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Haas-Kogan DA, Aboian MS, Minturn JE, Leary SES, Abdelbaki MS, Goldman S, Elster JD, Kraya A, Lueder MR, Ramakrishnan D, von Reppert M, Liu KX, Rokita JL, Resnick AC, Solomon DA, Phillips JJ, Prados M, Molinaro AM, Waszak SM, Mueller S. Everolimus for Children With Recurrent or Progressive Low-Grade Glioma: Results From the Phase II PNOC001 Trial. J Clin Oncol 2024; 42:441-451. [PMID: 37978951 PMCID: PMC10824388 DOI: 10.1200/jco.23.01838] [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: 09/03/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE The PNOC001 phase II single-arm trial sought to estimate progression-free survival (PFS) associated with everolimus therapy for progressive/recurrent pediatric low-grade glioma (pLGG) on the basis of phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathway activation as measured by phosphorylated-ribosomal protein S6 and to identify prognostic and predictive biomarkers. PATIENTS AND METHODS Patients, age 3-21 years, with progressive/recurrent pLGG received everolimus orally, 5 mg/m2 once daily. Frequency of driver gene alterations was compared among independent pLGG cohorts of newly diagnosed and progressive/recurrent patients. PFS at 6 months (primary end point) and median PFS (secondary end point) were estimated for association with everolimus therapy. RESULTS Between 2012 and 2019, 65 subjects with progressive/recurrent pLGG (median age, 9.6 years; range, 3.0-19.9; 46% female) were enrolled, with a median follow-up of 57.5 months. The 6-month PFS was 67.4% (95% CI, 60.0 to 80.0) and median PFS was 11.1 months (95% CI, 7.6 to 19.8). Hypertriglyceridemia was the most common grade ≥3 adverse event. PI3K/AKT/mTOR pathway activation did not correlate with clinical outcomes (6-month PFS, active 68.4% v nonactive 63.3%; median PFS, active 11.2 months v nonactive 11.1 months; P = .80). Rare/novel KIAA1549::BRAF fusion breakpoints were most frequent in supratentorial midline pilocytic astrocytomas, in patients with progressive/recurrent disease, and correlated with poor clinical outcomes (median PFS, rare/novel KIAA1549::BRAF fusion breakpoints 6.1 months v common KIAA1549::BRAF fusion breakpoints 16.7 months; P < .05). Multivariate analysis confirmed their independent risk factor status for disease progression in PNOC001 and other, independent cohorts. Additionally, rare pathogenic germline variants in homologous recombination genes were identified in 6.8% of PNOC001 patients. CONCLUSION Everolimus is a well-tolerated therapy for progressive/recurrent pLGGs. Rare/novel KIAA1549::BRAF fusion breakpoints may define biomarkers for progressive disease and should be assessed in future clinical trials.
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Affiliation(s)
- Daphne A Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Mariam S Aboian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Jane E Minturn
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sarah E S Leary
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Mohamed S Abdelbaki
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Stewart Goldman
- Phoenix Children's Hospital, Phoenix, AZ
- University of Arizona College of Medicine, Phoenix, AZ
| | - Jennifer D Elster
- Division of Hematology Oncology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, San Diego, CA
| | - Adam Kraya
- Division of Neurosurgery, Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Matthew R Lueder
- Division of Neurosurgery, Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Divya Ramakrishnan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Marc von Reppert
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
- University of Leipzig, Leipzig, Germany
| | - Kevin X Liu
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jo Lynne Rokita
- Division of Neurosurgery, Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Adam C Resnick
- Division of Neurosurgery, Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, San Francisco, CA
| | - Joanna J Phillips
- Department of Pathology, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Michael Prados
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Annette M Molinaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Sebastian M Waszak
- Laboratory of Computational Neuro-Oncology, Swiss Institute for Experimental Cancer Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Neurology, University of California, San Francisco, San Francisco, CA
- Centre for Molecular Medicine Norway (NCMM), Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Sabine Mueller
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
- Department of Pediatrics, University of Zurich, Zurich, Switzerland
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2
