that papilledema and other ophthalmic manifestations may occur in the syndrome of headache, neurologic deficits, and cerebrospinal fluid lymphocytosis (HaNDL). DESIGN Two interventional case reports. METHODS Two patients were seen with ophthalmologic findings, including decreased vision, papilledema, sixth nerve palsy, and a variety of neurologic deficits. Each underwent cerebrospinal fluid analysis and intracranial pressure measurement by spinal tap and neuroimaging studies to confirm the diagnosis of HaNDL. RESULTS Both patients received acetazolamide to lower intracranial pressure. The first patient had complete resolution of signs and symptoms. The second, who was also given systemic corticosteroids, was left with diminished visual acuity in the right eye with nasal visual field loss and optic atrophy. CONCLUSIONS The diagnosis of HaNDL is one of exclusion, which must be made in conjunction with a neurologist. HaNDL may be accompanied by elevated intracranial pressure and papilledema. As in other disorders causing papilledema, these patients may have permanent visual sequelae. Recognition by the ophthalmologist of this rarely reported syndrome will facilitate prompt patient diagnosis and treatment.
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Affiliation(s)
- David G Morrison
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, USA
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Abstract
Childhood brain tumors are collectively the most common solid neoplasm and the leading cause of cancer-related death in children. They are a diverse group of diseases and outcome is extremely variable. Current treatment is dependent on histology, location, and in some instances, patient age. Advances in treatment have led to improved survival for some patients, but for many the outcome remains dismal despite aggressive treatment. A growing body of work is aimed at improving the outcome for children with brain tumors not only through clinical trials, but also by focusing on the biologic underpinning of these diseases that have been poorly understood.
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Affiliation(s)
- A T Reddy
- Departments of Pediatrics and Neurology, University of Alabama at Birmingham, Children's Hospital of Alabama, 1600 7th Ave. South, Suite 516 ACC, Birmingham, AL 35233, USA.
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Abstract
BACKGROUND The outcome of a child with a primitive neuroectodermal tumors arising supratentorially (SPNET) is not well characterized and may differ from the outcome of a patient with a histologically similar cerebellar tumor (medulloblastoma [MB]). Recently, 5-year progression free survival rates as high as 80% have been reported for children with MB treated with craniospinal radiation (CRT) and chemotherapy including cisplatin, lomustine (CCNU), and vincristine (VCR). METHODS The authors reviewed the outcome of 22 consecutive patients age 3 years and older (mean age, 10 years; range, 3-18 years) with SPNET who were treated at the study institutions between 1981 and 1996. Tumor location included was 13 pineal, 6 cortical, and 3 thalamic or suprasellar. Five patients had disease dissemination at diagnosis. All patients underwent surgery and staging, followed by CRT and chemotherapy with cisplatin, CCNU, and VCR. RESULTS Of the 22 patients, 13 had developed disease progression and 10 had died at the time of last follow-up. Overall progression free survival (PFS) was 47% +/- 11% at 3 years and 37% +/- 11% at 5 years. There was a significant difference in PFS between patients with localized disease versus those with disseminated disease (P = 0.04). There was no statistical association between tumor location and survival. Although not significant (P = 0.21), there was a trend toward better survival of those patients with complete or near-complete resection compared with those with partial resection or biopsy. CONCLUSIONS The results of the current study demonstrate that the outcome for children with SPNET treated with radiation and chemotherapy appears worse than for children with MB treated with identical therapy. This suggests that there may be biologic differences between supratentorial and infratentorial primitive neuroectodermal tumors, thus requiring refinements in treatment.
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Affiliation(s)
- A T Reddy
- Department of Pediatrics, Children's Hospital of Alabama, University of Alabama at Birmingham, 35233, USA
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Abstract
OBJECTIVE To evaluate a series of patients with enlarged parietal foramina for associated brain anomalies. BACKGROUND Enlarged parietal foramina are usually considered a benign calvarial defect. METHODS Ten patients with enlarged parietal foramina were identified. Seven patients were evaluated with neuroimaging: two by cranial CT and five by CT and/or MRI. Three patients who underwent MRI also underwent MR angiography or MR venography. RESULTS Six of seven patients had cranial imaging showing a persistent falcine venous sinus. Three of six patients had variations of occipital cortical infolding. One patient had focal encephalomalacia in close proximity to the persistent falcine venous sinus and one had a previously undiagnosed atretic occipital encephalocele. CONCLUSION This constellation of findings suggests that aberrant vascular evolution during fetal development may affect cerebrovascular, brain, or skull development. Individuals with enlarged parietal foramina (>5 mm) warrant imaging of underlying brain parenchyma and vasculature.
