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Fernández EC, Tomassoni L, Zhang X, Wang J, Obradovic A, Laise P, Griffin AT, Vlahos L, Minns HE, Morales DV, Simmons C, Gallitto M, Wei HJ, Martins TJ, Becker PS, Crawford JR, Tzaridis T, Wechsler-Reya RJ, Garvin J, Gartrell RD, Szalontay L, Zacharoulis S, Wu CC, Zhang Z, Califano A, Pavisic J. Elucidation and Pharmacologic Targeting of Master Regulator Dependencies in Coexisting Diffuse Midline Glioma Subpopulations. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.17.585370. [PMID: 38559080 PMCID: PMC10979998 DOI: 10.1101/2024.03.17.585370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Diffuse Midline Gliomas (DMGs) are universally fatal, primarily pediatric malignancies affecting the midline structures of the central nervous system. Despite decades of clinical trials, treatment remains limited to palliative radiation therapy. A major challenge is the coexistence of molecularly distinct malignant cell states with potentially orthogonal drug sensitivities. To address this challenge, we leveraged established network-based methodologies to elucidate Master Regulator (MR) proteins representing mechanistic, non-oncogene dependencies of seven coexisting subpopulations identified by single-cell analysis-whose enrichment in essential genes was validated by pooled CRISPR/Cas9 screens. Perturbational profiles of 372 clinically relevant drugs helped identify those able to invert the activity of subpopulation-specific MRs for follow-up in vivo validation. While individual drugs predicted to target individual subpopulations-including avapritinib, larotrectinib, and ruxolitinib-produced only modest tumor growth reduction in orthotopic models, systemic co-administration induced significant survival extension, making this approach a valuable contribution to the rational design of combination therapy.
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Tzaridis T, Wechsler-Reya RJ. Just a spoonful of metformin helps the medicine go down. J Clin Invest 2024; 134:e179144. [PMID: 38488006 PMCID: PMC10940077 DOI: 10.1172/jci179144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a devastating brain tumor with a need for novel therapies. So far, monotherapies have failed to prolong survival for these patients, and combinatorial strategies have often shown severe, dose-limiting toxicities. In this issue of the JCI, Duchatel, Jackson, and colleagues address this challenge by introducing a drug combination that mitigates side effects and overcomes resistance. After identifying the PI3K/mTOR pathway as a therapeutic vulnerability, they treated DIPG-bearing mice with paxalisib and saw responses but also observed hyperglycemia as a severe side effect. Combining paxalisib with metformin mitigated this toxicity, but also upregulated protein kinase C (PKC) signaling. To tackle this mechanism of resistance, the authors added the PKC inhibitor enzastaurin to their drug combination and showed that this triple therapy led to improved survival. This approach paves the way for improved outcomes for patients with DIPG and other brain tumors.
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Affiliation(s)
- Theophilos Tzaridis
- Cancer Genome and Epigenetics Program, NCI-Designated Cancer Center, Sanford Burnham, Prebys Medical Discovery Institute, La Jolla, California, USA
| | - Robert J. Wechsler-Reya
- Cancer Genome and Epigenetics Program, NCI-Designated Cancer Center, Sanford Burnham, Prebys Medical Discovery Institute, La Jolla, California, USA
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York, USA
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Koschmann C, Al-Holou WN, Alonso MM, Anastas J, Bandopadhayay P, Barron T, Becher O, Cartaxo R, Castro MG, Chung C, Clausen M, Dang D, Doherty R, Duchatel R, Dun M, Filbin M, Franson A, Galban S, Garcia Moure M, Garton H, Gowda P, Marques JG, Hawkins C, Heath A, Hulleman E, Ji S, Jones C, Kilburn L, Kline C, Koldobskiy MA, Lim D, Lowenstein PR, Lu QR, Lum J, Mack S, Magge S, Marini B, Martin D, Marupudi N, Messinger D, Mody R, Morgan M, Mota M, Muraszko K, Mueller S, Natarajan SK, Nazarian J, Niculcea M, Nuechterlein N, Okada H, Opipari V, Pai MP, Pal S, Peterson E, Phoenix T, Prensner JR, Pun M, Raju GP, Reitman ZJ, Resnick A, Rogawski D, Saratsis A, Sbergio SG, Souweidane M, Stafford JM, Tzaridis T, Venkataraman S, Vittorio O, Wadden J, Wahl D, Wechsler-Reya RJ, Yadav VN, Zhang X, Zhang Q, Venneti S. A road map for the treatment of pediatric diffuse midline glioma. Cancer Cell 2024; 42:1-5. [PMID: 38039965 PMCID: PMC11067690 DOI: 10.1016/j.ccell.2023.11.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
Recent clinical trials for H3K27-altered diffuse midline gliomas (DMGs) have shown much promise. We present a consensus roadmap and identify three major barriers: (1) refinement of experimental models to include immune and brain-specific components; (2) collaboration among researchers, clinicians, and industry to integrate patient-derived data through sharing, transparency, and regulatory considerations; and (3) streamlining clinical efforts including biopsy, CNS-drug delivery, endpoint determination, and response monitoring. We highlight the importance of comprehensive collaboration to advance the understanding, diagnostics, and therapeutics for DMGs.
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Affiliation(s)
| | | | | | | | | | - Tara Barron
- Stanford University, Stanford, CA 94305, USA
| | - Oren Becher
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | | | - Chan Chung
- Daegu Gyeongbuk Institute of Science & Technology, Daegu, South Korea
| | | | - Derek Dang
- University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Ryan Duchatel
- University of Newcastle, Callaghan, NSW 2308, Australia
| | - Matthew Dun
- University of Newcastle, Callaghan, NSW 2308, Australia
| | | | | | | | | | - Hugh Garton
- University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | | | - Allison Heath
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Sunjong Ji
- University of Michigan, Ann Arbor, MI 48109, USA
| | - Chris Jones
- Division of Molecular Pathology, Institute for Cancer Research, London SM2 5NG, UK
| | | | - Cassie Kline
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Daniel Lim
- University of California, San Francisco, San Francisco, CA 94143, USA
| | | | - Q Richard Lu
- Cincinnati Children's Hospital Medical Center, and University of Cincinnati, Cincinnati, OH 45229, USA
| | - Joanna Lum
- University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Suresh Magge
- University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Donna Martin
- University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | - Rajen Mody
- University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Mateus Mota
- University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Sabine Mueller
- University of California, San Francisco, San Francisco, CA 94143, USA; Parker Institute for Cancer Immunotherapy, University of Zurich, Zurich, Switzerland
| | | | - Javad Nazarian
- Children's National, Washington, DC 20010, USA; University of Zurich, Zurich, Switzerland
| | | | - Nicholas Nuechterlein
- University of Michigan, Ann Arbor, MI 48109, USA; National Institutes of Health, Bethesda, MD, USA
| | - Hideho Okada
- University of California, San Francisco, San Francisco, CA 94143, USA
| | | | | | | | | | - Timothy Phoenix
- Cincinnati Children's Hospital Medical Center, and University of Cincinnati, Cincinnati, OH 45229, USA
| | | | - Matthew Pun
- University of Michigan, Ann Arbor, MI 48109, USA
| | - G Praveen Raju
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Adam Resnick
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | | | | | - Mark Souweidane
- Weill Cornell Medicine, New York Presbyterian and Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - James M Stafford
- Weill Cornell Medicine, New York Presbyterian and Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Theophilos Tzaridis
- Herbert Irving Comprehensive Cancer Center and Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA
| | | | - Orazio Vittorio
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jack Wadden
- University of Michigan, Ann Arbor, MI 48109, USA
| | - Daniel Wahl
- University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | - Xu Zhang
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Qiang Zhang
- University of Michigan, Ann Arbor, MI 48109, USA
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Zeyen T, Paech D, Weller J, Schäfer N, Tzaridis T, Duffy C, Nitsch L, Schneider M, Potthoff AL, Steinbach JP, Hau P, Schlegel U, Seidel C, Krex D, Grauer O, Goldbrunner R, Zeiner PS, Tabatabai G, Galldiks N, Stummer W, Hattingen E, Glas M, Radbruch A, Herrlinger U, Schaub C. Correction to: Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses. J Neurooncol 2023; 165:387. [PMID: 37921974 PMCID: PMC10689511 DOI: 10.1007/s11060-023-04488-z] [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: 11/05/2023]
Affiliation(s)
- Thomas Zeyen
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Cathrina Duffy
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Louisa Nitsch
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | | | | | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Uwe Schlegel
- Department of Neurology, Klinik Hirslanden, Zürich, Switzerland
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Dietmar Krex
- Department of Neurosurgery, Technische Universität Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | - Roland Goldbrunner
- Center of Neurosurgery Department of General, Neurosurgery University of Cologne, Cologne, Germany
| | - Pia Susan Zeiner
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, HertieTübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany and Research Center Juelich, Inst. of Neuroscience and Medicine (INM-3), Juelich, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, 60590, Frankfurt Am Main, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Medicine Essen, Hufelandstr. 55, 45147, Essen, Germany
| | | | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
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Brahmer A, Geiß C, Lygeraki A, Neuberger E, Tzaridis T, Nguyen TT, Luessi F, Régnier-Vigouroux A, Hartmann G, Simon P, Endres K, Bittner S, Reiners KS, Krämer-Albers EM. Assessment of technical and clinical utility of a bead-based flow cytometry platform for multiparametric phenotyping of CNS-derived extracellular vesicles. Cell Commun Signal 2023; 21:276. [PMID: 37803478 PMCID: PMC10559539 DOI: 10.1186/s12964-023-01308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Extracellular vesicles (EVs) originating from the central nervous system (CNS) can enter the blood stream and carry molecules characteristic of disease states. Therefore, circulating CNS-derived EVs have the potential to serve as liquid-biopsy markers for early diagnosis and follow-up of neurodegenerative diseases and brain tumors. Monitoring and profiling of CNS-derived EVs using multiparametric analysis would be a major advance for biomarker as well as basic research. Here, we explored the performance of a multiplex bead-based flow-cytometry assay (EV Neuro) for semi-quantitative detection of CNS-derived EVs in body fluids. METHODS EVs were separated from culture of glioblastoma cell lines (LN18, LN229, NCH82) and primary human astrocytes and measured at different input amounts in the MACSPlex EV Kit Neuro, human. In addition, EVs were separated from blood samples of small cohorts of glioblastoma (GB), multiple sclerosis (MS) and Alzheimer's disease patients as well as healthy controls (HC) and subjected to the EV Neuro assay. To determine statistically significant differences between relative marker signal intensities, an unpaired samples t-test or Wilcoxon rank sum test were computed. Data were subjected to tSNE, heatmap clustering, and correlation analysis to further explore the relationships between disease state and EV Neuro data. RESULTS Glioblastoma cell lines and primary human astrocytes showed distinct EV profiles. Signal intensities were increasing with higher EV input. Data normalization improved identification of markers that deviate from a common profile. Overall, patient blood-derived EV marker profiles were constant, but individual EV populations were significantly increased in disease compared to healthy controls, e.g. CD36+EVs in glioblastoma and GALC+EVs in multiple sclerosis. tSNE and heatmap clustering analysis separated GB patients from HC, but not MS patients from HC. Correlation analysis revealed a potential association of CD107a+EVs with neurofilament levels in blood of MS patients and HC. CONCLUSIONS The semi-quantitative EV Neuro assay demonstrated its utility for EV profiling in complex samples. However, reliable statistical results in biomarker studies require large sample cohorts and high effect sizes. Nonetheless, this exploratory trial confirmed the feasibility of discovering EV-associated biomarkers and monitoring circulating EV profiles in CNS diseases using the EV Neuro assay. Video Abstract.
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Affiliation(s)
- Alexandra Brahmer
- Cellular Neurobiology, Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany.
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sports Sciences, Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - Carsten Geiß
- Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Andriani Lygeraki
- Cellular Neurobiology, Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Elmo Neuberger
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sports Sciences, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen- Bonn-Cologne-Düsseldorf, Partner Site Bonn, University of Bonn, Bonn, Germany
| | - Tinh Thi Nguyen
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- Institute of Molecular Biology, Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne Régnier-Vigouroux
- Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Perikles Simon
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sports Sciences, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Kristina Endres
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katrin S Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Eva-Maria Krämer-Albers
- Cellular Neurobiology, Institute of Developmental Biology and Neurobiology, Johannes Gutenberg University of Mainz, Mainz, Germany.
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Weller J, Zeyen T, Schäfer N, Schaub C, Potthoff AL, Steinbach JP, Hau P, Seidel C, Goldbrunner R, Tabatabai G, Vatter H, Tzaridis T, Schneider M, Herrlinger U. The proneural subtype is not associated with survival benefit from bevacizumab in newly diagnosed glioblastoma: a secondary analysis of the GLARIUS trial. J Neurooncol 2023; 164:749-755. [PMID: 37787906 PMCID: PMC10589156 DOI: 10.1007/s11060-023-04470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE The AVAglio trial reported a significant survival benefit for first line bevacizumab treatment in patients with IDH wildtype glioblastoma of the proneural gene expression subtype. We here aim to replicate these findings in an independent trial cohort. METHODS We evaluate the treatment benefit of bevacizumab according to gene expression subtypes of pretreatment tumor samples (n = 123) in the GLARIUS trial (NCT00967330) for MGMT unmethylated glioblastoma patients with Kaplan-Meier analyses, log-rank tests and Cox regression models. RESULTS Employing the Phillips classifier, bevacizumab conferred a significant PFS advantage in patients with proneural IDH wild-type tumors (10.4 vs. 6.0 months, p = 0.002), but no OS advantage (16.4 vs. 17.4 months, p = 0.6). Multivariable analysis adjusting for prognostic covariates confirmed the absence of a significant OS advantage from bevacizumab (hazard ratio, 1.05, 95% CI, 0.42 to 2.64; p = 0.14). Further, there was no interaction between the proneural subtype and treatment arm (p = 0.15). These results were confirmed in analyses of tumor subgroups according to the Verhaak classifier. CONCLUSION In contrast to AVAglio, glioblastoma gene expression subgroups were not associated with a differential OS benefit from first-line bevacizumab in the GLARIUS trial.
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Affiliation(s)
- Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
| | - Thomas Zeyen
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, German Cancer Consortium (DKTK), partner site Frankfurt, University of Frankfurt, Frankfurt, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neurooncology, Hertie Institute for Clinical Brain Research, Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, partner site Tübingen, University Hospital Tübingen, German Cancer Consortium (DKTK), Eberhard Karls University, Tübingen, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
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7
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Zeyen T, Paech D, Weller J, Schäfer N, Tzaridis T, Duffy C, Nitsch L, Schneider M, Potthoff AL, Steinbach JP, Hau P, Schlegel U, Seidel C, Krex D, Grauer O, Goldbrunner R, Zeiner PS, Tabatabai G, Galldiks N, Stummer W, Hattingen E, Glas M, Radbruch A, Herrlinger U, Schaub C. Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses. J Neurooncol 2023; 164:607-616. [PMID: 37728779 PMCID: PMC10589172 DOI: 10.1007/s11060-023-04444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE In the randomized CeTeG/NOA-09 trial, lomustine/temozolomide (CCNU/TMZ) was superior to TMZ therapy regarding overall survival (OS) in MGMT promotor-methylated glioblastoma. Progression-free survival (PFS) and pseudoprogression rates (about 10%) were similar in both arms. Further evaluating this discrepancy, we analyzed patterns of postprogression survival (PPS) and MRI features at first progression according to modified RANO criteria (mRANO). METHODS We classified the patients of the CeTeG/NOA-09 trial according to long vs. short PPS employing a cut-off of 18 months and compared baseline characteristics and survival times. In patients with available MRIs and confirmed progression, the increase in T1-enhancing, FLAIR hyperintense lesion volume and the change in ADC mean value of contrast-enhancing tumor upon progression were determined. RESULTS Patients with long PPS in the CCNU/TMZ arm had a particularly short PFS (5.6 months). PFS in this subgroup was shorter than in the long PPS subgroup of the TMZ arm (11.1 months, p = 0.01). At mRANO-defined progression, patients of the CCNU/TMZ long PPS subgroup had a significantly higher increase of mean ADC values (p = 0.015) and a tendency to a stronger volumetric increase in T1-enhancement (p = 0.22) as compared to long PPS patients of the TMZ arm. CONCLUSION The combination of survival and MRI analyses identified a subgroup of CCNU/TMZ-treated patients with features that sets them apart from other patients in the trial: short first PFS despite long PPS and significant increase in mean ADC values upon mRANO-defined progression. The observed pattern is compatible with the features commonly observed in pseudoprogression suggesting mRANO-undetected pseudoprogressions in the CCNU/TMZ arm of CeTeG/NOA-09.