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Das A, Tabori U, Sambira Nahum LC, Collins NB, Deyell R, Dvir R, Faure-Conter C, Hassall TE, Minturn JE, Edwards M, Brookes E, Bianchi V, Levine A, Stone SC, Sudhaman S, Sanchez Ramirez S, Ercan AB, Stengs L, Chung J, Negm L, Getz G, Maruvka YE, Ertl-Wagner B, Ohashi PS, Pugh T, Hawkins C, Bouffet E, Morgenstern DA. Efficacy of Nivolumab in Pediatric Cancers with High Mutation Burden and Mismatch Repair Deficiency. Clin Cancer Res 2023; 29:4770-4783. [PMID: 37126021 PMCID: PMC10690097 DOI: 10.1158/1078-0432.ccr-23-0411] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 02/09/2023] [Revised: 03/23/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Checkpoint inhibitors have limited efficacy for children with unselected solid and brain tumors. We report the first prospective pediatric trial (NCT02992964) using nivolumab exclusively for refractory nonhematologic cancers harboring tumor mutation burden (TMB) ≥5 mutations/megabase (mut/Mb) and/or mismatch repair deficiency (MMRD). PATIENTS AND METHODS Twenty patients were screened, and 10 were ultimately included in the response cohort of whom nine had TMB >10 mut/Mb (three initially eligible based on MMRD) and one patient had TMB between 5 and 10 mut/Mb. RESULTS Delayed immune responses contributed to best overall response of 50%, improving on initial objective responses (20%) and leading to 2-year overall survival (OS) of 50% [95% confidence interval (CI), 27-93]. Four children, including three with refractory malignant gliomas are in complete remission at a median follow-up of 37 months (range, 32.4-60), culminating in 2-year OS of 43% (95% CI, 18.2-100). Biomarker analyses confirmed benefit in children with germline MMRD, microsatellite instability, higher activated and lower regulatory circulating T cells. Stochastic mutation accumulation driven by underlying germline MMRD impacted the tumor microenvironment, contributing to delayed responses. No benefit was observed in the single patient with an MMR-proficient tumor and TMB 7.4 mut/Mb. CONCLUSIONS Nivolumab resulted in durable responses and prolonged survival for the first time in a pediatric trial of refractory hypermutated cancers including malignant gliomas. Novel biomarkers identified here need to be translated rapidly to clinical care to identify children who can benefit from checkpoint inhibitors, including upfront management of cancer. See related commentary by Mardis, p. 4701.
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Affiliation(s)
- Anirban Das
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Uri Tabori
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Lauren C. Sambira Nahum
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Natalie B. Collins
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | - Rina Dvir
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Jane E. Minturn
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Edwards
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Elissa Brookes
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Vanessa Bianchi
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Adrian Levine
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Simone C. Stone
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario
| | - Sumedha Sudhaman
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Santiago Sanchez Ramirez
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Ayse B. Ercan
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Lucie Stengs
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Jill Chung
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Logine Negm
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Gad Getz
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | | | - Birgit Ertl-Wagner
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Pamela S. Ohashi
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario
| | - Trevor Pugh
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario
| | - Cynthia Hawkins
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Eric Bouffet
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Daniel A. Morgenstern
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
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Kotch C, Elgarten CW, McWhorter J, Schmus C, Wilhelm D, Li Y, Minturn JE. The Impact of Proactive Gastrostomy Tube Placement on Treatment-related Outcomes in Young Children With High-grade Central Nervous System Tumors. J Pediatr Hematol Oncol 2023; 45:333-338. [PMID: 37314947 DOI: 10.1097/mph.0000000000002694] [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] [Received: 01/19/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023]
Abstract
Young children undergoing treatment with intensive chemotherapy for high-grade central nervous system (CNS) tumors are at risk for malnutrition, yet no guidelines exist for the placement of enteral tubes. Prior studies evaluated the impact of proactive gastrostomy tube (GT) placement with a narrow scope of outcomes, such as weight. To examine the impact of proactive GT on comprehensive treatment outcomes, we performed a single-center, retrospective study of children younger than 60 months of age with high-grade CNS tumors treated per CCG99703 or ACNS0334 between 2015 and 2022. Of 26 patients included, 9 (35%) underwent proactive GT, 8 (30%) had rescue GT, and 9 (35%) had a nasogastric tube (NGT). Clinically significant weight loss occurred in 47% of patients with NGT during induction compared with 22% with proactive GT ( P = 0.274); however, between cohorts, there was no significant difference in antibiotic or parenteral nutrition utilization, weight loss at therapy completion, and duration of hospitalization. Therefore, proactive GT placement was modestly effective at preventing significant weight loss during induction, however, there was no clear benefit for hospitalization duration, antibiotic, or parental nutrition requirements compared with NGT. We recommend an individualized approach to GT placement for young children with CNS malignancies undergoing intensive chemotherapy.
