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Katz-Wise SL, Shah SN, Melvin P, Boskey ER, Grice AW, Kornetsky S, Young Poussaint T, Whitley MY, Stack AM, Emans SJ, Hoerner B, Horgan JJ, Ward VL. Establishing a Pediatric Health Equity, Diversity, and Inclusion Research Review Process. Pediatrics 2024; 153:e2023062946. [PMID: 38651252 DOI: 10.1542/peds.2023-062946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/25/2024] Open
Abstract
Equity, diversity, and inclusion (EDI) research is increasing, and there is a need for a more standardized approach for methodological and ethical review of this research. A supplemental review process for EDI-related human subject research protocols was developed and implemented at a pediatric academic medical center (AMC). The goal was to ensure that current EDI research principles are consistently used and that the research aligns with the AMC's declaration on EDI. The EDI Research Review Committee, established in January 2022, reviewed EDI protocols and provided recommendations and requirements for addressing EDI-related components of research studies. To evaluate this review process, the number and type of research protocols were reviewed, and the types of recommendations given to research teams were examined. In total, 78 research protocols were referred for EDI review during the 20-month implementation period from departments and divisions across the AMC. Of these, 67 were given requirements or recommendations to improve the EDI-related aspects of the project, and 11 had already considered a health equity framework and implemented EDI principles. Requirements or recommendations made applied to 1 or more stages of the research process, including design, execution, analysis, and dissemination. An EDI review of human subject research protocols can provide an opportunity to constructively examine and provide feedback on EDI research to ensure that a standardized approach is used based on current literature and practice.
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Affiliation(s)
- Sabra L Katz-Wise
- Divisions of Adolescent/Young Adult Medicine
- Departments of Pediatrics
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Snehal N Shah
- Departments of Pediatrics
- Accountable Care and Clinical Integration
- Office of Health Equity and Inclusion
- Clinical Research Compliance
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Patrice Melvin
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
| | - Elizabeth R Boskey
- Gynecology/Department of Surgery
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Tina Young Poussaint
- Clinical Research Compliance
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Melicia Y Whitley
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
| | - Anne M Stack
- Emergency Medicine
- Departments of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - S Jean Emans
- Divisions of Adolescent/Young Adult Medicine
- Departments of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Hoerner
- Office of the General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - James J Horgan
- Office of the General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - Valerie L Ward
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Bhatia A, Sabin ND, Fisher MJ, Poussaint TY. Review of imaging recommendations from Response Assessment in Pediatric Neuro-Oncology (RAPNO). Pediatr Radiol 2023; 53:2723-2741. [PMID: 37864711 DOI: 10.1007/s00247-023-05780-w] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
The Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group includes neuroradiologists, neuro-oncologists, neurosurgeons, radiation oncologists, and clinicians in various additional specialties. This review paper will summarize the imaging recommendations from RAPNO for the six RAPNO publications to date covering pediatric low-grade glioma, pediatric high-grade glioma, medulloblastoma and other leptomeningeal seeding tumors, diffuse intrinsic pontine glioma, ependymoma, and craniopharyngioma.
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Affiliation(s)
- Aashim Bhatia
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Noah D Sabin
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael J Fisher
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Division of Oncology, Department of Pediatrics , Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Tina Young Poussaint
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Snyder EJ, Sarma A, Poussaint TY, Krishnasarma R, Pruthi S. Complications of Cancer Therapy in Children: A Comprehensive Review of Neuroimaging Findings. J Comput Assist Tomogr 2023; 47:820-832. [PMID: 37707414 DOI: 10.1097/rct.0000000000001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ABSTRACT Complications of cancer therapy in children can result in a spectrum of neurologic toxicities that may occur at the initiation of therapy or months to years after treatment. Although childhood cancer remains rare, increasing survival rates mean that more children will be living longer after cancer treatment. Therefore, complications of cancer therapy will most likely occur with increasing frequency.At times, it is very difficult to differentiate between therapeutic complications and other entities such as tumor recurrence, development of secondary malignancy, and infection (among other conditions). Radiologists often play a key role in the diagnosis and evaluation of pediatric patients with malignancies, and thus, awareness of imaging findings of cancer complications and alternative diagnoses is essential in guiding management and avoiding misdiagnosis. The aim of this review article is to illustrate the typical neuroimaging findings of cancer therapy-related toxicities, including both early and late treatment effects, highlighting pearls that may aid in making the appropriate diagnosis.
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Affiliation(s)
- Elizabeth J Snyder
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Asha Sarma
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | | | - Rekha Krishnasarma
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Sumit Pruthi
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
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Rameh V, Vajapeyam S, Ziaei A, Kao P, London WB, Baker SJ, Chiang J, Lucas J, Tinkle CL, Wright KD, Poussaint TY. Correlation between Multiparametric MR Imaging and Molecular Genetics in Pontine Pediatric High-Grade Glioma. AJNR Am J Neuroradiol 2023:ajnr.A7910. [PMID: 37321859 PMCID: PMC10337620 DOI: 10.3174/ajnr.a7910] [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] [Received: 03/09/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND PURPOSE Molecular profiling is a crucial feature in the "integrated diagnosis" of CNS tumors. We aimed to determine whether radiomics could distinguish molecular types of pontine pediatric high-grade gliomas that have similar/overlapping phenotypes on conventional anatomic MR images. MATERIALS AND METHODS Baseline MR images from children with pontine pediatric high-grade gliomas were analyzed. Retrospective imaging studies included standard precontrast and postcontrast sequences and DTI. Imaging analyses included median, mean, mode, skewness, and kurtosis of the ADC histogram of the tumor volume based on T2 FLAIR and enhancement at baseline. Histone H3 mutations were identified through immunohistochemistry and/or Sanger or next-generation DNA sequencing. The log-rank test identified imaging factors prognostic of survival from the time of diagnosis. Wilcoxon rank-sum and Fisher exact tests compared imaging predictors among groups. RESULTS Eighty-three patients had pretreatment MR imaging and evaluable tissue sampling. The median age was 6 years (range, 0.7-17 years); 50 tumors had a K27M mutation in H3-3A, and 11, in H3C2/3. Seven tumors had histone H3 K27 alteration, but the specific gene was unknown. Fifteen were H3 wild-type. Overall survival was significantly higher in H3C2/3- compared with H3-3A-mutant tumors (P = .003) and in wild-type tumors compared with any histone mutation (P = .001). Lower overall survival was observed in patients with enhancing tumors (P = .02) compared with those without enhancement. H3C2/3-mutant tumors showed higher mean, median, and mode ADC_total values (P < .001) and ADC_enhancement (P < .004), with lower ADC_total skewness and kurtosis (P < .003) relative to H3-3A-mutant tumors. CONCLUSIONS ADC histogram parameters are correlated with histone H3 mutation status in pontine pediatric high-grade glioma.
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Affiliation(s)
- V Rameh
- From the Department of Radiology (V.R., S.V., A.Z., T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Vajapeyam
- From the Department of Radiology (V.R., S.V., A.Z., T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Ziaei
- From the Department of Radiology (V.R., S.V., A.Z., T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Kao
- Department of Pediatric Oncology (P.K., W.B.L., K.D.W.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - W B London
- Department of Pediatric Oncology (P.K., W.B.L., K.D.W.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - S J Baker
- Departments of Developmental Neurobiology (S.J.B.)
| | | | - J Lucas
- Radiation Oncology (J.L., C.L.T.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - C L Tinkle
- Radiation Oncology (J.L., C.L.T.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - K D Wright
- Department of Pediatric Oncology (P.K., W.B.L., K.D.W.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - T Y Poussaint
- From the Department of Radiology (V.R., S.V., A.Z., T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Jaju A, Li Y, Dahmoush H, Gottardo NG, Laughlin S, Mirsky D, Panigrahy A, Sabin ND, Shaw D, Storm PB, Poussaint TY, Patay Z, Bhatia A. Imaging of pediatric brain tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30147. [PMID: 36519599 PMCID: PMC10466217 DOI: 10.1002/pbc.30147] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/16/2022]
Abstract
Tumors of the central nervous system are the most common solid malignancies in children and the most common cause of pediatric cancer-related mortality. Imaging plays a central role in diagnosis, staging, treatment planning, and response assessment of pediatric brain tumors. However, the substantial variability in brain tumor imaging protocols across institutions leads to variability in patient risk stratification and treatment decisions, and complicates comparisons of clinical trial results. This White Paper provides consensus-based imaging recommendations for evaluating pediatric patients with primary brain tumors. The proposed brain magnetic resonance imaging protocol recommendations balance advancements in imaging techniques with the practicality of deployment across most imaging centers.
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Affiliation(s)
- Alok Jaju
- Department of Medical Imaging, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Yi Li
- UCSF Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Hisham Dahmoush
- Department of Radiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Nicholas G Gottardo
- Department of Paediatric and Adolescent Oncology and Haematology, Perth Children's Hospital, Brain Tumour Research Programme, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Suzanne Laughlin
- Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Noah D Sabin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Dennis Shaw
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Phillip B Storm
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Shankar LK, Schöder H, Sharon E, Wolchok J, Knopp MV, Wahl RL, Ellingson BM, Hall NC, Yaffe MJ, Towbin AJ, Farwell MD, Pryma D, Poussaint TY, Wright CL, Schwartz L, Harisinghani M, Mahmood U, Wu AM, Leung D, de Vries EGE, Tang Y, Beach G, Reeves SA. Harnessing imaging tools to guide immunotherapy trials: summary from the National Cancer Institute Cancer Imaging Steering Committee workshop. Lancet Oncol 2023; 24:e133-e143. [PMID: 36858729 PMCID: PMC10119769 DOI: 10.1016/s1470-2045(22)00742-2] [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] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 03/02/2023]
Abstract
As the immuno-oncology field continues the rapid growth witnessed over the past decade, optimising patient outcomes requires an evolution in the current response-assessment guidelines for phase 2 and 3 immunotherapy clinical trials and clinical care. Additionally, investigational tools-including image analysis of standard-of-care scans (such as CT, magnetic resonance, and PET) with analytics, such as radiomics, functional magnetic resonance agents, and novel molecular-imaging PET agents-offer promising advancements for assessment of immunotherapy. To document current challenges and opportunities and identify next steps in immunotherapy diagnostic imaging, the National Cancer Institute Clinical Imaging Steering Committee convened a meeting with diverse representation among imaging experts and oncologists to generate a comprehensive review of the state of the field.
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Affiliation(s)
- Lalitha K Shankar
- Clinical Trials Branch, National Cancer Institute, Rockville, MD, USA.
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elad Sharon
- Investigational Drug Branch, National Cancer Institute, Rockville, MD, USA
| | - Jedd Wolchok
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Michael V Knopp
- Department of Radiology, Ohio State University, Columbus, OH, USA
| | - Richard L Wahl
- Department of Radiology, Washington University, St Louis, MO, USA
| | - Benjamin M Ellingson
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Nathan C Hall
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin J Yaffe
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Alexander J Towbin
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Michael D Farwell
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Pryma
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Anna M Wu
- Department of Immunology & Theranostics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Steven A Reeves
- Coordinating Center for Clinical Trials, National Cancer Institute, Rockville, MD, USA
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Hoffman LM, Jaimes C, Mankad K, Mirsky DM, Tamrazi B, Tinkle CL, Kline C, Ramasubramanian A, Malbari F, Mangum R, Lindsay H, Horne V, Daniels DJ, Keole S, Grosshans DR, Young Poussaint T, Packer R, Cavalheiro S, Bison B, Hankinson TC, Müller HL, Bartels U, Warren KE, Chintagumpala M. Response assessment in pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) Working Group. Neuro Oncol 2023; 25:224-233. [PMID: 36124689 PMCID: PMC9925711 DOI: 10.1093/neuonc/noac221] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Craniopharyngioma is a histologically benign tumor of the suprasellar region for which survival is excellent but quality of life is often poor secondary to functional deficits from tumor and treatment. Standard therapy consists of maximal safe resection with or without radiation therapy. Few prospective trials have been performed, and response assessment has not been standardized. METHODS The Response Assessment in Pediatric Neuro-Oncology (RAPNO) committee devised consensus guidelines to assess craniopharyngioma response prospectively. RESULTS Magnetic resonance imaging is the recommended radiologic modality for baseline and follow-up assessments. Radiologic response is defined by 2-dimensional measurements of both solid and cystic tumor components. In certain clinical contexts, response to solid and cystic disease may be differentially considered based on their unique natural histories and responses to treatment. Importantly, the committee incorporated functional endpoints related to neuro-endocrine and visual assessments into craniopharyngioma response definitions. In most circumstances, the cystic disease should be considered progressive only if growth is associated with acute, new-onset or progressive functional impairment. CONCLUSIONS Craniopharyngioma is a common pediatric central nervous system tumor for which standardized response parameters have not been defined. A RAPNO committee devised guidelines for craniopharyngioma assessment to uniformly define response in future prospective trials.
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Affiliation(s)
- Lindsey M Hoffman
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Camilo Jaimes
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - David M Mirsky
- Department of Radiology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Benita Tamrazi
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Christopher L Tinkle
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Cassie Kline
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Fatema Malbari
- Division of Neurology and Developmental Neurosciences, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Ross Mangum
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Holly Lindsay
- Division of Hematology-Oncology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Vincent Horne
- Division of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - David J Daniels
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameer Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - David R Grosshans
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina Young Poussaint
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Roger Packer
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, Washington, District of Columbia, USA
| | - Sergio Cavalheiro
- Pediatric Oncology Institute, Federal University of São Paulo, São Paulo, Brazil
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Todd C Hankinson
- Department of Neurosurgery, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University Oldenburg, 26133 Oldenburg, Germany
| | - Ute Bartels
- Department of Pediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Katherine E Warren
- Division of Pediatric Neuro-Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Murali Chintagumpala
- Division of Hematology-Oncology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
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8
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Cogswell PM, Jack CR, Barakos JA, Barkhof F, Benzinger TS, Raji CA, Poussaint TY, Ramanan VK, Whitlow CT. Reply. AJNR Am J Neuroradiol 2023; 44:E6. [PMID: 36574316 PMCID: PMC9835908 DOI: 10.3174/ajnr.a7731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- P M Cogswell
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - C R Jack
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - J A Barakos
- Department of RadiologyCalifornia Pacific Medical CenterSan Francisco, California
| | - F Barkhof
- Departments of Radiology and Nuclear MedicineVU University Medical CenterAmsterdam, the NetherlandsQueen Square Institute of Neurology and Centre for Medical Image ComputingUniversity CollegeLondon, UK
| | - T S Benzinger
- Departments of Radiology and NeurosurgeryWashington University School of MedicineSt. Louis, Missouri
| | - C A Raji
- Departments of Radiology and NeurologyWashington University School of MedicineSt. Louis, Missouri
| | - T Y Poussaint
- Department of RadiologyBoston Children's HospitalBoston, Massachusetts
| | - V K Ramanan
- Department of NeurologyMayo ClinicRochester, Minnesota
| | - C T Whitlow
- Departments of Radiology and Biomedical EngineeringWake Forest School of MedicineWinston-Salem, North Carolina
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Cogswell PM, Barakos JA, Barkhof F, Benzinger TS, Jack CR, Poussaint TY, Raji CA, Ramanan VK, Whitlow CT. Amyloid-Related Imaging Abnormalities with Emerging Alzheimer Disease Therapeutics: Detection and Reporting Recommendations for Clinical Practice. AJNR Am J Neuroradiol 2022; 43:E19-E35. [PMID: 35953274 PMCID: PMC9451628 DOI: 10.3174/ajnr.a7586] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Monoclonal antibodies are emerging disease-modifying therapies for Alzheimer disease that require brain MR imaging for eligibility assessment as well as for monitoring for amyloid-related imaging abnormalities. Amyloid-related imaging abnormalities result from treatment-related loss of vascular integrity and may occur in 2 forms. Amyloid-related imaging abnormalities with edema or effusion are transient, treatment-induced edema or sulcal effusion, identified on T2-FLAIR. Amyloid-related imaging abnormalities with hemorrhage are treatment-induced microhemorrhages or superficial siderosis identified on T2* gradient recalled-echo. As monoclonal antibodies become more widely available, treatment screening and monitoring brain MR imaging examinations may greatly increase neuroradiology practice volumes. Radiologists must become familiar with the imaging appearance of amyloid-related imaging abnormalities, how to select an appropriate imaging protocol, and report findings in clinical practice. On the basis of clinical trial literature and expert experience from clinical trial imaging, we summarize imaging findings of amyloid-related imaging abnormalities, describe potential interpretation pitfalls, and provide recommendations for a standardized imaging protocol and an amyloid-related imaging abnormalities reporting template. Standardized imaging and reporting of these findings are important because an amyloid-related imaging abnormalities severity score, derived from the imaging findings, is used along with clinical status to determine patient management and eligibility for continued monoclonal antibody dosing.