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Affiliation(s)
- Thomas Zeyen
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Cathrina Duffy
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Louisa Nitsch
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | | | | | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Uwe Schlegel
- Department of Neurology, Klinik Hirslanden, Zürich, Switzerland
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Dietmar Krex
- Department of Neurosurgery, Technische Universität Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | - Roland Goldbrunner
- Center of Neurosurgery Department of General, Neurosurgery University of Cologne, Cologne, Germany
| | - Pia Susan Zeiner
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, HertieTübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany and Research Center Juelich, Inst. of Neuroscience and Medicine (INM-3), Juelich, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, 60590, Frankfurt Am Main, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Medicine Essen, Hufelandstr. 55, 45147, Essen, Germany
| | | | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
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8
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Roos C, Weller J, Landwehr C, Sciermoch A, Duffy C, Kohlmann K, Schaub C, Tzaridis T, Schneider M, Schuss P, Herrlinger U, Schäfer N. Distress in Neuro-Oncology Patients and Its Implications for Communication. J Adv Pract Oncol 2023; 14:292-299. [PMID: 37313277 PMCID: PMC10258858 DOI: 10.6004/jadpro.2023.14.4.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Psychoemotional distress affects patients with cancer, including patients with a diagnosis of a malignant brain tumor. Empathy, professional expertise, and conversational skills are required to ensure successful communication with patients. The purpose of this study was to assess whether knowing the communication needs of patients would be helpful to neuro-oncologists before meeting with them. Patients in our neuro-oncology center were asked to complete the National Comprehensive Cancer Network Distress Thermometer (DT) and a study-specific questionnaire on patients' expectations for communication with the treating physician. The questions targeted issues such as attention/caring and awareness of their disease and prognosis. Importance ratings were compared between patients, with high vs. low distress scores to analyze the impact of distress on the patient's needs in physician-patient communication. A total of 81 patients completed the DT and questionnaire. One third (n = 27) had IDH wild-type astrocytoma, and 42 patients (51.9%) were undergoing therapy for primary or recurrent disease. Mean distress was 4.88 (standard deviation ± 2.64) in the whole cohort, and 56.8% of patients had a high distress score (≥ 5 on a 10-point scale). All issues were assessed as important or very important for communication by the majority of patients, and importance ratings increased in patients with high distress levels for most items. Mean importance ratings correlated significantly with distress scores (p < .001). Distress was increased in neuro-oncology patients. Patients with higher distress levels considered issues of both attention/caring and medical information about the disease as more important than patients with lower distress levels. Using distress assessment may help physicians and advanced practitioners to tailor the contents of their discussion for successful communication with patients.
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Affiliation(s)
- Carolin Roos
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
| | - Johannes Weller
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
| | - Christiane Landwehr
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
| | - Anja Sciermoch
- Department of Neurosurgery, University Hospital of Bonn, Germany
| | - Cathrina Duffy
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
| | - Karoline Kohlmann
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
| | - Christina Schaub
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
| | - Theophilos Tzaridis
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
| | | | - Patrick Schuss
- Department of Neurosurgery, University Hospital of Bonn, Germany
| | - Ulrich Herrlinger
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
| | - Niklas Schäfer
- From Division of Clinical Neurooncology, Department of Neurology, University Hospital of Bonn, Germany
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9
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Zeyen T, Paech D, Weller J, Schäfer N, Tzaridis T, Duffy C, Nitsch L, Schneider M, Steinbach J, Hau P, Schlegel U, Seidel C, Krex D, Grauer O, Goldbrunner R, Zeiner P, Tabatabai G, Galldiks N, Stummer W, Hattingen E, Glas M, Radbruch A, Herrlinger U, Schaub C. NIMG-32. POSTPROGRESSION SURVIVAL AND MRI FEATURES AT PROGRESSION IN MGMT-METHYLATED GLIOBLASTOMA FOLLOWING TEMOZOLOMIDE (TMZ) OR CCNU/TMZ THERAPY - AN ANALYSIS OF THE CETEG/NOA-09-TRIAL. Neuro Oncol 2022. [PMCID: PMC9660969 DOI: 10.1093/neuonc/noac209.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
In the randomized CeTeG/NOA-09 trial, combined CCNU/TMZ was superior to TMZ therapy regarding overall survival (OS) in newly diagnosed patients with MGMT-methylated glioblastoma. Using modified RANO criteria, however, progression-free survival (PFS) and pseudoprogression rates were similar in both arms. Exploring the hypothesis of undetected pseudoprogressions being accountable for this discrepancy, we analyzed patterns of postprogression survival (PPS) and MRI features at RANO-defined progression.
METHODS
86 CeTeG/NOA-09 patients with progression (modified RANO criteria) and MRI evaluable for standardized T1 and FLAIR volumetry at baseline and progression were included. Patients were further subdivided to short PPS (< 24 months) or long PPS (> 24 months) and a PPS/PFS ratio was calculated.
RESULTS
In the CCNU/TMZ arm, long PPS patients (n=10) tended to a shorter PFS (median 7.3 months) than short PPS patients in the same arm (n=33, 14 months, p=0.089, logrank test) and long PPS patients in the TMZ arm (n=9, 12.7 months, p=0.21). The mean PPS/PFS ratio in the long PPS group was markedly higher in the CCNU/TMZ arm (5.8) compared to the TMZ arm (3.3, p=0.043, Mann-Whitney test). Patients with long PPS of the CCNU/TMZ arm showed a nonsignificant tendency to a stronger volumetric increase in T1 enhancement (mean delta 6184,86 vs. 697.5 mm³) and FLAIR–T1-enhancement (mean delta 42671 vs 16860 mm³) at progression as compared to long PPS patients of the TMZ arm.
CONCLUSION
Combining a substantially increased PPS/PFS ratio (long OS despite particularly short PFS according to RANO) with indications for increased contrast enhancement and FLAIR volume at progression, the patients with long PPS in the CCNU/TMZ arm appear to differ from those in the TMZ arm. These observations support the hypothesis that this group (~25% of CCNU/TMZ-treated patients) contained patients with pseudoprogression undetected by modified RANO criteria.
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Affiliation(s)
- Thomas Zeyen
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn , Bonn , Germany
| | - Johannes Weller
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Niklas Schäfer
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | | | - Cathrina Duffy
- Division of neurooncology, Universitiy hospital Bonn , Bonn , Germany
| | - Louisa Nitsch
- Division of neurooncology, Universitiy hospital Bonn , Bonn , Germany
| | | | | | - Peter Hau
- Universitätsklinikum Regensburg , Regensburg , Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr–University Bochum , Bochum , Germany
| | - Clemens Seidel
- Department of Radiotherapy, University Hospital Leipzig , Leipzig , Germany
| | | | - Oliver Grauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster , Münster , Germany
| | - Roland Goldbrunner
- Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
| | - Pia Zeiner
- Dr. Senckenberg Institute of Neurooncology , Frankfurt , Germany
| | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Norbert Galldiks
- Dept. of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital , Münster , Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany , Frankfurt , Germany
| | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany , Essen , Germany
| | - Alexander Radbruch
- Department of Neuroradiology, universitiy hospital Bonn , Bonn , Germany
| | - Ulrich Herrlinger
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Christina Schaub
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
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10
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Tzaridis T, Weller J, Bachurski D, Shakeri F, Schaub C, Hau P, Buness A, Schlegel U, Steinbach J, Seidel C, Goldbrunner R, Schäfer N, Wechsler‐Reya RJ, Hallek M, Scheffler B, Glas M, Haeberle L, Herrlinger U, Coch C, Reiners KS, Hartmann G. “A novel serum extracellular vesicle protein signature to monitor glioblastoma tumor progression”. Int J Cancer 2022; 152:308-319. [DOI: 10.1002/ijc.34261] [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] [Received: 05/19/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Theophilos Tzaridis
- Institute of Clinical Chemistry and Clinical Pharmacology University of Bonn Germany
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen‐Bonn‐Cologne‐Düsseldorf, Partner Site Bonn University of Bonn Germany
- Tumor Initiation & Maintenance Program Sanford Burnham Prebys Medical Discovery Institute La Jolla USA
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen‐Bonn‐Cologne‐Düsseldorf, Partner Site Bonn University of Bonn Germany
| | - Daniel Bachurski
- Department I of Internal Medicine, Center for Integrated Oncology Aachen‐Bonn‐Cologne‐Düsseldorf, Partner Site Cologne, Center for Molecular Medicine Cologne University of Cologne Germany
| | - Farhad Shakeri
- Institute for Medical Biometry, Informatics and Epidemiology, Institute for Genomic Statistics and Bioinformatics, Medical Faculty University of Bonn Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen‐Bonn‐Cologne‐Düsseldorf, Partner Site Bonn University of Bonn Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit University Hospital Regensburg Germany
| | - Andreas Buness
- Institute for Medical Biometry, Informatics and Epidemiology, Institute for Genomic Statistics and Bioinformatics, Medical Faculty University of Bonn Germany
| | - Uwe Schlegel
- Department of Neurology University Hospital Knappschaftskrankenhaus, Ruhr–University Bochum Germany
| | | | - Clemens Seidel
- Department of Radiation Oncology University of Leipzig Germany
| | | | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen‐Bonn‐Cologne‐Düsseldorf, Partner Site Bonn University of Bonn Germany
| | - Robert J. Wechsler‐Reya
- Tumor Initiation & Maintenance Program Sanford Burnham Prebys Medical Discovery Institute La Jolla USA
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen‐Bonn‐Cologne‐Düsseldorf, Partner Site Cologne, Center for Molecular Medicine Cologne University of Cologne Germany
| | - Björn Scheffler
- DKFZ‐Division Translational Neurooncology at the West German Cancer Center, German Cancer Consortium, DKFZ Heidelberg & Partner Site University Hospital Essen Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center, German Cancer Consortium University Hospital Essen Germany
| | - Lothar Haeberle
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen‐EMN Friedrich Alexander University of Erlangen– Nuremberg Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen‐Bonn‐Cologne‐Düsseldorf, Partner Site Bonn University of Bonn Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology University of Bonn Germany
| | - Katrin S. Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology University of Bonn Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology University of Bonn Germany
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11
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Tzaridis T, Eisemann T, Andrade AF, Hope JL, Romero MM, Becher OJ, Jabado N, Bradley LM, Wechsler-Reya RJ. DIPG-17. CD155 regulates cell growth and immune evasion in diffuse intrinsic pontine glioma. Neuro Oncol 2022. [PMCID: PMC9164992 DOI: 10.1093/neuonc/noac079.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is an unmet need for more effective treatment strategies for diffuse intrinsic pontine glioma (DIPG), a devastating brain tumour arising in children and young adults. While immunotherapy is emerging as a powerful approach to treatment of other cancers, clinical trials with immune checkpoint inhibitors have failed to show a survival benefit for DIPG patients. In this study, we analysed the expression of immune checkpoint molecules on the surface of human and murine DIPG cells by flow cytometry and identified CD155 and B7-H3 as the most highly expressed checkpoint molecules, with minimal expression of PD-L1, PD-L2, Galectin-9, CEACAM-1, CD86, CD252 and CD137. These findings were confirmed in primary patient samples from pediatric brain tumours, including high-grade gliomas, medulloblastomas and ependymomas. To test whether CD155 inhibition increases susceptibility to CD8+ T cell killing in vitro, we cultured DIPG cells expressing ovalbumin (OVA) with CD8+ T cells from OT-I mice, which express T cell receptors specific for OVA. Addition of CD155 blocking antibodies to these cultures increased expression of T cell activation markers (CD25, CD44 and CD69) as well as T cell-mediated tumour killing, supporting the notion that CD155 can function as an immune checkpoint in DIPG. In addition to its effects on T cells, CD155 also exerted direct effects on tumour cells: treatment with anti-CD155 antibodies led to impaired cell viability, and shRNA-mediated knockdown of CD155 resulted in reduced cell proliferation in vitro. Strikingly, knockdown of CD155 also led to reduced growth of DIPG cells in vivo, and mice transplanted with the CD155-deficient cells had a clear survival benefit compared to mice transplanted with wild type cells. These studies demonstrate that CD155 functions as an immune checkpoint and as a regulator of tumor growth in DIPG, and suggest that targeting CD155 could be a valuable therapeutic strategy for this devastating disease.
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Affiliation(s)
- Theophilos Tzaridis
- Tumor Initiation & Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla , CA , USA
| | - Tanja Eisemann
- Tumor Initiation & Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla , CA , USA
| | - Augusto F Andrade
- Department of Human Genetics, Department of Paediatrics of the McGill University and Research Institute of the McGill University Health Center , Montreal, QC , Canada
| | - Jennifer L Hope
- Aging, Cancer and Immunooncology Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla , CA , USA
| | - Megan M Romero
- Department of Pediatrics, Northwestern University , Chicago, IL , USA
| | - Oren J Becher
- Jack Martin Division of Pediatric Hematology-Oncology, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York City , NY , USA
| | - Nada Jabado
- Department of Human Genetics, Department of Paediatrics of the McGill University and Research Institute of the McGill University Health Center , Montreal, QC , Canada
| | - Linda M Bradley
- Aging, Cancer and Immunooncology Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla , CA , USA
| | - Robert J Wechsler-Reya
- Tumor Initiation & Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla , CA , USA
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12
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Tzaridis T, Weller J, Bachurski D, Shakheri F, Schaub C, Hau P, Buness A, Schlegel U, Steinbach J, Seidel C, Goldbrunner R, Schäfer N, Wechsler-Reya R, Scheffler B, Glas M, Haeberle L, Herrlinger U, Coch C, Reiners K, Hartmann G. BIOM-24. PROTEIN SURFACE SIGNATURE ON SERUM EXTRACELLULAR VESICLES FOR NON-INVASIVE DETECTION OF TUMOR PROGRESSION IN GLIOBLASTOMA PATIENTS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Detection of tumor progression in glioblastoma patients remains a major challenge for clinicians due to equivocal MRI results. Extracellular vesicles (EVs) are potential biomarkers and can be detected in the blood of tumor patients. In this study, we evaluated the potential of serum-derived EVs from glioblastoma patients to serve as a marker for tumor progression in adjunction with MRI assessment.
METHODS
Glioblastoma patients from two independent cohorts, one from the multicenter Phase III CeTeG/NOA-09 trial (n=36) and the other from patients treated at the University of Bonn (n=31), were included in this study. EVs from serum of glioblastoma patients and healthy volunteers were separated by size exclusion chromatography and ultracentrifugation. EV markers were defined by using a proximity-extension assay and bead-based flow cytometry. Tumor progression was defined according to modified RANO criteria.
RESULTS
EVs from the serum of glioblastoma patients (n=67) showed an upregulation of CD29 (p=0.08), CD44 (p< 0.0001), CD81 (p< 0.0001), CD146 (p< 0.0001), C1QA (p=0.003), and histone H3 (p< 0.0001) as compared to serum EVs from healthy volunteers. For both independent cohorts of glioblastoma patients, we noted upregulation of C1QA, CD44, and histone H3 upon tumor progression, but not in patients with stable disease. Notably, six patients with worse survival compared to the median survival of the cohort did not fulfill RANO criteria at the time of suspected progression, yet showed an elevation of at least one out of these three markers. In a multivariable logistic regression analysis, a combination of CD29, CD44, CD81, C1QA, and histone H3 correlated with RANO-defined tumor progression with an AUC of 0.76.
CONCLUSION
Measurement of CD29, CD44, CD81, C1QA, and histone H3 in serum-derived EVs of glioblastoma patients, along with standard MRI assessment, could improve detection of true tumor progression and thus be a useful tool for clinical decision making.
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Affiliation(s)
- Theophilos Tzaridis
- Tumor Initiation & Maintenance Program, Sanford Burnham Presbys Medical Discovery Institute, La Jolla, CA, USA
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Daniel Bachurski
- Department of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Cologne, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Farhad Shakheri
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital, Regensburg, Germany
| | - Andreas Buness
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr–University Bochum, Bochum, Germany
| | - Joachim Steinbach
- Dr. Senckenbergisches Institut für Neuroonkologie, Frankfurt, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Björn Scheffler
- DKFZ-Division Translational Neurooncology at the West German Cancer Center, German Cancer Consortium, DKFZ Heidelberg & Partner Site University Hospital Essen, Germany, Essen, Germany
| | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Lothar Haeberle
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Germany, Erlangen, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Katrin Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
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13
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Weller J, Waha A, Schneider M, Seidel C, Steinbach J, Hau P, Schlegel U, Tonn JC, Grauer O, Sabel M, Krex D, Schnell O, Ringel F, Tabatabai G, Goldbrunner R, Radbruch A, Schuss P, Güresir E, Vatter H, Glas M, Schmid M, Schäfer N, Tzaridis T, Giordano F, Zeyen T, Schaub C, Németh R, Pietsch T, Herrlinger U. BIOM-08. DNA METHYLATION-BASED SUBGROUPING PREDICTS SURVIVAL BENEFIT FROM LOMUSTINE/TEMOZOLOMID COMBINATION THERAPY IN MGMT PROMOTOR-METHYLATED GLIOBLASTOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The CeTeG/NOA-09 trial showed that lomustine/temozolomide chemotherapy prolongs survival for newly diagnosed MGMT-methylated glioblastoma patients. Previous reports on temozolomide monotherapy suggested, that the survival benefit of temozolomide in MGMT-methylated tumors may be restricted to the RTK II methylation subgroup and absent in RTK I and MES subgroups. To identify patients with a particularly strong benefit from CCNU/TMZ, we explored the association of methylation subgroups with outcome after lomustine/temozolomide therapy.
METHODS
All patients from the CeTeG/NOA-09 trial with sufficiently available tumor tissue (n = 98) underwent 850K methylation array analysis of their tumor and methylation subgroup annotation (Heidelberg brain tumor methylation classifier v11b4; calibrated score > 0.5 required). Overall survival (OS) was compared between a pooled cohort of tumors of the RTK I/MES subgroups and RTK II tumors.