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Affiliation(s)
- Chelsea Kotch
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
| | - Caitlin W Elgarten
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
| | - Jessica McWhorter
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
| | - Cynthia Schmus
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- University of Pennsylvania School of Nursing
| | - Darielle Wilhelm
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
| | - Yimei Li
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Jane E Minturn
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
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4
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Gubbiotti MA, Madsen PJ, Tucker AM, Abdullaev Z, Aldape K, Shekdar K, Yang A, Minturn JE, Santi M, Viaene AN. ZFTA-fused supratentorial ependymoma with a novel fusion partner, DUX4. J Neuropathol Exp Neurol 2023; 82:668-671. [PMID: 37218333 PMCID: PMC10501467 DOI: 10.1093/jnen/nlad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Maria A Gubbiotti
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter J Madsen
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander M Tucker
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Zied Abdullaev
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth Aldape
- Laboratory of Pathology and Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Karuna Shekdar
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adeline Yang
- Department of Pediatrics, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jane E Minturn
- Department of Pediatrics, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Angela N Viaene
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Kotch C, Wagner K, Broad JH, Dombi E, Minturn JE, Phillips P, Smith K, Li Y, Jacobs IN, Elden LM, Fisher MJ, Belasco J. Vinblastine/Methotrexate for Debilitating and Progressive Plexiform Neurofibroma in Children and Young Adults with Neurofibromatosis Type 1: A Phase 2 Study. Cancers (Basel) 2023; 15:cancers15092621. [PMID: 37174087 PMCID: PMC10177272 DOI: 10.3390/cancers15092621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Limited therapies exist for neurofibromatosis type 1 (NF1)-associated plexiform neurofibroma (PN). For this reason, the activity of vinblastine (VBL) and methotrexate (MTX) was evaluated in children and young adults with NF1 and PN. Patients ≤ 25 years of age with progressive and/or inoperable NF1-PN received VBL 6 mg/m2 and MTX 30 mg/m2 weekly for 26 weeks, followed by every 2 weeks for 26 weeks. Objective response rate was the primary endpoint. Of 25 participants enrolled, 23 were evaluable. The median age of participants was 6.6 years (range 0.3-20.7). The most frequent toxicities were neutropenia and elevation of transaminases. On two-dimensional (2D) imaging, 20 participants (87%) had stable tumor, with a median time to progression of 41.5 months (95% confidence interval 16.9, 64.9). Two of eight participants (25%) with airway involvement demonstrated functional improvements including decreased positive pressure requirements and apnea-hypopnea index. A post hoc three-dimensional (3D) analysis of PN volumes was completed on 15 participants with amenable imaging; 7 participants (46%) had progressive disease on or by the end of therapy. VBL/MTX was well-tolerated but did not result in objective volumetric response. Furthermore, 3D volumetric analysis highlighted the lack of sensitivity of 2D imaging for PN response evaluation.
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Affiliation(s)
- Chelsea Kotch
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kristina Wagner
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - J Harris Broad
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Anesthesiology, Valley Medical Center, Renton, WA 98055, USA
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Jane E Minturn
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter Phillips
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Katherine Smith
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yimei Li
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ian N Jacobs
- Division of Otolaryngology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Lisa M Elden
- Division of Otolaryngology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Michael J Fisher
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jean Belasco
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Lyons N, Waanders A, Williams M, Nazarian J, Eze A, Bornhorst M, Frenkel E, Mason J, Minturn JE, Koptyra M, Monje M, Hysinger J, Souweidane M, Greenfield JP, Campbell C, Uceda E, Smith A, Hegert J, Campion S, McLean G, Gustafson P, Gustafson A. EOLP-04. A CALL TO ACTION TO INCREASE ACCESS TO POST-MORTEM BRAIN TUMOR DONATIONS: GIFT FROM A CHILD. Neuro Oncol 2022. [PMCID: PMC9660322 DOI: 10.1093/neuonc/noac209.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Implementation of access to donate post mortem tissue among pediatric brain tumor patients remains a challenge[DSM1] . Previous attempts to develop a post-mortem network have been jeopardized by barriers such as a lack of education, logistical coordination of donation, and difficulties effectively communicating the benefit of post-mortem donations to families. [CC2] Utilizing feedback from patients’ families, clinicians, and researchers, standard operating procedures (SOP) were developed and utilized by six “tissue navigators” (TN) working across institutions. Tissue navigators are critical in implementation of access to donate as they serve as a liaison between patients’ families and clinical team to ensure post-mortem tissue is procured correctly and respectfully. From 2018 through 2021, there has been an increase in donations, which has led to establishment of tumor cell cultures translating rapidly to clinical development, and a growing network of centers participating in GFAC procedures. Donations have been facilitated at over 75 institutions. GFAC has coordinated 146 donations in this 3-year launch timeframe, with nearly half from families outside GFAC’s primary institutional network. Barriers to implementation were addressed with the design of GFAC’s SOPs, which lead to the successful implementation of access to donation. GFAC is developing CME training for clinicians and researchers to address communication of post-mortem donation, continuing awareness campaigns with collaborators in the field, advocating for families to receive feedback on the donation, and expanding on the SOPs as more is learned from clinicians and families.