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Affiliation(s)
- P M Cogswell
- From the Departments of Radiology (P.M.C., C.R.J.)
| | - J A Barakos
- Department of Radiology (J.A.B.), California Pacific Medical Center, San Francisco, California
| | - F Barkhof
- Departments of Radiology (F.B.)
- Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, UK
| | - T S Benzinger
- Departments of Radiology (T.S.B., C.A.R.)
- Neurosurgery (T.S.B.)
| | - C R Jack
- From the Departments of Radiology (P.M.C., C.R.J.)
| | - T Y Poussaint
- Department of Radiology (T.Y.P.), Boston Children's Hospital, Boston, Massachusetts
| | - C A Raji
- Departments of Radiology (T.S.B., C.A.R.)
- Neurology (C.A.R.),Washington University School of Medicine, St. Louis, Missouri
| | - V K Ramanan
- Neurology (V.K.R.), Mayo Clinic, Rochester, Minnesota
| | - C T Whitlow
- Departments of Radiology (C.T.W.)
- Biomedical Engineering (C.T.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
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10
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Lindsay HB, Massimino M, Avula S, Stivaros S, Grundy R, Metrock K, Bhatia A, Fernández-Teijeiro A, Chiapparini L, Bennett J, Wright K, Hoffman LM, Smith A, Pajtler KW, Poussaint TY, Warren KE, Foreman NK, Mirsky DM. Response assessment in paediatric intracranial ependymoma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol 2022; 23:e393-e401. [DOI: 10.1016/s1470-2045(22)00222-4] [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] [Received: 02/25/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 10/16/2022]
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Fangusaro JR, Onar-Thomas A, Poussaint TY, Wu S, Ligon AH, Lindeman NI, Banerjee A, Packer R, Kilburn LB, Pollack IF, Qaddoumi IA, Fisher PG, Dhall G, Baxter PA, Kreissman SG, Doyle LA, Smith MA, Fouladi M, Dunkel IJ. Corrigendum to: LTBK-01. Updates On The Phase Ii And Re-treatment Study Of AZD6244 (Selumetinib) For Children With Recurrent Or Refractory Pediatric Low Grade Glioma: A Pediatric Brain Tumor Consortium (PBTC) Study. Neuro Oncol 2022; 24:1404. [PMID: 35307742 PMCID: PMC9340620 DOI: 10.1093/neuonc/noac029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Affiliation(s)
- Jason R Fangusaro
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | | | - Shengjie Wu
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | - Roger Packer
- Children's National Health System, Washington, DC, USA
| | | | | | | | | | - Girish Dhall
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Patricia Ann Baxter
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Susan G Kreissman
- Duke University Medical Center, Durham, NC, USA
- Greenbaum Cancer Center, Baltimore, MD, USA
| | - L Austin Doyle
- Cancer Therapy Evaluation Program, National Cancer Institute, Washington, DC, USA
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Washington, DC, USA
| | - Maryam Fouladi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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Osborn AG, Louis DN, Poussaint TY, Linscott LL, Salzman KL. The 2021 World Health Organization Classification of Tumors of the Central Nervous System: What Neuroradiologists Need to Know. AJNR Am J Neuroradiol 2022; 43:928-937. [PMID: 35710121 DOI: 10.3174/ajnr.a7462] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022]
Abstract
Neuroradiologists play a key role in brain tumor diagnosis and management. Staying current with the latest classification systems and diagnostic markers is important to provide optimal patient care. Publication of the 2016 World Health Organization Classification of Tumors of the Central Nervous System introduced a paradigm shift in the diagnosis of CNS neoplasms. For the first time, both histologic features and genetic alterations were incorporated into the diagnostic framework, classifying and grading brain tumors. The newly published 2021 World Health Organization Classification of Tumors of the Central Nervous System, May 2021, 5th edition, has added even more molecular features and updated pathologic diagnoses. We present, summarize, and illustrate the most salient aspects of the new 5th edition. We have selected the key "must know" topics for practicing neuroradiologists.
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Affiliation(s)
- A G Osborn
- From the Department of Radiology and Imaging Sciences (A.G.O., K.L.S.), University of Utah School of Medicine, Salt Lake City, Utah
| | - D N Louis
- Department of Pathology (D.N.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - T Y Poussaint
- Department of Radiology (T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - L L Linscott
- Intermountain Pediatric Imaging (L.L.L.), Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - K L Salzman
- From the Department of Radiology and Imaging Sciences (A.G.O., K.L.S.), University of Utah School of Medicine, Salt Lake City, Utah
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Lindsay H, Massimino M, Avula S, Stivaros S, Grundy R, Metrock K, Bhatia A, Fernández-Teijeiro A, Chiapparini L, Bennett J, Wright K, Hoffman L, Smith A, Pajtler K, Poussaint TY, Warren K, Foreman N, Mirsky D. EPEN-01. Response assessment in pediatric intracranial ependymoma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.138] [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
INTRODUCTION: Ependymomas remain a major cause of cancer-related death in childhood and adolescence, with recurrence occurring in up to 50% of patients. Despite exciting molecular advances in understanding ependymoma tumorigenesis and recurrence, MRI remains the mainstay for assessing objective response to therapy and duration of disease stability. Standardized response assessment criteria for clinical trials studying pediatric intracranial ependymoma are critically needed in order to accurately compare results between studies. METHODS: To generate these standardized response criteria in pediatric intracranial ependymoma, a multidisciplinary team of pediatric neuro-oncologists, neuroradiologists, neurosurgeons, radiation oncologists, and molecular biologists formed the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. The expert members reviewed relevant published literature, assessed current clinical practices, and engaged in iterative discussions to provide consensus recommendations for objective response assessment in pediatric intracranial ependymoma for use in prospective clinical trials. RECOMMENDATIONS AND CONCLUSIONS: The primary sequences for detecting and measuring disease and assessing radiologic response to therapy should be the contrast-enhanced T1-weighted sequence or T2-weighted sequence (T2 or T2-FLAIR) depending on which sequence the tumor is best visualized. When metastatic disease is present, only the three largest lesions will be followed in addition to any residual disease at the primary tumor focus. Importantly, the RAPNO working group notes that radiologic response to therapy is of limited value in clinical trials of patients with ependymoma, since most patients enroll on clinical trials with either no evidence of disease or only minimal disease. In recurrent or progressive disease that cannot be resected, true radiologic disease response to therapy is less clinically meaningful as a study endpoint than event-free and/or overall survival (representing prolonged stable disease) but may provide a signal of efficacy worthy of future exploration in patients with complete to near complete resections.
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Affiliation(s)
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumouri , Milan , Italy
| | - Shivaram Avula
- Alder Hey Children’s NHS Foundation Trust , Liverpool , United Kingdom
| | - Stavros Stivaros
- Central Manchester University Hospitals NHS Foundation Trust , Manchester , United Kingdom
- University of Manchester , Manchester , United Kingdom
| | | | - Katie Metrock
- University of Alabana at Birmingham , Birmingham, AB , USA
| | - Aashim Bhatia
- Children’s Hospital of Philadelphia , Philadelphia, PA , USA
| | | | | | | | - Karen Wright
- Dana-Farber and Boston Children’s Cancer and Blood Disorders Center , Boston, MA , USA
| | | | - Amy Smith
- Orlando Health-Arnold Palmer Hospital , Orlando, FL , USA
| | - Kristian Pajtler
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
- Hopp Children’s Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
| | | | - Katherine Warren
- Dana-Farber and Boston Children’s Cancer and Blood Disorders Center , Boston, MA , USA
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14
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Hoffman LM, Levy JM, Kilburn L, Billups C, Stokes V, McCourt E, Poussaint TY, Campagne O, Partap S, Dorris K, Sait SF, Robinson G, Baxter P, Stewart CF, Fangusaro J, Onar-Thomas A, Dunkel I. EPCT-01. Pediatric Brain Tumor Consortium (PBTC)-055: A phase I study of trametinib and hydroxychloroquine (HCQ) for BRAF-fusion or Neurofibromatosis type-1 (NF1)-associated pediatric gliomas. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.129] [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
INTRODUCTION: Autophagy is a highly conserved process by which intracellular components are degraded and recycled promoting cell survival. Preclinically, autophagy has been implicated as a resistance mechanism in BRAF-mutant glioma cells treated with MAPK-pathway inhibitors. HCQ, an oral autophagy inhibitor, has been evaluated preclinically and clinically to overcome resistance. METHODS: PBTC-055 (NCT04201457) is a phase I/II trial of HCQ combined with trametinib (BRAF-fusion or NF1-associated gliomas) or trametinib and dabrafenib (BRAFV600E gliomas) in patients < 30 years with progressive glioma. Prior treatment with RAF and/or MEK inhibitor with sub-optimal response (no response or response followed by progression on therapy) was required. Here, we present phase I data combining trametinib with HCQ utilizing a rolling-6 design. HCQ was administered at escalating dose levels (8, 15, or 20 mg/kg/day divided BID) in combination with standard pediatric trametinib dosing. All patients received prior MEK inhibitor therapy; 5/18 (28%) exhibited no response and 13/18 (72%) progressed on active therapy. RESULTS: Eighteen eligible/evaluable subjects were enrolled. Median age was 9.6 years (2.5-20.4 years); 10 were male. There were 2 dose-limiting toxicities (both grade 3 rash one each at DL1 and DL3). The highest dose level of HCQ (20 mg/kg/day divided BID) was declared the RP2D. Grade 3 adverse events possibly related to therapy included skin infection, rash, cardiac ejection fraction decrease, weight loss, and anorexia. There were no grade 4 or 5 attributable toxicities. Preliminarily, combination pharmacokinetic assessment revealed similar metabolism of trametinib to that reported as a single agent; HCQ demonstrated more rapid clearance compared to adults. Pharmacodynamic assessments are ongoing. CONCLUSIONS: The combination of trametinib and HCQ is safe with a RP2D of HCQ of 20 mg/kg/day divided BID. Currently, subjects are enrolling on the phase II portion evaluating the efficacy of this novel combination.
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Affiliation(s)
| | | | | | | | - Vanetria Stokes
- St. Jude Children's Research Hospital , Memphis, Tennessee , USA
| | | | - Tina Young Poussaint
- Boston Children's Hospital , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
| | - Olivia Campagne
- St. Jude Children's Research Hospital , Memphis, Tennessee , USA
| | - Sonia Partap
- Stanford University, Palo Alto , California , USA
| | | | | | - Giles Robinson
- St. Jude Children's Research Hospital , Memphis, Tennessee , USA
| | | | | | | | - Arzu Onar-Thomas
- St. Jude Children's Research Hospital , Memphis, Tennessee , USA
| | - Ira Dunkel
- Memorial Sloan Kettering Cancer Center, New York , New York , USA
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15
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Fangusaro J, Onar-Thomas A, Poussaint TY, Lensing S, Wu S, Ligon AH, Lindeman N, Stewart CF, Jones DTW, Pfister SM, Smiley NP, Leach J, Packer R, Vezina G, Lenzen A, Jaju A, Goldman S, Doyle LA, Smith M, Fouladi M, Dunkel I. LGG-06. Selumetinib in pediatric patients with non-neurofibromatosis type 1-associated, non-optic pathway (OPG) and non-pilocytic recurrent/progressive low-grade glioma harboring BRAFV600E mutation or BRAF-KIAA1549 fusion: a multicenter prospective Pediatric Brain Tumor Consortium (PBTC) Phase 2 trial. Neuro Oncol 2022. [PMCID: PMC9164871 DOI: 10.1093/neuonc/noac079.322] [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: 11/15/2022] Open
Abstract
Abstract
BACKGROUND: A greater understanding of the Ras-MAP kinase pathway in pediatric low-grade glioma (LGG) paired with the availability of selective inhibitors has enhanced the ability to target this pathway with therapeutic intent. METHODS: The PBTC conducted a multi-institutional phase II study (NCT01089101) evaluating selumetinib (AZD6244, ARRY-142886), a MEK I/II inhibitor, in children with recurrent/progressive LGG assigned to 6 strata and treated at a dose of 25 mg/m2/dose PO BID for up to two years. Here we present stratum 5 which enrolled children without NF1, non-OPG and non-pilocytic LGG harboring either a BRAFV600E mutation or BRAF-KIAA1549 fusion. RESULTS: Twenty-four of 25 children enrolled were eligible; 23 were evaluable for the primary radiologic response endpoint. Enrollment stopped early due to slow accrual and initiation of COG ACNS1931. The most common histologies were ganglioglioma (42%) and astrocytoma NOS (33%). Thirteen tumors (54%) had BRAF-KIAA1549 fusion; 11 (46%) had the BRAFV600E mutation. Five of 23 (22%) evaluable patients achieved a centrally confirmed partial response (PR), 12 (52%) had stable disease and 6 (26%) had progression with a 2-year progression-free survival of 75 + 9%. Four of 11 (36%) patients with a BRAFV600E mutation and 1/12 (8%) with a BRAF-KIAA1549 fusion achieved a PR. The 2-year PFS did not significantly differ between tumors with BRAFV600E mutation (82 + 12%) versus BRAF-KIAA1549 fusion (68 + 13%) (n=24, p=0.548). No patient remains on therapy. The most common attributable toxicities were grade 1/2 ALT/AST elevation, dry skin and leukopenia. Rare grade 3/4 toxicities included elevated CPK, rash, paronychia, fever, weight gain and sinus tachycardia. CONCLUSIONS: Despite lower than planned accrual, selumetinib met the design threshold for success in treating children with recurrent/progressive non-pilocytic, non-OPG LGG without NF1 that harbored the common BRAF aberrations. Ongoing phase 3 prospective studies will better determine the role of this agent in this population.