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Affiliation(s)
- A T Reddy
- Department of Pediatrics, University of Alabama at Birmingham and The Children's Hospital of Alabama 35233, USA
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Abstract
The utilization of multi-modal therapy in the treatment of medulloblastoma has improved survival rates and overall outcome. Recent large clinical trials have supported the use of radiation and chemotherapy as adjuvant treatment. Treatment advances have been made despite a poor understanding of the biological underpinnings of medulloblastoma. Current laboratory investigations are shedding light on the oncogenesis of medulloblastoma and may lead to improved treatments.
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Affiliation(s)
- A T Reddy
- Division of Pediatric Neurology, The Children's Hospital of Alabama, University of Alabama at Birmingham, USA.
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Abstract
Low-grade gliomas are the most common histological type of pediatric brain tumor. They can arise in any part of the nervous system. Although low-grade gliomas are slow growing, they often recur or progress, especially in areas such as the diencephalon or brain stem, where resection is limited by proximity to vital and eloquent structures. Radiation has been used to treat progressive low-grade gliomas, but it is not clear that it improves long-term outcome. Radiotherapy also has potential significant cognitive, endocrine, and vascular side- effects. There is a growing body of evidence to suggest that chemotherapy can delay and may obviate the need for radiation therapy or aggressive surgery. This chapter reviews the published chemotherapeutic trials. Chemotherapy appears to have a major role in the management of children with progressive low-grade gliomas.
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Affiliation(s)
- A T Reddy
- Department of Pediatric Neurology, The Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Bubien JK, Keeton DA, Fuller CM, Gillespie GY, Reddy AT, Mapstone TB, Benos DJ. Malignant human gliomas express an amiloride-sensitive Na+ conductance. Am J Physiol 1999; 276:C1405-10. [PMID: 10362604 DOI: 10.1152/ajpcell.1999.276.6.c1405] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Human astrocytoma cells were studied using whole cell patch-clamp recording. An inward, amiloride-sensitive Na+ current was identified in four continuous cell lines originally derived from human glioblastoma cells (CH235, CRT, SKMG-1, and U251-MG) and in three primary cultures of cells obtained from glioblastoma multiforme tumors (up to 4 passages). In addition, cells freshly isolated from a resected medulloblastoma tumor displayed this same characteristic inward current. In contrast, amiloride-sensitive currents were not observed in normal human astrocytes, low-grade astrocytomas, or juvenile pilocytic astrocytomas. The only amiloride-sensitive Na+ channels thus far molecularly identified in brain are the brain Na+ channels (BNaCs). RT-PCR analyses demonstrated the presence of mRNA for either BNaC1 or BNaC2 in these tumors and in normal astrocytes. These results indicate that the functional expression of amiloride-sensitive Na+ currents is a characteristic feature of malignant brain tumor cells and that this pathway may be a potentially useful target for therapeutic intervention.
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Affiliation(s)
- J K Bubien
- Department of Physiology and Biophysics, University of Alabama at Birmingham, Birmingham, Alabama 35294-0005, USA
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Abstract
Much of the recent change in the management of brain tumors in children has centered on the expanded use of chemotherapy. The addition of chemotherapy has resulted in better survival rates for children with medulloblastoma and altered the management for those with low-grade gliomas. For other tumor types, therapeutic advances have been slower. High-dose chemotherapy increasingly is being employed to treat malignant childhood tumors, with variable results.
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Affiliation(s)
- A T Reddy
- Children's Hospital of Alabama, Division of Pediatric Neurology, University of Alabama, Birmingham 35233, USA
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Benveniste EN, Vidovic M, Panek RB, Norris JG, Reddy AT, Benos DJ. Interferon-gamma-induced astrocyte class II major histocompatibility complex gene expression is associated with both protein kinase C activation and Na+ entry. J Biol Chem 1991; 266:18119-26. [PMID: 1917946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Astrocytes can be induced by interferon-gamma (IFN-gamma) to express class II major histocompatibility complex (MHC) antigens. This study was undertaken to elucidate the intracellular signaling pathways involved in IFN-gamma induction of class II MHC. We examined the effects of Na+/H+ antiporter and protein kinase C (PKC) inhibitors on class II expression and Na+ influx in astrocytes. We found that amiloride and ethyl isopropylamiloride, inhibitors of Na+/H+ exchange, blocked IFN-gamma-induced class II gene expression. IFN-gamma stimulated Na+ influx, and this increased influx was inhibited by amiloride. Treatment of astrocytes with the PKC inhibitor H7 also blocked the increase in Na+ uptake induced by IFN-gamma, indicating that IFN-gamma-induced PKC activation is required for subsequent Na+ influx. IFN-gamma treatment produced an increase of total PKC activity, which was associated with a rapid translocation of PKC activity from cytosolic to particulate fraction. H7 and another PKC inhibitor, staurosporine, inhibited IFN-gamma-induced class II gene expression. However, 4 beta-phorbol 12 beta-myristate 13 alpha-acetate, a potent PKC activator, did not affect class II expression. Taken together, our data indicate that both IFN-gamma-induced PKC activation and Na+ influx are required for class II MHC expression in astrocytes but that activation of PKC alone is not sufficient for ultimate expression of this gene.