RESULTS
In the CCNU/TMZ arm of CeTeG/NOA-09, OS was prolonged in RTK I/MES (n = 16; median not reached, 4-year OS 69%) as compared to RTK II patients (n = 14; median 20.6 months, 4-year OS 23%; p = 0.004 logrank test). In the standard temozolomide arm of CeTeG/NOA-09, OS tended to be shorter in RTK I/MES (n = 7; median 23.7 months, 4-year OS 17%) as compared to RTK II patients (n = 17; median 35.2 months; 4-year OS 38%, p = 0.15).
CONCLUSION
The CCNU/TMZ-dependent survival prolongation in patients with RTK I/MES tumors as opposed to RTK II seen in CeTeG/NOA-09 suggests that methylation-based subgrouping could be predictive for CCNU/TMZ efficacy in newly diagnosed MGMT-methylated glioblastoma.
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Affiliation(s)
- Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Andreas Waha
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | | | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Joachim Steinbach
- Dr. Senckenbergisches Institut für Neuroonkologie, Frankfurt, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr–University Bochum, Bochum, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Munich, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | - Michael Sabel
- Departement of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Nordrhein-Westfalen, Germany
| | - Dietmar Krex
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Nordrhein-Westfalen, Germany
| | - Oliver Schnell
- University Clinic of Freiburg, Freiburg, Baden-Wurttemberg, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Ghazaleh Tabatabai
- Eberhard-Karls University Tübingen, Department of Neurology and Interdisciplinary Neuro-Oncology, Tübingen, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany, Cologne, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Medical Center Bonn, Univeristy of Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Tumor Initiation & Maintenance Program, Sanford Burnham Presbys Medical Discovery Institute, La Jolla, CA, USA
| | - Frank Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Thomas Zeyen
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Robert Németh
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
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14
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Li G, Chen TW, Nickel AC, Muhammad S, Steiger HJ, Tzaridis T, Hänggi D, Zeidler R, Zhang W, Kahlert UD. Carbonic Anhydrase XII is a Clinically Significant, Molecular Tumor-Subtype Specific Therapeutic Target in Glioma with the Potential to Combat Invasion of Brain Tumor Cells. Onco Targets Ther 2021; 14:1707-1718. [PMID: 33692626 PMCID: PMC7939492 DOI: 10.2147/ott.s300623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background The metabolic enzyme carbonic anhydrase 12 (CA12/CAXII) emerges as a promising cancer therapeutic target with drug development projects underway. Previous reports proposed the relevance of CA12 in the context of glioma but are limited in patient data quantity, ignore ethnic diversity of patients or rely on semi-quantitative, thereby out of date, methodology. Moreover, little is known on the association of CA12 to brain tumor stemness or on the effect of anti-CAXII-directed monotherapies on glioma stem cells (GSCs), in particular their response regarding mesenchymal differentiation status. Methods We performed in silico analysis on three independent, large-scale patient datasets interrogating state of the art molecular diagnostics alongside clinical outcomes. We analyzed CAXII abundance on a collection of GSCs and functionally tested their response to exposure to CAXII blocking antibody 6A10. Results CA12 is highly expressed in glial tumors compared with normal tissue and predicts for poor clinical course of tumor patients. CA12 expression in glioblastoma significantly correlates with clinically established, molecular markers of IDH1WT DNA, WHO grade IV or absence of 1p/19q chromosome arm co-deletion. Furthermore, tumors with elevated CA12 cluster into the mesenchymal transcription subclass of the disease. CAXII abundance in different GSCs ranges from almost absent to high levels and does not correlate to stem cell marker CD133/AC133 cell surface expression. Moreover, aiming to pharmacologically block CAXII in our cells with antibody 6A10 caused significant functional response only in one of the tested GSCs models, featuring suppression of cell invasion accompanied by reduction of ZEB1 protein and other stem cell markers. Conclusion CA12 represents a clinically relevant and molecular brain tumor-subtype specific therapeutic target. Our correlative data from experimental and clinical samples does not support CA12/CAXII to be GSC specific. 6A10 possesses promising potential to impede the invasive capacity of glioma cells and supports the emerging concept that CAXII interacts with cancer EMT programs. However, further mechanistic studies are required to comprehensively assess the therapeutic potential of 6A10 and to identify different resistance mechanisms of GSCs.
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Affiliation(s)
- Guanzhang Li
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China
| | - Ting-Wei Chen
- Clinic for Neurosurgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Ann-Christin Nickel
- Clinic for Neurosurgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Sajjad Muhammad
- Clinic for Neurosurgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Clinic for Neurosurgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, 53127, Germany.,Tumor Initiation & Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA
| | - Daniel Hänggi
- Clinic for Neurosurgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Reinhard Zeidler
- Department for Otorhinolaryngology, Klinikum der Universität München (LMU), Munich, Germany
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Chinese Glioma Genome Atlas Network (CGGA) and Asian Glioma Genome Atlas Network (AGGA), Beijing, People's Republic of China
| | - Ulf Dietrich Kahlert
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.,Clinic for Neurosurgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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15
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Tzaridis T, Schäfer N, Weller J, Steinbach JP, Schlegel U, Seidel S, Sabel M, Hau P, Seidel C, Krex D, Goldbrunner R, Tonn JC, Grauer O, Kebir S, Schneider M, Schaub C, Vatter H, Coch C, Glas M, Fimmers R, Pietsch T, Reifenberger G, Herrlinger U, Felsberg J. MGMT promoter methylation analysis for allocating combined CCNU/TMZ chemotherapy: Lessons learned from the CeTeG/NOA-09 trial. Int J Cancer 2020; 148:1695-1707. [PMID: 33113214 DOI: 10.1002/ijc.33363] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/26/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022]
Abstract
The CeTeG/NOA-09 trial showed a survival benefit for combined CCNU/TMZ therapy in MGMT-promoter-methylated glioblastoma patients (quantitative methylation-specific PCR [qMSP] ratio > 2). Here, we report on the prognostic value of the MGMT promoter methylation ratio determined by qMSP and evaluate the concordance of MGMT methylation results obtained by qMSP, pyrosequencing (PSQ) or DNA methylation arrays (MGMT-STP27). A potential association of qMSP ratio with survival was analyzed in the CeTeG/NOA-09 trial population (n = 129; log-rank tests, Cox regression analyses). The concordance of MGMT methylation assays (qMSP, PSQ and MGMT-STP27) was evaluated in 76 screened patients. Patients with tumors of qMSP ratio > 4 showed superior survival compared to those with ratios 2-4 (P = .0251, log-rank test). In multivariate analysis, the qMSP ratio was not prognostic across the study cohort (hazard ratio [HR] = 0.88; 95% CI: 0.72-1.08). With different cutoffs for qMSP ratio (4, 9, 12 or 25), the CCNU/TMZ benefit tended to be larger in subgroups with lower ratios (eg, for cutoff 9: HR 0.32 for lower subgroup, 0.73 for higher subgroup). The concordance rates with qMSP were 94.4% (PSQ) and 90.2% (MGMT-STP27). Discordant results were restricted to tumors with qMSP ratios ≤4 and PSQ mean methylation rate ≤25%. Despite a shorter survival in MGMT-promoter-methylated patients with lower methylation according to qMSP, these patients had a benefit from combined CCNU/TMZ therapy, which even tended to be stronger than in patients with higher methylation rates. With acceptable concordance rates, decisions on CCNU/TMZ therapy may also be based on PSQ or MGMT-STP27.
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Affiliation(s)
- Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany.,Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Joachim-Peter Steinbach
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt am Main, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Sabine Seidel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | | | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Oliver Grauer
- Department of Neurology with Institute for Translational Neurology, University of Münster, Münster, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany.,Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center (WTZ), German Cancer Consortium, Partner Site Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University of Bonn, Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany.,Study Center Bonn, University of Bonn, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany.,Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center (WTZ), German Cancer Consortium, Partner Site Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology and DGNN Brain Tumor Reference Center, University of Bonn, Bonn, Germany
| | - Guido Reifenberger
- Institute of Neuropathology and DGNN Brain Tumor Reference Center, Medical Faculty, Heinrich Heine University and German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Jörg Felsberg
- Institute of Neuropathology and DGNN Brain Tumor Reference Center, Medical Faculty, Heinrich Heine University and German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Düsseldorf, Germany
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16
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Tzaridis T, Weller J, Bachurski D, Schäfer N, Schaub C, Hallek M, Scheffler B, Glas M, Hartmann G, Herrlinger U, Wild S, Coch C, Reiners K. BIOM-40. ANALYSIS OF SERUM MIRNA IN GLIOBLASTOMA PATIENTS: TARGETED ENRICHMENT OF EXTRACELLULAR VESICLES ENHANCES SPECIFICITY FOR PROGNOSTIC SIGNATURE. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Glioblastoma is a devastating disease, for which biomarkers allowing a prediction of prognosis are urgently needed. microRNAs have been described as potentially valuable biomarkers in cancer. Here, we studied a panel of microRNAs in extracellular vesicles (EV) from the serum of glioblastoma patients and also in total serum without prior EV separation, and evaluated their correlation with the survival of these patients. Our study included 55 patients in total, 26 (47.3%) of which were treated within the multicenter Phase III CeTeG/NOA-09 trial and 29 (52.7%) in the Division of Clinical Neurooncology of the University Hospital of Bonn, as well as 10 healthy volunteers (HV). Blood was drawn from patients during the adjuvant chemotherapeutic treatment. A panel of 15 microRNAs was studied by quantitative real-time PCR in EV that were separated by size-exclusion chromatography, followed by CDxx* immunoprecipitation (SEC+CDxx*), and compared with those from total serum of glioblastoma patients and HV. Comparing SEC+CDxx* to total serum, we found evidence for enrichment of miR-21-3p and miR-106a-5p and, conversely, lower levels of miR-15b-3p in SEC+CDxx* EV. miR-15b-3p and miR-21-3p were upregulated in serum of glioblastoma patients compared to healthy subjects. Significant correlation with survival of the patients was found for levels of miR-15b-3p in total serum and miR-15b-3p, miR-21-3p, miR-106a-5p and miR-328-3p in SEC+CDxx* EV. Combining miR-15b-3p in serum or miR-106a-5p in SEC+CDxx* EV with any one of the other three microRNAs in SEC+CDxx* EV allowed for a prognostic stratification of glioblastoma patients. We have thus identified four microRNAs whose levels, in combination, can predict the prognosis for these patients. *=Cluster of Differentiation xx (CDxx); Molecule cannot be specifically mentioned due to pending patent.
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Affiliation(s)
- Theophilos Tzaridis
- Institute of Clinical Chemistry and Clinical Pharmacology & Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Bonn, University Hospital Bonn, Bonn, Germany, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Dept. of Neurology, University Hospital Bonn, Bonn, Germany, Bonn, Germany
| | - Daniel Bachurski
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Cologne, CECAD Center of Excellence on “Cellular Stress Responses in Aging-Associated Diseases”, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany, Cologne, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Dept. of Neurology, University Hospital Bonn, Bonn, Germany, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Dept. of Neurology, University Hospital Bonn, Bonn, Germany, Bonn, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Cologne, CECAD Center of Excellence on “Cellular Stress Responses in Aging-Associated Diseases”, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany, Cologne, Germany
| | - Björn Scheffler
- DKFZ-Division Translational Neurooncology at the WTZ, DKTK partner site, University Hospital Essen, Essen, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Dept. of Neurology, University Hospital Bonn, Bonn, Germany, Bonn, Germany
| | - Stefan Wild
- Miltenyi Biomedicine GmbH, Bergisch Gladbach, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany, Bonn, Germany
| | - Katrin Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany, Bonn, Germany
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17
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Tzaridis T, Reiners KS, Weller J, Bachurski D, Schäfer N, Schaub C, Hallek M, Scheffler B, Glas M, Herrlinger U, Wild S, Coch C, Hartmann G. Analysis of Serum miRNA in Glioblastoma Patients: CD44-Based Enrichment of Extracellular Vesicles Enhances Specificity for the Prognostic Signature. Int J Mol Sci 2020; 21:ijms21197211. [PMID: 33003586 PMCID: PMC7583802 DOI: 10.3390/ijms21197211] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/18/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022] Open
Abstract
Glioblastoma is a devastating disease, for which biomarkers allowing a prediction of prognosis are urgently needed. microRNAs have been described as potentially valuable biomarkers in cancer. Here, we studied a panel of microRNAs in extracellular vesicles (EVs) from the serum of glioblastoma patients and evaluated their correlation with the prognosis of these patients. The levels of 15 microRNAs in EVs that were separated by size-exclusion chromatography were studied by quantitative real-time PCR, followed by CD44 immunoprecipitation (SEC + CD44), and compared with those from the total serum of glioblastoma patients (n = 55) and healthy volunteers (n = 10). Compared to total serum, we found evidence for the enrichment of miR-21-3p and miR-106a-5p and, conversely, lower levels of miR-15b-3p, in SEC + CD44 EVs. miR-15b-3p and miR-21-3p were upregulated in glioblastoma patients compared to healthy subjects. A significant correlation with survival of the patients was found for levels of miR-15b-3p in total serum and miR-15b-3p, miR-21-3p, miR-106a-5p, and miR-328-3p in SEC + CD44 EVs. Combining miR-15b-3p in serum or miR-106a-5p in SEC + CD44 EVs with any one of the other three microRNAs in SEC + CD44 EVs allowed for a prognostic stratification of glioblastoma patients. We have thus identified four microRNAs in glioblastoma patients whose levels, in combination, can predict the prognosis for these patients.
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Affiliation(s)
- Theophilos Tzaridis
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, 53127 Bonn, Germany; (T.T.); (C.C.); (G.H.)
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Bonn, University Hospital Bonn, 53127 Bonn, Germany; (J.W.); (N.S.); (C.S.); (U.H.)
- Tumor Initiation & Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Katrin S Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, 53127 Bonn, Germany; (T.T.); (C.C.); (G.H.)
- Correspondence:
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Bonn, University Hospital Bonn, 53127 Bonn, Germany; (J.W.); (N.S.); (C.S.); (U.H.)
| | - Daniel Bachurski
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Cologne, CECAD Center of Excellence on ‘‘Cellular Stress Responses in Aging-Associated Diseases’’, Center for Molecular Medicine Cologne, University of Cologne, 50937 Cologne, Germany; (D.B.); (M.H.)
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Bonn, University Hospital Bonn, 53127 Bonn, Germany; (J.W.); (N.S.); (C.S.); (U.H.)
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Bonn, University Hospital Bonn, 53127 Bonn, Germany; (J.W.); (N.S.); (C.S.); (U.H.)
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Cologne, CECAD Center of Excellence on ‘‘Cellular Stress Responses in Aging-Associated Diseases’’, Center for Molecular Medicine Cologne, University of Cologne, 50937 Cologne, Germany; (D.B.); (M.H.)
| | - Björn Scheffler
- DKFZ-Division Translational Neurooncology at the West German Cancer Center (WTZ), German Cancer Consortium (DKTK), DKFZ Heidelberg & Partner Site Univ Hospital Essen, 45147 Essen, Germany;
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center (WTZ), German Cancer Consortium, University Hospital Essen, 45147 Essen, Germany;
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, Center of Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Partner Site Bonn, University Hospital Bonn, 53127 Bonn, Germany; (J.W.); (N.S.); (C.S.); (U.H.)
| | - Stefan Wild
- Miltenyi Biotec & Biomedicine GmbH, 51429 Bergisch Gladbach, Germany;
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, 53127 Bonn, Germany; (T.T.); (C.C.); (G.H.)
- Miltenyi Biotec & Biomedicine GmbH, 51429 Bergisch Gladbach, Germany;
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, 53127 Bonn, Germany; (T.T.); (C.C.); (G.H.)