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Affiliation(s)
- Jason Fangusaro
- Children's Healthcare of Atlanta and Emory University , Atlanta, GA , USA
| | | | | | - Shelly Lensing
- St. Jude Children's Research Hospital , Memphis, TN , USA
| | - Shengjie Wu
- St. Jude Children's Research Hospital , Memphis, TN , USA
| | | | | | | | - David T W Jones
- Kitz Hopp Children's Cancer Research Institute , Heidelberg , Germany
| | - Stefan M Pfister
- Kitz Hopp Children's Cancer Research Institute , Heidelberg , Germany
| | | | - James Leach
- Cincinnati Children's Hospital , Cincinnati, OH , USA
| | - Roger Packer
- DC National Children's Hospital , Washington, DC , USA
| | | | - Alicia Lenzen
- Ann and Robert H. Lurie Children's Hospital , Chicago, IL , USA
| | - Alok Jaju
- Ann and Robert H. Lurie Children's Hospital , Chicago, IL , USA
| | | | | | - Malcolm Smith
- Cancer Therapy Evaluation Program, National Cancer Institute , Bethesda, MD , USA
| | | | - Ira Dunkel
- Memorial Sloan Kettering Cancer Center, New York , NY , USA
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16
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Hoffman LM, Jaimes C, Mankad K, Mirsky DM, Tamrazi B, Tinkle CL, Kline C, Ramasubramanian A, Malbari F, Mangum R, Lindsay H, Horne V, Daniels DJ, Keole S, Grosshans DR, Poussaint TY, Packer R, Cavalheiro S, Bison B, Hankinson TC, Müller HL, Bartels U, Warren KE, Chintagumpala M. IMG-08. Response assessment for pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.284] [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: 11/15/2022] Open
Abstract
Abstract
INTRODUCTION: Craniopharyngioma (CP) is a histologically benign tumor of the pituitary stalk that accounts for 4% of pediatric central nervous system (CNS) tumors. Given its location, CP often causes neuro-endocrine, hypothalamic, and vision dysfunction. Standard therapy consists of maximally safe resection +/- radiation therapy (RT). Medical management, including intra-cystic therapy, may have utility in certain contexts. Survival after CP is excellent, but quality of life is often poor secondary to functional deficits from the tumor and/or treatment. Few prospective CP trials have been performed, and response assessment has not been standardized. METHODS: The Response Assessment in Pediatric Neuro-Oncology (RAPNO) committee, formed of international experts in relevant subspecialties, devised consensus guidelines from published literature and/or expert opinion to assess CP response in prospective clinical trials. RESULTS: Magnetic resonance imaging (MRI) is the recommended radiological modality for baseline and follow-up CP assessment. Computed tomography can be useful for identification of calcification in the initial diagnostic work-up. The committee defined specific standard MRI-based sequences focused on comprehensive evaluation of the suprasellar space. Radiologic CP response is defined by two-dimensional measurements of both solid and cystic tumor components. Three-dimensional measurements are also encouraged in prospective trials. In certain clinical contexts, response of solid and cystic disease may be differentially considered based on their unique natural histories and responses to treatment (including transient cyst growth during or after RT). Importantly, the committee incorporated functional endpoints related to neuro-endocrine and visual assessments into CP response definitions. In most circumstances, cystic disease should be considered progressive only if growth is associated with acute, new-onset or progressive functional impairment. CONCLUSION: CP is a common pediatric CNS tumor for which standardized response parameters have not been defined. A RAPNO committee devised guidelines for baseline and longitudinal assessments of CP to uniformly define response in future prospective trials.
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Affiliation(s)
| | - Camilo Jaimes
- Boston Children's Hospital , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
| | - Kshitij Mankad
- Great Ormond Street Hospital for Children , London , United Kingdom
| | | | - Benita Tamrazi
- Children’s Hospital Los Angeles, Los Angeles , California , USA
| | | | - Cassie Kline
- Children's Hospital of Philadelphia , Philadelphia, Pennsylvania , USA
- University of Pennsylvania , Philadelphia, Pennsylvania , USA
| | | | | | - Ross Mangum
- Phoenix Children's Hospital , Phoenix, Arizona , USA
| | | | | | | | | | | | - Tina Young Poussaint
- Boston Children's Hospital , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
| | - Roger Packer
- Children's National Medical Center , Washington, DC , USA
| | | | | | | | | | - Ute Bartels
- The Hospital for Sick Children , Toronto , Canada
| | - Katherine E Warren
- Boston Children's Hospital , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
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17
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Piccardo A, Albert NL, Borgwardt L, Fahey FH, Hargrave D, Galldiks N, Jehanno N, Kurch L, Law I, Lim R, Lopci E, Marner L, Morana G, Young Poussaint T, Seghers VJ, Shulkin BL, Warren KE, Traub-Weidinger T, Zucchetta P. Joint EANM/SIOPE/RAPNO practice guidelines/SNMMI procedure standards for imaging of paediatric gliomas using PET with radiolabelled amino acids and [ 18F]FDG: version 1.0. Eur J Nucl Med Mol Imaging 2022; 49:3852-3869. [PMID: 35536420 PMCID: PMC9399211 DOI: 10.1007/s00259-022-05817-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/23/2022] [Indexed: 01/18/2023]
Abstract
Positron emission tomography (PET) has been widely used in paediatric oncology. 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is the most commonly used radiopharmaceutical for PET imaging. For oncological brain imaging, different amino acid PET radiopharmaceuticals have been introduced in the last years. The purpose of this document is to provide imaging specialists and clinicians guidelines for indication, acquisition, and interpretation of [18F]FDG and radiolabelled amino acid PET in paediatric patients affected by brain gliomas. There is no high level of evidence for all recommendations suggested in this paper. These recommendations represent instead the consensus opinion of experienced leaders in the field. Further studies are needed to reach evidence-based recommendations for the applications of [18F]FDG and radiolabelled amino acid PET in paediatric neuro-oncology. These recommendations are not intended to be a substitute for national and international legal or regulatory provisions and should be considered in the context of good practice in nuclear medicine. The present guidelines/standards were developed collaboratively by the EANM and SNMMI with the European Society for Paediatric Oncology (SIOPE) Brain Tumour Group and the Response Assessment in Paediatric Neuro-Oncology (RAPNO) working group. They summarize also the views of the Neuroimaging and Oncology and Theranostics Committees of the EANM and reflect recommendations for which the EANM and other societies cannot be held responsible.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Darren Hargrave
- Department of Paediatric Oncology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie Paris, Paris, France
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victor J Seghers
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Barry L Shulkin
- Nuclear Medicine Department of Diagnostic Imaging St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
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18
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Leary SES, Kilburn L, Geyer JR, Kocak M, Huang J, Smith KS, Hadley J, Ermoian R, MacDonald TJ, Goldman S, Phillips P, Young Poussaint T, Olson JM, Ellison DW, Dunkel IJ, Fouladi M, Onar-Thomas A, Northcott PA. Vorinostat and isotretinoin with chemotherapy in young children with embryonal brain tumors: A report from the Pediatric Brain Tumor Consortium (PBTC-026). Neuro Oncol 2021; 24:1178-1190. [PMID: 34935967 PMCID: PMC9248403 DOI: 10.1093/neuonc/noab293] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Embryonal tumors of the CNS are the most common malignant tumors occurring in the first years of life. This study evaluated the feasibility and safety of incorporating novel non-cytotoxic therapy with vorinostat and isotretinoin to an intensive cytotoxic chemotherapy backbone. METHODS PBTC-026 was a prospective multi-institutional clinical trial for children <48 months of age with newly diagnosed embryonal tumors of the CNS. Treatment included three 21-day cycles of induction therapy with vorinostat and isotretinoin, cisplatin, vincristine, cyclophosphamide, and etoposide; three 28-day cycles of consolidation therapy with carboplatin and thiotepa followed by stem cell rescue; and twelve 28-day cycles of maintenance therapy with vorinostat and isotretinoin. Patients with M0 medulloblastoma (MB) received focal radiation following consolidation therapy. Molecular classification was by DNA methylation array. RESULTS Thirty-one patients with median age of 26 months (range 6-46) received treatment on study; 19 (61%) were male. Diagnosis was MB in 20 and supratentorial CNS embryonal tumor in 11. 24/31 patients completed induction therapy within a pre-specified feasibility window of 98 days. Five-year progression-free survival (PFS) and overall survival (OS) for all 31 patients were 55 ± 15 and 61 ± 13, respectively. Five-year PFS was 42 ± 13 for group 3 MB (n = 12); 80 ± 25 for SHH MB (n = 5); 33 ± 19 for embryonal tumor with multilayered rosettes (ETMR, n = 6). CONCLUSION It was safe and feasible to incorporate vorinostat and isotretinoin into an intensive chemotherapy regimen. Further study to define efficacy in this high-risk group of patients is warranted.
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Affiliation(s)
- Sarah E S Leary
- Corresponding Author: Sarah E. S. Leary, MD, MS, Seattle Children’s Hospital, Mail Stop MB.8.501, 4800 Sand Point Way NE, Seattle, WA 98105, USA ()
| | - Lindsay Kilburn
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - J Russell Geyer
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mehmet Kocak
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jie Huang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Kyle S Smith
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jennifer Hadley
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ralph Ermoian
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Tobey J MacDonald
- Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, Georgia, USA
| | - Stewart Goldman
- Department of Child Health, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Peter Phillips
- Department of Pediatric Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tina Young Poussaint
- Department of Radiology, Boston Children’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - James M Olson
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - David W Ellison
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maryam Fouladi
- Department of Pediatric Hematology & Oncology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Paul A Northcott
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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19
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DeWire MD, Fuller C, Campagne O, Lin T, Pan H, Young Poussaint T, Baxter PA, Hwang EI, Bukowinski A, Dorris K, Hoffman L, Waanders AJ, Karajannis MA, Stewart CF, Onar-Thomas A, Fouladi M, Dunkel IJ. A Phase I and Surgical Study of Ribociclib and Everolimus in Children with Recurrent or Refractory Malignant Brain Tumors: A Pediatric Brain Tumor Consortium Study. Clin Cancer Res 2021; 27:2442-2451. [PMID: 33547201 PMCID: PMC8132306 DOI: 10.1158/1078-0432.ccr-20-4078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/16/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Genomic aberrations in cell cycle and PI3K pathways are commonly observed in pediatric brain tumors. This study determined the MTD/recommended phase II dose (RP2D) of ribociclib and everolimus and characterized single-agent ribociclib concentrations in plasma and tumor in children undergoing resection. PATIENTS AND METHODS Patients were enrolled in the phase I study according to a rolling 6 design and received ribociclib and everolimus daily for 21 and 28 days, respectively. Surgical patients received ribociclib at the pediatric RP2D (350 mg/m2) for 7-10 days preoperatively followed by enrollment on the phase I study. Pharmacokinetics were analyzed for both cohorts. RESULTS Sixteen patients were enrolled on the phase I study (median age, 10.3 years; range, 3.9-20.4) and 6 patients in the surgical cohort (median age, 11.4 years; range: 7.2-17.1). Thirteen patients were enrolled at dose level 1 without dose-limiting toxicities (DLT). Two of the 3 patients at dose level 2 experienced DLTs (grade 3 hypertension and grade 4 alanine aminotransferase). The most common grade 3/4 toxicities were lymphopenia, neutropenia, and leukopenia. The RP2D of ribociclib and everolimus was 120 and 1.2 mg/m2 for 21 and 28 days, respectively. Steady-state everolimus exposures with ribociclib were 2.5-fold higher than everolimus administered alone. Ribociclib plasma, tumor concentrations, and cerebrospinal fluid (CSF) samples were collected. The mean tumor-to-plasma ratio of ribociclib was 19.8 (range, 2.22-53.4). CONCLUSIONS Ribociclib and everolimus were well-tolerated and demonstrated pharmacokinetic properties similar to those in adults. Potential therapeutic ribociclib concentrations could be achieved in CSF and tumor tissue, although interpatient variability was observed.
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Affiliation(s)
- Mariko D DeWire
- Department of Pediatrics College of Medicine, Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, University of Cincinnati, Cincinnati, Ohio
| | - Christine Fuller
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pathology, Upstate Medical University, Syracuse, New York
| | - Olivia Campagne
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tong Lin
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Patricia A Baxter
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Eugene I Hwang
- Division of Oncology, Children's National Medical Center, Washington, DC
| | - Andrew Bukowinski
- Division of Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen Dorris
- Division of Oncology, Denver Children's Hospital, Denver, Colorado
| | - Lindsey Hoffman
- Division of Oncology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Angela J Waanders
- Division of Hematology/Oncology, Ann & Robert H Lurie Children's Hospital, Chicago, Illinois
| | - Matthias A Karajannis
- Pediatric Neuro-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Clinton F Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Maryam Fouladi
- Department of Pediatrics College of Medicine, Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, University of Cincinnati, Cincinnati, Ohio
- Hematology/Oncology & BMT, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ira J Dunkel
- Pediatric Neuro-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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20
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Baxter PA, Su JM, Onar-Thomas A, Billups CA, Li XN, Poussaint TY, Smith ER, Thompson P, Adesina A, Ansell P, Giranda V, Paulino A, Kilburn L, Quaddoumi I, Broniscer A, Blaney SM, Dunkel IJ, Fouladi M. A phase I/II study of veliparib (ABT-888) with radiation and temozolomide in newly diagnosed diffuse pontine glioma: a Pediatric Brain Tumor Consortium study. Neuro Oncol 2021; 22:875-885. [PMID: 32009149 DOI: 10.1093/neuonc/noaa016] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A Pediatric Brain Tumor Consortium (PBTC) phase I/II trial of veliparib and radiation followed by veliparib and temozolomide (TMZ) was conducted in children with newly diagnosed diffuse intrinsic pontine glioma (DIPG). The objectives were to: (i) estimate the recommended phase II dose (RP2D) of veliparib with concurrent radiation; (ii) evaluate the pharmacokinetic parameters of veliparib during radiation; (iii) evaluate feasibility of intrapatient TMZ dose escalation; (iv) describe toxicities of protocol therapy; and (v) estimate the overall survival distribution compared with historical series. METHODS Veliparib was given Monday through Friday b.i.d. during radiation followed by a 4-week rest. Patients then received veliparib at 25 mg/m2 b.i.d. and TMZ 135 mg/m2 daily for 5 days every 28 days. Intrapatient dose escalation of TMZ was investigated for patients experiencing minimal toxicity. RESULTS Sixty-six patients (65 eligible) were enrolled. The RP2D of veliparib was 65 mg/m2 b.i.d. with radiation. Dose-limiting toxicities during radiation with veliparib therapy included: grade 2 intratumoral hemorrhage (n = 1), grade 3 maculopapular rash (n = 2), and grade 3 nervous system disorder (generalized neurologic deterioration) (n = 1). Intrapatient TMZ dose escalation during maintenance was not tolerated. Following a planned interim analysis, it was concluded that this treatment did not show a survival benefit compared with PBTC historical controls, and accrual was stopped for futility. The 1- and 2-year overall survival rates were 37.2% (SE 7%) and 5.3% (SE 3%), respectively. CONCLUSION Addition of veliparib to radiation followed by TMZ and veliparib was tolerated but did not improve survival for patients with newly diagnosed DIPG. TRIAL REGISTRATION NCT01514201.
