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Illert AL, Stenzinger A, Bitzer M, Horak P, Gaidzik VI, Möller Y, Beha J, Öner Ö, Schmitt F, Laßmann S, Ossowski S, Schaaf CP, Hallek M, Brümmendorf TH, Albers P, Fehm T, Brossart P, Glimm H, Schadendorf D, Bleckmann A, Brandts CH, Esposito I, Mack E, Peters C, Bokemeyer C, Fröhling S, Kindler T, Algül H, Heinemann V, Döhner H, Bargou R, Ellenrieder V, Hillemanns P, Lordick F, Hochhaus A, Beckmann MW, Pukrop T, Trepel M, Sundmacher L, Wesselmann S, Nettekoven G, Kohlhuber F, Heinze O, Budczies J, Werner M, Nikolaou K, Beer AJ, Tabatabai G, Weichert W, Keilholz U, Boerries M, Kohlbacher O, Duyster J, Thimme R, Seufferlein T, Schirmacher P, Malek NP. The German Network for Personalized Medicine to enhance patient care and translational research. Nat Med 2023:10.1038/s41591-023-02354-z. [PMID: 37280276 DOI: 10.1038/s41591-023-02354-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- A L Illert
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Medicine III, Faculty of Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Center for Personalized Medicine (ZPM), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Partner Site TU Munich, Munich, Germany
| | - A Stenzinger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - M Bitzer
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - P Horak
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - V I Gaidzik
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
- Center for Personalized Medicine (ZPM), Ulm, Germany
| | - Y Möller
- Center for Personalized Medicine (ZPM), Tübingen, Germany
- M3 Research Institute University Hospital Tübingen, Tübingen, Germany
| | - J Beha
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Ö Öner
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - F Schmitt
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - S Laßmann
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
| | - S Ossowski
- Center for Personalized Medicine (ZPM), Tübingen, Germany
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Institute for Bioinformatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
| | - C P Schaaf
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - M Hallek
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for integrated Oncology (CIO-ABCD), Aachen-Bonn-Cologne-Düsseldorf, Germany
| | - T H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Center for integrated Oncology (CIO-ABCD), Aachen-Bonn-Cologne-Düsseldorf, Germany
| | - P Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
- Center for integrated Oncology (CIO-ABCD), Aachen-Bonn-Cologne-Düsseldorf, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Center for integrated Oncology (CIO-ABCD), Aachen-Bonn-Cologne-Düsseldorf, Germany
| | - P Brossart
- Department of Oncology, Hematology, Stem Cell Transplantation, Cell- and Immunotherapies, Clinical Immunology and Rheumatology, University Hospital Bonn, Bonn, Germany
- Center for integrated Oncology (CIO-ABCD), Aachen-Bonn-Cologne-Düsseldorf, Germany
| | - H Glimm
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Dresden, Germany
| | - D Schadendorf
- Department of Dermatology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, Essen, Germany
- National Center for Tumor Diseases (NCT), NCT-West, Campus Essen, Essen, Germany
- Westdeutsches Tumorzentrum (WTZ), Essen, Germany
- Research Alliance Ruhr - Research Center One Health, University Duisburg-Essen, Essen, Germany
| | - A Bleckmann
- Department of Medicine A: Hematology, Oncology, and Pneumology, University Hospital Münster (UKM), Münster, Germany
- West German Cancer Center, University Hospital Münster, Münster, Germany
| | - C H Brandts
- University Cancer Center (UCT) Frankfurt-Marburg, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK) Partner Site, Frankfurt, Germany
| | - I Esposito
- Institute of Pathology, Heinrich-Heine University and University Hospital, Düsseldorf, Germany
- Center for Personalized Medicine (ZPM), Düsseldorf, Germany
| | - E Mack
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps-University, Marburg, Germany
| | - C Peters
- Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - C Bokemeyer
- Department of Oncology, Hematology and BMT with section of Pneumology, University of Hamburg, Hamburg, Germany
| | - S Fröhling
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - T Kindler
- University Cancer Center, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
- German Cancer Consortium (DKTK) Partner Site Mainz, Mainz, Germany
| | - H Algül
- Institute for Tumor Metabolism, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Comprehensive Cancer Center Munich TUM, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - V Heinemann
- Comprehensive Cancer Center Munich, Klinikum Großhadern, Ludwig Maximilian University of Munich, Munich, Germany
- Department of Medicine III, Klinikum Großhadern, Ludwig Maximilian University of Munich, Munich, Germany
| | - H Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - R Bargou
- Comprehensive Cancer Center Mainfranken, Uniklinikum Würzburg, Würzburg, Germany
- Bavarian Cancer Research Center (BZKF), Partner Site Würzburg, Würzburg, Germany
| | - V Ellenrieder
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - P Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - F Lordick
- Comprehensive Cancer Center Central Germany and University Cancer Center Leipzig,, University Medicine Leipzig, Leipzig, Germany
| | - A Hochhaus
- Comprehensive Cancer Center Central Germany and Department of Hematology and Internal Oncology, Universitätsklinikum Jena, Jena, Germany
| | - M W Beckmann
- University Hospital Erlangen, Department of Obstetrics and Gynecology, Friedrich-Alexander-Universität Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nuremberg, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Partner Site Erlangen, Erlangen, Germany
| | - T Pukrop
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
- Comprehensive Cancer Center Ostbayern, Regensburg, Germany
- Bavarian Cancer Research Center (BZKF), Partner Site Regensburg, Regensburg, Germany
| | - M Trepel
- Department of Hematology and Medical Oncology, Augsburg University Hospital, Augsburg, Germany
- Comprehensive Cancer Center Augsburg, CCC Alliance WERA, Augsburg, Germany
- Bavarian Cancer Research Center (BZKF), Partner Site Augsburg, Augsburg, Germany
| | - L Sundmacher
- Department of Health Services Management, Ludwig-Maximilians-Universität, Munich, Germany
| | - S Wesselmann
- Deutsche Krebsgesellschaft (DKG), Berlin, Germany
| | | | | | - O Heinze
- Department Medical Information Systems, University Hospital Heidelberg, Heidelberg, Germany
| | - J Budczies
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - M Werner
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - K Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A J Beer
- Department of Nuclear Medicine, Ulm University Hospital, Ulm, Germany
| | - G Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, Center for Neuro-Oncology, University Hospital Tübingen, Tübingen, Germany
- Comprehensive Cancer Center Tübingen-Stuttgart, Stuttgart, Germany
| | - W Weichert
- Center for Personalized Medicine (ZPM), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Institute of Pathology, Technische Universität München, Munich, Germany
- German Cancer Consortium (DKTK) Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Partner Site TU Munich, Munich, Germany
| | - U Keilholz
- Charité Comprehensive Cancer Center, Charité, Berlin, Germany
| | - M Boerries
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - O Kohlbacher
- Center for Personalized Medicine (ZPM), Tübingen, Germany
- Institute for Bioinformatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
- Institute for Translational Bioinformatics, University Medical Center, Tübingen, Germany
- Department of Computer Science, Applied Bioinformatics, University of Tübingen, Tübingen, Germany
| | - J Duyster
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - R Thimme
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
- Department of Medicine II, Freiburg, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - T Seufferlein
- Center for Personalized Medicine (ZPM), Ulm, Germany
- Department of Internal Medicine I, University Hospital, University of Ulm, Ulm, Germany
| | - P Schirmacher
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - N P Malek
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany.
- Center for Personalized Medicine (ZPM), Tübingen, Germany.
- M3 Research Institute University Hospital Tübingen, Tübingen, Germany.
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Remde H, Schmidt-Pennington L, Reuter M, Landwehr LS, Jensen M, Lahner H, Kimpel O, Altieri B, Laubner K, Schreiner J, Bojunga J, Kircher S, Kunze CA, Pohrt A, Teleanu MV, Hübschmann D, Stenzinger A, Glimm H, Fröhling S, Fassnacht M, Mai K, Kroiss M. Outcome of Immunotherapy in Adrenocortical Carcinoma - A retrospective cohort study. Eur J Endocrinol 2023:7187724. [PMID: 37260092 DOI: 10.1093/ejendo/lvad054] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/13/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Clinical trials with immune checkpoint inhibitors (ICI) in adrenocortical carcinoma (ACC) have yielded contradictory results. We aimed to evaluate treatment response and safety of ICI in ACC in a real-life setting. DESIGN Retrospective cohort study of 54 patients with advanced ACC receiving ICI as compassionate use at six German reference centres between 2016 and 2022. METHODS Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and treatment-related adverse events (TRAE) were assessed. RESULTS In 52 patients surviving at least 4 weeks after initiation of ICI, ORR was 13.5% (6-26) and DCR 24% (16-41). PFS was 3.0 months (95%CI 2.3-3.7). In all patients, median OS was 10.4 months (3.8-17). 17 TRAE occurred in 15 patients, which was associated with a longer PFS of 5.5 (1.9-9.2) vs. 2.5 (2.0- 3.0) months (HR 0.29, 95%CI 0.13-0.66, p=0.001) and OS of 28.2 (9.5-46.8) vs. 7.0 (4.1-10.2) months (HR 0.34, 95%CI 0.12-0.93). Positive tissue staining for programmed cell death ligand 1 (PD-L1) was associated with a longer PFS of 3.2 (2.6-3.8) vs. 2.3 (1.6-3.0, p<0.05) months. Adjusted for concomitant mitotane use, treatment with nivolumab was associated with lower risk of progression (HR 0.36, 0.15-0.90) and death (HR 0.20, 0.06-0.72) compared to pembrolizumab. CONCLUSIONS In the real-life setting we observe a response comparable to other second-line therapies and an acceptable safety profile in ACC patients receiving different ICI. The relevance of PD-L1 as a marker of response and the potentially more favourable outcome in nivolumab treated patients require confirmation.