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Affiliation(s)
| | - Angela Waanders
- Ann & Robert H Lurie Children's Hospital , Chicago, IL , USA
| | | | - Javad Nazarian
- Department of Oncology, Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland , Zurich , Switzerland
| | - Augustine Eze
- Children's National Medical Center, Washington D.C. , DC , USA
| | | | | | - Jennifer Mason
- Children's Hospital of Philadelphia , Philadelphia, PA , USA
| | - Jane E Minturn
- Children's Hospital of Philadelphia , Philadelphia, PA , USA
| | | | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University , Stanford, CA , USA
| | - Jared Hysinger
- Sandford University/Lucille Packard Children's Hospital , Palo Alto, CA , USA
| | | | | | | | | | - Amy Smith
- Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, FL , Orlando , USA
| | - Julia Hegert
- Orlando’s Arnold Palmer Hospital for Children , Orlando, FL , USA
| | - Stephani Campion
- Orlando’s Arnold Palmer Hospital for Children , Orlando, FL , USA
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7
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Hocking MC, Schultz RT, Minturn JE, Brodsky C, Albee M, Herrington JD. Reduced Fusiform Gyrus Activation During Face Processing in Pediatric Brain Tumor Survivors. J Int Neuropsychol Soc 2022; 28:937-946. [PMID: 34605383 PMCID: PMC8977397 DOI: 10.1017/s135561772100117x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The neural mechanisms contributing to the social problems of pediatric brain tumor survivors (PBTS) are unknown. Face processing is important to social communication, social behavior, and peer acceptance. Research with other populations with social difficulties, namely autism spectrum disorder, suggests atypical brain activation in areas important for face processing. This case-controlled functional magnetic resonance imaging (fMRI) study compared brain activation during face processing in PBTS and typically developing (TD) youth. METHODS Participants included 36 age-, gender-, and IQ-matched youth (N = 18 per group). PBTS were at least 5 years from diagnosis and 2 years from the completion of tumor therapy. fMRI data were acquired during a face identity task and a control condition. Groups were compared on activation magnitude within the fusiform gyrus for the faces condition compared to the control condition. Correlational analyses evaluated associations between neuroimaging metrics and indices of social behavior for PBTS participants. RESULTS Both groups demonstrated face-specific activation within the social brain for the faces condition compared to the control condition. PBTS showed significantly decreased activation for faces in the medial portions of the fusiform gyrus bilaterally compared to TD youth, ps ≤ .004. Higher peak activity in the left fusiform gyrus was associated with better socialization (r = .53, p < .05). CONCLUSIONS This study offers initial evidence of atypical activation in a key face processing area in PBTS. Such atypical activation may underlie some of the social difficulties of PBTS. Social cognitive neuroscience methodologies may elucidate the neurobiological bases for PBTS social behavior.