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Affiliation(s)
- Patricia A Baxter
- Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Jack M Su
- Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | | | | | - Xiao-Nan Li
- Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | | | | | - Patrick Thompson
- University of North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Adekunle Adesina
- Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | | | | | - Arnold Paulino
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Susan M Blaney
- Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Van Mater D, Gururangan S, Becher O, Campagne O, Leary S, Phillips JJ, Huang J, Lin T, Poussaint TY, Goldman S, Baxter P, Dhall G, Robinson G, DeWire-Schottmiller M, Hwang EI, Stewart CF, Onar-Thomas A, Dunkel IJ, Fouladi M. A phase I trial of the CDK 4/6 inhibitor palbociclib in pediatric patients with progressive brain tumors: A Pediatric Brain Tumor Consortium study (PBTC-042). Pediatr Blood Cancer 2021; 68:e28879. [PMID: 33405376 PMCID: PMC8414988 DOI: 10.1002/pbc.28879] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Disruption of cell-cycle regulators is a potential therapeutic target for brain tumors in children and adolescents. The aim of this study was to determine the maximum tolerated dose (MTD) and describe toxicities related to palbociclib, a selective cyclin-dependent kinase 4/6 (CDK4/6) inhibitor in pediatric patients with progressive/refractory brain tumors with intact retinoblastoma protein. METHODS Palbociclib was administered orally starting at 50 mg/m2 daily for the first 21 days of a 28-day course. Dose escalation was according to the Rolling-6 statistical design in less heavily (stratum I) and heavily pretreated (stratum II) patients, and MTD was determined separately for each group. Pharmacokinetic studies were performed during the first course, and pharmacodynamic studies were conducted to evaluate relationships between drug levels and toxicities. RESULTS A total of 21 patients were enrolled on stratum I and 14 patients on stratum II. The MTD for both strata was 75 mg/m2 . Palbociclib absorption (mean Tmax between 4.9 and 6.6 h) and elimination (mean half-life between 11.3 and 19.5 h) were assessed. The most common toxicity was myelosuppression. Higher palbociclib exposure was associated with grade 3/4 neutropenia and leukopenia. Dose limiting toxicities included grade 4 neutropenia and grade 3 thrombocytopenia and dehydration. No patients had an objective response to palbociclib therapy. CONCLUSIONS Palbociclib was safely administered to children and adolescents at a dosage of 75 mg/m2 for 21 consecutive days followed by seven days of rest in both strata. Future studies will establish its optimal utilization in pediatric patients with brain tumors.
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Affiliation(s)
- David Van Mater
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Sridharan Gururangan
- Preston A. Wells Center for Brain Tumor Therapy, McKnight Brain Institute, Department of Neurosurgery, University of Florida, Gainesville, FL
| | - Oren Becher
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Olivia Campagne
- Pharmaceutical Sciences Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sarah Leary
- Division of Pediatrics, Seattle Children’s Hospital, Seattle WA
| | - Joanna J. Phillips
- Departments of Neurological Surgery and Pathology, University of California San Francisco, San Francisco, CA
| | - Jie Huang
- Department of Biostatistics, St Jude Children’s Hospital, Memphis TN
| | - Tong Lin
- Department of Biostatistics, St Jude Children’s Hospital, Memphis TN
| | | | - Stewart Goldman
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Patricia Baxter
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
| | - Girish Dhall
- Division of Hematology and Oncology, Children’s of Alabama, Birmingham, AL
| | - Giles Robinson
- Division of Neuro-Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Eugene I. Hwang
- Children’s National Medical Center, Washington, District of Columbia
| | - Clinton F. Stewart
- Pharmaceutical Sciences Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Arzu Onar-Thomas
- Department of Biostatistics, St Jude Children’s Hospital, Memphis TN
| | - Ira J. Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maryam Fouladi
- Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH
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22
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Fangusaro J, Onar-Thomas A, Poussaint TY, Wu S, Ligon AH, Lindeman N, Campagne O, Banerjee A, Gururangan S, Kilburn L, Goldman S, Qaddoumi I, Baxter P, Vezina G, Bregman C, Patay Z, Jones JY, Stewart CF, Fisher MJ, Doyle LA, Smith M, Dunkel IJ, Fouladi M. A Phase 2 Trial of Selumetinib in Children with Recurrent Optic Pathway and Hypothalamic Low-Grade Glioma without NF1: A Pediatric Brain Tumor Consortium Study. Neuro Oncol 2021; 23:1777-1788. [PMID: 33631016 DOI: 10.1093/neuonc/noab047] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pediatric low-grade gliomas (pLGGs) are the most common childhood brain tumor. Progression-free survival (PFS) is much lower than overall survival, emphasizing the need for alternative treatments. Sporadic (without neurofibromatosis type-1) optic pathway and hypothalamic glioma (OPHGs) are often multiply recurrent and cause significant visual deficits. Recently, there has been a prioritization of functional outcomes. METHODS We present results from children with recurrent/progressive OPHGs treated on a PBTC phase 2 trial evaluating efficacy of selumetinib, (AZD6244, ARRY-142886) a MEK-1/2 inhibitor. Stratum 4 of PBTC-029 included patients with sporadic recurrent/progressive OPHGs treated with selumetinib at the recommended phase 2 dose (25mg/m 2 /dose BID) for a maximum of 26 courses. RESULTS Twenty-five eligible and evaluable patients were enrolled with a median of 4 (1-11) previous therapies. Six of 25 (24%) had partial response, 14/25 (56%) had stable disease and 5 (20%) had progressive disease while on treatment. The median treatment courses were 26 (2-26); 14/25 patients completed all 26 courses. Two-year PFS was 78 ± 8.5%. Nineteen of 25 patients were evaluable for visual acuity which improved in 4/19 patients (21%), was stable in 13/19 (68%) and worsened in 2/19 (11%). Five of 19 patients (26%) had improved visual fields and 14/19 (74%) were stable. The most common toxicities were grade 1/2 CPK elevation, anemia, diarrhea, headache, nausea/emesis, fatigue, AST and ALT increase, hypoalbuminemia and rash. CONCLUSIONS Selumetinib was tolerable and led to responses and prolonged disease stability in children with recurrent/progressive OPHGs based upon radiographic response, PFS and visual outcomes.
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Affiliation(s)
- Jason Fangusaro
- Department of Hematology, Oncology, and Stem Cell Transplantation. Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | | | - Shengjie Wu
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Azra H Ligon
- Department of Pathology. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal Lindeman
- Department of Pathology. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivia Campagne
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Anu Banerjee
- Center for Cancer and Blood Disorders. University of California, San Francisco, CA
| | | | - Lindsay Kilburn
- Division of Oncology (LBK) and Department of Radiology (GV). Children's National Hospital, Washington DC
| | - Stewart Goldman
- Department of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplantation (SG) and Department of Medical Imaging (CB). Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ibrahim Qaddoumi
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Patricia Baxter
- Department of Hematology and Oncology. Texas Children's Hospital, Houston, TX, USA
| | - Gilbert Vezina
- Division of Oncology (LBK) and Department of Radiology (GV). Children's National Hospital, Washington DC
| | - Corey Bregman
- Department of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplantation (SG) and Department of Medical Imaging (CB). Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Zoltan Patay
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Jeremy Y Jones
- Department of Radiology (JYJ) and Department of Hematology and Oncology (MF). Nationwide Children's Hospital, Columbus, OH
| | - Clinton F Stewart
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Michael J Fisher
- Division of Oncology. The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laurence Austin Doyle
- Investigational Drug Branch (LAD) and Clinical Investigation Branch (MS). National Cancer Institute and Cancer Therapy Evaluation Program, Rockville, MD
| | - Malcolm Smith
- Investigational Drug Branch (LAD) and Clinical Investigation Branch (MS). National Cancer Institute and Cancer Therapy Evaluation Program, Rockville, MD
| | - Ira J Dunkel
- Department of Pediatrics. Memorial Sloan Kettering Cancer Center, NY
| | - Maryam Fouladi
- Department of Radiology (JYJ) and Department of Hematology and Oncology (MF). Nationwide Children's Hospital, Columbus, OH
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23
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Cooney T, Cohen KJ, Guimaraes CV, Dhall G, Leach J, Massimino M, Erbetta A, Chiapparini L, Malbari F, Kramer K, Pollack IF, Baxter P, Laughlin S, Patay Z, Poussaint TY, Warren KE. IMG-09. RESPONSE ASSESSMENT IN DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG): RECOMMENDATIONS FROM THE RESPONSE ASSESSMENT IN PEDIATRIC NEURO-ONCOLOGY COMMITTEE. Neuro Oncol 2020. [PMCID: PMC7715248 DOI: 10.1093/neuonc/noaa222.345] [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: 11/23/2022] Open
Abstract
Optimizing the conduct of clinical trials for diffuse intrinsic pontine glioma (DIPG) involves use of consistent, objective disease assessments and standardized response criteria. The Response Assessment in Pediatric Neuro-Oncology (RAPNO) committee, an international panel of pediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address unique challenges in assessing response in children with CNS tumors. A subcommittee of RAPNO was formed to specifically address response assessment in children and young adults with DIPG and to develop a consensus on recommendations for response assessment. Distinct issues related to the response assessment of DIPG include its definition and recent molecular classifications, dearth of imaging response data, the phenomena of pseudoprogression, and measuring response in the era of focal drug delivery. The committee has recommended response be assessed using magnetic resonance imaging (MRI) of brain and spine, neurologic examination, and use of supportive medication, i.e. steroids and anti-angiogenic agents. Clinical imaging standards and imaging quality control are defined. Unique recommendations for DIPG response include an eight-week response duration, a twenty-five percent decrease for partial response, and the distinction of pontine and extra-pontine response for trials that use focal drug delivery. The recommendations presented here represent an initial effort to uniformly collect and evaluate response assessment criteria; these recommendations can now be incorporated into clinical trials to assess feasibility and corroboration with patient outcomes.
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Affiliation(s)
| | | | | | - Girish Dhall
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Leach
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Kim Kramer
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian F Pollack
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Zoltan Patay
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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24
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Lindsay H, Onar-Thomas A, Kocak M, Poussaint TY, Dhall G, Broniscer A, Vinitsky A, MacDonald T, Trifan O, Fangusaro J, Dunkel I. EPCT-02. PBTC-051: FIRST IN PEDIATRICS PHASE 1 STUDY OF CD40 AGONISTIC MONOCLONAL ANTIBODY APX005M IN PEDIATRIC SUBJECTS WITH RECURRENT/REFRACTORY BRAIN TUMORS. Neuro Oncol 2020. [PMCID: PMC7715375 DOI: 10.1093/neuonc/noaa222.127] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
CD40 is a co-stimulatory molecule expressed on antigen presenting cells (APCs). APX005M is a CD40 agonist monoclonal antibody which stimulates innate and adaptive anti-tumor immunity through activation of APCs, macrophages, and antigen-specific CD8+T-cells. Pediatric Brain Tumor Consortium study PBTC-051 is the first investigation of APX005M in pediatric patients and is evaluating the safety, recommended phase 2 dose (RP2D), pharmacokinetics, and preliminary efficacy of APX005M in children with central nervous system (CNS) tumors.
RESULTS
Accrual of patients with recurrent/refractory primary malignant CNS tumors (stratum 1) began in March 2018. 16 patients (2 ineligible) have enrolled on this stratum; 14 were treated. Dose escalation through 3 planned dose levels of APX005M was completed without excessive or unanticipated toxicities. The highest dose level (0.6 mg/kg q3 weeks) is the presumptive RP2D, and an expansion cohort is currently enrolling at this dose. 2 patients at dose level 3 have received >12 cycles of therapy. Grade 3 or higher adverse events at least possibly attributable to APX005M include 11 lymphopenia, 5 neutropenia, 5 leukopenia, 3 ALT elevations, 1 AST elevation, 1 thrombocytopenia, and 1 hypoalbuminemia. PK data will be available March 2020. Stratum 2 is now enrolling patients with post-radiation/pre-progression DIPG beginning at dose level 2, with 1 patient currently enrolled.
CONCLUSION
The CD40 agonistic antibody APX005M has demonstrated preliminary safety in pediatric patients with recurrent/refractory primary malignant CNS tumors and has a likely RP2D of 0.6 mg/kg q3 weeks in this population. Preliminary efficacy data are pending.
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Affiliation(s)
- Holly Lindsay
- Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St Jude Children’s Hospital, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Girish Dhall
- Division of Hematology and Oncology, Children’s of Alabama, Birmingham, AL, USA
| | | | - Anna Vinitsky
- Division of Neuro-Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tobey MacDonald
- Children’s Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | | | - Jason Fangusaro
- Children’s Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Ira Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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25
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Fangusaro J, Witt O, Driever PH, Bag A, de Blank P, Kadom N, Kilburn L, Lober R, Robison N, Fisher M, Packer R, Poussaint TY, Papusha L, Avula S, Brandes A, Bouffet E, Bowers D, Artemov A, Chintagumpala M, Zurakowski D, van den Bent M, Bison B, Yeom K, Taal W, Warren K. IMG-03. RESPONSE ASSESSMENT IN PEDIATRIC LOW-GRADE GLIOMA: RECOMMENDATIONS FROM THE RESPONSE ASSESSMENT IN PEDIATRIC NEURO-ONCOLOGY (RAPNO) WORKING GROUP. Neuro Oncol 2020. [PMCID: PMC7715927 DOI: 10.1093/neuonc/noaa222.339] [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: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Pediatric low-grade gliomas (pLGG) show clinical and biological features that are distinct from their adult counterparts. Consequently, additional considerations are needed for response assessment in children compared to the established adult Response Assessment in Neuro-Oncology (RANO) criteria. Standardized response criteria in pediatric clinical trials are lacking, complicating comparisons of responses across studies. We therefore established an international committee of the Radiologic Assessment in Pediatric Neuro-Oncology (RAPNO) working group to develop consensus recommendations for response assessment in pLGG.
METHODS
The committee consisted of 25 international experts in the areas of Pediatric Neuro-Oncology, Neuroradiology and Neurosurgery. The committee first developed a set of agreed upon topics they deemed necessary to understand the controversies of imaging utilization and assessment in pLGG. These topics were divided up among the committee members who presented all available literature to the entire RAPNO committee via web teleconference. Once presented, the group discussed these data and developed consensus statements and recommendations based on available literature, committee expertise and clinical experience. Each topic was discussed until a consensus was reached.