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Affiliation(s)
- H Remde
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - L Schmidt-Pennington
- Department of Endocrinology & Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Insitute of Health, 10117 Berlin, Germany
| | - M Reuter
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - L-S Landwehr
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - M Jensen
- Department of Endocrinology & Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Insitute of Health, 10117 Berlin, Germany
| | - H Lahner
- Department of Endocrinology and Metabolism, University Hospital Duisburg-Essen, Essen, Germany
| | - O Kimpel
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - B Altieri
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - K Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, University of Freiburg
| | - J Schreiner
- University Hospital Munich, Department of Internal Medicine IV, Ludwig-Maximilians-University München, Munich, Germany
| | - J Bojunga
- Department of Internal Medicine 1, Division of Endocrinology, Goethe University Frankfurt, Faculty 16 Medicine, Frankfurt am Main, Germany
| | - S Kircher
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - C A Kunze
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M V Teleanu
- National Center for Tumor Diseases Heidelberg and German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - D Hübschmann
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ) Heidelberg, Germany
- Pattern Recognition and Digital Medicine Group, Heidelberg Institute for Stem cell Technology and Experimental Medicine (HI-STEM) gGmbH, Heidelberg, Germany
- German Cancer Consortium, Im Neuenheimer Feld 280, 69120 Heidelberg Germany
| | - A Stenzinger
- Universitätsklinikum Heidelberg, Institut für Pathologie, Im Neuenheimer Feld 224, 69120 Heidelberg
| | - H Glimm
- Department for Translational Medical Oncology, National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- Translational Medical Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Translational Functional Cancer Genomics, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK) Dresden, Germany
| | - S Fröhling
- National Center for Tumor Diseases Heidelberg and German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
- German Cancer Consortium, Im Neuenheimer Feld 280, 69120 Heidelberg Germany
| | - M Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - K Mai
- Department of Endocrinology & Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Insitute of Health, 10117 Berlin, Germany
| | - M Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
- University Hospital Munich, Department of Internal Medicine IV, Ludwig-Maximilians-University München, Munich, Germany
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Hamacher R, Pabst K, Cheung P, Heilig C, Hüllein J, Liffers ST, Schaarschmidt B, Costa P, Kessler L, Falkenhorst J, Glimm H, Umutlu L, Schuler M, Hübschmann D, Bauer S, Fröhling S, Herrmann K, Siveke J, Schildhaus HU, Fendler W. 99P Fibroblast activation protein alpha (FAP) as theranostic target in solitary fibrous tumor. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Heilig C, Teleanu MV, Bhatti I, Richter S, Siveke J, Wagner S, Kopp HG, Kindler T, Illert L, Golf A, Dormann K, Benner A, Süsse H, Freitag A, Von Kalle C, Glimm H, Hübschmann D, Fröhling S, Schlenk R. 487P Randomized phase II study of trabectedin/olaparib compared to physician’s choice in subjects with previously treated advanced or recurrent solid tumors harboring DNA repair deficiencies. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Heilig CE, Horak P, Kreutzfeldt S, Teleanu V, Mock A, Renner M, Bhatti IA, Hutter B, Hüllein J, Fröhlich M, Uhrig S, Süße H, Heiligenthal L, Ochsenreither S, Illert AL, Vogel A, Desuki A, Heinemann V, Heidegger S, Bitzer M, Scheytt M, Brors B, Hübschmann D, Baretton G, Stenzinger A, Steindorf K, Benner A, Jäger D, Heining C, Glimm H, Fröhling S, Schlenk RF. Rationale and design of the CRAFT (Continuous ReAssessment with Flexible ExTension in Rare Malignancies) multicenter phase II trial. ESMO Open 2021; 6:100310. [PMID: 34808524 PMCID: PMC8609144 DOI: 10.1016/j.esmoop.2021.100310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Approvals of cancer therapeutics are primarily disease entity specific. Current molecular diagnostic approaches frequently identify actionable alterations in rare cancers or rare subtypes of common cancers for which the corresponding treatments are not approved and unavailable within clinical trials due to entity-related eligibility criteria. Access may be negotiated with health insurances. However, approval rates vary, and critical information required for a scientific evaluation of treatment-associated risks and benefits is not systematically collected. Thus clinical trials with optimized patient selection and comprehensive molecular characterization are essential for translating experimental treatments into standard care. PATIENTS AND METHODS Continuous ReAssessment with Flexible ExTension in Rare Malignancies (CRAFT) is an open-label phase II trial for adults with pretreated, locally advanced, or metastatic solid tumors. Based on the evaluation by a molecular tumor board, patients are assigned to combinations of six molecularly targeted agents and a programmed death-ligand 1 (PD-L1) antagonist within seven study arms focusing on (i) BRAF V600 mutations; (ii) ERBB2 amplification and/or overexpression, activating ERBB2 mutations; (iii) ALK rearrangements, activating ALK mutations; (iv and v) activating PIK3CA and AKT mutations, other aberrations predicting increased PI3K-AKT pathway activity; (vi) aberrations predicting increased RAF-MEK-ERK pathway activity; (vii) high tumor mutational burden and other alterations predicting sensitivity to PD-L1 inhibition. The primary endpoint is the disease control rate (DCR) at week 16; secondary and exploratory endpoints include the progression-free survival ratio, overall survival, and patient-reported outcomes. Using Simon's optimal two-stage design, 14 patients are accrued for each study arm. If three or fewer patients achieve disease control, the study arm is stopped. Otherwise, 11 additional patients are accrued. If the DCR exceeds 7 of 25 patients, the null hypothesis is rejected for the respective study arm. CONCLUSIONS CRAFT was activated in October 2021 and will recruit at 10 centers in Germany. TRIAL REGISTRATION NUMBERS EudraCT: 2019-003192-18; ClinicalTrials.gov: NCT04551521.
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Affiliation(s)
- C E Heilig
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - P Horak
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - S Kreutzfeldt
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - V Teleanu
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - A Mock
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; Department of Medical Oncology, NCT Heidelberg and Heidelberg University Hospital, Heidelberg, Germany
| | - M Renner
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany; Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - I A Bhatti
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; Department of Medical Oncology, NCT Heidelberg and Heidelberg University Hospital, Heidelberg, Germany
| | - B Hutter
- Computational Oncology Group, Molecular Precision Oncology Program, NCT Heidelberg and DKFZ, Heidelberg, Germany; Division of Applied Bioinformatics, DKFZ, Heidelberg, Germany
| | - J Hüllein
- Computational Oncology Group, Molecular Precision Oncology Program, NCT Heidelberg and DKFZ, Heidelberg, Germany
| | - M Fröhlich
- Computational Oncology Group, Molecular Precision Oncology Program, NCT Heidelberg and DKFZ, Heidelberg, Germany; Division of Applied Bioinformatics, DKFZ, Heidelberg, Germany
| | - S Uhrig
- Computational Oncology Group, Molecular Precision Oncology Program, NCT Heidelberg and DKFZ, Heidelberg, Germany; Division of Applied Bioinformatics, DKFZ, Heidelberg, Germany
| | - H Süße
- NCT Trial Center, NCT Heidelberg and DKFZ, Heidelberg, Germany
| | - L Heiligenthal
- NCT Trial Center, NCT Heidelberg and DKFZ, Heidelberg, Germany
| | - S Ochsenreither
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany; DKTK, Berlin, Germany
| | - A L Illert
- Comprehensive Cancer Center Freiburg, University of Freiburg Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Internal Medicine I, University of Freiburg Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DKTK, Freiburg, Germany
| | - A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Desuki
- University Cancer Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany; DKTK, Mainz, Germany; Third Medical Department, University Medical Center, Mainz, Germany
| | - V Heinemann
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Munich, Germany; DKTK, Munich, Germany
| | - S Heidegger
- DKTK, Munich, Germany; Department of Medicine III, School of Medicine, Technical University of Munich, Munich, Germany
| | - M Bitzer
- Center for Personalized Medicine, Eberhard-Karls University, Tübingen, Germany; Department of Internal Medicine I, University Hospital, Eberhard-Karls University, Tübingen, Germany; DKTK, Tübingen, Germany
| | - M Scheytt
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany; Department of Internal Medicine II, Würzburg University Medical Center, Würzburg, Germany
| | - B Brors
- German Cancer Consortium (DKTK), Heidelberg, Germany; Division of Applied Bioinformatics, DKFZ, Heidelberg, Germany
| | - D Hübschmann
- German Cancer Consortium (DKTK), Heidelberg, Germany; Computational Oncology Group, Molecular Precision Oncology Program, NCT Heidelberg and DKFZ, Heidelberg, Germany; Heidelberg Institute for Stem Cell Technology and Experimental Medicine, Heidelberg, Germany
| | - G Baretton
- Institute for Pathology, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - A Stenzinger
- German Cancer Consortium (DKTK), Heidelberg, Germany; Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, NCT Heidelberg and DKFZ, Heidelberg, Germany
| | - A Benner
- Division of Biostatistics, DKFZ, Heidelberg, Germany
| | - D Jäger
- Department of Medical Oncology, NCT Heidelberg and Heidelberg University Hospital, Heidelberg, Germany
| | - C Heining
- Department of Translational Medical Oncology, NCT Dresden and DKFZ, Dresden, Germany; Center for Personalized Oncology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany; DKTK, Dresden, Germany
| | - H Glimm
- Department of Translational Medical Oncology, NCT Dresden and DKFZ, Dresden, Germany; Center for Personalized Oncology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany; DKTK, Dresden, Germany
| | - S Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - R F Schlenk
- German Cancer Consortium (DKTK), Heidelberg, Germany; Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany; Department of Medical Oncology, NCT Heidelberg and Heidelberg University Hospital, Heidelberg, Germany; NCT Trial Center, NCT Heidelberg and DKFZ, Heidelberg, Germany.