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Affiliation(s)
- Matthew C. Hocking
- Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA
- Correspondence and reprint requests to: Matthew C. Hocking, Ph.D., Division of Oncology, The Children’s Hospital of Philadelphia, 3615 Civic Center Blvd., 1427B Abramson Pediatric Research Center, Philadelphia, PA 19104, USA.
| | - Robert T. Schultz
- Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Jane E. Minturn
- Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Cole Brodsky
- Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - May Albee
- Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - John D. Herrington
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA
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8
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Lazow MA, Fuller C, DeWire M, Lane A, Bandopadhayay P, Bartels U, Bouffet E, Cheng S, Cohen KJ, Cooney TM, Coven SL, Dholaria H, Diez B, Dorris K, El-ayadi M, El-Sheikh A, Fisher PG, Fonseca A, Garcia Lombardi M, Greiner RJ, Goldman S, Gottardo N, Gururangan S, Hansford JR, Hassall T, Hawkins C, Kilburn L, Koschmann C, Leary SE, Ma J, Minturn JE, Monje-Deisseroth M, Packer R, Samson Y, Sandler ES, Sevlever G, Tinkle CL, Tsui K, Wagner LM, Zaghloul M, Ziegler DS, Chaney B, Black K, Asher A, Drissi R, Fouladi M, Jones BV, Leach JL. Accuracy of central neuro-imaging review of DIPG compared with histopathology in the International DIPG Registry. Neuro Oncol 2022; 24:821-833. [PMID: 34668975 PMCID: PMC9071293 DOI: 10.1093/neuonc/noab245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diffuse intrinsic pontine glioma (DIPG) remains a clinico-radiologic diagnosis without routine tissue acquisition. Reliable imaging distinction between DIPG and other pontine tumors with potentially more favorable prognoses and treatment considerations is essential. METHODS Cases submitted to the International DIPG registry (IDIPGR) with histopathologic and/or radiologic data were analyzed. Central imaging review was performed on diagnostic brain MRIs (if available) by two neuro-radiologists. Imaging features suggestive of alternative diagnoses included nonpontine origin, <50% pontine involvement, focally exophytic morphology, sharply defined margins, and/or marked diffusion restriction throughout. RESULTS Among 286 patients with pathology from biopsy and/or autopsy, 23 (8%) had histologic diagnoses inconsistent with DIPG, most commonly nondiffuse low-grade gliomas and embryonal tumors. Among 569 patients with centrally-reviewed diagnostic MRIs, 40 (7%) were classified as non-DIPG, alternative diagnosis suspected. The combined analysis included 151 patients with both histopathology and centrally-reviewed MRI. Of 77 patients with imaging classified as characteristic of DIPG, 76 (99%) had histopathologic diagnoses consistent with DIPG (infiltrating grade II-IV gliomas). Of 57 patients classified as likely DIPG with some unusual imaging features, 55 (96%) had histopathologic diagnoses consistent with DIPG. Of 17 patients with imaging features suggestive of an alternative diagnosis, eight (47%) had histopathologic diagnoses inconsistent with DIPG (remaining patients were excluded due to nonpontine tumor origin). Association between central neuro-imaging review impression and histopathology was significant (p < 0.001), and central neuro-imaging impression was prognostic of overall survival. CONCLUSIONS The accuracy and important role of central neuro-imaging review in confirming the diagnosis of DIPG is demonstrated.
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Affiliation(s)
- Margot A Lazow
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatric Neuro-Oncology Program, Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Christine Fuller
- Department of Pathology, Upstate Medical University, Syracuse, New York, USA
| | - Mariko DeWire
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam Lane
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Ute Bartels
- Division of Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sylvia Cheng
- Division of Pediatric Hematology/Oncology/BMT, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth J Cohen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Tabitha M Cooney
- Dana Farber Cancer Institute, Harvard Cancer Center, Boston, Massachusetts, USA
| | - Scott L Coven
- Division of Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Hetal Dholaria
- Department of Oncology, Perth Children’s Hospital, Nedlands, Australia
| | - Blanca Diez
- Department of Oncology and Pathology, Fundacion para la lucha de las enfermedades neurologicas de la infancia FLENI, Buenos Aires, Argentina
| | - Kathleen Dorris
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Moatasem El-ayadi
- National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt, Cairo, Egypt
| | - Ayman El-Sheikh
- Division of Oncology, Dayton Children’s Hospital, Dayton, Ohio, USA
| | - Paul G Fisher
- Department of Neurology, Stanford University, Stanford, California, USA
| | - Adriana Fonseca
- Division of Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Robert J Greiner
- Division of Oncology, Penn State Health Children’s Hospital, Hershey, Pennsylvania, USA
| | - Stewart Goldman