RESULTS
Final consensus included recommendations about the following topics: specific imaging sequences, advanced imaging techniques, NF1-associated pLGG, molecular and histologic classification, assessment of cysts, vision and other functional outcomes as well as overall radiologic response assessment.
CONCLUSIONS
The RAPNO pLGG consensus establishes systemic recommendations that represent an initial effort to uniformly collect and assess response in pLGG. These recommendations should now be evaluated internationally and prospectively in an effort to assess clinical utility, validate and modify as appropriate.
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Affiliation(s)
- Jason Fangusaro
- Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Olas Witt
- Hopp Children’s Cancer Center (KiTZ), University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pablo Hernaiz Driever
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Asim Bag
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Peter de Blank
- University of Cincinnati and Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Nadja Kadom
- Emory University and the Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Robert Lober
- Dayton Children’s Hospital and Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Nathan Robison
- Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Michael Fisher
- The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roger Packer
- Children’s National Hospital, Washington, DC, USA
| | | | - Ludmila Papusha
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Moscow, Russian Federation
| | - Shivaram Avula
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Anton Artemov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | | | - David Zurakowski
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Kristen Yeom
- Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA
| | - Walter Taal
- Erasmus University MC Cancer Institute, Rotterdam, Netherlands
| | - Katherine Warren
- Dana Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
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Fangusaro J, Onar-Thomas A, Wu S, Poussaint TY, Packer R, Kilburn L, Qaddoumi I, Dhall G, Pollack IF, Lenzen A, Partap S, Fouladi M, Dunkel I. LGG-04. A PHASE II RE-TREATMENT STUDY OF SELUMETINIB FOR RECURRENT OR PROGRESSIVE PEDIATRIC LOW-GRADE GLIOMA (pLGG): A PEDIATRIC BRAIN TUMOR CONSORTIUM (PBTC) STUDY. Neuro Oncol 2020. [PMCID: PMC7715425 DOI: 10.1093/neuonc/noaa222.389] [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: 11/15/2022] Open
Abstract
The PBTC conducted a re-treatment study (NCT01089101) evaluating selumetinib (AZD6244, ARRY-142886), a MEK I/II inhibitor, in children with recurrent/progressive pLGG. Eligible patients must have previously enrolled on PBTC-029 or PBTC-029B and progressed after coming off treatment with selumetinib. Patients must have maintained stable disease (SD) for ≥12 courses or had a sustained radiographic response (partial or complete) during their first exposure to selumetinib. Thirty-five eligible patients (median age: 13.11 years [range 7.96–25.33]) were enrolled, 57% of whom had optic pathway or hypothalamic target lesions. At the time of submission, median duration of treatment was 18 courses (range 2–48) and 21 subjects remained on therapy. Best responses reported to date are 6/35 (17%) partial response, 22/35 (63%) SD and 7/35 (20%) progressive disease with a 2-year progression-free survival of 75.7 + 8.3%, which met the design parameters for success. The most common attributable toxicities were grade 1 diarrhea, elevated AST, hypoalbuminemia, elevated CPK, maculo-papular rash, fatigue, paronychia, ALT elevation, acneiform rash and grade 2 CPK elevation. Rare grade 3 toxicities included CPK elevation (3), lymphopenia (2), paronychia (2) and ALT elevation (2). There was only one grade 4 CPK elevation. Five patients (14%) required dose reductions due to toxicity. There does not appear to be a notable difference in toxicities observed during initial selumetinib therapy versus re-treatment. In pLGG that has recurred/progressed following treatment with selumetinib, re-treatment with selumetinib appears to be effective with 80% of patients again achieving response or prolonged stable disease. Long-term follow-up is ongoing.
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Affiliation(s)
- Jason Fangusaro
- Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Shengjie Wu
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Roger Packer
- Children’s National Hospital, Washington, DC, USA
| | | | | | - Girish Dhall
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ian F Pollack
- Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sonia Partap
- Stanford University & Lucile Packard Children’s Hospital, Palo Alto, CA, USA
| | | | - Ira Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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27
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Quon JL, Bala W, Chen LC, Wright J, Kim LH, Han M, Shpanskaya K, Lee EH, Tong E, Iv M, Seekins J, Lungren MP, Braun KRM, Poussaint TY, Laughlin S, Taylor MD, Lober RM, Vogel H, Fisher PG, Grant GA, Ramaswamy V, Vitanza NA, Ho CY, Edwards MSB, Cheshier SH, Yeom KW. Deep Learning for Pediatric Posterior Fossa Tumor Detection and Classification: A Multi-Institutional Study. AJNR Am J Neuroradiol 2020; 41:1718-1725. [PMID: 32816765 PMCID: PMC7583118 DOI: 10.3174/ajnr.a6704] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Posterior fossa tumors are the most common pediatric brain tumors. MR imaging is key to tumor detection, diagnosis, and therapy guidance. We sought to develop an MR imaging-based deep learning model for posterior fossa tumor detection and tumor pathology classification. MATERIALS AND METHODS The study cohort comprised 617 children (median age, 92 months; 56% males) from 5 pediatric institutions with posterior fossa tumors: diffuse midline glioma of the pons (n = 122), medulloblastoma (n = 272), pilocytic astrocytoma (n = 135), and ependymoma (n = 88). There were 199 controls. Tumor histology served as ground truth except for diffuse midline glioma of the pons, which was primarily diagnosed by MR imaging. A modified ResNeXt-50-32x4d architecture served as the backbone for a multitask classifier model, using T2-weighted MRIs as input to detect the presence of tumor and predict tumor class. Deep learning model performance was compared against that of 4 radiologists. RESULTS Model tumor detection accuracy exceeded an AUROC of 0.99 and was similar to that of 4 radiologists. Model tumor classification accuracy was 92% with an F1 score of 0.80. The model was most accurate at predicting diffuse midline glioma of the pons, followed by pilocytic astrocytoma and medulloblastoma. Ependymoma prediction was the least accurate. Tumor type classification accuracy and F1 score were higher than those of 2 of the 4 radiologists. CONCLUSIONS We present a multi-institutional deep learning model for pediatric posterior fossa tumor detection and classification with the potential to augment and improve the accuracy of radiologic diagnosis.
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Affiliation(s)
- J L Quon
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - W Bala
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | | | - J Wright
- Department of Radiology (J.W.), Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - L H Kim
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - M Han
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - K Shpanskaya
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - E H Lee
- Electrical Engineering (E.H.L.)
| | | | | | - J Seekins
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | - M P Lungren
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | - K R M Braun
- Departments of Clinical Radiology & Imaging Sciences (K.R.M.B., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - T Y Poussaint
- Departments of Radiology (T.Y.P.), Boston Children's Hospital, Boston, Massachusetts
| | - S Laughlin
- Departments of diagnostic Imaging (S.L.)
| | | | - R M Lober
- Department of Neurosurgery (R.M.L.), Dayton Children's Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - H Vogel
- and Pathology (H.V.), Stanford University, Stanford, California
| | - P G Fisher
- Division of Child Neurology (P.G.F.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - G A Grant
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - V Ramaswamy
- and Haematology/Oncology (V.R.), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle Washington.,Fred Hutchinson Cancer Research Center (N.A.V.), Seattle, Washington
| | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (K.R.M.B., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - M S B Edwards
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - S H Cheshier
- Departments of Neurosurgery (S.H.C.), University of Utah School of Medicine, Salt Lake City, Utah
| | - K W Yeom
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
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28
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Cooney TM, Cohen KJ, Guimaraes CV, Dhall G, Leach J, Massimino M, Erbetta A, Chiapparini L, Malbari F, Kramer K, Pollack IF, Baxter P, Laughlin S, Patay Z, Young Poussaint T, Warren KE. Response assessment in diffuse intrinsic pontine glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol 2020; 21:e330-e336. [PMID: 32502459 DOI: 10.1016/s1470-2045(20)30166-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
Optimising the conduct of clinical trials for diffuse intrinsic pontine glioma involves use of consistent, objective disease assessments and standardised response criteria. The Response Assessment in Pediatric Neuro-Oncology working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. A working group was formed specifically to address response assessment in children and young adults with diffuse intrinsic pontine glioma and to develop a consensus on recommendations for response assessment. Response should be assessed using MRI of brain and spine, neurological examination, and anti-inflammatory or antiangiogenic drugs. Clinical imaging standards are defined. As with previous consensus recommendations, these recommendations will need to be validated in prospective clinical trials.
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Affiliation(s)
- Tabitha M Cooney
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kenneth J Cohen
- Departments of Pediatrics and Oncology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Girish Dhall
- Department of Pediatrics, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maura Massimino
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luisa Chiapparini
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fatema Malbari
- Department of Pediatrics, Section of Neurology and Developmental Neurosciences, Texas Children's Hospital, Houston, TX, USA
| | - Kim Kramer
- Department of Pediatric Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Patricia Baxter
- Section of Pediatric Hematology-Oncology, Texas Children's Hospital, Houston, TX, USA
| | - Suzanne Laughlin
- Department of Medical Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zoltán Patay
- Department of Radiology, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Katherine E Warren
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Institute, Boston, MA, USA.
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29
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Fangusaro J, Witt O, Hernáiz Driever P, Bag AK, de Blank P, Kadom N, Kilburn L, Lober RM, Robison NJ, Fisher MJ, Packer RJ, Young Poussaint T, Papusha L, Avula S, Brandes AA, Bouffet E, Bowers D, Artemov A, Chintagumpala M, Zurakowski D, van den Bent M, Bison B, Yeom KW, Taal W, Warren KE. Response assessment in paediatric low-grade glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol 2020; 21:e305-e316. [PMID: 32502457 DOI: 10.1016/s1470-2045(20)30064-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/23/2022]
Abstract
Paediatric low-grade gliomas (also known as pLGG) are the most common type of CNS tumours in children. In general, paediatric low-grade gliomas show clinical and biological features that are distinct from adult low-grade gliomas, and the developing paediatric brain is more susceptible to toxic late effects of the tumour and its treatment. Therefore, response assessment in children requires additional considerations compared with the adult Response Assessment in Neuro-Oncology criteria. There are no standardised response criteria in paediatric clinical trials, which makes it more difficult to compare responses across studies. The Response Assessment in Pediatric Neuro-Oncology working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. We established a subcommittee to develop consensus recommendations for response assessment in paediatric low-grade gliomas. Final recommendations were based on literature review, current practice, and expert opinion of working group members. Consensus recommendations include imaging response assessments, with additional guidelines for visual functional outcomes in patients with optic pathway tumours. As with previous consensus recommendations, these recommendations will need to be validated in prospective clinical trials.
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Affiliation(s)
- Jason Fangusaro
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Aflac Cancer Center, Emory University and the Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Olaf Witt
- Department CCU Pediatric Oncology, Hopp Children's Cancer Center (KiTZ), University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Asim K Bag
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Peter de Blank
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nadja Kadom
- Pediatric Neuroradiology, Emory University and the Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lindsay Kilburn
- Department of Hematology and Oncology, National Medical Center, Washington, DC, USA
| | - Robert M Lober
- Department of Neurosurgery, Dayton Children's Hospital and Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Nathan J Robison
- Division of Hematology and Oncology, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Michael J Fisher
- Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, DC, USA
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ludmila Papusha
- Department of Neuro-Oncology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Alba A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daniel Bowers
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Anton Artemov
- Department of Neuro-Oncology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | | | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Brigitte Bison
- Diagnostic and Interventional Radiology, Universitatsklinikum Würzburg, Würzburg, Germany
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Walter Taal
- Department of Neurology/Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Institute, Boston, MA, USA
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30
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Jaimes C, Vajapeyam S, Brown D, Kao PC, Ma C, Greenspan L, Gupta N, Goumnerova L, Bandopahayay P, Dubois F, Greenwald NF, Zack T, Shapira O, Beroukhim R, Ligon KL, Chi S, Kieran MW, Wright KD, Poussaint TY. MR Imaging Correlates for Molecular and Mutational Analyses in Children with Diffuse Intrinsic Pontine Glioma. AJNR Am J Neuroradiol 2020; 41:874-881. [PMID: 32381545 DOI: 10.3174/ajnr.a6546] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/16/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Recent advances in molecular techniques have characterized distinct subtypes of diffuse intrinsic pontine gliomas. Our aim was the identification of MR imaging correlates of these subtypes. MATERIALS AND METHODS Initial MRIs from subjects with diffuse intrinsic pontine gliomas recruited for a prospective clinical trial before treatment were analyzed. Retrospective imaging analyses included FLAIR/T2 tumor volume, tumor volume enhancing, the presence of cyst and/or necrosis, median, mean, mode, skewness, kurtosis of ADC tumor volume based on FLAIR, and enhancement at baseline. Molecular subgroups based on EGFR and MGMT mutations were established. Histone mutations were also determined (H3F3A, HIST1H3B, HIST1H3C). Univariate Cox proportional hazards regression was used to test the association of imaging predictors with overall and progression-free survival. Wilcoxon rank sum, Kruskal-Wallis, and Fisher exact tests were used to compare imaging measures among groups. RESULTS Fifty patients had biopsy and MR imaging. The median age at trial registration was 6 years (range, 3.3-17.5 years); 52% were female. On the basis of immunohistochemical results, 48 patients were assigned to 1 of 4 subgroups: 28 in MGMT-/epidermal growth factor receptor (EGFR)-, 14 in MGMT-/EGFR+, 3 in MGMT+/EGFR-, and 3 in MGMT+/EGFR+. Twenty-three patients had histone mutations in H3F3A, 8 in HIST1H3B, and 3 in HIST1H3C. Enhancing tumor volume was near-significantly different across molecular subgroups (P = .04), after accounting for the false discovery rate. Tumor volume enhancing, median, mode, skewness, and kurtosis ADC T2-FLAIR/T2 were significantly different (P ≤ .048) between patients with H3F3A and HIST1H3B/C mutations. CONCLUSIONS MR imaging features including enhancement and ADC histogram parameters are correlated with molecular subgroups and mutations in children with diffuse intrinsic pontine gliomas.