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6
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Maurus K, Kosnopfel C, Kneitz H, Appenzeller S, Schrama D, Glutsch V, Roth S, Gerhard-Hartmann E, Rosenfeldt M, Möhrmann L, Fröhlich M, Hübschmann D, Stenzinger A, Glimm H, Fröhling S, Goebeler M, Rosenwald A, Kutzner H, Schilling B. Cutaneous epithelioid hemangiomas show somatic mutations in the MAPK pathway. Br J Dermatol 2021; 186:553-563. [PMID: 34726260 DOI: 10.1111/bjd.20869] [Citation(s) in RCA: 2] [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] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epithelioid hemangioma (EH) arising from the skin is a benign vascular tumor with marked inflammatory cell infiltration, which exhibits a high tendency to persist and frequently recurs after resection. So far, the underlying pathogenesis is largely elusive. OBJECTIVES To identify genetic alterations by next-generation-sequencing and/or droplet digital PCR (ddPCR) in cutaneous EH. METHODS DNA and RNA from an EH lesion of an index patient were subjected to whole genome and RNA sequencing. Multiplex PCR-based panel sequencing of genomic DNA isolated from archival formalin-fixed paraffin-embedded (FFPE) tissue of 18 cutaneous EH patients was performed. ddPCR was used to confirm mutations. RESULTS We identified somatic mutations in genes of the MAPK pathway (MAP2K1 and KRAS) in cutaneous EH biopsies. By ddPCR we could confirm the recurrent presence of activating, low-frequency mutations affecting MAP2K1. In total, 9 out of 18 analyzed patients showed activating MAPK pathway mutations, which were mutually exclusive. Comparative analysis of tissue areas enriched for lymphatic infiltrate or aberrant endothelial cells, respectively, revealed an association of these mutations with the presence of endothelial cells. CONCLUSIONS Taken together, our data suggest that EH shows somatic mutations in genes of the MAPK pathway which might contribute to the formation of this benign tumor.
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Affiliation(s)
- K Maurus
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - C Kosnopfel
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - H Kneitz
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - S Appenzeller
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - D Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - V Glutsch
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - S Roth
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | | | - M Rosenfeldt
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - L Möhrmann
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), Dresden, Germany
- Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
- Center for Personalized Oncology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - M Fröhlich
- Computational Oncology Group, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D Hübschmann
- Computational Oncology Group, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Dresden, Germany
| | - A Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - H Glimm
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), Dresden, Germany
- Center for Personalized Oncology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Functional Cancer Genomics, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Fröhling
- German Cancer Consortium (DKTK), Dresden, Germany
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - A Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - H Kutzner
- Dermatopathology, Friedrichshafen, Germany
| | - B Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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7
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Westphal D, Garzarolli M, Sergon M, Horak P, Hutter B, Becker JC, Wiegel M, Maczey E, Blum S, Grosche-Schlee S, Rütten A, Ugurel S, Stenzinger A, Glimm H, Aust D, Baretton G, Beissert S, Fröhling S, Redler S, Surowy H, Meier F. High tumour mutational burden and EGFR/MAPK pathway activation are therapeutic targets in metastatic porocarcinoma. Br J Dermatol 2021; 185:1186-1199. [PMID: 34185311 DOI: 10.1111/bjd.20604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Eccrine porocarcinoma (EPC) is a rare skin cancer arising from the eccrine sweat glands. Due to the lack of effective therapies, metastasis is associated with a high mortality rate. OBJECTIVES To investigate the drivers of EPC progression. METHODS We carried out genomic and transcriptomic profiling of metastatic EPC (mEPC), validation of the observed alterations in an EPC patient-derived cell line, confirmation of relevant observations in a large patient cohort of 30 tumour tissues, and successful treatment of a patient with mEPC under the identified treatment regimens. RESULTS mEPC was characterized by a high tumour mutational burden (TMB) with an ultraviolet signature, widespread copy number alterations and gene expression changes that affected cancer-relevant cellular processes such as cell cycle regulation and proliferation, including a pathogenic TP53 (tumour protein 53) mutation, a copy number deletion in the CDKN2A (cyclin dependent kinase inhibitor 2A) region and a CTNND1/PAK1 [catenin delta 1/p21 (RAC1) activated kinase 1] gene fusion. The overexpression of EGFR (epidermal growth factor receptor), PAK1 and MAP2K1 (mitogen-activated protein kinase kinase 1; also known as MEK1) genes translated into strong protein expression and respective pathway activation in the tumour tissue. Furthermore, a patient-derived cell line was sensitive to EGFR and MEK inhibition, confirming the functional relevance of the pathway activation. Immunohistochemistry analyses in a large patient cohort showed the relevance of the observed changes to the pathogenesis of EPC. Our results indicate that mEPC should respond to immune or kinase inhibitor therapy. Indeed, the advanced disease of our index patient was controlled by EGFR-directed therapy and immune checkpoint inhibition for more than 2 years. CONCLUSIONS Molecular profiling demonstrated high TMB and EGFR/MAPK pathway activation to be novel therapeutic targets in mEPC.