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18
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Tzaridis T, Gepfner-Tuma I, Hirsch S, Skardelly M, Bender B, Paulsen F, Schaub C, Weller J, Schäfer N, Herrlinger U, Tabatabai G. Regorafenib in advanced high-grade glioma: a retrospective bicentric analysis. Neuro Oncol 2020; 21:954-955. [PMID: 31089718 DOI: 10.1093/neuonc/noz071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Theophilos Tzaridis
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany.,Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Irina Gepfner-Tuma
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sophie Hirsch
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marco Skardelly
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neuroradiology, University Hospital of Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Radiation Oncology, University Hospital of Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Christina Schaub
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany
| | - Johannes Weller
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany.,German Consortium for Translational Oncology, German Cancer Research Center partner site Tübingen
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19
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Gepfner-Tuma I, Hirsch S, Schittenhelm J, Tzaridis T, Ziemann U, Tatagiba M, Herrlinger U, Tabatabai G. Corticosteroid-responsive aseptic meningitis during regorafenib treatment. Neurooncol Pract 2020; 6:508-509. [PMID: 32257278 DOI: 10.1093/nop/npz030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Irina Gepfner-Tuma
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen, Stuttgart; Eberhard Karls University Tübingen, Germany
| | - Sophie Hirsch
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Germany
| | - Jens Schittenhelm
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen, Stuttgart; Eberhard Karls University Tübingen, Germany.,Department of Neuropathology, University Hospital of Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn
| | - Ulf Ziemann
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen, Stuttgart; Eberhard Karls University Tübingen, Germany
| | - Marcos Tatagiba
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen, Stuttgart; Eberhard Karls University Tübingen, Germany
| | - Ulrich Herrlinger
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen, Stuttgart; Eberhard Karls University Tübingen, Germany.,German Consortium for Translational Oncology (DKTK), DKFZ partner site Tübingen
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20
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Tzaridis T, Schäfer N, Weller J, Steinbach J, Seidel S, Schlegel U, Sabel M, Hau P, Seidel C, Krex D, Goldbrunner R, Tonn JC, Grauer O, Schaub C, Coch C, Glas M, Pietsch T, Fimmers R, Reifenberger G, Felsberg J, Herrlinger U. ACTR-53. MGMT PROMOTER METHYLATION ANALYSIS FOR ALLOCATING COMBINED CCNU/TMZ CHEMOTHERAPY: LESSONS LEARNED FROM THE CeTeG/NOA-09 TRIAL. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
The CeTeG/NOA-09 trial recently showed a survival benefit for combination chemotherapy with CCNU/TMZ in glioblastoma patients with a methylated MGMT promoter as determined by quantitative Methylation-Specific PCR (qMSP). Identifying patient subgroups with a pronounced benefit from this novel treatment is crucial. Here, we report on the prognostic and predictive value of MGMT promoter methylation ratio determined by qMSP and investigate the concordance of pyrosequencing (PSQ) and qMSP for patients in this trial.
METHODS
qMSP and PSQ were used for MGMT promoter methylation analysis. The mITT population of the CeTeG/NOA-09 trial was used for multivariate analysis including the parameters MGMT promoter methylation ratio, RPA class and study center.
RESULTS
Patients of the mITT population of the CeTeG/NOA-09 trial (n=129) with MGMT promoter methylation ratio greater than 4 (qMSP) showed a superior overall survival compared to patients with borderline methylation ratio of 2–4 (p=0.0251). In the latter patients, treatment with CCNU/TMZ did not show a survival benefit (p=0.924). Multivariate analysis with treatment arm, RPA class and study center as covariates did not confirm a prognostic or predictive value of MGMT promoter methylation ratio (qMSP) for patients of the mITT population (n=129, HR=0.88; 95% CI: 0.72 – 1.08) or patients with a ratio greater than 4 (n=117, HR =0.86; 95% CI: 0.69 – 1.07). In a subset of 49 trial patients, qMSP and PSQ showed not only a high qualitative (45/49; 91.8%), but also a high quantitative concordance rate (Spearman correlation, r=0.83, p< 0.0001).
CONCLUSION
Glioblastoma patients with borderline MGMT promoter methylation (qMSP ratio 2–4) do not seem to benefit from combination treatment with CCNU/TMZ. Thus, we propose a qMSP cut-off of 4 as a novel decision tool for clinicians. qMSP and PSQ show a high concordance rate indicating that a decision for combination therapy can also be based on PSQ results.
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Affiliation(s)
- Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology & Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn Medical Center, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Joachim Steinbach
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Sabine Seidel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Bochum, Germany
| | - Michael Sabel
- Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany
| | - Peter Hau
- Regensburg University Hospital, Regensburg, Germany
| | | | - Dietmar Krex
- Carl Gustav Carus Universitätsklinikum Dresden, Dresden, Sachsen, Germany
| | | | | | | | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn Medical Center, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Torsten Pietsch
- University of Bonn Medical School, Department of Neuropathology, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn Medical Center, Bonn, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
| | - Jörg Felsberg
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
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21
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Weller J, Tzaridis T, Mack F, Steinbach JP, Schlegel U, Hau P, Krex D, Grauer O, Goldbrunner R, Bähr O, Uhl M, Seidel C, Tabatabai G, Brehmer S, Bullinger L, Galldiks N, Schaub C, Kebir S, Stummer W, Simon M, Fimmers R, Coch C, Glas M, Herrlinger U, Schäfer N. Health-related quality of life and neurocognitive functioning with lomustine-temozolomide versus temozolomide in patients with newly diagnosed, MGMT-methylated glioblastoma (CeTeG/NOA-09): a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 2019; 20:1444-1453. [PMID: 31488360 DOI: 10.1016/s1470-2045(19)30502-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The CeTeG/NOA-09 trial showed significantly longer overall survival with combined lomustine-temozolomide therapy compared with standard temozolomide for patients with glioblastoma with methylated MGMT promoter. The trial also aimed to investigate the effect of lomustine-temozolomide therapy on health-related quality of life (HRQOL) and neurocognitive function, which we report here. METHODS In this randomised, multicentre, open-label, phase 3 trial, newly diagnosed, chemoradiotherapy-naive patients with MGMT-methylated glioblastoma, aged 18-70 years, with a Karnofsky performance score of 70% or higher, were recruited and enrolled at 17 university hospitals in Germany. Patients received standard radiotherapy (60 Gy) and were randomly assigned (1:1, stratified by centre by allocating complete blocks of six to a centre, without masking) to either six 6-week courses of oral combined lomustine (100 mg/m2 on day 1) plus temozolomide (100-200 mg/m2 on days 2-6) or standard oral temozolomide (75 mg/m2 daily during radiotherapy plus six 4-week courses of temozolomide [150-200 mg/m2] on days 1-5, every 4 weeks). The primary endpoint was overall survival. HRQOL, assessed using the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire core-30 and the EORTC brain cancer module (BN20); and neurocognitive function, assessed using the Mini Mental State Examination (MMSE), plus a neurocognitive test battery (NOA-07), including Trail Making Test A and B (TMT-A and B), working memory tests, and tests for lexical (Controlled Oral Word Association [COWA]) and semantic verbal fluency, were secondary endpoints analysed in the modified intention-to-treat population (mITT; all randomly assigned patients who received at least one dose of study chemotherapy). We used linear mixed-model analyses to investigate differences between treatment groups regarding HRQOL (clinically relevant ≥10 points) and MMSE scores (clinically relevant ≥3 points). The trial is registered with ClinicalTrials.gov, NCT01149109. FINDINGS Between June 17, 2011 and April 8, 2014, 141 patients were randomly assigned and 129 patients began treatment and were included in the mITT population (63 in the temozolomide and 66 in the lomustine-temozolomide group). Median follow-up for HRQOL (the item global health) was 19·4 months (IQR 7·8-38·6), for MMSE was 15·3 months (4·1-29·6), and for COWA was 11·0 months (0-27·5). We found no significant impairment regarding any item of HRQOL in the lomustine-temozolomide group (difference between the groups for global health 0·30 [95% CI -0·23 to 0·83]; p=0·26). Differences in MMSE were in favour of the temozolomide group (difference -0·11 [95% CI -0·19 to -0·03]; p=0·0058) but were not clinically relevant (1·76/30 points over 4 years). We found no significant difference between the groups in any subtest of the neurocognitive test battery (difference for COWA 0·04 [95% CI -0·01 to 0·09]; p=0·14). INTERPRETATION The absence of systematic and clinically relevant changes in HRQOL and neurocognitive function combined with the survival benefit of lomustine-temozolomide versus temozolomide alone suggests that a long-term net clinical benefit exists for patients with newly diagnosed glioblastoma with methylation of the MGMT promoter and supports the use of lomustine-temozolomide as a treatment option for these patients. FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Frederic Mack
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Joachim Peter Steinbach
- Dr Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt am Main, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Oliver Bähr
- Dr Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt am Main, Germany
| | - Martin Uhl
- Department of Neurology and Wilhelm Sander Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neurooncology, University of Tübingen, Tübingen, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University of Mannheim, Mannheim, Germany
| | - Lars Bullinger
- Department of Internal Medicine, University of Ulm, Ulm, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine, Forschungszentrum Juelich, Juelich, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Matthias Simon
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Christoph Coch
- Study Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center, German Cancer Consortium, Partner Site Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
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22
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Herrlinger U, Tzaridis T, Mack F, Steinbach JP, Schlegel U, Sabel M, Hau P, Kortmann RD, Krex D, Grauer O, Goldbrunner R, Schnell O, Bähr O, Uhl M, Seidel C, Tabatabai G, Kowalski T, Ringel F, Schmidt-Graf F, Suchorska B, Brehmer S, Weyerbrock A, Renovanz M, Bullinger L, Galldiks N, Vajkoczy P, Misch M, Vatter H, Stuplich M, Schäfer N, Kebir S, Weller J, Schaub C, Stummer W, Tonn JC, Simon M, Keil VC, Nelles M, Urbach H, Coenen M, Wick W, Weller M, Fimmers R, Schmid M, Hattingen E, Pietsch T, Coch C, Glas M. Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA-09): a randomised, open-label, phase 3 trial. Lancet 2019; 393:678-688. [PMID: 30782343 DOI: 10.1016/s0140-6736(18)31791-4] [Citation(s) in RCA: 309] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/12/2018] [Accepted: 07/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is an urgent need for more effective therapies for glioblastoma. Data from a previous unrandomised phase 2 trial suggested that lomustine-temozolomide plus radiotherapy might be superior to temozolomide chemoradiotherapy in newly diagnosed glioblastoma with methylation of the MGMT promoter. In the CeTeG/NOA-09 trial, we aimed to further investigate the effect of lomustine-temozolomide therapy in the setting of a randomised phase 3 trial. METHODS In this open-label, randomised, phase 3 trial, we enrolled patients from 17 German university hospitals who were aged 18-70 years, with newly diagnosed glioblastoma with methylated MGMT promoter, and a Karnofsky Performance Score of 70% and higher. Patients were randomly assigned (1:1) with a predefined SAS-generated randomisation list to standard temozolomide chemoradiotherapy (75 mg/m2 per day concomitant to radiotherapy [59-60 Gy] followed by six courses of temozolomide 150-200 mg/m2 per day on the first 5 days of the 4-week course) or to up to six courses of lomustine (100 mg/m2 on day 1) plus temozolomide (100-200 mg/m2 per day on days 2-6 of the 6-week course) in addition to radiotherapy (59-60 Gy). Because of the different schedules, patients and physicians were not masked to treatment groups. The primary endpoint was overall survival in the modified intention-to-treat population, comprising all randomly assigned patients who started their allocated chemotherapy. The prespecified test for overall survival differences was a log-rank test stratified for centre and recursive partitioning analysis class. The trial is registered with ClinicalTrials.gov, number NCT01149109. FINDINGS Between June 17, 2011, and April 8, 2014, 141 patients were randomly assigned to the treatment groups; 129 patients (63 in the temozolomide and 66 in the lomustine-temozolomide group) constituted the modified intention-to-treat population. Median overall survival was improved from 31·4 months (95% CI 27·7-47·1) with temozolomide to 48·1 months (32·6 months-not assessable) with lomustine-temozolomide (hazard ratio [HR] 0·60, 95% CI 0·35-1·03; p=0·0492 for log-rank analysis). A significant overall survival difference between groups was also found in a secondary analysis of the intention-to-treat population (n=141, HR 0·60, 95% CI 0·35-1·03; p=0·0432 for log-rank analysis). Adverse events of grade 3 or higher were observed in 32 (51%) of 63 patients in the temozolomide group and 39 (59%) of 66 patients in the lomustine-temozolomide group. There were no treatment-related deaths. INTERPRETATION Our results suggest that lomustine-temozolomide chemotherapy might improve survival compared with temozolomide standard therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter. The findings should be interpreted with caution, owing to the small size of the trial. FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Frederic Mack
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Sabel
- Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
| | | | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Oliver Schnell
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium, Partner Site Munich, Munich, Germany; Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Oliver Bähr
- Dr Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Martin Uhl
- Department of Neurology and Wilhelm Sander Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neurooncology, University of Tübingen, Tübingen, Germany
| | - Thomas Kowalski
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Florian Ringel
- Department of Neurosurgery, Technical University of Munich, Munich, Germany; Department of Neurosurgery, University of Mainz, Mainz, Germany
| | | | - Bogdana Suchorska
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University of Mannheim, Mannheim, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Miriam Renovanz
- Department of Neurosurgery, University of Mainz, Mainz, Germany
| | - Lars Bullinger
- Department of Internal Medicine, University of Ulm, Ulm, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Juelich, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University of Berlin, Berlin, Germany
| | - Martin Misch
- Department of Neurosurgery, Charité University of Berlin, Berlin, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Moritz Stuplich
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Matthias Simon
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Vera C Keil
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Michael Nelles
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany; Department of Neuroradiology, University of Freiburg, Freiburg, Germany
| | - Martin Coenen
- Study Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Wolfgang Wick
- Department of Neurology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology and DGNN Brain Tumor Reference Centre, University Hospital Bonn, Bonn, Germany
| | - Christoph Coch
- Study Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany; Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center, German Cancer Consortium, Partner Site Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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23
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Tzaridis T, Reiners K, Herrlinger U, Gunther H, Scheffler B, Glas M, Coch C. CBMT-17. NOVEL APPROACH OF UTILISING SERUM/PLASMA EV AND CELL-FREE RNA FOR TREATMENT MONITORING IN GLIOBLASTOMA PATIENTS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Katrin Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital of Bonn, Bonn Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, University of Bonn Medical Center, Bonn, Nordrhein-Westfalen, Germany
| | - Hartmann Gunther
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital of Bonn, Bonn Germany
| | - Björn Scheffler
- DKFZ-Division Translational Neurooncology at the West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital of Bonn, Bonn Germany
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24
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Weller J, Tzaridis T, Steinbach J, Schlegel U, Hau P, Krex D, Grauer O, Goldbrunner R, Bähr O, Uhl M, Seidel C, Tabatabai G, Bullinger L, Galldiks N, Schaub C, Stummer W, Simon M, Fimmers R, Matthias S, Coch C, Glas M, Herrlinger U, Schäfer N. QOLP-20. QUALITY OF LIFE IN THE PHASE III CeTeG/NOA-09 TRIAL RANDOMIZING CCNU/TEMOZOLOMIDE (TMZ) COMBINATION THERAPY VS. STANDARD TMZ THERAPY FOR NEWLY DIAGNOSED MGMT-METHYLATED GLIOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.906] [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: 11/14/2022] Open
Affiliation(s)
- Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Joachim Steinbach
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Martin Uhl
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, University Hospital Tuebingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Lars Bullinger
- Department of Internal Medicine, University of Ulm, Ulm, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Germany
| | - Matthias Simon
- Department of Neurosurgery, University of Bonn, Bonn, Germany
| | - Rolf Fimmers
- Study Center Bonn, Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Germany
| | - Schmid Matthias
- Study Center Bonn, Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital of Bonn, Bonn Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, University of Bonn Medical Center, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
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25
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Lazaridis L, Schäfer N, Kebir S, Weller J, Tzaridis T, Scheffler B, Pierscianek D, Kleinschnitz C, Stuschke M, Sure U, Herrlinger U, Glas M. P01.012 Tumor Treating Fields (TTFields) in combination with lomustine (CCNU) and temozolomide (TMZ) in patients with newly diagnosed glioblastoma (GBM). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.054] [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: 11/14/2022] Open
Affiliation(s)
- L Lazaridis
- Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany
- West German Cancer Center (WTZ), Essen, Germany
| | - N Schäfer
- Division of Clinical Neurooncology, University of Bonn Medical Center, Bonn, Germany
| | - S Kebir
- Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany
- West German Cancer Center (WTZ), Essen, Germany
| | - J Weller
- Division of Clinical Neurooncology, University of Bonn Medical Center, Bonn, Germany
| | - T Tzaridis
- Division of Clinical Neurooncology, University of Bonn Medical Center, Bonn, Germany
| | - B Scheffler
- DKFZ-Division Translational Neurooncology at the West German Cancer Center (WTZ), Essen, Germany
| | - D Pierscianek
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - C Kleinschnitz
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - M Stuschke
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - U Sure
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - U Herrlinger
- Division of Clinical Neurooncology, University of Bonn Medical Center, Bonn, Germany
| | - M Glas
- Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany
- West German Cancer Center (WTZ), Essen, Germany
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Schäfer N, Proescholdt M, Steinbach JP, Weyerbrock A, Hau P, Grauer O, Goldbrunner R, Friedrich F, Rohde V, Ringel F, Schlegel U, Sabel M, Ronellenfitsch MW, Uhl M, Grau S, Hänel M, Schnell O, Krex D, Vajkoczy P, Tabatabai G, Mack F, Schaub C, Tzaridis T, Nießen M, Kebir S, Leutgeb B, Urbach H, Belka C, Stummer W, Glas M, Herrlinger U. Quality of life in the GLARIUS trial randomizing bevacizumab/irinotecan versus temozolomide in newly diagnosed, MGMT-nonmethylated glioblastoma. Neuro Oncol 2018; 20:975-985. [PMID: 29121274 DOI: 10.1093/neuonc/nox204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The GLARIUS trial, which investigated the efficacy of bevacizumab (BEV)/irinotecan (IRI) compared with standard temozolomide in the first-line therapy of O6-methylguanine-DNA methyltransferase (MGMT)-nonmethylated glioblastoma, showed that progression-free survival was significantly prolonged by BEV/IRI, while overall survival was similar in both arms. The present report focuses on quality of life (QoL) and Karnofsky performance score (KPS) during the whole course of the disease. Methods Patients (n = 170) received standard radiotherapy and were randomized (2:1) for BEV/IRI or standard temozolomide. At least every 3 months KPS was determined and QoL was measured using the European Organisation for Research and Treatment of Cancer 30-item Core Quality of Life and 20-item Brain Neoplasm questionnaires. A generalized estimating equation (GEE) model evaluated differences in the course of QoL and KPS over time. Also, the time to first deterioration and the time to postprogression deterioration were analyzed separately. Results In all dimensions of QoL and KPS, GEE analyses and time to first deterioration analyses did not detect significant differences between the treatment arms. At progression, 82% of patients receiving second-line therapy in the standard arm received BEV second-line therapy. For the dimensions of motor dysfunction and headaches, time to postprogression deterioration was prolonged in the standard arm receiving crossover second-line BEV in the vast majority of patients at the time of evaluation. Conclusions GLARIUS did not find indications for a BEV-induced detrimental effect on QoL in first-line therapy of MGMT-nonmethylated GBM patients. Moreover, GLARIUS provided some indirect corroborative data supporting the notion that BEV may have beneficial effects upon QoL in relapsed GBM.