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Affiliation(s)
- E N Benveniste
- Department of Neurology, University of Alabama, Birmingham 35294
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Reddy AT, Ayyanna K, Yellamma K. Sensitivity of brain cholinesterase to cypermethrin toxicity in freshwater teleost Tilapia mossambica. Biochem Int 1991; 23:959-62. [PMID: 1883402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cypermethrin at sublethal concentrations induced significant changes in acetylcholinesterase (AChE) activity and acetylcholine (ACh) content in the brain tissue of both juvenile and adult-fish. Maximum inhibition of AChE activity is noticed at 6h and 12h after exposure to cypermethrin in juvenile and adult fish respectively. In contrast, the ACh levels registered an elevation in both the cases. During subsequent periods the rate of recovery in AChE activity and ACh content is variable in both the groups.
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Affiliation(s)
- A T Reddy
- Department of Zoology, Sri Venkateswara University, Tirupati, India
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Reddy AT, Yellamma K. Cypermethrin induced changes in nitrogen metabolism of fish, Tilapia mossambica. Biochem Int 1991; 23:649-54. [PMID: 1872879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
At sublethal concentrations, cypermethrin caused a decrease in total proteins and an increase in free amino acids, protease, alanine aminotransferase and aspartate aminotransferase in liver, brain and gill tissues of Tilapia mossambica. Nitrogen metabolic profiles like ammonia, urea and glutamine were also elevated in all the tissues as a consequence of cypermethrin toxicity. Glutamate dehydrogenase, AMP deaminase and adenosine deaminase activity was also increased in the present study.
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Affiliation(s)
- A T Reddy
- Department of Zoology, S.V. University, Tirupati, India
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Reddy AT, Ayyanna K, Yellamma K. Cypermethrin induced modulations in lipid metabolism of freshwater teleost, Tilapia mossambica. Biochem Int 1991; 23:963-7. [PMID: 1883403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Significant changes in lipid metabolic profiles were observed in brain, liver and gill tissues of T. mossambica under chronic exposure to sublethal concentrations of cypermethrin. Increase in total lipid, lipase and free fatty acids with decrease in glycerol content suggests simultaneous operation of lipogenesis and lipolysis during cypermethrin stress. Phospholipid levels dropped, while cholesterol content increased in all the tissues as a consequence of cypermethrin toxicity.
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Affiliation(s)
- A T Reddy
- Department of Zoology, Sri Venkateswara University, Tirupati, India
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Reddy AT, Yellamma K. The possible metabolic diversions adapted by the cockroach, Periplaneta americana to counteract the toxicity of fenvalerate. Biochem Int 1991; 23:359-65. [PMID: 1859437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Effects of sublethal doses of fenvalerate through topical application were monitored in the central nervous system (CNS) of P. americana. A decrease in total and soluble proteins with an increase in free amino acids, alanine aminotransferase (AlAT) and aspartate aminotransferase (AAT) was observed during fenvalerate toxicity. Further the levels of glycogen, pyruvate and activities of succinate dehydrogenase (SDH) and malate dehydrogenase (MDH) dropped significantly. Lactate content and lactate dehydrogenase (LDH) activity also showed an elevation following fenvalerate toxicity.
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Affiliation(s)
- A T Reddy
- Department of Zoology, S.V. University, Tirupati, India
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Babu GR, Reddy GR, Reddy AT, Rajendra W, Chetty CS. Modulations in ionic composition and ATPase system in the brain of albino rat under induced propoxur toxicity. Biochem Int 1990; 21:1105-11. [PMID: 1964380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Modulations in ionic composition were seen in the rat brain during propoxur treatment indicating an impairment in the electric activity of neurons, oxygen consumption, ATPase system, disruption in the movement of ions across ionic pumps and synaptic transmission. The specific activity levels of ATPases were also altered confirming that the impairment in the ATPase system might be due to the ionic imbalances under propoxur stress.
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Affiliation(s)
- G R Babu
- Department of Zoology, Sri Venkateswara University, Tirupati, India
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Babu GR, Reddy GR, Reddy AT, Rajendra W, Chetty CS. Effect in vitro of propoxur on calcium dependent ATP hydrolysis and calcium uptake by the rat brain synaptosomes. Biochem Int 1990; 21:1089-94. [PMID: 2150478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Effect in vitro of propoxur on the specific activity of calcium stimulated ATPase and calcium uptake was studied in the rat brain synaptosomes. The data suggest that propoxur might disrupt the synaptic function by altering the calcium dependent ATP hydrolysis and calcium uptake in the central nervous system.
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Affiliation(s)
- G R Babu
- Department of Zoology, Sri Venkateswara University Tirupati, India
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