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Affiliation(s)
- C Jaimes
- From the Departments of Radiology (C.J., S.V., T.Y.P.).,Fetal-Neonatal Neuroimaging and Developmental Science Center (C.J.), Division of Newborn Medicine; Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - S Vajapeyam
- From the Departments of Radiology (C.J., S.V., T.Y.P.).,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - D Brown
- Tumor Imaging Metrics Core (D.B.), Massachusetts General Hospital, Boston, Massachusetts
| | - P-C Kao
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts
| | - C Ma
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - L Greenspan
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts
| | - N Gupta
- Department of Pediatric Neurosurgery (N.G.), University of California San Francisco Benioff Children's Hospital, San Francisco, California.,University of California San Francisco School of Medicine (N.G., T.Z.), San Francisco, California
| | | | - P Bandopahayay
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - F Dubois
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - N F Greenwald
- Stanford University School of Medicine (N.F.G.), Palo Alto, California
| | - T Zack
- University of California San Francisco School of Medicine (N.G., T.Z.), San Francisco, California
| | - O Shapira
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Broad Institute of Massachusetts Institute of Technology and Harvard University (O.S.), Cambridge, Massachusetts
| | - R Beroukhim
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - K L Ligon
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Department of Pathology (K.L.L.), Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - S Chi
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - M W Kieran
- Clinical Trials Division (M.W.K.), Bristol-Myers-Squibb, New York, New York
| | - K D Wright
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - T Y Poussaint
- From the Departments of Radiology (C.J., S.V., T.Y.P.) .,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
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31
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Vajapeyam S, Brown D, Billups C, Patay Z, Vezina G, Shiroishi MS, Law M, Baxter P, Onar-Thomas A, Fangusaro JR, Dunkel IJ, Poussaint TY. Advanced ADC Histogram, Perfusion, and Permeability Metrics Show an Association with Survival and Pseudoprogression in Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium. AJNR Am J Neuroradiol 2020; 41:718-724. [PMID: 32241771 DOI: 10.3174/ajnr.a6499] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Diffuse intrinsic pontine glioma is a lethal childhood brain cancer with dismal prognosis and MR imaging is the primary methodology used for diagnosis and monitoring. Our aim was to determine whether advanced diffusion, perfusion, and permeability MR imaging metrics predict survival and pseudoprogression in children with newly diagnosed diffuse intrinsic pontine glioma. MATERIALS AND METHODS A clinical trial using the poly (adenosine diphosphate ribose) polymerase (PARP) inhibitor veliparib concurrently with radiation therapy, followed by maintenance therapy with veliparib + temozolomide, in children with diffuse intrinsic pontine glioma was conducted by the Pediatric Brain Tumor Consortium. Standard MR imaging, DWI, dynamic contrast-enhanced perfusion, and DSC perfusion were performed at baseline and approximately every 2 months throughout treatment. ADC histogram metrics of T2-weighted FLAIR and enhancing tumor volume, dynamic contrast-enhanced permeability metrics for enhancing tumors, and tumor relative CBV from DSC perfusion MR imaging were calculated. Baseline values, post-radiation therapy changes, and longitudinal trends for all metrics were evaluated for associations with survival and pseudoprogression. RESULTS Fifty children were evaluable for survival analyses. Higher baseline relative CBV was associated with shorter progression-free survival (P = .02, Q = 0.089) and overall survival (P = .006, Q = 0.055). Associations of higher baseline mean transfer constant from the blood plasma into the extravascular extracellular space with shorter progression-free survival (P = .03, Q = 0.105) and overall survival (P = .03, Q = 0.102) trended toward significance. An increase in relative CBV with time was associated with shorter progression-free survival (P < .001, Q < 0.001) and overall survival (P = .004, Q = 0.043). Associations of longitudinal mean extravascular extracellular volume fraction with progression-free survival (P = .03, Q = 0.104) and overall survival (P = .03, Q = 0.105) and maximum transfer constant from the blood plasma into the extravascular extracellular space with progression-free survival (P = .03, Q = 0.102) trended toward significance. Greater increases with time were associated with worse outcomes. True radiologic progression showed greater post-radiation therapy decreases in mode_ADC_FLAIR compared with pseudoprogression (means, -268.15 versus -26.11, P = .01.) CONCLUSIONS: ADC histogram, perfusion, and permeability MR imaging metrics in diffuse intrinsic pontine glioma are useful in predicting survival and pseudoprogression.
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Affiliation(s)
- S Vajapeyam
- From the Radiology (S.V., T.Y.P.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - D Brown
- DF/HCC Tumor Imaging Metrics Core (D.B.), Massachusetts General Hospital, Boston, Massachusetts
| | | | - Z Patay
- Diagnostic Imaging (Z.P.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - G Vezina
- Radiology (G.V.), Children's National Medical Center, Washington, DC
| | - M S Shiroishi
- Radiology (M.S.S.), Keck Medical Center of USC, Los Angeles, California
| | - M Law
- Neuroscience (M.L.), Monash University, Melbourne, Australia
| | - P Baxter
- Cancer and Hematology Center (P.B.), Texas Children's Hospital, Houston, Texas
| | | | - J R Fangusaro
- Aflac Cancer and Blood Disorders Center (J.R.F.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - I J Dunkel
- Pediatrics (I.J.D.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - T Y Poussaint
- From the Radiology (S.V., T.Y.P.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Fangusaro J, Onar-Thomas A, Young Poussaint T, Wu S, Ligon AH, Lindeman N, Banerjee A, Packer RJ, Kilburn LB, Goldman S, Pollack IF, Qaddoumi I, Jakacki RI, Fisher PG, Dhall G, Baxter P, Kreissman SG, Stewart CF, Jones DTW, Pfister SM, Vezina G, Stern JS, Panigrahy A, Patay Z, Tamrazi B, Jones JY, Haque SS, Enterline DS, Cha S, Fisher MJ, Doyle LA, Smith M, Dunkel IJ, Fouladi M. Selumetinib in paediatric patients with BRAF-aberrant or neurofibromatosis type 1-associated recurrent, refractory, or progressive low-grade glioma: a multicentre, phase 2 trial. Lancet Oncol 2019; 20:1011-1022. [PMID: 31151904 DOI: 10.1016/s1470-2045(19)30277-3] [Citation(s) in RCA: 277] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Paediatric low-grade glioma is the most common CNS tumour of childhood. Although overall survival is good, disease often recurs. No single universally accepted treatment exists for these patients; however, standard cytotoxic chemotherapies are generally used. We aimed to assess the activity of selumetinib, a MEK1/2 inhibitor, in these patients. METHODS The Pediatric Brain Tumor Consortium performed a multicentre, phase 2 study in patients with paediatric low-grade glioma in 11 hospitals in the USA. Patients aged 3-21 years with a Lansky or Karnofsky performance score greater than 60 and the presence of recurrent, refractory, or progressive paediatric low-grade glioma after at least one standard therapy were eligible for inclusion. Patients were assigned to six unique strata according to histology, tumour location, NF1 status, and BRAF aberration status; herein, we report the results of strata 1 and 3. Stratum 1 comprised patients with WHO grade I pilocytic astrocytoma harbouring either one of the two most common BRAF aberrations (KIAA1549-BRAF fusion or the BRAFV600E [Val600Glu] mutation). Stratum 3 comprised patients with any neurofibromatosis type 1 (NF1)-associated paediatric low-grade glioma (WHO grades I and II). Selumetinib was provided as capsules given orally at the recommended phase 2 dose of 25 mg/m2 twice daily in 28-day courses for up to 26 courses. The primary endpoint was the proportion of patients with a stratum-specific objective response (partial response or complete response), as assessed by the local site and sustained for at least 8 weeks. All responses were reviewed centrally. All eligible patients who initiated treatment were evaluable for the activity and toxicity analyses. Although the trial is ongoing in other strata, enrolment and planned follow-up is complete for strata 1 and 3. This trial is registered with ClinicalTrials.gov, number NCT01089101. FINDINGS Between July 25, 2013, and June 12, 2015, 25 eligible and evaluable patients were accrued to stratum 1, and between Aug 28, 2013, and June 25, 2015, 25 eligible and evaluable patients were accrued to stratum 3. In stratum 1, nine (36% [95% CI 18-57]) of 25 patients achieved a sustained partial response. The median follow-up for the 11 patients who had not had a progression event by Aug 9, 2018, was 36·40 months (IQR 21·72-45·59). In stratum 3, ten (40% [21-61]) of 25 patients achieved a sustained partial response; median follow-up was 48·60 months (IQR 39·14-51·31) for the 17 patients without a progression event by Aug 9, 2018. The most frequent grade 3 or worse adverse events were elevated creatine phosphokinase (five [10%]) and maculopapular rash (five [10%]). No treatment-realted deaths were reported. INTERPRETATION Selumetinib is active in recurrent, refractory, or progressive pilocytic astrocytoma harbouring common BRAF aberrations and NF1-associated paediatric low-grade glioma. These results show that selumetinib could be an alternative to standard chemotherapy for these subgroups of patients, and have directly led to the development of two Children's Oncology Group phase 3 studies comparing standard chemotherapy to selumetinib in patients with newly diagnosed paediatric low-grade glioma both with and without NF1. FUNDING National Cancer Institute Cancer Therapy Evaluation Program, the American Lebanese Syrian Associated Charities, and AstraZeneca.
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Affiliation(s)
- Jason Fangusaro
- Department of Hematology, Oncology, and Stem Cell Transplantation, Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA.
| | - Arzu Onar-Thomas
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Shengjie Wu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Azra H Ligon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal Lindeman
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anuradha Banerjee
- Center for Cancer and Blood Disorders, University of California, San Francisco, San Francisco, CA, USA
| | - Roger J Packer
- Department of Neurology, Children's National Medical Center, Washington, DC, USA
| | - Lindsay B Kilburn
- Department of Haematology and Oncology, Children's National Medical Center, Washington, DC, USA
| | - Stewart Goldman
- Department of Haematology, Oncology, Neuro-Oncology, and Stem Cell Transplantation, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ian F Pollack
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Regina I Jakacki
- Department of Hematology and Oncology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Paul G Fisher
- Department of Neurology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Girish Dhall
- Department of Hematology and Oncology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Patricia Baxter
- Department of Hematology and Oncology, Texas Children's Hospital, Houston, TX, USA
| | - Susan G Kreissman
- Department of Hematology and Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Clinton F Stewart
- Department of Pharmaceutical Science, St Jude Children's Research Hospital, Memphis, TN, USA
| | - David T W Jones
- Department of Pediatric Glioma Research Group, Hopp Children's Cancer Center Heidelberg (KiTZ) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Department of Pediatric Neuro-Oncology, Hopp Children's Cancer Center Heidelberg (KiTZ) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gilbert Vezina
- Department of Radiology, Children's National Medical Center, Washington, DC, USA
| | - Jessica S Stern
- Department of Radiology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltan Patay
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jeremy Y Jones
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sofia S Haque
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David S Enterline
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Soonmee Cha
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Michael J Fisher
- Department of Pediatric Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laurence Austin Doyle
- Investigational Drug Branch, National Cancer Institute and Cancer Therapy Evaluation Program, Bethesda, MD, USA
| | - Malcolm Smith
- Clinical Investigation Branch, National Cancer Institute and Cancer Therapy Evaluation Program, Bethesda, MD, USA
| | - Ira J Dunkel
- Department of Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maryam Fouladi
- Department of Haematology and Oncology, Cincinnati Children's Hospital, Cincinnati, OH, USA
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Poussaint TY, Vajapeyam S, Brown D, Kao PC, Ma C, Greenspan L, Gupta N, Goumnerova L, Bandopadhayay P, Beroukhim R, Ligon K, Kieran M, Chi S, Wright K. DIPG-02. TRANSLATIONAL MR IMAGING CORRELATES FOR MOLECULAR ANALYSES IN DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG). Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.023] [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: 11/12/2022] Open
Affiliation(s)
- Tina Young Poussaint
- Boston Children’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sridhar Vajapeyam
- Boston Children’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Douglas Brown
- Boston Children’s Hospital, Boston, MA, USA
- Massachusetts General Hospital, Boston, USA, MA
| | - Pei-Chi Kao
- Boston Children’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Clement Ma
- Boston Children’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Nalin Gupta
- University of California San Francisco, San Francisco, CA, USA
| | - Liliana Goumnerova
- Boston Children’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pratiti Bandopadhayay
- Dana-Farber Cancer Institute, Boston, MA, USA
- Boston Children’s Hospital, Boston, MA, USA
| | | | - Keith Ligon
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mark Kieran
- Dana-Farber Cancer Institute, Boston, MA, USA
- Boston Children’s Hospital, Boston, MA, USA
| | - Susan Chi
- Boston Children’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Karen Wright
- Boston Children’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute, Boston, MA, USA
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Abstract
Pediatric headache is a common problem, with various underlying causes. Appropriate patient selection for neuroimaging is necessary to optimize the clinical evaluation. This review aims to provide a focused discussion of the clinical evaluation of children with headache, including published guidelines pertaining to neuroimaging, technical considerations for neuroimaging, and tailoring of examinations for specific clinical entities known to cause pediatric headache.
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Affiliation(s)
- Asha Sarma
- Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 2200 Children's Way, Suite 1421, Nashville, TN 37232-9700, USA.
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02130, USA
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Haas-Kogan D, Indelicato D, Paganetti H, Esiashvili N, Mahajan A, Yock T, Flampouri S, MacDonald S, Fouladi M, Stephen K, Kalapurakal J, Terezakis S, Kooy H, Grosshans D, Makrigiorgos M, Mishra K, Poussaint TY, Cohen K, Fitzgerald T, Gondi V, Liu A, Michalski J, Mirkovic D, Mohan R, Perkins S, Wong K, Vikram B, Buchsbaum J, Kun L. National Cancer Institute Workshop on Proton Therapy for Children: Considerations Regarding Brainstem Injury. Int J Radiat Oncol Biol Phys 2019; 101:152-168. [PMID: 29619963 DOI: 10.1016/j.ijrobp.2018.01.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/21/2017] [Accepted: 01/01/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Proton therapy can allow for superior avoidance of normal tissues. A widespread consensus has been reached that proton therapy should be used for patients with curable pediatric brain tumor to avoid critical central nervous system structures. Brainstem necrosis is a potentially devastating, but rare, complication of radiation. Recent reports of brainstem necrosis after proton therapy have raised concerns over the potential biological differences among radiation modalities. We have summarized findings from the National Cancer Institute Workshop on Proton Therapy for Children convened in May 2016 to examine brainstem injury. METHODS AND MATERIALS Twenty-seven physicians, physicists, and researchers from 17 institutions with expertise met to discuss this issue. The definition of brainstem injury, imaging of this entity, clinical experience with photons and photons, and potential biological differences among these radiation modalities were thoroughly discussed and reviewed. The 3 largest US pediatric proton therapy centers collectively summarized the incidence of symptomatic brainstem injury and physics details (planning, dosimetry, delivery) for 671 children with focal posterior fossa tumors treated with protons from 2006 to 2016. RESULTS The average rate of symptomatic brainstem toxicity from the 3 largest US pediatric proton centers was 2.38%. The actuarial rate of grade ≥2 brainstem toxicity was successfully reduced from 12.7% to 0% at 1 center after adopting modified radiation guidelines. Guidelines for treatment planning and current consensus brainstem constraints for proton therapy are presented. The current knowledge regarding linear energy transfer (LET) and its relationship to relative biological effectiveness (RBE) are defined. We review the current state of LET-based planning. CONCLUSIONS Brainstem injury is a rare complication of radiation therapy for both photons and protons. Substantial dosimetric data have been collected for brainstem injury after proton therapy, and established guidelines to allow for safe delivery of proton radiation have been defined. Increased capability exists to incorporate LET optimization; however, further research is needed to fully explore the capabilities of LET- and RBE-based planning.