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Affiliation(s)
- Niklas Schäfer
- Division of Clinical Neuro-oncology, Department of Neurology, University of Bonn, Bonn, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, University of Regensburg, Regensburg, Germany
| | - Joachim P Steinbach
- Dr Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Oliver Grauer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | | | | | - Veit Rohde
- Department of Neurosurgery, University of Goettingen, Goettingen, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar Technical University of Munich, Munich, Germany
| | - Uwe Schlegel
- Department of Neurology, Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Sabel
- Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany
| | | | - Martin Uhl
- Department of Neurology and Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany
| | - Mathias Hänel
- Department of Internal Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Ludwig Maximillian University Munich, Munich, Germany
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University of Berlin, Berlin, Germany
| | | | - Frederic Mack
- Division of Clinical Neuro-oncology, Department of Neurology, University of Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neuro-oncology, Department of Neurology, University of Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neuro-oncology, Department of Neurology, University of Bonn, Bonn, Germany
| | - Michael Nießen
- Division of Clinical Neuro-oncology, Department of Neurology, University of Bonn, Bonn, Germany
| | - Sied Kebir
- Division of Clinical Neuro-oncology, Department of Neurology, University of Bonn, Bonn, Germany
| | - Barbara Leutgeb
- Department of Neurosurgery, University of Regensburg, Regensburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
| | - Claus Belka
- Department of Radiation Oncology, Ludwig Maximillian University Munich, Munich, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Martin Glas
- Division of Clinical Neuro-oncology, Department of Neurology, University of Bonn, Bonn, Germany.,Division of Clinical Neuro-Oncology, Department of Neurology, University of Essen Medical Center, Essen, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-oncology, Department of Neurology, University of Bonn, Bonn, Germany
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Schaub C, Kebir S, Junold N, Hattingen E, Schäfer N, Steinbach JP, Weyerbrock A, Hau P, Goldbrunner R, Niessen M, Mack F, Stuplich M, Tzaridis T, Bähr O, Kortmann RD, Schlegel U, Schmidt-Graf F, Rohde V, Braun C, Hänel M, Sabel M, Gerlach R, Krex D, Belka C, Vatter H, Proescholdt M, Herrlinger U, Glas M. Tumor growth patterns of MGMT-non-methylated glioblastoma in the randomized GLARIUS trial. J Cancer Res Clin Oncol 2018; 144:1581-1589. [PMID: 29808316 DOI: 10.1007/s00432-018-2671-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND We evaluated patterns of tumor growth in patients with newly diagnosed MGMT-non-methylated glioblastoma who were assigned to undergo radiotherapy in conjunction with bevacizumab/irinotecan (BEV/IRI) or standard temozolomide (TMZ) within the randomized phase II GLARIUS trial. METHODS In 142 patients (94 BEV/IRI, 48 TMZ), we reviewed magnetic resonance imaging scans at baseline and first tumor recurrence. Based on contrast-enhanced T1-weighted and fluid-attenuated inversion recovery images, we assessed tumor growth patterns and tumor invasiveness. Tumor growth patterns were classified as either multifocal or local at baseline and recurrence; at first recurrence, we additionally assessed whether distant lesions appeared. Invasiveness was determined as either diffuse or non-diffuse. Associations with treatment arms were calculated using Fisher's exact test. RESULTS At baseline, 115 of 142 evaluable patients (81%) had a locally confined tumor. Between treatment arms, there was no significant difference in the fraction of tumors that changed from an initially local tumor growth pattern to a multifocal pattern (12 and 13%, p = 0.55). Distant lesions appeared in 17% (BEV/IRI) and 13% (TMZ) of patients (p = 0.69). 15% of patients in the BEV/IRI arm and 8% in the TMZ arm developed a diffuse growth pattern from an initially non-diffuse pattern (p = 0.42). CONCLUSIONS The tumor growth and invasiveness patterns do not differ between BEV/IRI and TMZ-treated MGMT-non-methylated glioblastoma patients in the GLARIUS trial. BEV/IRI was not associated with an increased rate of multifocal, distant, or highly invasive tumors at the time of recurrence.
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Affiliation(s)
- Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany.,West German Cancer Center (WTZ), University Hospital Essen and German Cancer Consortium, Partner Site University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nina Junold
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Elke Hattingen
- Neuroradiology; Department of Radiology, University of Bonn Medical Center, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany.,West German Cancer Center (WTZ), University Hospital Essen and German Cancer Consortium, Partner Site University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University of Regensburg, Regensburg, Germany
| | | | - Michael Niessen
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Frederic Mack
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Moritz Stuplich
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | | | - Uwe Schlegel
- Department of Neurology, Knappschaftskrankenhaus Klinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg-August-University, Göttingen, Germany
| | - Christian Braun
- Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Rüdiger Gerlach
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Dietmar Krex
- Department of Neurosurgery, Technical University Dresden, Dresden, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU Munich, Munich, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, University of Regensburg, Regensburg, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany. .,West German Cancer Center (WTZ), University Hospital Essen and German Cancer Consortium, Partner Site University Hospital Essen, University Duisburg-Essen, Essen, Germany. .,Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Kebir S, Rauschenbach L, Gielen GH, Schäfer N, Tzaridis T, Scheffler B, Giordano FA, Lazaridis L, Herrlinger U, Glas M. Recurrent pseudoprogression in isocitrate dehydrogenase 1 mutant glioblastoma. J Clin Neurosci 2018; 53:255-258. [PMID: 29754968 DOI: 10.1016/j.jocn.2018.04.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/22/2018] [Indexed: 11/19/2022]
Abstract
In a subset of glioblastoma (GBM) patients, the differentiation between tumor progression and tumor pseudoprogression (PsP) is challenging. This case describes a male patient suffering from isocitrate dehydrogenase 1 (IDH1) mutant GBM who demonstrated an increasing contrast-enhancing (CE) lesion on a cranial magnetic resonance imaging (cMRI) scan 8 months after radiochemotherapy. In accordance with the response assessment in neuro-oncology (RANO) criteria, the cMRI lesion was classified as recurrent tumor, although 18F-fluoroethyl-L-tyrosine positron emission tomography (18F-FET-PET) did not indicate vital tumor tissue. The patient underwent re-surgery but histopathology only revealed reactive and necrotic tissue, consistent with PsP. Nine weeks after complete resection of the CE lesion, a new lesion emerged that later regressed in the follow-up cMRI scans, thereby retrospectively establishing the diagnosis of recurrent PsP.
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Affiliation(s)
- Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, University of Bonn, Bonn, Germany; West German Cancer Center (WTZ) & German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Division of Translational Oncology/Neurooncology, German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany.
| | - Laurèl Rauschenbach
- West German Cancer Center (WTZ) & German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Division of Translational Oncology/Neurooncology, German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany; Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - Gerrit H Gielen
- Institute of Neuropathology, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - Björn Scheffler
- West German Cancer Center (WTZ) & German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Division of Translational Oncology/Neurooncology, German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany.
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Mannheim, University of Mannheim, Germany.
| | - Lazaros Lazaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; West German Cancer Center (WTZ) & German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Division of Translational Oncology/Neurooncology, German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany.
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, University of Bonn, Bonn, Germany; West German Cancer Center (WTZ) & German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Division of Translational Oncology/Neurooncology, German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany.
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29
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Herrlinger U, Tzaridis T, Mack F, Steinbach J, Schlegel U, Sabel M, Hau P, Kortman RD, Krex D, Grauer O, Goldbrunner R, Schnell O, Baehr O, Uhl M, Tabatabai G, Ringel F, Schmidt-Graf F, Brehmer S, Weyerbrock A, Bullinger L, Vajkoczy P, Vatter H, Schäfer N, Kebir S, Weller J, Stummer W, Simon M, Keil V, Nelles M, Fimmers R, Pietsch T, Hattingen E, Coch C, Glas M. ACTR-58. PHASE III TRIAL OF CCNU/TEMOZOLOMIDE (TMZ) COMBINATION THERAPY VS. STANDARD TMZ THERAPY FOR NEWLY DIAGNOSED MGMT-METHYLATED GLIOBLASTOMA PATIENTS: THE CeTeg/NOA-09 trial. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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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30
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Burger M, Ronellenfitsch M, Lorenz N, Wagner M, Voss M, Capper D, Tzaridis T, Herrlinger U, Steinbach J, Stoffels G, Langen KJ, Brandts C, Senft C, Harter P, Baehr O. RARE-35. DABRAFENIB IN PATIENTS WITH RECURRENT, BRAF V600E MUTATED MALIGNANT GLIOMA AND LEPTOMENINGEAL DISEASE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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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31
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Burger MC, Ronellenfitsch MW, Lorenz NI, Wagner M, Voss M, Capper D, Tzaridis T, Herrlinger U, Steinbach JP, Stoffels G, Langen KJ, Brandts C, Senft C, Harter PN, Bähr O. Dabrafenib in patients with recurrent, BRAF V600E mutated malignant glioma and leptomeningeal disease. Oncol Rep 2017; 38:3291-3296. [PMID: 29039591 PMCID: PMC5783574 DOI: 10.3892/or.2017.6013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022] Open
Abstract
BRAF V600E mutations occur frequently in malignant melanoma, but are rare in most malignant glioma subtypes. Besides, more benign brain tumors such as ganglioglioma, dysembryoblastic neuroepithelial tumours and supratentorial pilocytic astrocytomas, only pleomorphic xanthoastrocytomas (50–78%) and epitheloid glioblastoma (50%) regularly exhibit BRAF mutations. In the present study, we report on three patients with recurrent malignant gliomas harbouring a BRAF V600E mutation. All patients presented with markedly disseminated leptomeningeal disease at recurrence and had progressed after radiotherapy and alkylating chemotherapy. Therefore, estimated life expectancy at recurrence was a few weeks. All three patients received dabrafenib as a single agent and all showed a complete or nearly complete response. Treatment is ongoing and patients are stable for 27 months, 7 months and 3 months, respectively. One patient showed a dramatic radiologic and clinical response after one week of treatment. We were able to generate an ex vivo tumor cell culture from CSF in one patient. Treatment of this cell culture with dabrafenib resulted in reduced cell density and inhibition of ERK phosphorylation in vitro. To date, this is the first series on adult patients with BRAF-mutated malignant glioma and leptomeningeal dissemination treated with dabrafenib monotherapy. All patients showed a dramatic response with one patient showing an ongoing response for more than two years.
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Affiliation(s)
- Michael C Burger
- Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt, Germany
| | | | - Nadja I Lorenz
- Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe-University Hospital, Frankfurt, Germany
| | - Martin Voss
- Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt, Germany
| | - David Capper
- Department of Neuropathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Christian Brandts
- Department of Medicine, Hematology/Oncology, Goethe-University Hospital, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, Goethe-University Hospital, Frankfurt, Germany
| | - Patrick N Harter
- Institute of Neurology (Edinger-Institute), Goethe-University, Frankfurt, Germany
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt, Germany
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Margolin-Miller Y, Yanichkin N, Shichrur K, Toledano H, Ohali A, Tzaridis T, Michowitz S, Fichman-Horn S, Feinmesser M, Pfister SM, Witt H, Tabori U, Bouffet E, Ramaswamy V, Hawkins C, Taylor MD, Yaniv I, Avigad S. Prognostic relevance of miR-124-3p and its targetTP53INP1in pediatric ependymoma. Genes Chromosomes Cancer 2017; 56:639-650. [DOI: 10.1002/gcc.22467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yulia Margolin-Miller
- Molecular Oncology, Felsenstein Medical Research Center, Rabin Medical Center; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Natalia Yanichkin
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Pathology Department; Rabin Medical Center; Petah Tikva Israel
| | - Keren Shichrur
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel; Petah Tikva Israel
| | - Helen Toledano
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel; Petah Tikva Israel
| | - Anat Ohali
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel; Petah Tikva Israel
| | - Theophilos Tzaridis
- Division of Pediatric Neurooncology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Shalom Michowitz
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Neurosurgery; Schneider Children's Medical Center of Israel; Petah Tikva Israel
| | - Suzana Fichman-Horn
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Pathology Department; Rabin Medical Center; Petah Tikva Israel
| | - Meora Feinmesser
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Pathology Department; Rabin Medical Center; Petah Tikva Israel
| | - Stefan M. Pfister
- Division of Pediatric Neurooncology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Hendrik Witt
- Department of Pediatric Oncology Hematology and Immunology; Children's Hospital, University of Heidelberg; Heidelberg Germany
| | - Uri Tabori
- Division of Hematology Oncology; Hospital for Sick Children, University of Toronto; Toronto Canada
| | - Eric Bouffet
- Division of Hematology Oncology; Hospital for Sick Children, University of Toronto; Toronto Canada
| | - Vijay Ramaswamy
- Division of Hematology Oncology; Hospital for Sick Children, University of Toronto; Toronto Canada
| | - Cynthia Hawkins
- Division of Hematology Oncology; Hospital for Sick Children, University of Toronto; Toronto Canada
| | - Michael D. Taylor
- Division of Hematology Oncology; Hospital for Sick Children, University of Toronto; Toronto Canada
| | - Isaac Yaniv
- Molecular Oncology, Felsenstein Medical Research Center, Rabin Medical Center; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel; Petah Tikva Israel
| | - Smadar Avigad
- Molecular Oncology, Felsenstein Medical Research Center, Rabin Medical Center; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel; Petah Tikva Israel
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Müller A, Jurcoane A, Kebir S, Ditter P, Schrader F, Herrlinger U, Tzaridis T, Mädler B, Schild HH, Glas M, Hattingen E. Quantitative T1-mapping detects cloudy-enhancing tumor compartments predicting outcome of patients with glioblastoma. Cancer Med 2016; 6:89-99. [PMID: 27891815 PMCID: PMC5269700 DOI: 10.1002/cam4.966] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/11/2016] [Accepted: 10/25/2016] [Indexed: 12/13/2022] Open
Abstract
Contrast enhancement of glioblastomas (GBM) is caused by the decrease in relaxation time, T1. Here, we demonstrate that the quantitative measurement of T1 (qT1) discovers a subtle enhancement in GBM patients that is invisible in standard MRI. We assessed the volume change of this “cloudy” enhancement during radio‐chemotherapy and its impact on patients’ progression‐free survival (PFS). We enrolled 18 GBM patients in this observational, prospective cohort study and measured 3T‐MRI pre‐ and post contrast agent with standard T1‐weighted (T1w) and with sequences to quantify T1 before radiation, and at 6‐week intervals during radio‐chemotherapy. We measured contrast enhancement by subtracting pre from post contrast contrast images, yielding relative signal increase ∆T1w and relative T1 shortening ∆qT1. On ∆qT1, we identified a solid and a cloudy‐enhancing compartment and evaluated the impact of their therapy‐related volume change upon PFS. In ∆qT1 maps cloudy‐enhancing compartments were found in all but two patients at baseline and in all patients during therapy. The qT1 decrease in the cloudy‐enhancing compartment post contrast was 21.64% versus 1.96% in the contralateral control tissue (P < 0.001). It was located at the margin of solid enhancement which was also seen on T1w. In contrast, the cloudy‐enhancing compartment was visually undetectable on ∆T1w. A volume decrease of more than 21.4% of the cloudy‐enhancing compartment at first follow‐up predicted longer PFS (P = 0.038). Cloudy‐enhancing compartment outside the solid contrast‐enhancing area of GBM is a new observation which is only visually detectable with qT1‐mapping and may represent tumor infiltration. Its early volume decrease predicts a longer PFS in GBM patients during standard radio‐chemotherapy.