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Affiliation(s)
- D Westphal
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - M Garzarolli
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany
| | - M Sergon
- Institute of Pathology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - P Horak
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and DKFZ, Heidelberg, Germany
| | - B Hutter
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Computational Oncology, Molecular Diagnostics Program, NCT Heidelberg and DKFZ, Heidelberg, Germany.,Division of Applied Bioinformatics, DKFZ, Heidelberg, Germany
| | - J C Becker
- Department of Dermatology, University Hospital Essen, Essen, Germany.,Translational Skin Cancer Research, DKTK, Partner Site Essen, Essen, Germany
| | - M Wiegel
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany
| | - E Maczey
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - S Blum
- Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - S Grosche-Schlee
- Clinic and Policlinic of Nuclear Medicine, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - A Rütten
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - S Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - A Stenzinger
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - H Glimm
- Translational Functional Cancer Genomics, NCT Heidelberg and DKFZ, Heidelberg, Germany.,Department of Translational Medical Oncology NCT Dresden and DKFZ, Dresden, Germany.,Center for Personalized Oncology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany.,DKTK, Dresden, Germany
| | - D Aust
- National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Institute of Pathology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany.,Tumor and Normal Tissue Bank of the UCC/NCT Site Dresden, NCT Dresden and University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - G Baretton
- National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Institute of Pathology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany.,Tumor and Normal Tissue Bank of the UCC/NCT Site Dresden, NCT Dresden and University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - S Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - S Fröhling
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and DKFZ, Heidelberg, Germany
| | - S Redler
- Institute of Human Genetics, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - H Surowy
- Institute of Human Genetics, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - F Meier
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Skin Cancer Center at the University Cancer Center Dresden, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
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8
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Stenzinger A, Endris V, Budczies J, Merkelbach-Bruse S, Dietmaier W, Siebolts U, Maas J, Merino D, Stewart M, Allen J, Glimm H, Thiemann M, Aust D, Hummel M, Moch H, Jung A, Haller F, Weichert W, Dietel M. Harmonization and standardization of panel-based tumour mutational burden (TMB) measurement: Real-world results and recommendations of the QuIP study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Horak P, Kreutzfeldt S, Mock A, Heining C, Heilig C, Möhrmann L, Uhrig S, Hübschmann D, Beck K, Richter D, Schlenk R, Klink B, Hutter B, Weichert W, Stenzinger A, Schröck E, Brors B, Glimm H, Fröhling S. Comprehensive genomic and transcriptomic profiling in advanced-stage cancers and rare malignancies: Clinical results from the MASTER trial of the German Cancer Consortium. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Mock A, Heilig C, Kreutzfeldt S, Hübschmann D, Heining C, Schröck E, Brors B, Stenzinger A, Jäger D, Schlenk R, Glimm H, Fröhling S, Horak P. Community-driven development of a modified progression-free survival ratio for precision oncology trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Heilig C, Hübschmann D, Kopp HG, Metzeler K, Richter S, Hermes B, von Bubnoff N, Kindler T, Siveke J, Wagner S, Ochsenreither S, Süße H, Brors B, Benner A, Jäger D, Von Kalle C, Glimm H, Gröschel S, Fröhling S, Schlenk R. Randomized phase II study of trabectedin/olaparib compared to physician’s choice in subjects with previously treated advanced or recurrent solid tumors harboring dna repair deficiencies. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Abstract
CLINICAL ISSUE Innovative next generation sequencing (NGS) technologies and comprehensive sequencing investigations in large patient cohorts have paved the way for very promising personalized treatment strategies based on the molecular characteristics of individual tumors. STANDARD TREATMENT Targeted therapies, such as tyrosine kinase inhibitors, antibodies and modern immunotherapeutic approaches are well established as monotherapy and combination therapy for many hematological and oncological malignancies. TREATMENT INNOVATIONS A plethora of innovative therapies targeting various components of intracellular signaling cascades and effective mechanisms against oncogenes as well as the availability of NGS technologies enable personalized cancer treatment based on the molecular profiles of individual tumors and genetic stratification, within clinical trials. DIAGNOSTIC WORK-UP Comprehensive genetic approaches including cancer gene panel sequencing, whole exome, whole genome and transcriptome sequencing are carried out to a varying extent and particularly in the academic setting. PERFORMANCE Principally, a comprehensive characterization of tumors in addition to DNA and RNA sequencing that also incorporates epigenetic, metabolomic, and proteomic alterations would be desirable. A comprehensive clinical implementation of integrative, multidimensional genetic typing is, however, currently not possible. ACHIEVEMENTS It remains to be demonstrated whether these approaches will translate into significantly better outcomes for patients and whether they can be increasingly implemented in the routine diagnostic work-up. PRACTICAL RECOMMENDATIONS The selection of diagnostic tools in individual cases and the extent of genomic analyses in the clinical context, need to take the availability of methods as well as the present clinical situation into account.
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Affiliation(s)
- C Heining
- Abteilung für Translationale Onkologie, Nationales Centrum für Tumorerkrankungen Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland
| | - P Horak
- Abteilung für Translationale Onkologie, Nationales Centrum für Tumorerkrankungen Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland
| | - S Gröschel
- Abteilung für Translationale Onkologie, Nationales Centrum für Tumorerkrankungen Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland
| | - H Glimm
- Abteilung für Translationale Onkologie, Nationales Centrum für Tumorerkrankungen Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland
| | - S Fröhling
- Abteilung für Translationale Onkologie, Nationales Centrum für Tumorerkrankungen Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland.
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13
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Pfarr N, Boxberg M, Riedmann K, Jesinghaus M, Konukiewitz B, Glimm H, Jost P, Fröhling S, Weichert W. Reliability of the detection of the mutation burden status by targeted next generation sequencing applying a large gene panel. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy493.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Rippinger N, Haun MW, Fischer C, Rhiem K, Hübbel A, Grill S, Kiechle M, Cremer FW, Kast K, Nguyen HP, Ditsch N, Kratz P, Pfister S, Pajtler KW, Speiser D, Seitz S, Glimm H, Maatouk I, Hahne A, Sutter C, Schmutzler RK, Dikow N, Sohn C, Schott S. Prophylactic surgery among germline TP53 mutation carriers in Germany – a multicentric observational study. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- N Rippinger
- University Hospital Heidelberg, Department of Gynaecology and Obstetrics, Heidelberg, Deutschland
| | - MW Haun
- University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Deutschland
| | - C Fischer
- University Hospital Heidelberg, Institute of Human Genetics, Heidelberg, Deutschland
| | - K Rhiem
- University Hospital of Cologne, Department of Gynaecology and Obstetrics, Cologne, Deutschland
| | - A Hübbel
- University Hospital of Cologne, Department of Gynaecology and Obstetrics, Cologne, Deutschland
| | - S Grill
- Klinikum rechts der Isar; Technical University of Munich, Department of Gynaecology and Centre for Hereditary Breast and Ovarian Cancer, Munich, Deutschland
| | - M Kiechle
- Klinikum rechts der Isar; Technical University of Munich, Department of Gynaecology and Centre for Hereditary Breast and Ovarian Cancer, Munich, Deutschland
| | - FW Cremer
- SYNLAB Centre for Human Genetics, Mannheim, Deutschland
| | - K Kast
- Medical Faculty and University Hospital Carl Gustav Carus, Technical University Dresden, Department of Gynaecology and Obstetrics, Dresden, Deutschland
- National Center for Tumor Diseases, Partner Site Dresden, Dresden, Deutschland
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Dresden, Deutschland
| | - HP Nguyen
- University Hospital of Tuebingen, Institute of Medical Genetics and Applied Genomics, Tuebingen, Deutschland
- University of Bochum, Department of Human Genetics, Bochum, Deutschland
| | - N Ditsch
- Ludwig-Maximilians University, University Hospital of Munich, Department of Gynaecology and Obstetrics, Munich, Deutschland
| | - P Kratz
- Hannover Medical School, Paediatric Haematology and Oncology, Hannover, Deutschland
| | - S Pfister
- Hopp Children's Cancer Centre at the NCT Heidelberg (KiTZ), Heidelberg, Deutschland
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Division of Paediatric Neurooncology, Heidelberg, Deutschland
- University Hospital Heidelberg, Department of Paediatric Oncology, Hematology and Immunology, Heidelberg, Deutschland
| | - KW Pajtler
- Hopp Children's Cancer Centre at the NCT Heidelberg (KiTZ), Heidelberg, Deutschland
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Division of Paediatric Neurooncology, Heidelberg, Deutschland
- University Hospital Heidelberg, Department of Paediatric Oncology, Hematology and Immunology, Heidelberg, Deutschland
| | - D Speiser
- University Hospital Charité Berlin, Department of Gynaecology and Obstetrics, Berlin, Deutschland
| | - S Seitz
- University Medical Centre Regensburg, Department of Gynaecology and Obstetrics, Regensburg, Deutschland
| | - H Glimm
- National Center for Tumor Diseases (NCT), Heidelberg, Deutschland
| | - I Maatouk
- University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Deutschland
| | - A Hahne
- BRCA Network, Hannover, Deutschland
| | - C Sutter
- University Hospital Heidelberg, Department of Human Genetics, Heidelberg, Deutschland
| | - RK Schmutzler
- University Hospital of Cologne, Department of Gynaecology and Obstetrics, Cologne, Deutschland
| | - N Dikow
- University Hospital Heidelberg, Department of Human Genetics, Heidelberg, Deutschland
| | - C Sohn
- University Hospital Heidelberg, Department of Gynaecology and Obstetrics, Heidelberg, Deutschland
| | - S Schott
- University Hospital Heidelberg, Department of Gynaecology and Obstetrics, Heidelberg, Deutschland
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15
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Apostolidis L, Kreutzfeldt S, Oles M, Gieldon L, Heining C, Horak P, Hutter B, Fröhlich M, Klink B, Lamping M, Uhrig S, Stenzinger A, Winkler E, Wiedenmann B, Jäger D, Schröck E, Keilholz U, Pavel M, Glimm H, Fröhling S. Prospective genome and transcriptome sequencing in advanced-stage neuroendocrine neoplasms. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Fröhling S, Barth T, Gröschel S, Folprecht G, Richter S, Mayer-Steinacker R, Schultheiss M, Möller P, Bauer S, Siveke J, Dettmer S, Richter D, Heining C, Horak P, Glimm H, Jäger D, Von Kalle C, Schlenk R. CDK4/6 inhibition in locally advanced/metastatic chordoma (NCT PMO-1601). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx387.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Dieter S, Heining C, Agaimy A, Huebschmann D, Bonekamp D, Hutter B, Ehrenberg K, Fröhlich M, Schlesner M, Scholl C, Schlemmer HP, Wolf S, Mavratzas A, Jung C, Gröschel S, von Kalle C, Eils R, Brors B, Penzel R, Kriegsmann M, Reuss D, Schirmacher P, Stenzinger A, Federspil P, Weichert W, Glimm H, Fröhling S. Mutant KIT as imatinib-sensitive target in metastatic sinonasal carcinoma. Ann Oncol 2017; 28:142-148. [DOI: 10.1093/annonc/mdw446] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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18
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Czink E, Heining C, Weber TF, Lasitschka F, Schemmer P, Schirmacher P, Weiss KH, Glimm H, Brors B, Weichert W, Jäger D, Fröhling S, Springfeld C. [Durable remission under dual HER2 blockade with Trastuzumab and Pertuzumab in a patient with metastatic gallbladder cancer]. Z Gastroenterol 2016; 54:426-30. [PMID: 27171333 DOI: 10.1055/s-0042-103498] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gallbladder cancer represents a rare but dismal disease. The only curative option is complete surgical resection, though patients often develop recurrent disease. In patients with advanced biliary tract cancer, the combination of cisplatin and gemcitabine showed a benefit in overall survival compared to gemcitabine alone. However, there is no standardized second-line regimen after treatment failure. We report on a young patient with early recurrence of a gallbladder cancer with cutaneous and peritoneal metastases. Upon identification of an ERBB2 gene amplification within the NCT MASTER (Molecularly Aided Stratification for Tumor Eradication Research) exome sequencing program with resulting overexpression of HER2 in the tumors cells, the patient received a targeted therapy with the HER2 antibodies pertuzumab and trastuzumab in combination with nab-paclitaxel, which led to a durable remission for more than one year. This case report underlines the potential of molecularly aided personalized targeted therapy for patients with biliary tract cancer and the need for respective clinical trials.