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Affiliation(s)
- Daphne Haas-Kogan
- Department of Radiation Oncology, Harvard Medical School and Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Daniel Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Harald Paganetti
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Anita Mahajan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Torunn Yock
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Shannon MacDonald
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Maryam Fouladi
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kry Stephen
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Kalapurakal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie Terezakis
- Department of Radiation Oncology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Hanne Kooy
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - David Grosshans
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mike Makrigiorgos
- Department of Radiation Oncology, Harvard Medical School and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kavita Mishra
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School and Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Kenneth Cohen
- Department of Pediatrics, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Thomas Fitzgerald
- Department of Radiation Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Vinai Gondi
- Northwestern Medicine Chicago Proton Center, Chicago, Illinois
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Dragan Mirkovic
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Radhe Mohan
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephanie Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kenneth Wong
- Children's Hospital of Angeles and University of Southern California Keck School of Medicine, Los Angles, California
| | - Bhadrasain Vikram
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jeff Buchsbaum
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Larry Kun
- Department of Radiation Oncology, University of Texas Southwestern Medical School, Dallas, Texas.
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Ceschin R, Kocak M, Vajapeyam S, Pollack IF, Onar-Thomas A, Dunkel IJ, Poussaint TY, Panigrahy A. Quantifying radiation therapy response using apparent diffusion coefficient (ADC) parametric mapping of pediatric diffuse intrinsic pontine glioma: a report from the pediatric brain tumor consortium. J Neurooncol 2019; 143:79-86. [PMID: 30810873 DOI: 10.1007/s11060-019-03133-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/16/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Baseline diffusion or apparent diffusion coefficient (ADC) characteristics have been shown to predict outcome related to DIPG, but the predictive value of post-radiation ADC is less well understood. ADC parametric mapping (FDM) was used to measure radiation-related changes in ADC and compared these metrics to baseline ADC in predicting progression-free survival and overall survival using a large multi-center cohort of DIPG patients (Pediatric Brain Tumor Consortium-PBTC). MATERIALS AND METHODS MR studies at baseline and post-RT in 95 DIPG patients were obtained and serial quantitative ADC parametric maps were generated from diffusion-weighted imaging based on T2/FLAIR and enhancement regions of interest (ROIs). Metrics assessed included total voxels with: increase in ADC (iADC); decrease in ADC (dADC), no change in ADC (nADC), fraction of voxels with increased ADC (fiADC), fraction of voxels with decreased ADC (fdADC), and the ratio of fiADC and fdADC (fDM Ratio). RESULTS A total of 72 patients were included in the final analysis. Tumors with higher fiADC between baseline and the first RT time point showed a trend toward shorter PFS with a hazard ratio of 6.44 (CI 0.79, 52.79, p = 0.083). In contrast, tumors with higher log mean ADC at baseline had longer PFS, with a hazard ratio of 0.27 (CI 0.09, 0.82, p = 0.022). There was no significant association between fDM derived metrics and overall survival. CONCLUSIONS Baseline ADC values are a stronger predictor of outcome compared to radiation related ADC changes in pediatric DIPG. We show the feasibility of employing parametric mapping techniques in multi-center studies to quantitate spatially heterogeneous treatment response in pediatric tumors, including DIPG.
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Affiliation(s)
- Rafael Ceschin
- Department of Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, 4401 Penn Avenue, Suite 2464, Pittsburgh, PA, 15201, USA.
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Pediatric Imaging Research Center, Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, 45th Street and Penn Avenue, Pittsburgh, PA, 15224, USA.
| | - Mehmet Kocak
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Sridhar Vajapeyam
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Ian F Pollack
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tina Young Poussaint
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, 4401 Penn Avenue, Suite 2464, Pittsburgh, PA, 15201, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Fahey F, Christian P, Zukotynski K, Sexton-Stallone B, Kiss C, Clarke B, Onar-Thomas A, Poussaint TY. Use of a Qualification Phantom for PET Brain Imaging in a Multicenter Consortium: A Collaboration Between the Pediatric Brain Tumor Consortium and the SNMMI Clinical Trials Network. J Nucl Med 2018; 60:677-682. [PMID: 30530829 DOI: 10.2967/jnumed.118.219998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/05/2018] [Accepted: 11/14/2018] [Indexed: 01/13/2023] Open
Abstract
The purpose of this study was to assess image quality and quantitative brain PET across a multicenter consortium. Methods: All academic centers and children's hospitals in the Pediatric Brain Tumor Consortium (PBTC) scanned a phantom developed by the Society of Nuclear Medicine and Molecular Imaging Clinical Trials Network (SNMMI CTN) for the validation of brain PET studies associated with clinical trials. The phantom comprises 2 separate, fillable sections: a resolution/uniformity section and a clinical simulation section. The resolution/uniformity section is a cylinder 12.7 cm long and 20 cm in diameter; spatial resolution is evaluated subjectively with 2 sets of rods (hot and cold) of varying diameter (4.0, 5.0, 6.25, 7.81, 9.67, and 12.2 mm) and spacing (twice the rod diameter). The clinical simulation section simulates a transverse section of midbrain with ventricles and gray and white matter compartments. If properly filled, hot rods have a 4:1 target-to-background ratio, and gray-to-white matter sections have a 4:1 ratio. Uniformity and image quality were evaluated using the SUV in a small volume of interest as well as subjectively by 2 independent observers using a 4-point scale. Results: Eleven PBTC sites scanned the phantom on 13 PET scanners. The phantom's complexity led to suboptimal filling, particularly of the hot rod section, in 5 sites. The SUV in the uniformity section was within 10% of unity on only 5 of 13 scanners, although 12 of 13 were subjectively judged to have very good to excellent uniformity. Four of 6 hot rods were discernable by all 13 scanners, whereas 3 of 6 cold rods were discernable by only 5 scanners. Four of 13 scanners had a gray-to-white matter ratio between 3.0 and 5.0 (4.0 is truth); however, 11 of 13 scanners were subjectively judged to have very good or excellent image quality. Conclusion: Eleven sites were able to image a powerful phantom developed by the SNMMI CTN that evaluated image uniformity, spatial resolution, and image quality of brain PET. There was considerable variation in PET data across the PBTC sites, possibly resulting from variations in scanning across the sites due to challenges in filling the phantom.
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Affiliation(s)
- Frederic Fahey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts .,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Paul Christian
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Katherine Zukotynski
- Department of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Briana Sexton-Stallone
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Christina Kiss
- Clinical Trials Network, Society of Nuclear Medicine and Molecular Imaging, Reston Virginia
| | - Bonnie Clarke
- Clinical Trials Network, Society of Nuclear Medicine and Molecular Imaging, Reston Virginia
| | | | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School, Boston, Massachusetts.,Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
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Banerjee A, Jakacki RI, Onar-Thomas A, Wu S, Nicolaides T, Young Poussaint T, Fangusaro J, Phillips J, Perry A, Turner D, Prados M, Packer RJ, Qaddoumi I, Gururangan S, Pollack IF, Goldman S, Doyle LA, Stewart CF, Boyett JM, Kun LE, Fouladi M. A phase I trial of the MEK inhibitor selumetinib (AZD6244) in pediatric patients with recurrent or refractory low-grade glioma: a Pediatric Brain Tumor Consortium (PBTC) study. Neuro Oncol 2018; 19:1135-1144. [PMID: 28339824 DOI: 10.1093/neuonc/now282] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Activation of the mitogen-activated protein kinase pathway is important for growth of pediatric low-grade gliomas (LGGs). The aim of this study was to determine the recommended phase II dose (RP2D) and the dose-limiting toxicities (DLTs) of the MEK inhibitor selumetinib in children with progressive LGG. Methods Selumetinib was administered orally starting at 33 mg/m2/dose b.i.d., using the modified continual reassessment method. Pharmacokinetic analysis was performed during the first course. BRAF aberrations in tumor tissue were determined by real-time polymerase chain reaction and fluorescence in situ hybridization. Results Thirty-eight eligible subjects were enrolled. Dose levels 1 and 2 (33 and 43 mg/m2/dose b.i.d.) were excessively toxic. DLTs included grade 3 elevated amylase/lipase (n = 1), headache (n = 1), mucositis (n = 2), and grades 2-3 rash (n = 6). At dose level 0 (25 mg/m2/dose b.i.d, the RP2D), only 3 of 24 subjects experienced DLTs (elevated amylase/lipase, rash, and mucositis). At the R2PD, the median (range) area under the curve (AUC0-∞) and apparent oral clearance of selumetinib were 3855 ng*h/mL (1780 to 7250 ng × h/mL) and 6.5 L × h-1 × m-2 (3.4 to 14.0 L × h-1 × m-2), respectively. Thirteen of 19 tumors had BRAF abnormalities. Among the 5 (20%) of 25 subjects with sustained partial responses, all at the RP2D, 4 had BRAF aberrations, 1 had insufficient tissue. Subjects received a median of 13 cycles (range: 1-26). Fourteen (37%) completed all protocol treatment (26 cycles [n = 13], 13 cycles [n = 1]) with at least stable disease; 2-year progression-free survival at the RP2D was 69 ± SE 9.8%. Conclusion Selumetinib has promising antitumor activity in children with LGG. Rash and mucositis were the most common DLTs.
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Affiliation(s)
- Anuradha Banerjee
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Regina I Jakacki
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arzu Onar-Thomas
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shengjie Wu
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Theodore Nicolaides
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tina Young Poussaint
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason Fangusaro
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joanna Phillips
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arie Perry
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Turner
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Prados
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roger J Packer
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ibrahim Qaddoumi
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sridharan Gururangan
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ian F Pollack
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stewart Goldman
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lawrence A Doyle
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Clinton F Stewart
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James M Boyett
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Larry E Kun
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maryam Fouladi
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Kilburn LB, Kocak M, Baxter P, Poussaint TY, Paulino AC, McIntyre C, Lemenuel-Diot A, Lopez-Diaz C, Kun L, Chintagumpala M, Su JM, Broniscer A, Baker JN, Hwang EI, Fouladi M, Boyett JM, Blaney SM. A pediatric brain tumor consortium phase II trial of capecitabine rapidly disintegrating tablets with concomitant radiation therapy in children with newly diagnosed diffuse intrinsic pontine gliomas. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26832. [PMID: 29090526 PMCID: PMC5774861 DOI: 10.1002/pbc.26832] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND We conducted a phase II study of oral capecitabine rapidly disintegrating tablets given concurrently with radiation therapy (RT) to assess progression-free survival (PFS) in children with newly diagnosed diffuse intrinsic pontine gliomas (DIPG). PATIENTS AND METHODS Children 3-17 years with newly diagnosed DIPG were eligible. Capecitabine, 650 mg/m2 /dose BID (maximum tolerated dose [MTD] in children with concurrent radiation), was administered for 9 weeks starting the first day of RT. Following a 2-week break, three courses of capecitabine, 1,250 mg/m2 /dose BID for 14 days followed by a 7-day rest, were administered. As prospectively designed, 10 evaluable patients treated at the MTD on the phase I trial were included in the phase II analyses. The design was based on comparison of the PFS distribution to a contemporary historical control (n = 140) with 90% power to detect a 15% absolute improvement in the 1-year PFS with a type-1 error rate, α = 0.10. RESULTS Forty-four patients were evaluable for the phase II objectives. Capecitabine and RT was well tolerated with low-grade palmar plantar erythrodyesthesia, increased alanine aminotransferase, cytopenias, and vomiting the most commonly reported toxicities. Findings were significant for earlier progression with 1-year PFS of 7.21% (SE = 3.47%) in the capecitabine-treated cohort versus 15.59% (SE = 3.05%) in the historical control (P = 0.007), but there was no difference for overall survival (OS) distributions (P = 0.30). Tumor enhancement at diagnosis was associated with shorter PFS and OS. Capecitabine was rapidly absorbed and converted to its metabolites. CONCLUSION Capecitabine did not improve the outcome for children with newly diagnosed DIPG.
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Affiliation(s)
- Lindsay B. Kilburn
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington, DC
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Patricia Baxter
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston TX
| | - Tina Young Poussaint
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston MA
| | - Arnold C. Paulino
- Department of Radiation Oncology MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Larry Kun
- Department of Radiological Sciences, St. Jude Children’s Research Hospital Memphis, TN
| | | | - Jack M Su
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston TX
| | - Alberto Broniscer
- Department of Oncology St. Jude Children’s Research Hospital, Memphis, TN,Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
| | - Justin N. Baker
- Department of Oncology St. Jude Children’s Research Hospital, Memphis, TN
| | - Eugene I. Hwang
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington, DC
| | - Maryam Fouladi
- Division of Hematology/Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - James M. Boyett
- Department of Biostatistics, Operations and Biostatistics Center for PBTC St. Jude Children’s Research Hospital, Memphis, TN
| | - Susan M. Blaney
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston TX
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Vajapeyam S, Brown D, Johnston PR, Ricci KI, Kieran MW, Lidov HGW, Poussaint TY. Multiparametric Analysis of Permeability and ADC Histogram Metrics for Classification of Pediatric Brain Tumors by Tumor Grade. AJNR Am J Neuroradiol 2018; 39:552-557. [PMID: 29301780 DOI: 10.3174/ajnr.a5502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/30/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Accurate tumor grading is essential for treatment planning of pediatric brain tumors. We hypothesized that multiparametric analyses of a combination of permeability metrics and ADC histogram metrics would differentiate high- and low-grade tumors with high accuracy. MATERIALS AND METHODS DTI and dynamic contrast-enhanced MR imaging using T1-mapping with flip angles of 2°, 5°, 10°, and 15°, followed by a 0.1-mmol/kg body weight gadolinium-based bolus was performed on all patients in addition to standard MR imaging. Permeability data were processed and transfer constant from the blood plasma into the extracellular extravascular space, rate constant from the extracellular extravascular space back into blood plasma, extravascular extracellular volume fraction, and fractional blood plasma volume were calculated from 3D tumor volumes. Apparent diffusion coefficient histogram metrics were calculated for 3 separate tumor volumes derived from T2-FLAIR sequences, T1 contrast-enhanced sequences, and permeability maps, respectively. RESULTS Results from 41 patients (0.3-16.76 years of age; mean, 6.22 years) with newly diagnosed contrast-enhancing brain tumors (16 low-grade; 25 high-grade) were included in the institutional review board-approved retrospective analysis. Wilcoxon tests showed a higher transfer constant from blood plasma into extracellular extravascular space and rate constant from extracellular extravascular space back into blood plasma, and lower extracellular extravascular volume fraction (P < .001) in high-grade tumors. The mean ADCs of FLAIR and enhancing tumor volumes were significantly lower in high-grade tumors (P < .001). ROC analysis showed that a combination of extravascular volume fraction and mean ADC of FLAIR volume differentiated high- and low-grade tumors with high accuracy (area under receiver operating characteristic curve = 0.918). CONCLUSIONS ADC histogram metrics combined with permeability metrics differentiate low- and high-grade pediatric brain tumors with high accuracy.