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Affiliation(s)
- Andreas Müller
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Alina Jurcoane
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Philip Ditter
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Felix Schrader
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Burkhard Mädler
- Philips GmbH, UB Healthcare, Lübeckertordamm 5, Hamburg, 20099, Germany
| | - Hans H Schild
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany.,Division of Experimental and Translational Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany.,Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Clinic & University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Elke Hattingen
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
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Kebir S, Hattingen E, Schaub C, Schäfer N, Steinbach J, Weyerbrock A, Hau P, Goldbrunner R, Tzaridis T, Baehr O, Proescholdt M, Glas M, Herrlinger U. ACTR-17. EFFECT OF AGE ON OUTCOME IN THE GLARIUS TRIAL. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.016] [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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Schaub C, Schäfer N, Mack F, Stuplich M, Kebir S, Niessen M, Tzaridis T, Banat M, Vatter H, Waha A, Herrlinger U, Glas M. The earlier the better? Bevacizumab in the treatment of recurrent MGMT-non-methylated glioblastoma. J Cancer Res Clin Oncol 2016; 142:1825-9. [PMID: 27318492 DOI: 10.1007/s00432-016-2187-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The adequate second-line therapy of patients with glioblastoma (GBM) is a matter of ongoing debate. This particularly applies to patients with a non-methylated MGMT promotor who are known to have a poor response to alkylating chemotherapy. In some countries, antiangiogenic therapy with BEV is applied as second-line therapy, and in others nitrosourea therapy is second-line choice. It is an open question whether the delay of BEV to third-line therapy has a negative impact on survival. METHODS A total of 61 adult patients (median age 56.9 years) with MGMT-non-methylated relapsed GBM treated with BEV (n = 45) or nitrosourea (n = 16) as second-line therapy were analyzed retrospectively and compared regarding progression-free survival (PFS) and overall survival (OS). RESULTS Patients treated with second-line BEV had longer median PFS (107 days, 95 % CI 80.7-133.2 days) than patients with second-line nitrosourea (52 days, 95 % CI 36.3-67.7 days, P = 0.011, logrank test). However, there was no significant difference in overall survival (BEV median 170 days, 95 % CI 87.2-252.8 days; nitrosourea median 256 days, 95 % CI 159.9-352.0 days, P = 0.468). PFS was similar after BEV third-line therapy (median 117 days, 95 % CI 23.6-210.4 days) as compared to second-line BEV therapy (median 107 days, 95 % CI 80.7-133.3 days, P = 0.584). CONCLUSION Our findings suggest that early treatment with BEV in patients with MGMT-non-methylated relapsed GBM is associated with a better PFS, but not with superior OS, possibly implicating that the early, i.e., second-line, use of BEV is not mandatory and BEV treatment may safely be delayed to third-line therapy in this subgroup of patients.
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Affiliation(s)
- Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.,Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Frederic Mack
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Moritz Stuplich
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.,Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Michael Niessen
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Andreas Waha
- Department of Neuropathology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany. .,Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany. .,Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Klinik, Villenstraße 8, 53129, Bonn, Germany.
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Schäfer N, Gielen GH, Kebir S, Wieland A, Till A, Mack F, Schaub C, Tzaridis T, Reinartz R, Niessen M, Fimmers R, Simon M, Coch C, Fuhrmann C, Herrlinger U, Scheffler B, Glas M. Phase I trial of dovitinib (TKI258) in recurrent glioblastoma. J Cancer Res Clin Oncol 2016; 142:1581-9. [PMID: 27100354 DOI: 10.1007/s00432-016-2161-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/07/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Dovitinib (TKI258) is an oral multi-tyrosine kinase inhibitor of FGFR, VEGFR, PDGFR β, and c-Kit. Since dovitinib is able to cross the blood-brain barrier and targets brain tumor-relevant pathways, we conducted a phase I trial to demonstrate its safety in recurrent glioblastoma (GBM). PATIENTS AND METHODS Patients with first or second GBM recurrence started treatment with the maximal tolerated dose (MTD) previously established in systemic cancer patients (500 mg/d, 5 days on/2 days off). A modified 3 + 3 design in three cohorts (500, 400, 300 mg) was used. RESULTS Twelve patients were enrolled. Seventy-two adverse events (AEs) occurred and 16.7 % of AEs were classified as ≥CTC grade 3 toxicity, mainly including hepatotoxicity and hematotoxicity. Only one out of six patients of the 300-mg cohort showed grade 3 toxicity. The PFS-6 rate was 16.7 %, and it was not associated with detection of the FGFR-TACC gene fusion in the tumor. CONCLUSION Dovitinib is safe in patients with recurrent GBM and showed efficacy in only some patients unselected for target expression. The recommended phase II dose of 300 mg would be substantially lower than the recently established MTD in systemic cancer patients. Further personalized trials are recommended.
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Affiliation(s)
- Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, Medical Center Bonn, 53127, Bonn, Germany.,Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, 53127, Bonn, Germany
| | - Gerrit H Gielen
- Institute of Neuropathology, Medical Center Bonn, 53127, Bonn, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, Medical Center Bonn, 53127, Bonn, Germany.,Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, 53127, Bonn, Germany
| | - Anja Wieland
- Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, 53127, Bonn, Germany
| | - Andreas Till
- Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, 53127, Bonn, Germany
| | - Frederic Mack
- Division of Clinical Neurooncology, Department of Neurology, Medical Center Bonn, 53127, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, Medical Center Bonn, 53127, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, Medical Center Bonn, 53127, Bonn, Germany
| | - Roman Reinartz
- Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, 53127, Bonn, Germany
| | - Michael Niessen
- Division of Clinical Neurooncology, Department of Neurology, Medical Center Bonn, 53127, Bonn, Germany
| | - Rolf Fimmers
- Institute of Bioinformatics, Medical Center Bonn, 53127, Bonn, Germany
| | - Matthias Simon
- Department of Neurosurgery, Medical Center Bonn, 53127, Bonn, Germany
| | - Christoph Coch
- Study Center Bonn, Institute of Clinical Chemistry and Clinical Pharmacology, Medical Center Bonn, 53127, Bonn, Germany
| | - Christine Fuhrmann
- Study Center Bonn, Institute of Clinical Chemistry and Clinical Pharmacology, Medical Center Bonn, 53127, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, Medical Center Bonn, 53127, Bonn, Germany
| | - Björn Scheffler
- Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, 53127, Bonn, Germany.,Division of Translational Oncology/Neurooncology, German Cancer Research Center (DKFZ), Heidelberg; West German Cancer Center (WTZ) and German Cancer Consortium (DKTK), University Hospital Essen, 45147, Essen, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, Medical Center Bonn, 53127, Bonn, Germany. .,Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, 53127, Bonn, Germany. .,Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Klinik, 53129, Bonn, Germany.
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Kebir S, Fimmers R, Galldiks N, Schäfer N, Mack F, Schaub C, Stuplich M, Niessen M, Tzaridis T, Simon M, Stoffels G, Langen KJ, Scheffler B, Glas M, Herrlinger U. Late Pseudoprogression in Glioblastoma: Diagnostic Value of Dynamic O-(2-[18F]fluoroethyl)-L-Tyrosine PET. Clin Cancer Res 2015; 22:2190-6. [PMID: 26673798 DOI: 10.1158/1078-0432.ccr-15-1334] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/23/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Pseudoprogression (PsP) is characterized by therapy-associated but not tumor growth-associated increases of contrast-enhancing glioblastoma lesions on MRI. Although typically occurring during the first 3 months after radiochemotherapy, PsP may occur later in the course of the disease and may then be particularly difficult to distinguish from true tumor progression. We explored PET using O-(2-[(18)F]fluoroethyl)-L-tyrosine ((18)F-FET-PET) to approach the diagnostic dilemma. EXPERIMENTAL DESIGN Twenty-six patients with glioblastoma that presented with increasing contrast-enhancing lesions later than 3 months after completion of radiochemotherapy underwent (18)F-FET-PET. Maximum and mean tumor/brain ratios (TBRmax and TBRmean) of (18)F-FET uptake as well as time-to-peak (TTP) and patterns of the time-activity curves were determined. The final diagnosis of true progression versus late PsP was based on follow-up MRI using RANO criteria. RESULTS Late PsP occurred in 7 patients with a median time from radiochemotherapy completion of 24 weeks while the remaining patients showed true tumor progression. TBRmax and TBRmean were significantly higher in patients with true progression than in patients with late PsP (TBRmax 2.4 ± 0.1 vs. 1.5 ± 0.2, P = 0.003; TBRmean 2.1 ± 0.1 vs. 1.5 ± 0.2, P = 0.012) whereas TTP was significantly shorter (mean TTP 25 ± 2 vs. 40 ± 2 min, P < 0.001). ROC analysis yielded an optimal cutoff value of 1.9 for TBRmax to differentiate between true progression and late PsP (sensitivity 84%, specificity 86%, accuracy 85%, P = 0.015). CONCLUSIONS O-(2-[(18)F]fluoroethyl)-L-tyrosine PET provides valuable information in assessing the elusive phenomenon of late PsP. Clin Cancer Res; 22(9); 2190-6. ©2015 AACR.
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Affiliation(s)
- Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany.
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn Medical Centre, Bonn, Germany
| | - Norbert Galldiks
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany. Deptartment of Neurology, University of Cologne, Cologne, Germany. Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany
| | - Frederic Mack
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany
| | - Moritz Stuplich
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany
| | - Michael Niessen
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany
| | - Matthias Simon
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany. Department of Neurosurgery, Forschungszentrum Jülich, Jülich, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany. Department of Nuclear Medicine, University of Aachen, Aachen, Germany
| | - Björn Scheffler
- Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany. Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany. Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Bonn, Germany
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Kebir S, Schaub C, Hattingen E, Junold N, Schäfer N, Steinbach JP, Weyerbrock A, Hau P, Goldbrunner R, Niessen M, Mack F, Stuplich M, Tzaridis T, Bähr O, Proescholdt M, Glas M, Herrlinger U. NIMG-41MRI FINDINGS IN THE GLARIUS TRIAL: PROGNOSTIC AND PREDICTIVE IMPLICATIONS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov225.41] [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: 11/14/2022] Open
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Kebir S, Schaub C, Hattingen E, Junold N, Schäfer N, Steinbach JP, Weyerbrock A, Hau P, Goldbrunner R, Niessen M, Mack F, Stuplich M, Tzaridis T, Bähr O, Proescholdt M, Glas M, Herrlinger U. NIMG-40MRI TUMOR PROGRESSION PATTERNS IN THE GLARIUS TRIAL. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov225.40] [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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Traschütz A, Tzaridis T, Penner AH, Kuchelmeister K, Urbach H, Hattingen E, Heneka MT. Reduction of microbleeds by immunosuppression in a patient with Aβ-related vascular inflammation. Neurol Neuroimmunol Neuroinflamm 2015; 2:e165. [PMID: 26516630 PMCID: PMC4608757 DOI: 10.1212/nxi.0000000000000165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022]
Abstract
Objective: To investigate whether the occurrence or clearance of microhemorrhages in cerebral amyloid angiopathy (CAA)-related vascular inflammation can be modified by immunosuppressive treatment. Methods: Clinical and radiologic follow-up for more than 5 years of a patient with histopathologically confirmed CAA-related vascular inflammation treated with a prolonged and tapered regimen of IV cyclophosphamide and oral steroids. Results: Under long-term immunosuppressive treatment, a reduced number of cortical micobleeds was observed on repeat MRIs because of both the prevention of new microbleeds and the clearance of those existing at baseline. Conclusions: Sustained immunosuppression should be considered and systematically investigated as a treatment option for cortical microbleeds in CAA and related inflammatory phenotypes. Classification of evidence: This study provides Class IV evidence. This is a single observational study without controls.
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Affiliation(s)
- Andreas Traschütz
- Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
| | - Theophilos Tzaridis
- Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
| | - Arndt-Hendrik Penner
- Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
| | - Klaus Kuchelmeister
- Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
| | - Horst Urbach
- Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
| | - Elke Hattingen
- Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
| | - Michael T Heneka
- Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
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Witt H, Sill M, Wani K, Mack S, Capper D, Heim S, Johann P, Lambert S, Rhyzova M, Hovestadt V, Tzaridis T, Pajtler K, Bender S, Milde T, Northcott PA, Kulozik AE, Witt O, Lichter P, Collins VP, Deimling AV, Kool M, Taylor MD, Hasselblatt M, Jones DT, Korshunov A, Aldape K, Pfister S. Abstract 3094: Epigenetic classification of ependymal brain tumors across age groups. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-3094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Since it has become evident that histopathological grading of ependymoma according to the WHO classification of CNS tumors is not capable of accurately classifying patients into meaningful strata, a broadly accepted molecular classification scheme with prognostic significance is desperately needed. In recent years, ependymomas were classified into molecular subgroups based on transcriptomic alterations. In tumors localized within the posterior fossa, two distinct biological entities of ependymoma were delineated by several studies (designated posterior fossa A and posterior fossa B), which show striking differences in genetic characteristics and clinical outcome. A similar consensus for supratentorial and spinal ependymoma is lacking.
We studied genome-wide DNA methylation (Illumina HumanMethylation450 (450k) array) in 180 primary ependymal tumors (80 with corresponding gene expression profiling data generated by Affymetrix 133plus2.0 arrays), including ependymomas (posterior fossa, supratentorial, spinal), subependymomas (SE), myxopapillary ependymoma (MPE), pineal parenchymal tumors of intermediate differentiation (PPTID), and papillary tumors of the pineal region (PTPR). We performed hierarchical clustering to identify robust molecular subgroups. Independent gene expression profiling datasets from previously published ependymoma studies (Johnson et al.; Wani et al.; Witt et al.) were used as validation cohorts.
DNA methylation data showed that ependymal brain tumors can be classified into eight molecular subgroups. Notably, MPE, SE, PPTID and PTPR tumors formed robust distinct clusters, as did posterior fossa Group A and Group B ependymomas. Supratentorial ependymomas can be classified into two principle molecular subgroups, one of which displays a dismal prognosis, and comprises predominantly children and infants, and is associated with highly recurrent gene fusion. Notably, a significant number of ependymomas previously classified by histology as WHO Grade II/III look like SE by methylation, and also have extremely good survival.
In summary, using genome-wide DNA methylation and transcriptome analysis we could decipher robust molecular subgroups of ependymal brain tumors including supratentorial ependymoma. Diagnoses of tumors with challenging histopathological features can now be supported by this technology. Hence, this approach offers the possibility to replace the unambiguous histological grading system that is currently in use with a robust molecular classification that readily distinguishes biologically, genetically, and clinically meaningful subgroups of ependymal brain tumors.