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Affiliation(s)
- E Czink
- Universitätsklinikum Heidelberg, Nationales Centrum für Tumorerkrankungen, Abteilung Medizinische Onkologie * Sektion Personalisierte Onkologie
| | - C Heining
- Nationales Centrum für Tumorerkrankungen und Deutsches Krebsforschungszentrum (DKFZ), Abteilung Translationale Onkologie
| | - T F Weber
- Universitätsklinikum Heidelberg, Abteilung Diagnostische und Interventionelle Radiologie
| | - F Lasitschka
- Universitätsklinikum Heidelberg, Pathologisches Institut
| | - P Schemmer
- Universitätsklinikum Heidelberg, Abteilung für Allgemein-, Viszeral- & Transplantationschirurgie
| | - P Schirmacher
- Universitätsklinikum Heidelberg, Pathologisches Institut
| | - K H Weiss
- Universitätsklinikum Heidelberg, Abteilung Gastroenterologie, Infektionskrankheiten, Vergiftungen
| | - H Glimm
- Nationales Centrum für Tumorerkrankungen und Deutsches Krebsforschungszentrum (DKFZ), Abteilung Translationale Onkologie
| | - B Brors
- Deutsches Krebsforschungszentrum (DKFZ), Abteilung Angewandte Bioinformatik
| | - W Weichert
- Universitätsklinikum Heidelberg, Pathologisches Institut
| | - D Jäger
- Universitätsklinikum Heidelberg, Nationales Centrum für Tumorerkrankungen, Abteilung Medizinische Onkologie * Sektion Personalisierte Onkologie
| | - S Fröhling
- Nationales Centrum für Tumorerkrankungen und Deutsches Krebsforschungszentrum (DKFZ), Abteilung Translationale Onkologie
| | - C Springfeld
- Universitätsklinikum Heidelberg, Nationales Centrum für Tumorerkrankungen, Abteilung Medizinische Onkologie * Sektion Personalisierte Onkologie
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19
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Kordes M, Röring M, Heining C, Braun S, Hutter B, Richter D, Geörg C, Scholl C, Gröschel S, Roth W, Rosenwald A, Geissinger E, von Kalle C, Jäger D, Brors B, Weichert W, Grüllich C, Glimm H, Brummer T, Fröhling S. Cooperation of BRAF(F595L) and mutant HRAS in histiocytic sarcoma provides new insights into oncogenic BRAF signaling. Leukemia 2015; 30:937-46. [PMID: 26582644 DOI: 10.1038/leu.2015.319] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 12/19/2022]
Abstract
Activating BRAF mutations, in particular V600E/K, drive many cancers and are considered mutually exclusive with mutant RAS, whereas inactivating BRAF mutations in the D(594)F(595)G(596) motif cooperate with RAS via paradoxical MEK/ERK activation. Due to the increasing use of comprehensive tumor genomic profiling, many non-V600 BRAF mutations are being detected whose functional consequences and therapeutic actionability are often unknown. We investigated an atypical BRAF mutation, F595L, which was identified along with mutant HRAS in histiocytic sarcoma and also occurs in epithelial cancers, melanoma and neuroblastoma, and determined its interaction with mutant RAS. Unlike other DFG motif mutants, BRAF(F595L) is a gain-of-function variant with intermediate activity that does not act paradoxically, but nevertheless cooperates with mutant RAS to promote oncogenic signaling, which is efficiently blocked by pan-RAF and MEK inhibitors. Mutation data from patients and cell lines show that BRAF(F595L), as well as other intermediate-activity BRAF mutations, frequently coincide with mutant RAS in various cancers. These data define a distinct class of activating BRAF mutations, extend the spectrum of patients with systemic histiocytoses and other malignancies who are candidates for therapeutic blockade of the RAF-MEK-ERK pathway and underscore the value of comprehensive genomic testing for uncovering the vulnerabilities of individual tumors.
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Affiliation(s)
- M Kordes
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Internal Medicine VI, Heidelberg University Hospital, Heidelberg, Germany
| | - M Röring
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany
| | - C Heining
- Department of Translational Oncology, NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Section for Personalized Oncology, Heidelberg University Hospital, Heidelberg, Germany.,DKTK, Heidelberg, Germany
| | - S Braun
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany
| | - B Hutter
- DKTK, Heidelberg, Germany.,Division of Applied Bioinformatics, DKFZ and NCT Heidelberg, Heidelberg, Germany
| | - D Richter
- Department of Translational Oncology, NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,DKTK, Heidelberg, Germany
| | - C Geörg
- Department of Translational Oncology, NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,DKTK, Heidelberg, Germany.,DKFZ-Heidelberg Center for Personalized Oncology (HIPO), Heidelberg, Germany
| | - C Scholl
- Department of Translational Oncology, NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,DKTK, Heidelberg, Germany
| | - S Gröschel
- Department of Translational Oncology, NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Section for Personalized Oncology, Heidelberg University Hospital, Heidelberg, Germany.,DKTK, Heidelberg, Germany
| | - W Roth
- Institute of Pathology, Heidelberg University Hospital and NCT Heidelberg, Heidelberg, Germany
| | - A Rosenwald
- Institute of Pathology, Comprehensive Cancer Center Mainfranken, University of Würzburg and Würzburg University Hospital, Würzburg, Germany
| | - E Geissinger
- Institute of Pathology, Comprehensive Cancer Center Mainfranken, University of Würzburg and Würzburg University Hospital, Würzburg, Germany
| | - C von Kalle
- Department of Translational Oncology, NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Section for Personalized Oncology, Heidelberg University Hospital, Heidelberg, Germany.,DKTK, Heidelberg, Germany.,DKFZ-Heidelberg Center for Personalized Oncology (HIPO), Heidelberg, Germany
| | - D Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Internal Medicine VI, Heidelberg University Hospital, Heidelberg, Germany
| | - B Brors
- DKTK, Heidelberg, Germany.,Division of Applied Bioinformatics, DKFZ and NCT Heidelberg, Heidelberg, Germany
| | - W Weichert
- DKTK, Heidelberg, Germany.,Institute of Pathology, Heidelberg University Hospital and NCT Heidelberg, Heidelberg, Germany
| | - C Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Internal Medicine VI, Heidelberg University Hospital, Heidelberg, Germany
| | - H Glimm
- Department of Translational Oncology, NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Section for Personalized Oncology, Heidelberg University Hospital, Heidelberg, Germany.,DKTK, Heidelberg, Germany
| | - T Brummer
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany
| | - S Fröhling
- Department of Translational Oncology, NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Section for Personalized Oncology, Heidelberg University Hospital, Heidelberg, Germany.,DKTK, Heidelberg, Germany
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20
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Voloshanenko O, Erdmann G, Dubash T, Augustin I, Metzig M, Kerr G, Ball C, Glimm H, Spang R, Boutros M. 538: Wnt secretion is required to maintain Wnt activity in colon cancer. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Hoffmann K, Glimm H, Radeleff B, Richter G, Heining C, Schenkel I, Zahlten-Hinguranage A, Schirrmacher P, Schmidt J, Büchler MW, Jaeger D, von Kalle C, Schemmer P. Prospective, randomized, double-blind, multi-center, Phase III clinical study on transarterial chemoembolization (TACE) combined with Sorafenib versus TACE plus placebo in patients with hepatocellular cancer before liver transplantation - HeiLivCa [ISRCTN24081794]. BMC Cancer 2008; 8:349. [PMID: 19036146 PMCID: PMC2630329 DOI: 10.1186/1471-2407-8-349] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 11/26/2008] [Indexed: 01/01/2023] Open
Abstract
Background Disease progression of hepatocellular cancer (HCC) in patients eligible for liver transplantation (LTx) occurs in up to 50% of patients, resulting in withdrawal from the LTx waiting list. Transarterial chemoembolization (TACE) is used as bridging therapy with highly variable response rates. The oral multikinase inhibitor sorafenib significantly increases overall survival and time-to-progression in patients with advanced hepatocellular cancer. Design The HeiLivCa study is a double-blinded, controlled, prospective, randomized multi-centre phase III trial. Patients in study arm A will be treated with transarterial chemoembolization plus sorafenib 400 mg bid. Patients in study arm B will be treated with transarterial chemoembolization plus placebo. A total of 208 patients with histologically confirmed hepatocellular carcinoma or HCC diagnosed according to EASL criteria will be enrolled. An interim patients' analysis will be performed after 60 events. Evaluation of time-to-progression as primary endpoint (TTP) will be performed at 120 events. Secondary endpoints are number of patients reaching LTx, disease control rates, OS, progression free survival, quality of live, toxicity and safety. Discussion As TACE is the most widely used primary treatment of HCC before LTx and sorafenib is the only proven effective systemic treatment for advanced HCC there is a strong rational to combine both treatment modalities. This study is designed to reveal potential superiority of the combined TACE plus sorafenib treatment over TACE alone and explore a new neo-adjuvant treatment concept in HCC before LTx.