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Affiliation(s)
- S Vajapeyam
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.) .,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - D Brown
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
| | - P R Johnston
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
| | - K I Ricci
- Cancer Center (K.I.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - M W Kieran
- Division of Pediatric Oncology (M.W.K.), Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - H G W Lidov
- Pathology (H.G.W.L.), Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - T Y Poussaint
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.).,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
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42
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Zukotynski KA, Vajapeyam S, Fahey FH, Kocak M, Brown D, Ricci KI, Onar-Thomas A, Fouladi M, Poussaint TY. Correlation of 18F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium. J Nucl Med 2017; 58:1264-1269. [PMID: 28360212 DOI: 10.2967/jnumed.116.185389] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 10/12/2016] [Accepted: 02/26/2017] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to describe baseline 18F-FDG PET voxel characteristics in pediatric diffuse intrinsic pontine glioma (DIPG) and to correlate these metrics with baseline MRI apparent diffusion coefficient (ADC) histogram metrics, progression-free survival (PFS), and overall survival. Methods: Baseline brain 18F-FDG PET and MRI scans were obtained in 33 children from Pediatric Brain Tumor Consortium clinical DIPG trials. 18F-FDG PET images, postgadolinium MR images, and ADC MR images were registered to baseline fluid attenuation inversion recovery MR images. Three-dimensional regions of interest on fluid attenuation inversion recovery MR images and postgadolinium MR images and 18F-FDG PET and MR ADC histograms were generated. Metrics evaluated included peak number, skewness, and kurtosis. Correlation between PET and MR ADC histogram metrics was evaluated. PET pixel values within the region of interest for each tumor were plotted against MR ADC values. The association of these imaging markers with survival was described. Results: PET histograms were almost always unimodal (94%, vs. 6% bimodal). None of the PET histogram parameters (skewness or kurtosis) had a significant association with PFS, although a higher PET postgadolinium skewness tended toward a less favorable PFS (hazard ratio, 3.48; 95% confidence interval [CI], 0.75-16.28 [P = 0.11]). There was a significant association between higher MR ADC postgadolinium skewness and shorter PFS (hazard ratio, 2.56; 95% CI, 1.11-5.91 [P = 0.028]), and there was the suggestion that this also led to shorter overall survival (hazard ratio, 2.18; 95% CI, 0.95-5.04 [P = 0.067]). Higher MR ADC postgadolinium kurtosis tended toward shorter PFS (hazard ratio, 1.30; 95% CI, 0.98-1.74 [P = 0.073]). PET and MR ADC pixel values were negatively correlated using the Pearson correlation coefficient. Further, the level of PET and MR ADC correlation was significantly positively associated with PFS; tumors with higher values of ADC-PET correlation had more favorable PFS (hazard ratio, 0.17; 95% CI, 0.03-0.89 [P = 0.036]), suggesting that a higher level of negative ADC-PET correlation leads to less favorable PFS. A more significant negative correlation may indicate higher-grade elements within the tumor leading to poorer outcomes. Conclusion:18F-FDG PET and MR ADC histogram metrics in pediatric DIPG demonstrate different characteristics with often a negative correlation between PET and MR ADC pixel values. A higher negative correlation is associated with a worse PFS, which may indicate higher-grade elements within the tumor.
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Affiliation(s)
| | - Sridhar Vajapeyam
- Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Frederic H Fahey
- Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Mehmet Kocak
- University of Tennessee Health Science Center, Memphis, Tennessee.,St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Kelsey I Ricci
- Massachusetts General Hospital, Boston, Massachusetts; and
| | | | | | - Tina Young Poussaint
- Boston Children's Hospital, Boston, Massachusetts .,Harvard Medical School, Boston, Massachusetts
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Abstract
Pediatric brain tumors are the leading cause of death from solid tumors in childhood. The most common posterior fossa tumors in children are medulloblastoma, atypical teratoid/rhabdoid tumor, cerebellar pilocytic astrocytoma, ependymoma, and brainstem glioma. Location, and imaging findings on computed tomography (CT) and conventional MR (cMR) imaging may provide important clues to the most likely diagnosis. Moreover, information obtained from advanced MR imaging techniques increase diagnostic confidence and help distinguish between different histologic tumor types. Here we discuss the most common posterior fossa tumors in children, including typical imaging findings on CT, cMR imaging, and advanced MR imaging studies.
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Affiliation(s)
- Lara A Brandão
- Radiologic Department, Clínica Felippe Mattoso, Fleury Medicina Diagnóstica, Avenida das Américas 700, sala 320, Barra Da Tijuca, Rio De Janeiro, Rio De Janeiro CEP 22640-100, Brazil; Department of Radiology, Clínica IRM- Ressonância Magnética, Rua Capitão Salomão, Humaitá, Rio De Janeiro, Rio De Janeiro CEP 22271-040, Brazil.
| | - Tina Young Poussaint
- Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Warren K, Harreld J, Chamberlain M, Vezina G, Warmuth-Metz M, Hoff KV, Packer R, Brandes AA, Reiss M, Goldman S, Fisher M, Poussaint TY, Pollack I, Prados M, Wen P, Chang S, Dufour C, Zurakowski D, Kortman RD, Kieran M. PDCT-13. GUIDELINES FOR RESPONSE ASSESSMENT IN MEDULLOBLASTOMA AND OTHER LEPTOMENINGEAL SEEDING TUMORS: A REPORT FROM THE RESPONSE ASSESSMENT IN PEDIATRIC NEURO-ONCOLOGY (RAPNO) WORKING GROUP. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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45
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Poussaint TY, Vajapeyam S, Ricci KI, Panigrahy A, Kocak M, Kun LE, Boyett JM, Pollack IF, Fouladi M. Apparent diffusion coefficient histogram metrics correlate with survival in diffuse intrinsic pontine glioma: a report from the Pediatric Brain Tumor Consortium. Neuro Oncol 2015; 18:725-34. [PMID: 26487690 DOI: 10.1093/neuonc/nov256] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 07/14/2015] [Accepted: 09/16/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Diffuse intrinsic pontine glioma (DIPG) is associated with poor survival regardless of therapy. We used volumetric apparent diffusion coefficient (ADC) histogram metrics to determine associations with progression-free survival (PFS) and overall survival (OS) at baseline and after radiation therapy (RT). METHODS Baseline and post-RT quantitative ADC histograms were generated from fluid-attenuated inversion recovery (FLAIR) images and enhancement regions of interest. Metrics assessed included number of peaks (ie, unimodal or bimodal), mean and median ADC, standard deviation, mode, skewness, and kurtosis. RESULTS Based on FLAIR images, the majority of tumors had unimodal peaks with significantly shorter average survival. Pre-RT FLAIR mean, mode, and median values were significantly associated with decreased risk of progression; higher pre-RT ADC values had longer PFS on average. Pre-RT FLAIR skewness and standard deviation were significantly associated with increased risk of progression; higher pre-RT FLAIR skewness and standard deviation had shorter PFS. Nonenhancing tumors at baseline showed higher ADC FLAIR mean values, lower kurtosis, and higher PFS. For enhancing tumors at baseline, bimodal enhancement histograms had much worse PFS and OS than unimodal cases and significantly lower mean peak values. Enhancement in tumors only after RT led to significantly shorter PFS and OS than in patients with baseline or no baseline enhancement. CONCLUSIONS ADC histogram metrics in DIPG demonstrate significant correlations between diffusion metrics and survival, with lower diffusion values (increased cellularity), increased skewness, and enhancement associated with shorter survival, requiring future investigations in large DIPG clinical trials.
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Affiliation(s)
- Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
| | - Sridhar Vajapeyam
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
| | - Kelsey I Ricci
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
| | - Ashok Panigrahy
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
| | - Mehmet Kocak
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
| | - Larry E Kun
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
| | - James M Boyett
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
| | - Ian F Pollack
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
| | - Maryam Fouladi
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts (T.Y.P., S.V., K.I.R.); Department of Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.P.); Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (I.F.P.); Neuro-Oncology Program, Cincinnati Children's Hospital, Cincinnati, Ohio (M.F.)
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Poussaint TY, Huisman TAGM. Introduction to 'Advances in Pediatric Neuroradiology'. Pediatr Radiol 2015; 45 Suppl 3:S369. [PMID: 26346141 DOI: 10.1007/s00247-015-3347-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA,
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Mulkern RV, Ricci KI, Vajapeyam S, Chenevert TL, Malyarenko DI, Kocak M, Poussaint TY. Pediatric brain tumor consortium multisite assessment of apparent diffusion coefficient z-axis variation assessed with an ice-water phantom. Acad Radiol 2015; 22:363-9. [PMID: 25435183 DOI: 10.1016/j.acra.2014.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 08/25/2014] [Revised: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance diffusion imaging can characterize physiologic characteristics of pediatric brain tumors used to assess therapy response. The purpose of this study was to assess the variability of the apparent diffusion coefficient (ADC) along z-axis of scanners in the multicenter Pediatric Brain Tumor Consortium (PBTC). MATERIALS AND METHODS Ice-water diffusion phantoms for each PBTC site were distributed with a specific diffusion imaging protocol. The phantom was scanned four successive times to 1) confirm water in the tube reached thermal equilibrium and 2) allow for assessment of intra-examination ADC repeatability. ADC profiles across slice positions for each vendor and institution combination were characterized using linear regression modeling with a quadratic fit. RESULTS Eleven sites collected data with a high degree of compliance to the diffusion protocol for each scanner. The mean ADC value at slice position zero for vendor A was 1.123 × 10(-3) mm(2)/s, vendor B was 1.0964 × 10(-3) mm(2)/s, and vendor C was 1.110 × 10(-3) mm(2)/s. The percentage coefficient of variation across all sites was 0.309% (standard deviation = 0.322). The ADC values conformed well to a second-order polynomial along the z-axis, (ie, following a linear model pattern with quadratic fit) for vendor-institution combinations and across vendor-institution combinations as shown in the longitudinal model. CONCLUSIONS Assessment of the variability of diffusion metrics is essential for establishing the validity of using these quantitative metrics in multicenter trials. The low variability in ADC values across vendors and institutions and validates the use of ADC as a quantitative tumor marker in pediatric multicenter trials.
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Affiliation(s)
- Robert V Mulkern
- Department of Radiology, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Kelsey I Ricci
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Sridhar Vajapeyam
- Department of Radiology, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Dariya I Malyarenko
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Mehmet Kocak
- Division of Biostatistics and Epidemiology, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Pediatric Brain Tumor Consortium, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School, Boston, Massachusetts; Pediatric Brain Tumor Consortium Neuroimaging Center, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115.
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Affiliation(s)
- Sharon Byrd
- Department of Radiology, Rush University Medical Center, Chicago, Ill*
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Gururangan S, Fangusaro J, Poussaint TY, McLendon RE, Onar-Thomas A, Wu S, Packer RJ, Banerjee A, Gilbertson RJ, Fahey F, Vajapeyam S, Jakacki R, Gajjar A, Goldman S, Pollack IF, Friedman HS, Boyett JM, Fouladi M, Kun LE. Efficacy of bevacizumab plus irinotecan in children with recurrent low-grade gliomas--a Pediatric Brain Tumor Consortium study. Neuro Oncol 2013; 16:310-7. [PMID: 24311632 DOI: 10.1093/neuonc/not154] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A phase II study of bevacizumab (BVZ) plus irinotecan (CPT-11) was conducted in children with recurrent low-grade glioma to measure sustained response and/or stable disease lasting ≥6 months and progression-free survival. METHODS Thirty-five evaluable patients received 2 doses (10 mg/kg each) of single-agent BVZ intravenously 2 weeks apart and then BVZ + CPT-11 every 2 weeks until progressive disease, unacceptable toxicity, or a maximum of 2 years of therapy. Correlative studies included neuroimaging and expression of tumor angiogenic markers (vascular endothelial growth factor [VEGF], VEGF receptor 2, hypoxia-inducible factor 2α, and carbonic anhydrase 9). RESULTS Thirty-five evaluable patients (median age 8.4 y [range, 0.6-17.6]) received a median of 12 courses of BVZ + CPT-11 (range, 2-26). Twenty-nine of 35 patients (83%) received treatment for at least 6 months. Eight patients progressed on treatment at a median time of 5.4 months (range, 1-17.8). Six patients (17.7%) still in follow-up have had stable disease without receiving additional treatment for a median of 40.1 months (range, 30.6-49.3) from initiating therapy. The 6-month and 2-year progression-free survivals were 85.4% (SE ± 5.96%) and 47.8% (SE ± 9.27%), respectively. The commonest toxicities related to BVZ included grades 1-2 hypertension in 24, grades 1-2 fatigue in 23, grades 1-2 epistaxis in 18, and grades 1-4 proteinuria in 15. The median volume of enhancement decreased significantly between baseline and day 15 (P < .0001) and over the duration of treatment (P < .037). CONCLUSION The combination of BVZ + CPT-11 appears to produce sustained disease control in some children with recurrent low-grade gliomas.
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Affiliation(s)
- Sridharan Gururangan
- Corresponding author: Sri Gururangan, MRCP, Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Hanes House, Room 307, 330 Trent Drive, Box 102382, Durham, NC 27710.
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Fangusaro J, Gururangan S, Poussaint TY, McLendon RE, Onar-Thomas A, Warren KE, Wu S, Packer RJ, Banerjee A, Gilbertson RJ, Jakacki R, Gajjar A, Goldman S, Pollack IF, Friedman HS, Boyett JM, Kun LE, Fouladi M. Bevacizumab (BVZ)-associated toxicities in children with recurrent central nervous system tumors treated with BVZ and irinotecan (CPT-11): a Pediatric Brain Tumor Consortium Study (PBTC-022). Cancer 2013; 119:4180-7. [PMID: 24104527 DOI: 10.1002/cncr.28343] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 05/24/2013] [Revised: 06/20/2013] [Accepted: 06/24/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND The incidence and spectrum of acute toxicities related to the use of bevacizumab (BVZ)-containing regimens in children are largely unknown. This report describes the adverse events in a recently completed large phase 2 trial of BVZ plus irinotecan (CPT-11) in children with recurrent central nervous system tumors. METHODS Pediatric Brain Tumor Consortium trial-022 evaluated the efficacy and toxicity of BVZ (10 mg/kg administered intravenously) as a single agent for 2 doses given 2 weeks apart and then combined with CPT-11 every 2 weeks (1 course = 4 weeks) in children with recurrent central nervous system tumors. Children were treated until they experienced progressive disease, unacceptable toxicity or completed up to a maximum of 2 years of therapy. Toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0. Patients who received at least 1 dose of BVZ were included for toxicity assessment. RESULTS Between October 2006 and June 2010, 92 patients evaluable for toxicity were enrolled and received 687 treatment courses. The most common toxicities attributable to BVZ included grade I-III hypertension (38% of patients), grade I-III fatigue (30%), grade I-II epistaxis (24%), and grade I-IV proteinuria (22%). Twenty-two patients (24%) stopped therapy due to toxicity. CONCLUSIONS The combination of BVZ and CPT-11 was fairly well-tolerated, and most severe BVZ-related toxicities were rare, self-limiting, and manageable.
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Affiliation(s)
- Jason Fangusaro
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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