Citation Format: Hendrik Witt, Martin Sill, Khalida Wani, Steve Mack, David Capper, Stephanie Heim, Pascal Johann, Sally Lambert, Marina Rhyzova, Volker Hovestadt, Theophilos Tzaridis, Kristian Pajtler, Sebastian Bender, Till Milde, Paul A. Northcott, Andreas E. Kulozik, Olaf Witt, Peter Lichter, V Peter Collins, Andreas von Deimling, Marcel Kool, Michael D. Taylor, Martin Hasselblatt, David TW Jones, Andrey Korshunov, Ken Aldape, Stefan Pfister. Epigenetic classification of ependymal brain tumors across age groups. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3094. doi:10.1158/1538-7445.AM2014-3094
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Affiliation(s)
- Hendrik Witt
- 1German Cancer Research Center, Heidelberg, Germany
| | - Martin Sill
- 1German Cancer Research Center, Heidelberg, Germany
| | - Khalida Wani
- 2MD Anderson, Divison of Neuropathology, Houston, TX
| | - Steve Mack
- 3Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Capper
- 4Department of Neuropathology, University of Heidelberg, Heidelberg, Germany
| | - Stephanie Heim
- 5Department of Neuropathology, University of Münster, Heidelberg, Germany
| | | | - Sally Lambert
- 6Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Marina Rhyzova
- 7NN Burdenko Neurosurgical Institute, Moscow, Russian Federation
| | - Volker Hovestadt
- 8German Cancer Research Center, Molecular Genetics, Heidelberg, Germany
| | | | | | | | - Till Milde
- 1German Cancer Research Center, Heidelberg, Germany
| | | | - Andreas E. Kulozik
- 9Department of Pediatric Oncology, University of Heidelberg, Heidelberg, Germany
| | - Olaf Witt
- 1German Cancer Research Center, Heidelberg, Germany
| | | | - V Peter Collins
- 6Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | | | - Marcel Kool
- 1German Cancer Research Center, Heidelberg, Germany
| | - Michael D. Taylor
- 3Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin Hasselblatt
- 5Department of Neuropathology, University of Münster, Heidelberg, Germany
| | | | - Andrey Korshunov
- 4Department of Neuropathology, University of Heidelberg, Heidelberg, Germany
| | - Ken Aldape
- 2MD Anderson, Divison of Neuropathology, Houston, TX
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Hoffman LM, Donson AM, Nakachi I, Griesinger AM, Birks DK, Amani V, Hemenway MS, Liu AK, Wang M, Hankinson TC, Handler MH, Foreman NK, Zakrzewska M, Zakrzewski K, Fendler W, Stefanczyk L, Liberski PP, Massimino M, Gandola L, Ferroli P, Valentini L, Biassoni V, Garre ML, Sardi I, Genitori L, Giussani C, Massimi L, Bertin D, Mussano A, Viscardi E, Modena P, Mastronuzzi A, Barra S, Scarzello G, Cinalli G, Peretta P, Giangaspero F, Massimino M, Boschetti L, Biassoni V, Garre ML, Schiavello E, Sardi I, Genitori L, Bertin D, Modena P, Calareso G, Barra S, Scarzello G, Cinalli G, Peretta P, Mastronuzzi A, Giussani C, Giangaspero F, Antonelli M, Pecori E, Gandola L, Massimino M, Biassoni V, Di Meco F, Garre ML, Schiavello E, Sardi I, Genitori L, Bertin D, Viscardi E, Modena P, Barra S, Scarzello G, Cinalli G, Peretta P, Migliorati R, Taborelli A, Giangaspero F, Antonelli M, Pecori E, Gandola L, Witt H, Sill M, Wani K, Mack SC, Capper D, Pajtler K, Lambert S, Tzaridis T, Milde T, Northcott PA, Kulozik AE, Witt O, Collins VP, Ellison DW, Taylor MD, Kool M, Jones DTW, Korshunov A, Ken A, Pfister SM, Makino K, Nakamura H, Kuroda JI, Kuratsu JI, Toledano H, Margolin Y, Ohali A, Michowiz S, Witt H, Johann P, Tzaridis T, Tabori U, Walker E, Hawkins C, Taylor M, Yaniv I, Avigad S, Hoffman L, Plimpton SR, Foreman NK, Stence NV, Hankinson TC, Handler MH, Hemenway MS, Vibhakar R, Liu AK, Lourdusamy A, Rahman R, Ward J, Rogers H, Grundy R, Punchihewa C, Lee R, Lin T, Orisme W, Dalton J, Aronica E, Smith A, Gajjar A, Onar A, Pounds S, Tatevossian R, Merchant T, Ellison D, Parker M, Mohankumar K, Punchihewa C, Weinlich R, Dalton J, Tatevossian R, Phoenix T, Thiruvenkatam R, White E, Gupta K, Gajjar A, Merchant T, Boop F, Smith A, Ding L, Mardis E, Wilson R, Downing J, Ellison D, Gilbertson R, Ward J, Lourdusamy A, Speed D, Gould T, Grundy R, Rahman R, Mack SC, Witt H, Pfister SM, Korshunov A, Taylor MD, Consortium TIE, Hoffman LM, Griesinger A, Donson A, Birks D, Amani V, Foreman NK, Ohe N, Yano H, Nakayama N, Iwama T, Wright K, Hassall T, Bowers DC, Crawford J, Bendel A, Fisher PG, Merchant T, Ellison D, Klimo P, Boop F, Armstrong G, Qaddoumi I, Robinson G, Wetmore C, Broniscer A, Gajjar A, Rogers H, Chapman R, Mayne C, Duane H, Kilday JP, Coyle B, Grundy R, Graul-Conroy A, Hartsell W, Bragg T, Goldman S, Rebsamen S, Puccetti D, Salamat S, Patel NJ, Gomi A, Oguma H, Hayase T, Kawahara Y, Yagi M, Morimoto A, Wilbur C, Dunham C, Hawkins C, Tabori U, Mabbott D, Carret AS, Lafay-Cousin L, McNeely PD, Eisenstat D, Wilson B, Johnston D, Hukin J, Mynarek M, Kortmann RD, Kaatsch P, Pietsch T, Timmermann B, Fleischhack G, Benesch M, Friedrich C, von Bueren AO, Gerber NU, Muller K, Tippelt S, Warmuth-Metz M, Rutkowski S, von Hoff K, Murugesan MK, White E, Poppleton H, Thiruvenkatam R, Gupta K, Currle S, Kranenburg T, Eden C, Wright K, Ellison D, Gilbertson R, Boulos N, Dapper J, Patel Y, Wright K, Mohankumar K, Freeman B, Gajjar A, Shelat A, Stewart C, Guy R, Gilbertson R, Adamski J, Taylor M, Tabori U, Huang A, Bartels U, Ramaswamy V, Krishnatry R, Laperriere N, Hawkins C, Bouffet E, Araki A, Chocholous M, Gojo J, Dorfer C, Czech T, Dieckmann K, Slavc I, Haberler C, Pietsch T, Mynarek M, Doerner E, Muehlen AZ, Warmuth-Metz M, Kortmann R, von Buehren A, Friedrich C, von Hoff K, Rutkowski S, von Hoff K, Kortmann RD, Gerber NU, Mynarek M, Muller K, Friedrich C, von Bueren AO, Benesch M, Warmuth-Metz M, Ottensmeier H, Resch A, Kwiecien R, Faldum A, Kuehl J, Pietsch T, Rutkowski S, Sabnis D, Storer L, Simmonds L, Blackburn S, Lowe J, Grundy R, Kerr I, Coyle B, Pietsch T, Wohlers I, Goschzik T, Dreschmann V, Denkhaus D, Doerner E, Rahmann S, Klein-Hitpass L, Iglesias MJL, Riet FG, Dhermain FD, Canale S, Dufour C, Rose CS, Puget S, Grill J, Bolle S, Parkes J, Davidson A, Figaji A, Pillay K, Kilborn T, Padayachy L, Hendricks M, Van Eyssen A, Piccinin E, Lorenzetto E, Brenca M, Massimino M, Modena P, Taylor M, Ramaswamy V, Bouffet E, Aldape K, Cho YJ, Weiss W, Phillips J, Jabado N, Mora J, Fan X, Jung S, Lee JY, Zitterbart K, French P, Kros JM, Hauser P, Faria C, Korshunov A, Pfister S, Mack SC. EPENDYMOMA. Neuro Oncol 2014; 16:i17-i25. [PMCID: PMC4046284 DOI: 10.1093/neuonc/nou068] [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: 08/07/2023] Open
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Bie L, Ju Y, Jin Z, Donovan L, Birks S, Grunewald L, Zmuda F, Pilkington G, Kaul A, Chen YH, Dahiya S, Emnett R, Gianino S, Gutmann D, Poschl J, Bianchi E, Bockstaller M, Neumann P, Schuller U, Gevorgian A, Morozova E, Kazantsev I, Iukhta T, Safonova S, Punanov Y, Zheludkova O, Afanasyev B, Buss M, Remke M, Gandhi K, Kool M, Northcott P, Pfister S, Taylor M, Castellino R, Thompson J, Margraf L, Donahue D, Head H, Murray J, Burger P, Wortham M, Reitman Z, He Y, Bigner D, Yan H, Lee C, Triscott J, Foster C, Manoranjan B, Pambid MR, Fotovati A, Berns R, Venugopal C, O'Halloran K, Narendran A, Northcott P, Taylor MD, Singh SK, Singhal A, Rassekh R, Maxwell CA, Dunham C, Dunn SE, Pambid MR, Berns R, Hu K, Adomat H, Moniri M, Chin MY, Hessein M, Zisman N, Maurer N, Dunham C, Guns E, Dunn S, Koks C, De Vleeschouwer S, Graf N, Van Gool S, D'Asti E, Huang A, Korshunov A, Pfister S, Rak J, Gump W, Moriarty T, Gump W, Skjei K, Karkare S, Castelo-Branco P, Choufani S, Mack S, Gallagher D, Zhang C, Merino D, Wasserman J, Kool M, Jones DT, Croul S, Kreitzer F, Largaespada D, Conklin B, Taylor M, Weiss W, Garzia L, Morrissy S, Zayne K, Wu X, Dirks P, Hawkins C, Dick J, Stein L, Collier L, Largaespada D, Dupuy A, Taylor M, Rampazzo G, Moraes L, Paniago M, Oliveira I, Hitzler J, Silva N, Cappellano A, Cavalheiro S, Alves MT, Cerutti J, Toledo S, Liu Z, Zhao X, Mao H, Baxter P, Wang JCY, Huang Y, Yu L, Su J, Adekunle A, Perlaky L, Hurwitz M, Hurwitz R, Lau C, Chintagumpala M, Blaney S, Baruchel S, Li XN, Zhang J, Hariono S, Hashizume R, Fan Q, James CD, Weiss WA, Nicolaides T, Madsen PJ, Slaunwhite ES, Dirks PB, Ma JF, Henn RE, Hanno AG, Boucher KL, Storm PB, Resnick AC, Lourdusamy A, Rogers H, Ward J, Rahman R, Malkin D, Gilbertson R, Grundy R, Lourdusamy A, Rogers H, Ward J, Rahman R, Gilbertson R, Grundy R, Karajannis M, Fisher M, Pfister S, Milla S, Cohen K, Legault G, Wisoff J, Harter D, Merkelson A, Bloom M, Dhall G, Jones D, Korshunov A, Taylor MD, Pfister S, Eberhart C, Sievert A, Resnick A, Zagzag D, Allen J, Hankinson T, Gump J, Serrano-Almeida C, Torok M, Weksberg R, Handler M, Liu A, Foreman N, Garancher A, Rocques N, Miquel C, Sainte-Rose C, Delattre O, Bourdeaut F, Eychene A, Tabori U, Pouponnot C, Danielpour M, Levy R, Antonuk CD, Rodriguez J, Aravena JM, Kim GB, Gate D, Bannykh S, Svendsen C, Huang X, Town T, Breunig J, Amakye D, Robinson D, Rose K, Cho YJ, Ligon KL, Sharp T, Ando Y, Geoerger B, He Y, Doz F, Ashley D, Hargrave D, Casanova M, Tawbi H, Heath J, Bouffet E, Brandes AA, Chisholm J, Rodon J, Dubuc AM, Thomas A, Mita A, MacDonald T, Kieran M, Eisenstat D, Song X, Danielpour M, Levy R, Antonuk CD, Rodriguez J, Hashizume R, Aravena JM, Kim GB, Gate D, Bannykh S, Svendsen C, Town T, Breunig J, Morrissy AS, Mayoh C, Lo A, Zhang W, Thiessen N, Tse K, Moore R, Mungall A, Wu X, Van Meter TE, Cho YJ, Collins VP, MacDonald TJ, Li XN, Stehbens S, Fernandez-Lopez A, Malkin D, Marra MA, Taylor MD, Karajannis M, Legault G, Hagiwara M, Vega E, Merkelson A, Wisoff J, Younger S, Golfinos J, Roland JT, Allen J, Antonuk CD, Levy R, Kim GB, Town T, Danielpour M, Breunig J, Pak E, Barshow S, Zhao X, Ponomaryov T, Segal R, Levy R, Antonuk CD, Aravena JM, Kim GB, Svendsen C, Town T, Danielpour M, Zhu S, Breunig J, Chi S, Cohen K, Fisher M, Biegel J, Bowers D, Fangusaro J, Manley P, Janss A, Zimmerman MA, Wu X, Kieran M, Sayour E, Pham C, Sanchez-Perez L, Snyder D, Flores C, Kemeny H, Xie W, Cui X, Bigner D, Taylor MD, Sampson J, Mitchell D, Bandopadhayay P, Nguyen B, Masoud S, Vue N, Gholamin S, Yu F, Schubert S, Bergthold G, Weiss WA, Mitra S, Qi J, Bradner J, Kieran M, Beroukhim R, Cho YJ, Reddick W, Glass J, Ji Q, Paulus E, James CD, Gajjar A, Ogg R, Vanner R, Remke M, Aviv T, Lee L, Zhu X, Clarke I, Taylor M, Dirks P, Shuman MA, Hamilton R, Pollack I, Calligaris D, Liu X, Feldman D, Thompson C, Ide J, Buhrlage S, Gray N, Kieran M, Jan YN, Stiles C, Agar N, Remke M, Cavalli FMG, Northcott PA, Kool M, Pfister SM, Taylor MD, Project MAGIC, Rakopoulos P, Jan LY, Pajovic S, Buczkowicz P, Morrison A, Bouffet E, Bartels U, Becher O, Hawkins C, Truffaux N, Puget S, Philippe C, Gump W, Castel D, Taylor K, Mackay A, Le Dret L, Saulnier P, Calmon R, Boddaert N, Blauwblomme T, Sainte-Rose C, Jones C, Mutchnick I, Grill J, Liu X, Ebling M, Ide J, Wang L, Davis E, Marchionni M, Stuart D, Alberta J, Kieran M, Li KKW, Stiles C, Agar N, Remke M, Cavalli FMG, Northcott PA, Kool M, Pfister SM, Taylor MD, Project MAGIC, Tien AC, Pang JCS, Griveau A, Rowitch D, Ramkissoon L, Horowitz P, Craig J, Ramkissoon S, Rich B, Bergthold G, Tabori U, Taha H, Ng HK, Bowers D, Hawkins C, Packer R, Eberhart C, Goumnerova L, Chan J, Santagata S, Pomeroy S, Ligon A, Kieran M, Jackson S, Beroukhim R, Ligon K, Kuan CT, Chandramohan V, Keir S, Pastan I, Bigner D, Zhou Z, Ho S, Voss H, Patay Z, Souweidane M, Salloum R, DeWire M, Fouladi M, Goldman S, Chow L, Hummel T, Dorris K, Miles L, Sutton M, Howarth R, Stevenson C, Leach J, Griesinger A, Donson A, Hoffman L, Birks D, Amani V, Handler M, Foreman N, Sangar MC, Pai A, Pedro K, Ditzler SH, Girard E, Olson J, Gustafson WC, Meyerowitz J, Nekritz E, Charron E, Matthay K, Hertz N, Onar-Thomas A, Shokat K, Weiss W, Hanaford A, Raabe E, Eberhart C, Griesinger A, Donson A, Hoffman L, Amani V, Birks D, Gajjar A, Handler M, Mulcahy-Levy J, Foreman N, Olow AK, Dasgupta T, Yang X, Mueller S, Hashizume R, Kolkowitz I, Weiss W, Broniscer A, Resnick AC, Sievert AJ, Nicolaides T, Prados MD, Berger MS, Gupta N, James CD, Haas-Kogan DA, Flores C, Pham C, Dietl SM, Snyder D, Sanchez-Perez L, Bigner D, Sampson J, Mitchell D, Prakash V, Batanian J, Guzman M, Geller T, Pham CD, Wolfl M, Pei Y, Flores C, Snyder D, Bigner DD, Sampson JH, Wechsler-Reya RJ, Mitchell DA, Van Ommeren R, Venugopal C, Manoranjan B, Beilhack A, McFarlane N, Hallett R, Hassell J, Dunn S, Singh S, Dasgupta T, Olow A, Yang X, Hashizume R, Mueller S, Riedel S, Nicolaides T, Kolkowitz I, Weiss W, Prados M, Gupta N, James CD, Haas-Kogan D, Zhao H, Li L, Picotte K, Monoranu C, Stewart R, Modzelewska K, Boer E, Picard D, Huang A, Radiloff D, Lee C, Dunn S, Hutt M, Nazarian J, Dietl S, Price A, Lim KJ, Warren K, Chang H, Eberhart CG, Raabe EH, Persson A, Huang M, Chandler-Militello D, Li N, Vince GH, Berger M, James D, Goldman S, Weiss W, Lindquist R, Tate M, Rowitch D, Alvarez-Buylla A, Hoffman L, Donson A, Eyrich M, Birks D, Griesinger A, Amani V, Handler M, Foreman N, Meijer L, Walker D, Grundy R, O'Dowd S, Jaspan T, Schlegel PG, Dineen R, Fotovati A, Radiloff D, Coute N, Triscott J, Chen J, Yip S, Louis D, Toyota B, Hukin J, Weitzel D, Rassekh SR, Singhal A, Dunham C, Dunn S, Ahsan S, Hanaford A, Taylor I, Eberhart C, Raabe E, Sun YG, Ashcraft K, Stiles C, Han L, Zhang K, Chen L, Shi Z, Pu P, Dong L, Kang C, Cordero F, Lewis P, Liu C, Hoeman C, Schroeder K, Allis CD, Becher O, Gururangan S, Grant G, Driscoll T, Archer G, Herndon J, Friedman H, Li W, Kurtzberg J, Bigner D, Sampson J, Mitchell D, Yadavilli S, Kambhampati M, Becher O, MacDonald T, Bellamkonds R, Packer R, Buckley A, Nazarian J, DeWire M, Fouladi M, Stewart C, Wetmore C, Hawkins C, Jacobs C, Yuan Y, Goldman S, Fisher P, Rodriguez R, Rytting M, Bouffet E, Khakoo Y, Hwang E, Foreman N, Gilbert M, Gilbertson R, Gajjar A, Saratsis