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Affiliation(s)
- K Hoffmann
- Department of Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
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22
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Hoffmann K, Glimm H, Radeleff B, Richter G, Heining C, Schenkel I, Zahlten-Hinguranage A, Schirrmacher P, Schmidt J, Büchler MW, Jaeger D, von Kalle C, Schemmer P. Prospective, randomized, double-blind, multi-center, Phase III clinical study on transarterial chemoembolization (TACE) combined with Sorafenib versus TACE plus placebo in patients with hepatocellular cancer before liver transplantation - HeiLivCa [ISRCTN24081794]. BMC Cancer 2008. [PMID: 19036146 DOI: 10.1186/1471-2407-8-3491471-2407-8-349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Disease progression of hepatocellular cancer (HCC) in patients eligible for liver transplantation (LTx) occurs in up to 50% of patients, resulting in withdrawal from the LTx waiting list. Transarterial chemoembolization (TACE) is used as bridging therapy with highly variable response rates. The oral multikinase inhibitor sorafenib significantly increases overall survival and time-to-progression in patients with advanced hepatocellular cancer. DESIGN The HeiLivCa study is a double-blinded, controlled, prospective, randomized multi-centre phase III trial. Patients in study arm A will be treated with transarterial chemoembolization plus sorafenib 400 mg bid. Patients in study arm B will be treated with transarterial chemoembolization plus placebo. A total of 208 patients with histologically confirmed hepatocellular carcinoma or HCC diagnosed according to EASL criteria will be enrolled. An interim patients' analysis will be performed after 60 events. Evaluation of time-to-progression as primary endpoint (TTP) will be performed at 120 events. Secondary endpoints are number of patients reaching LTx, disease control rates, OS, progression free survival, quality of live, toxicity and safety. DISCUSSION As TACE is the most widely used primary treatment of HCC before LTx and sorafenib is the only proven effective systemic treatment for advanced HCC there is a strong rational to combine both treatment modalities. This study is designed to reveal potential superiority of the combined TACE plus sorafenib treatment over TACE alone and explore a new neo-adjuvant treatment concept in HCC before LTx.
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Affiliation(s)
- K Hoffmann
- Department of Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
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23
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Rückert A, Glimm H, Lübbert M, Grüllich C. Successful treatment of life-threatening Evans syndrome due to antiphospholipid antibody syndrome by rituximab-based regimen: a case with long-term follow-up. Lupus 2008; 17:757-60. [PMID: 18625656 DOI: 10.1177/0961203307087876] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An association of antiphospholipid antibody syndrome with antibodies directed against either phospholipids or plasma proteins strongly suggest that B-cell dysfunction may be involved in its pathogenesis. Antiphospholipid antibody syndrome with autoimmune cytopenias shows a poor response rate to conventional treatment with anticoagulants, glucocorticosteroids, immunosuppressive agents, intravenous immunoglobulin or plasmapheresis. We report a case of life-threatening antiphospholipid antibody syndrome with Evans syndrome receiving successful multimodal treatment including anti-CD20 monoclonal antibody rituximab with long-term follow-up.
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Affiliation(s)
- A Rückert
- Department of Internal Medicine, Haematology and Oncology, Albert-Ludwigs University Freiburg, Hugstetter Strasse 55, Freiburg, Germany
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24
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Abstract
In recent years much progress has been made in the understanding of the biology of hematopoietic stem cells (HSC) and their involvement in normal blood cell development. Using immunophenotyping it is possible, to enrich HSC, however, so far we are not able to positively select HSC. For the identification, characterization and quantification of HSC it is necessary to use functional assay systems, such as xenotransplantation models. HSC from bone marrow, peripheral blood and in some cases also cord blood have been used for years in transplantation settings especially in patients with leukemia. A better understanding of the mechanisms underlying stem cell regulation as well as stem cell self renewal would have clinical implications e. g. for clinical transplantation strategies. A number of hematological diseases such as chronic myeloid leukemia originates from a malignant transformed HSC. A better understanding of the biology of normal as well as malignant HSC is therefore crucial not only for a better understanding of the disease, but also for the development of strategies aiming at the discrimination of normal and malignant stem cell candidates and the development of therapies targeting the leukemic stem cell.
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Affiliation(s)
- C Buske
- Medizinische Klinik III, Klinikum Grosshadern der Ludwig-Maximilians-Universität München
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25
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Ball C, Pilz I, Schmidt M, Schrempp M, von Kalle C, Glimm H. 441. Stable Oligo-to Polyclonal Hematopoiesis without Clonal Exhaustion Following Extended Reduced Intensity Selection of MGMT-P140K Expressing Murine Repopulating Stem Cells in Serially Transplanted Mice. Mol Ther 2006. [DOI: 10.1016/j.ymthe.2006.08.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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26
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Eisterer W, Jiang X, Christ O, Glimm H, Lee KH, Pang E, Lambie K, Shaw G, Holyoake TL, Petzer AL, Auewarakul C, Barnett MJ, Eaves CJ, Eaves AC. Different subsets of primary chronic myeloid leukemia stem cells engraft immunodeficient mice and produce a model of the human disease. Leukemia 2005; 19:435-41. [PMID: 15674418 DOI: 10.1038/sj.leu.2403649] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [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: 11/08/2022]
Abstract
Xenograft models of chronic phase human chronic myeloid leukemia (CML) have been difficult to develop because of the persistence of normal hematopoietic stem cells in most chronic phase CML patients and the lack of methods to selectively isolate the rarer CML stem cells. To circumvent this problem, we first identified nine patients' samples in which the long-term culture-initiating cells were predominantly leukemic and then transplanted cells from these samples into sublethally irradiated NOD/SCID and NOD/SCID-beta2microglobulin-/- mice. This resulted in the consistent and durable (>5 months) repopulation of both host genotypes with similar numbers of BCR-ABL+/Ph+ cells. The regenerated leukemic cells included an initial, transient population derived from CD34+CD38+ cells as well as more sustained populations derived from CD34+CD38- progenitors, indicative of a hierarchy of transplantable leukemic cells. Analysis of the phenotypes produced revealed a reduced output of B-lineage cells, enhanced myelopoiesis with excessive production of erythroid and megakaropoietic cells and the generation of primitive (CD34+) leukemic cells displaying an autocrine IL-3 and G-CSF phenotype, all characteristics of primary CML cells. These findings demonstrate the validity of this xenograft model of chronic phase human CML, which should enable future investigation of disease pathogenesis and new approaches to therapy.
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Affiliation(s)
- W Eisterer
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, BC, Canada
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27
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Eaves C, Glimm H, Eisterer W, Audet J, Maguer-Satta V, Piret J. Characterization of human hematopoietic cells with short-lived in vivo repopulating activity. Ann N Y Acad Sci 2001; 938:63-70; discussion 70-1. [PMID: 11458527 DOI: 10.1111/j.1749-6632.2001.tb03575.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 12/22/2022]
Abstract
Recent studies with purified hematopoietic stem cells in vitro support a model of stem cell self-renewal control that involves distinct mechanisms regulating permissiveness to and execution of lineage restriction. Such a model predicts the existence of phenotypically separable populations of hematopoietic cells that are pluripotent and either capable or incapable of extensive self-renewal. Such populations have been previously described in the mouse. We describe here the first evidence that such cells can now be identified in humans using different types of immunodeficient mice as hosts.