A, Yadavilli S, Wetzel W, Snyder K, Kambhampati M, Hall J, Raabe E, Warren K, Packer R, Nazarian J, Thompson J, Griesinger A, Foreman N, Spazojevic I, Rush S, Levy JM, Hutt M, Karajannis MA, Shah S, Eberhart CG, Raabe E, Rodriguez FJ, Gump J, Donson A, Tovmasyan A, Birks D, Handler M, Foreman N, Hankinson T, Torchia J, Khuong-Quang DA, Ho KC, Picard D, Letourneau L, Chan T, Peters K, Golbourn B, Morrissy S, Birks D, Faria C, Foreman N, Taylor M, Rutka J, Pfister S, Bouffet E, Hawkins C, Batinic-Haberle I, Majewski J, Kim SK, Jabado N, Huang A, Ladner T, Tomycz L, Watchmaker J, Yang T, Kaufman L, Pearson M, Dewhirst M, Ogg RJ, Scoggins MA, Zou P, Taherbhoy S, Jones MM, Li Y, Glass JO, Merchant TE, Reddick WE, Conklin HM, Gholamin S, Gajjar A, Khan A, Kumar A, Tye GW, Broaddus WC, Van Meter TE, Shih DJH, Northcott PA, Remke M, Korshunov A, Mitra S, Jones DTW, Kool M, Pfister SM, Taylor MD, Mille F, Levesque M, Remke M, Korshunov A, Izzi L, Kool M, Richard C, Northcott PA, Taylor MD, Pfister SM, Charron F, Yu F, Masoud S, Nguyen B, Vue N, Schubert S, Tolliday N, Kong DS, Sengupta S, Weeraratne D, Schreiber S, Cho YJ, Birks D, Jones K, Griesinger A, Amani V, Handler M, Vibhakar R, Achrol A, Foreman N, Brown R, Rangan K, Finlay J, Olch A, Freyer D, Bluml S, Gate D, Danielpour M, Rodriguez J, Shae JJ, Kim GB, Levy R, Bannykh S, Breunig JJ, Town T, Monje-Deisseroth M, Cho YJ, Weissman I, Cheshier S, Buczkowicz P, Rakopoulos P, Bouffet E, Morrison A, Bartels U, Becher O, Hawkins C, Dey A, Kenney A, Van Gool S, Pauwels F, De Vleeschouwer S, Barszczyk M, Buczkowicz P, Castelo-Branco P, Mack S, Nethery-Brokx K, Morrison A, Taylor M, Dirks P, Tabori U, Hawkins C, Chandramohan V, Keir ST, Bao X, Pastan IH, Kuan CT, Bigner DD, Bender S, Jones D, Kool M, Sturm D, Korshunov A, Lichter P, Pfister SM, Chen M, Lu J, Wang J, Keir S, Zhang M, Zhao S, Mook R, Barak L, Lyerly HK, Chen W, Ramachandran C, Nair S, Escalon E, Khatib Z, Quirrin KW, Melnick S, Kievit F, Stephen Z, Wang K, Silber J, Ellenbogen R, Zhang M, Hutzen B, Studebaker A, Bratasz A, Powell K, Raffel C, Guo C, Chang CC, Wortham M, Chen L, Kernagis D, Qin X, Cho YW, Chi JT, Grant G, McLendon R, Yan H, Ge K, Papadopoulos N, Bigner D, He Y, Cristiano B, Venkataraman S, Birks DK, Alimova I, Harris PS, Dubuc A, Taylor MD, Foreman NK, Vibhakar R, Ichimura K, Fukushima S, Totoki Y, Suzuki T, Mukasa A, Saito N, Kumabe T, Tominaga T, Kobayashi K, Nagane M, Iuchi T, Mizoguchi M, Sasaki T, Tamura K, Sugiyama K, Narita Y, Shibui S, Matsutani M, Shibata T, Nishikawa R, Northcott P, Zichner T, Jones D, Kool M, Jager N, Feychting M, Lannering B, Tynes T, Wesenberg F, Hauser P, Ra YS, Zitterbart K, Jabado N, Chan J, Fults D, Mueller S, Grajkowska W, Lichter P, Korbel J, Pfister S, Kool M, Jones DTW, Jaeger N, Northcott PA, Pugh T, Hovestadt V, Markant SL, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schueller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Keir S, Pegram C, Lipp E, Rasheed A, Chandramohan V, Kuan CT, Kwatra M, Yan H, Bigner D, Chornenkyy Y, Buczkowicz P, Agnihotri S, Becher O, Hawkins C, Rogers H, Mayne C, Kilday JP, Coyle B, Grundy R, Sun T, Warrington N, Luo J, Brooks M, Dahiya S, Sengupta R, Rubin J, Erdreich-Epstein A, Robison N, Ren X, Zhou H, Ji L, Margo A, Jones D, Pfister S, Kool M, Sposto R, Asgharzadeh S, Clifford S, Gustafsson G, Ellison D, Figarella-Branger D, Doz F, Rutkowski S, Lannering B, Pietsch T, Broniscer A, Tatevossian R, Sabin N, Klimo P, Dalton J, Lee R, Gajjar A, Ellison D, Garzia L, Dubuc A, Pitcher G, Northcott P, Mariampillai A, Chan T, Skowron P, Wu X, Yao Y, Hawkins C, Peacock J, Zayne K, Croul S, Rutka J, Kenney A, Huang A, Yang V, Baylin S, Salter M, Taylor M, Ward S, Sengupta R, Rubin J, Garzia L, Morrissy S, Skowron P, Jelveh S, Lindsay P, Largaespada D, Collier L, Dupuy A, Hill R, Taylor M, Lulla RR, Laskowski J, Fangusaro J, DiPatri AJ, Alden T, Vanin EF, Tomita T, Goldman S, Soares MB, Rajagopal MU, Lau LS, Hathout Y, Gordish-Dressman H, Rood B, Datar V, Bochare S, Singh A, Khatau S, Fangusaro J, Goldman S, Lulla R, Rajaram V, Gopalakrishnan V, Morfouace M, Shelat A, Jaccus M, Freeman B, Zindy F, Robinson G, Guy K, Stewart C, Gajjar A, Roussel M, Krebs S, Chow K, Yi Z, Brawley V, Ahmed N, Gottschalk S, Lerner R, Harness J, Yoshida Y, Santos R, Torre JDL, Nicolaides T, Ozawa T, James D, Petritsch C, Vitte J, Chareyre F, Stemmer-Rachamimov A, Giovannini M, Hashizume R, Yu-Jen L, Tom M, Ihara Y, Huang X, Waldman T, Mueller S, Gupta N, James D, Shevtsov M, Yakovleva L, Nikolaev B, Dobrodumov A, Onokhin K, Bychkova N, Mikhrina A, Khachatryan W, Guzhova I, Martynova M, Bystrova O, Ischenko A, Margulis B, Martin A, Nirschl C, Polanczyk M, Cohen K, Pardoll D, Drake C, Lim M, Crowther A, Chang S, Yuan H, Deshmukh M, Gershon T, Meyerowitz JG, Gustafson WC, Nekritz EA, Swartling F, Shokat KM, Ruggero D, Weiss WA, Bergthold G, Rich B, Bandopadhayay P, Chan J, Santaga S, Hoshida Y, Golub T, Tabak B, Ferrer-Luna R, Grill J, Wen PY, Stiles C, Kieran M, Ligon K, Beroukhim R, Lulla RR, Laskowski J, Gireud M, Fangusaro J, Goldman S, Gopalakrishnan V, Merino D, Shlien A, Pienkowska M, Tabori U, Gilbertson R, Malkin D, Mueller S, Hashizume R, Yang X, Kolkowitz I, Olow A, Phillips J, Smirnov I, Tom M, Prados M, Berger M, Gupta N, Haas-Kogan D, Beez T, Sarikaya-Seiwert S, Janssen G, Felsberg J, Steiger HJ, Hanggi D, Marino AM, Baryawno N, Johnsen JI, Ostman A, Wade A, Engler JR, Robinson AE, Phillips JJ, Witt H, Sill M, Mack SC, Wani KM, Lambert S, Tzaridis T, Bender S, Jones DT, Milde T, Northcott PA, Kool M, von Deimling A, Kulozik AE, Witt O, Lichter P, Collins VP, Aldape K, Taylor MD, Korshunov A, Pfister SM, Hatcher R, Das C, Datar V, Taylor P, Singh A, Lee D, Fuller G, Ji L, Fangusaro J, Rajaram V, Goldman S, Eberhart C, Gopalakrishnan V, Griveau A, Lerner R, Ihrie R, Sugiarto S, Ihara Y, Reichholf B, Huillard E, Mcmahon M, James D, Phillips J, Buylla AA, Rowitch D, Petritsch C, Snuderl M, Batista A, Kirkpatrick N, de Almodovar CR, Riedemann L, Knevels E, Schmidt T, Peterson T, Roberge S, Bais C, Yip S, Hasselblatt M, Rossig C, Ferrara N, Klagsbrun M, Duda D, Fukumura D, Xu L, Carmeliet P, Jain R, Nguyen A, Pencreach E, Lasthaus C, Lobstein V, Guerin E, Guenot D, Entz-Werle N, Diaz R, Golbourn B, Faria C, Shih D, MacKenzie D, Picard D, Bryant M, Smith C, Taylor M, Huang A, Rutka J, Gromeier M, Desjardins A, Sampson JH, Threatt SJE, Herndon JE, Friedman A, Friedman HS, Bigner DD, Cavalli FMG, Morrissy AS, Li Y, Chu A, Remke M, Thiessen N, Mungall AJ, Bader GD, Malkin D, Marra MA, Taylor MD, Manoranjan B, Wang X, Hallett R, Venugopal C, Mack S, McFarlane N, Nolte S, Scheinemann K, Gunnarsson T, Hassell J, Taylor M, Lee C, Triscott J, Foster C, Dunham C, Hawkins C, Dunn S, Singh S, McCrea HJ, Bander E, Venn RA, Reiner AS, Iorgulescu JB, Puchi LA, Schaefer PM, Cederquist G, Greenfield JP, Tsoli M, Luk P, Dilda P, Hogg P, Haber M, Ziegler D, Mack S, Agnihotri S, Witt H, Shih D, Wang X, Ramaswamy V, Zayne K, Bertrand K, Massimi L, Grajkowska W, Lach B, Gupta N, Weiss W, Guha A, Zadeh G, Rutka J, Korshunov A, Pfister S, Taylor M, Mack S, Witt H, Jager N, Zuyderduyn S, Nethery-Brokx K, Garzia L, Zayne K, Wang X, Barszczyk M, Wani K, Bouffet E, Weiss W, Hawkins C, Rutka J, Bader G, Aldape K, Dirks P, Pfister S, Korshunov A, Taylor M, Engler J, Robinson A, Wade A, Molinaro A, Phillips J, Ramaswamy V, Remke M, Bouffet E, Faria C, Shih D, Gururangan S, McLendon R, Schuller U, Ligon K, Pomeroy S, Jabado N, Dunn S, Fouladi M, Rutka J, Hawkins C, Tabori U, Packer R, Pfister S, Korshunov A, Taylor M, Faria C, Dubuc A, Golbourn B, Diaz R, Agnihotri S, Sabha N, Luck A, Leadly M, Reynaud D, Wu X, Remke M, Ramaswamy V, Northcott P, Pfister S, Croul S, Kool M, Korshunov A, Smith C, Taylor M, Rutka J, Pietsch T, Doerner E, Muehlen AZ, Velez-Char N, Warmuth-Metz M, Kortmann R, von Hoff K, Friedrich C, Rutkowski S, von Bueren A, Lu YJ, James CD, Hashizume R, Mueller S, Phillips J, Gupta N, Sturm D, Northcott PA, Jones DTW, Korshunov A, Picard D, Lichter P, Huang A, Pfister SM, Kool M, Ward J, Teague C, Shriyan B, Grundy R, Rahman R, Taylor K, Mackay A, Morozova O, Butterfield Y, Truffaux N, Philippe C, Vinci M, de Torres C, Cruz O, Mora J, Hargrave D, Puget S, Yip S, Jones C, Grill J, Smith S, Ward J, Tan C, Grundy R, Rahman R, Bjerke L, Mackay A, Nandhabalan M, Burford A, Jury A, Popov S, Bax D, Carvalho D, Taylor K, Vinci M, Bajrami I, McGonnell I, Lord C, Reis R, Hargrave D, Ashworth A, Workman P, Jones C, Carvalho D, Mackay A, Burford A, Bjerke L, Chen L, Kozarewa I, Lord C, Ashworth A, Hargrave D, Reis R, Jones C, Marigil M, Jauregui PJ, Alonso M, Chan TS, Hawkins C, Picard D, Henkin J, Huang A, Trubicka J, Kucharczyk M, Pelc M, Chrzanowska K, Ciara E, Perek-Polnik M, Grajkowska W, Piekutowska-Abramczuk D, Jurkiewicz D, Luczak S, Borucka-Mankiewicz M, Kowalski P, Krajewska-Walasek M, de Mola RML, Laskowski J, Fangusaro J, Costa FF, Vanin EF, Goldman S, Soares MB, Lulla RR, Mann A, Venugopal C, Vora P, Singh M, van Ommeren R, McFarlane N, Manoranjan B, Qazi M, Scheinemann K, MacDonald P, Delaney K, Whitton A, Dunn S, Singh S, Sievert A, Lang SS, Boucher K, Madsen P, Slaunwhite E, Choudhari N, Kellet M, Storm P, Resnick A, Agnihotri S, Burrell K, Fernandez N, Golbourn B, Clarke I, Barszczyk M, Sabha N, Dirks P, Jones C, Rutka J, Zadeh G, Hawkins C, Murphy B, Obad S, Bihannic L, Ayrault O, Zindy F, Kauppinen S, Roussel M, Golbourn B, Agnihotri S, Cairns R, Mischel P, Aldape K, Hawkins C, Zadeh G, Rutka J, Rush S, Donson A, Kleinschmidt-DeMasters B, Bemis L, Birks D, Chan M, Smith A, Handler M, Foreman N, Gronych J, Jones DTW, Zuckermann M, Hutter S, Korshunov A, Kool M, Ryzhova M, Reifenberger G, Pfister SM, Lichter P, Jones DTW, Hovestadt V, Picelli S, Wang W, Northcott PA, Kool M, Jager N, Reifenberger G, Rutkowski S, Pietsch T, Sultan M, Yaspo ML, Landgraf P, Eils R, Korshunov A, Zapatka M, Pfister SM, Radlwimmer B, Lichter P, Huang Y, Mao H, Wang Y, Kogiso M, Zhao X, Baxter P, Man C, Wang Z, Zhou Y, Li XN, Chung AH, Crabtree D, Schroeder K, Becher OJ, Panosyan E, Wang Y, Lasky J, Liu Z, Zhao X, Wang Y, Mao H, Huang Y, Kogiso M, Baxter P, Adesina A, Su J, Picard D, Huang A, Perlaky L, Chintagumpala M, Lau C, Blaney S, Li XN, Huang M, Persson A, Swartling F, Moriarity B. Abstracts. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not047] [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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Jones DTW, Jäger N, Kool M, Zichner T, Hutter B, Sultan M, Cho YJ, Pugh TJ, Hovestadt V, Stütz AM, Rausch T, Warnatz HJ, Ryzhova M, Bender S, Sturm D, Pleier S, Cin H, Pfaff E, Sieber L, Wittmann A, Remke M, Witt H, Hutter S, Tzaridis T, Weischenfeldt J, Raeder B, Avci M, Amstislavskiy V, Zapatka M, Weber UD, Wang Q, Lasitschka B, Bartholomae CC, Schmidt M, von Kalle C, Ast V, Lawerenz C, Eils J, Kabbe R, Benes V, van Sluis P, Koster J, Volckmann R, Shih D, Betts MJ, Russell RB, Coco S, Tonini GP, Schüller U, Hans V, Graf N, Kim YJ, Monoranu C, Roggendorf W, Unterberg A, Herold-Mende C, Milde T, Kulozik AE, von Deimling A, Witt O, Maass E, Rössler J, Ebinger M, Schuhmann MU, Frühwald MC, Hasselblatt M, Jabado N, Rutkowski S, von Bueren AO, Williamson D, Clifford SC, McCabe MG, Collins VP, Wolf S, Wiemann S, Lehrach H, Brors B, Scheurlen W, Felsberg J, Reifenberger G, Northcott PA, Taylor MD, Meyerson M, Pomeroy SL, Yaspo ML, Korbel JO, Korshunov A, Eils R, Pfister SM, Lichter P. Dissecting the genomic complexity underlying medulloblastoma. Nature 2012; 488:100-5. [PMID: 22832583 DOI: 10.1038/nature11284] [Citation(s) in RCA: 647] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/06/2012] [Indexed: 12/31/2022]
Abstract
Medulloblastoma is an aggressively growing tumour, arising in the cerebellum or medulla/brain stem. It is the most common malignant brain tumour in children, and shows tremendous biological and clinical heterogeneity. Despite recent treatment advances, approximately 40% of children experience tumour recurrence, and 30% will die from their disease. Those who survive often have a significantly reduced quality of life. Four tumour subgroups with distinct clinical, biological and genetic profiles are currently identified. WNT tumours, showing activated wingless pathway signalling, carry a favourable prognosis under current treatment regimens. SHH tumours show hedgehog pathway activation, and have an intermediate prognosis. Group 3 and 4 tumours are molecularly less well characterized, and also present the greatest clinical challenges. The full repertoire of genetic events driving this distinction, however, remains unclear. Here we describe an integrative deep-sequencing analysis of 125 tumour-normal pairs, conducted as part of the International Cancer Genome Consortium (ICGC) PedBrain Tumor Project. Tetraploidy was identified as a frequent early event in Group 3 and 4 tumours, and a positive correlation between patient age and mutation rate was observed. Several recurrent mutations were identified, both in known medulloblastoma-related genes (CTNNB1, PTCH1, MLL2, SMARCA4) and in genes not previously linked to this tumour (DDX3X, CTDNEP1, KDM6A, TBR1), often in subgroup-specific patterns. RNA sequencing confirmed these alterations, and revealed the expression of what are, to our knowledge, the first medulloblastoma fusion genes identified. Chromatin modifiers were frequently altered across all subgroups. These findings enhance our understanding of the genomic complexity and heterogeneity underlying medulloblastoma, and provide several potential targets for new therapeutics, especially for Group 3 and 4 patients.
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Affiliation(s)
- David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
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