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Affiliation(s)
- C Eaves
- Terry Fox Laboratory, 601 West 10th Avenue, Vancouver, B.C., Canada V5Z 1L3.
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28
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Schmidt M, Glimm H, Lemke N, Muessig A, Speckmann C, Haas S, Zickler P, Hoffmann G, Von Kalle C. A model for the detection of clonality in marked hematopoietic stem cells. Ann N Y Acad Sci 2001; 938:146-55; discussion 155-6. [PMID: 11458502 DOI: 10.1111/j.1749-6632.2001.tb03584.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The semirandom location of retroviral integration in the target cell genome introduces a marker in the form of a fusion sequence composed of a genomic and a proviral part that is unique for each transduced cell and its clonal progeny. High-sensitivity detection of these fusion sequences would allow the tracking of clonal contributions of individual, marked hematopoietic progenitor, and stem cells in vivo. Clone detection by Southern blot has helped to analyze models of oligoclonal repopulation but is limited in sensitivity and specificity. Inverse PCR (Nolta et al., Proc. Natl. Acad. Sci. USA 93: 2414-2419) can demonstrate the clonal identity by sequencing but does not permit simultaneous detection of multiple clones. In an efficiently transduced rhesus macaque model (Tisdale et al., Blood 92: 2681-2687; Wu et al., Mol. Ther. 1: 285-293) Kim et al. (Blood 96: 1-8) have identified more than 40 insertion sequences from marrow CFU by inverse PCR. However, no previous study has been able to directly analyze the number of clones active in vivo. Here we demonstrate that the application of a recently developed PCR technology allows the simultaneous visualization of multiple integration sites from small clonal contributions to hematopoietic cells. By combining solid-phase primer extension with ligation-mediated PCR, direct genomic sequencing of retroviral integration sites was obtained in murine bone marrow samples. Further development of this technology will allow analysis of the clonal composition of marked hematopoiesis in small and large animals as well as in human gene transfer.
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Affiliation(s)
- M Schmidt
- Department I of Internal Medicine, University of Freiburg, Germany
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29
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Schmidt M, Hoffmann G, Wissler M, Lemke N, Müssig A, Glimm H, Williams DA, Ragg S, Hesemann CU, von Kalle C. Detection and direct genomic sequencing of multiple rare unknown flanking DNA in highly complex samples. Hum Gene Ther 2001; 12:743-9. [PMID: 11339891 DOI: 10.1089/104303401750148649] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [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: 11/13/2022] Open
Abstract
By identifying the sequence of retro- and lentiviral integration sites in peripheral blood leukocytes, the clonal composition and fate of genetically modified hematopoietic progenitor and stem cells could be mapped in vitro and in vivo. Previously available methods have been limited to the analysis of mono- or oligoclonal integration sites present in high copy numbers. Here, we perform characterization of multiple rare retroviral and lentiviral integration sites in highly complex DNA samples. The reliability of this method results from nontarget DNA removal via magnetic extension primer tag selection (EPTS) preceding solid-phase ligation-mediated PCR. EPTS/LM-PCR allowed the simultaneous direct genomic sequencing of multiple proviral LTR-flanking sequences of retro- and lentiviral vectors even if only 1 per 100 to 1000 cells contained the provirus. A primer walking "around" the integration locus demonstrated the adaptability of EPTS/LM-PCR to study unknown flanking DNA regions unrelated to proviruses. The technique is fast, inexpensive, and sensitive in minimal samples. It enables studies of retro- and lentiviral integration, viral vector tracking in gene therapy, insertional mutagenesis, transgene integration, and direct genomic sequencing that until now have been difficult or impossible to perform.
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Affiliation(s)
- M Schmidt
- Department I of Internal Medicine, University of Freiburg, 79106 Freiburg, Germany
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30
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Glimm H, Eisterer W, Lee K, Cashman J, Holyoake TL, Nicolini F, Shultz LD, von Kalle C, Eaves CJ. Previously undetected human hematopoietic cell populations with short-term repopulating activity selectively engraft NOD/SCID-beta2 microglobulin-null mice. J Clin Invest 2001; 107:199-206. [PMID: 11160136 PMCID: PMC199177 DOI: 10.1172/jci11519] [Citation(s) in RCA: 158] [Impact Index Per Article: 6.9] [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: 11/17/2022] Open
Abstract
Increasing use of purified or cultured human hematopoietic cells as transplants has revealed an urgent need for better methods to predict the speed and durability of their engraftment potential. We now show that NOD/SCID-beta2 microglobulin-null (NOD/SCID-beta2m-/-) mice are sequentially engrafted by two distinct and previously unrecognized populations of transplantable human short-term repopulating hematopoietic cells (STRCs), neither of which efficiently engraft NOD/SCID mice. One is predominantly CD34+CD38+ and is myeloid-restricted; the other is predominantly CD34+CD38- and has broader lymphomyeloid differentiation potential. In contrast, the long-term repopulating human cells that generate lymphoid and myeloid progeny in NOD/SCID mice engraft and self-renew in NOD/SCID-beta2m-/- mice equally efficiently. In short-term expansion cultures of adult bone marrow cells, myeloid-restricted STRCs were preferentially amplified (greater than tenfold) and, interestingly, both types of STRC were found to be selectively elevated in mobilized peripheral blood harvests. These results suggest an enhanced sensitivity of STRCs to natural killer cell-mediated rejection. They also provide new in vivo assays for different types of human STRC that may help to predict the engraftment potential of clinical transplants and facilitate future investigation of early stages of human hematopoietic stem cell differentiation.
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Affiliation(s)
- H Glimm
- Terry Fox Laboratory, British Columbia Cancer Agency, and Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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31
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Glimm H, Oh IH, Eaves CJ. Human hematopoietic stem cells stimulated to proliferate in vitro lose engraftment potential during their S/G(2)/M transit and do not reenter G(0). Blood 2000; 96:4185-93. [PMID: 11110690] [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: 02/18/2023] Open
Abstract
An understanding of mechanisms regulating hematopoietic stem cell engraftment is of pivotal importance to the clinical use of cultured and genetically modified transplants. Human cord blood (CB) cells with lymphomyeloid repopulating activity in NOD/SCID mice were recently shown to undergo multiple self-renewal divisions within 6 days in serum-free cultures containing Flt3-ligand, Steel factor, interleukin 3 (IL-3), IL-6, and granulocyte colony-stimulating factor. The present study shows that, on the fifth day, the transplantable stem cell activity is restricted to the G(1) fraction, even though both colony-forming cells (CFCs) and long-term culture-initiating cells (LTC-ICs) in the same cultures are approximately equally distributed between G(0)/G(1) and S/G(2)/M. Interestingly, the G(0) cells defined by their low levels of Hoechst 33342 and Pyronin Y staining, and reduced Ki67 and cyclin D expression (representing 21% of the cultured CB population) include some mature erythroid CFCs but very few primitive CFCs, LTC-ICs, or repopulating cells. Although these findings suggest a cell cycle-associated change in in vivo stem cell homing, the cultured G(0)/G(1) and S/G(2)/M CD34(+) CB cells exhibited no differences in levels of expression of VLA-4, VLA-5, or CXCR-4. Moreover, further incubation of these cells for 1 day in the presence of a concentration of transforming growth factor beta(1) that increased the G(0)/G(1) fraction did not enhance detection of repopulating cells. The demonstration of a cell cycle-associated mechanism that selectively silences the transplantability of proliferating human hematopoietic stem cells poses both challenges and opportunities for the future improvement of ex vivo-manipulated grafts. (Blood. 2000;96:4185-4193)
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MESH Headings
- Animals
- Bone Marrow Purging
- Cell Cycle
- Cell Division/drug effects
- Cell Survival
- Cells, Cultured/cytology
- Cells, Cultured/drug effects
- Cells, Cultured/transplantation
- Colony-Forming Units Assay
- Culture Media, Serum-Free
- Cyclin D3
- Cyclins/biosynthesis
- Cyclins/genetics
- Fetal Blood/cytology
- G2 Phase
- Gene Expression Regulation, Developmental
- Graft Survival
- Granulocyte Colony-Stimulating Factor/pharmacology
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/classification
- Hematopoietic Stem Cells/cytology
- Hematopoietic Stem Cells/drug effects
- Humans
- Hyaluronan Receptors/biosynthesis
- Hyaluronan Receptors/genetics
- Infant, Newborn
- Integrin alpha4beta1
- Integrins/biosynthesis
- Integrins/genetics
- Interleukin-3/pharmacology
- Ki-67 Antigen/biosynthesis
- Ki-67 Antigen/genetics
- Membrane Proteins/pharmacology
- Metaphase
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Radiation Chimera
- Receptors, CXCR4/biosynthesis
- Receptors, CXCR4/genetics
- Receptors, Fibronectin/biosynthesis
- Receptors, Fibronectin/genetics
- Receptors, Lymphocyte Homing/biosynthesis
- Receptors, Lymphocyte Homing/genetics
- Resting Phase, Cell Cycle
- Reverse Transcriptase Polymerase Chain Reaction
- S Phase
- Stem Cell Factor/pharmacology
- Transforming Growth Factor beta/pharmacology
- Transforming Growth Factor beta1
- Transplantation, Heterologous
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Affiliation(s)
- H Glimm
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Glimm H, Eaves CJ. Direct evidence for multiple self-renewal divisions of human in vivo repopulating hematopoietic cells in short-term culture. Blood 1999; 94:2161-8. [PMID: 10498585] [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: 02/14/2023] Open
Abstract
Recently, culture conditions that stimulate the proliferation of primitive hematopoietic cells defined by various phenotypic and functional endpoints in vitro have been identified. However, evidence that they support a high probability of self-renewal leading to a large net expansion in vitro of transplantable cells with lympho-myeloid repopulating ability has been more difficult to obtain. The present study was designed to investigate whether the low overall expansion of human repopulating hematopoietic cells seen in vitro reflects a selective unresponsiveness of these rare cells to the growth factors currently used to stimulate them or, alternatively, whether they do proliferate in vitro but lose engrafting potential. For this, we used a high-resolution procedure for tracking and reisolating cells as a function of their proliferation history based on the loss of cellular fluorescence after staining with (5- and 6-) carboxyfluorescein diacetate succinimidyl ester. The results show that the vast majority of long-term culture-initiating cells and in vivo lympho-myeloid competitive repopulating units present in 5-day suspension cultures initiated with CD34(+) human cord blood and fetal liver cells are the progeny of cells that have divided at least once in response to stimulation by interleukin-3, interleukin-6, granulocyte colony-stimulating factor, Steel factor, and Flt3-ligand. Thus, most human repopulating cells from these two sources are stimulated to undergo multiple divisions under currently used short-term suspension culture conditions and a proportion of these retain engraftment potential.
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Affiliation(s)
- H Glimm
- Terry Fox Laboratory, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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Glimm H, Flügge K, Möbest D, Hofmann VM, Postmus J, Henschler R, Lange W, Finke J, Kiem HP, Schulz G, Rosenthal F, Mertelsmann R, von Kalle C. Efficient serum-free retroviral gene transfer into primitive human hematopoietic progenitor cells by a defined, high-titer, nonconcentrated vector-containing medium. Hum Gene Ther 1998; 9:771-8. [PMID: 9581900 DOI: 10.1089/hum.1998.9.6-771] [Citation(s) in RCA: 19] [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: 11/13/2022] Open
Abstract
Defined serum-free conditions have great conceptual advantages for the biological safety and standardization of clinical gene transfer into hematopoietic stem cells. In the only study reported to date, Sekhar et al. achieved low serum conditions by a complex concentration procedure of a retroviral supernatant initially containing 10% fetal bovine serum. The high cost, small volume, possible coenrichment of serum-derived pathogens, limited recovery of vector particles, and low titer of the final diluted medium restrict the clinical application of this procedure. Transduction of primitive hematopoietic progenitor cells was not demonstrated. In the present study, a defined serum-free medium containing high titers of the pseudotyped retroviral vector PG13/LN was generated from PG13/LN producer cells without requiring a physical enrichment procedure. The transduction of committed hematopoietic progenitor cells in the serum-free vector-containing medium was efficient, and similar to that occurring under serum-containing control conditions. The number of primitive human hematopoietic long-term culture-initiating cell-derived colonies (LTC-IC-derived colonies) generated from CD34+ and CD34+/HLA-DRlo peripheral blood progenitor "stem" cells (PBSCs) increased during 7 days of treatment in this vector-containing medium in the presence of IL-3, SCF, and flt-3 ligand. The described procedure allowed efficient transduction of LTC-IC-derived colonies generated from CD34+, CD34+/HLA-DRlo, and CD34+/CD38lo PBSCs. This is the first report to demonstrate an increase in primitive peripheral blood LTC-IC-derived colonies in vitro as well as their efficient transduction in a high-titer, serum-free vector-containing medium that can be produced exclusively from defined pharmaceutical-grade components, making it ideally suited for applications in clinical gene therapy.
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Affiliation(s)
- H Glimm
- Department of Internal Medicine I, Albert-Ludwigs-University, Freiburg, Germany
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Abstract
The possibility of maintaining, manipulating, and expanding human hematopoietic stem cells in ex vivo culture could help to provide patients with autologous and allogeneic stem cell transplants improved in purity and performance and could offer access to gene therapy of the hematopoietic system. Recent advances in the ex vivo culture of immature human hematopoietic progenitor cells and human hematopoietic stem cells have led to experimental evidence for the qualitative and quantitative maintenance and possible numerical expansion of hematopoietic stem cells in ex vivo culture, making ex vivo graft engineering a realistic possibility. This review summarizes recent developments in the field, their regulatory implications and their application in hematopoietic gene therapy.
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Glimm H, Kiem HP, Darovsky B, Storb R, Wolf J, Diehl V, Mertelsmann R, Von Kalle C. Efficient gene transfer in primitive CD34+/CD38lo human bone marrow cells reselected after long-term exposure to GALV-pseudotyped retroviral vector. Hum Gene Ther 1997; 8:2079-86. [PMID: 9414256 DOI: 10.1089/hum.1997.8.17-2079] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 02/05/2023] Open
Abstract
Successful retroviral gene transfer into human hematopoietic stem cells was demonstrated in preliminary clinical trials at low efficiency. We have shown previously that gene transfer into committed hematopoietic progenitor cells is more efficient using a gibbon ape leukemia virus (GALV)-pseudotyped retroviral vector instead of an amphotropic retroviral vector. Here, we have conducted a systematic study of human hematopoietic progenitor cells after extended transduction with a GALV-pseudotyped retroviral vector. CD34+/CD38lo Cells were transduced for 5 days and reselected according to phenotype after culture and analyzed for cell cycle status, long-term culture-initiating cell (LTC-IC) activity, and gene transfer. Reselection of rare, very primitive progenitor cells was successful. Equal to fresh CD34+/CD38lo cells, >90% of reselected CD34+/CD38lo cells were in G0/G1. CD34+/CD38lo reselection enriched for LTC-IC (10-fold), as compared to freshly isolated CD34+/CD38lo cells with excellent specificity (82.7% of total LTC-IC were recovered in the reselected CD34+/CD38lo population) and recovery (62% of initial LTC-IC number in CD34+/CD38lo cells were recovered in the reselected fraction after transduction). Gene transfer into primitive progenitor cells was efficient with 50.5% G418-resistant LTC-IC colonies and more than 40 copies of vector provirus detectable per 100 nuclei of CD34+/CD38lo cells. To our knowledge, this is the first systematic analysis of phenotype, function, and cell cycle demonstrating retroviral gene transfer into rare, very primitive human hematopoietic progenitor cells. The chosen strategy should be of considerable value for analyzing and improving gene therapy of the hematopoietic system.
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Affiliation(s)
- H Glimm
- Department of Internal Medicine I, Albert-Ludwigs-University, Freiburg, Germany
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Abstract
Electrophysiological properties of neurofilament-positive neurones in dissociated cell cultures were prepared at postnatal days 4-5 from rat dentate gyrus and studied using the whole-cell patch-clamp technique. These cells expressed a fast-inactivating, 0.5 microM tetrodotoxin-sensitive Na+ current; a high-voltage-activated (HVA) Ca2+ current, which was 30 microM Cd(2+)- and partially 2 microM nicardipine-sensitive; and an inward rectifier current, which was sensitive to extracellularly applied 1 mM Cs+. The outward current pattern was composed of a delayed rectifier-like outward current sensitive to 20 mM tetraethylammonium (TEA) and a fast-inactivating, Ca(2+)-dependent outward current. This transient Ca(2+)-dependent K+ outward current was identified by a subtraction procedure. K+ currents recorded under conditions of blocked Ca2+ currents (after rundown of the HVA Ca2+ current or blocked by extracellularly applied Cd2+) were subtracted from control currents. By comparison with the current pattern of identified dentate granule cells, it is concluded that the investigated cell type originated from interneurones or projection neurones of the dentate hilus.
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Affiliation(s)
- H Glimm
- Abteilung für Neurophysiologie, Humboldt Universität Berlin, Germany
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