- Department of Pediatrics, Phoenix Children’s Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Nicholas Gottardo
- Department of Oncology, Perth Children’s Hospital, Nedlands, Australia
| | | | - Jordan R Hansford
- Children’s Cancer Centre, Royal Children’s Hospital Murdoch Children’s Research Institute University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Hassall
- Division of Oncology, Queensland Children’s Hospital, South Brisbane, Australia
| | - Cynthia Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lindsay Kilburn
- Division of Oncology, Children’s National Medical Center, Washinton, District of Columbia, USA
| | - Carl Koschmann
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah E Leary
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Jie Ma
- Division of Oncology, Xinhua Hospital, Shanghai, China
| | - Jane E Minturn
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michelle Monje-Deisseroth
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Roger Packer
- Division of Oncology, Children’s National Medical Center, Washinton, District of Columbia, USA
| | - Yvan Samson
- Division of Oncology, CHU Saint Justine, Montreal, Quebec, Canada
| | - Eric S Sandler
- Division of Oncology, Nemours Children’s Health System, Wilmington, Delaware, USA
| | - Gustavo Sevlever
- Department of Oncology and Pathology, Fundacion para la lucha de las enfermedades neurologicas de la infancia FLENI, Buenos Aires, Argentina
| | - Christopher L Tinkle
- Division of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Karen Tsui
- Division of Oncology, Starship Children’s Hospital, Auckland, New Zealand
| | - Lars M Wagner
- Division of Pediatric Hematology/Oncology, University of Kentucky, Lexington, Kentucky, USA
| | - Mohamed Zaghloul
- National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt, Cairo, Egypt
| | - David S Ziegler
- School of Women’s and Children’s Health and Children’s Cancer Institute, University of New South Wales, Sydney, Australia
| | - Brooklyn Chaney
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Katie Black
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anthony Asher
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rachid Drissi
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Childhood Cancer & Blood Disorders, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Maryam Fouladi
- Pediatric Neuro-Oncology Program, Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Blaise V Jones
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James L Leach
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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9
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Devine KJ, Diorio C, Richman SA, Henderson AA, Oranges K, Armideo E, Kolb MS, Freedman JL, Aplenc R, Fisher MJ, Minturn JE, Olson T, Bagatell R, Barakat L, Croy C, Mauro J, Vitlip L, Acord MR, Mattei P, Johnson VK, Devine CM, Pasquariello C, Reilly AF. Guideline for Children With Cancer Receiving General Anesthesia for Procedures and Imaging. J Pediatr Hematol Oncol 2022; 44:e859-e865. [PMID: 35235547 DOI: 10.1097/mph.0000000000002430] [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] [Received: 04/16/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
Children with cancer and those undergoing hematopoietic stem cell transplantation frequently require anesthesia for imaging as well as diagnostic and therapeutic procedures from diagnosis through follow-up. Due to their underlying disease and side effects of chemotherapy and radiation, they are at risk for complications during this time, yet no published guideline exists for preanesthesia preparation. A comprehensive literature review served as the basis for discussions among our multidisciplinary panel of oncologists, anesthesiologists, nurse practitioners, clinical pharmacists, pediatric psychologists, surgeons and child life specialists at the Children's Hospital of Philadelphia. Due to limited literature available, this panel created an expert consensus guideline addressing anesthesia preparation for this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lamia Barakat
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Colleen Croy
- Division of Oncology
- Department of Pharmacy, Children's Hospital of Philadelphia
| | - Jane Mauro
- Division of Oncology
- Department of Pharmacy, Children's Hospital of Philadelphia
| | | | - Michael R Acord
- Division of Interventional Radiology
- Radiology, Perelman School of Medicine at the University of Pennsylvania
| | - Peter Mattei
- Surgery, The Children's Hospital of Philadelphia
| | - Victoria K Johnson
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia
| | - Conor M Devine
- Division of Otolaryngology
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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10
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Lazow MA, Nievelstein MT, Lane A, Bandopadhayhay P, DeWire-Schottmiller M, Fouladi M, Glod JW, Greiner RJ, Hoffman LM, Hummel TR, Kilburn L, Leary S, Minturn JE, Packer R, Ziegler DS, Chaney B, Black K, de Blank P, Leach JL. Volumetric endpoints in diffuse intrinsic pontine glioma: comparison to cross-sectional measures and outcome correlations in the International DIPG/DMG Registry. Neuro Oncol 2022; 24:1598-1608. [PMID: 35148393 PMCID: PMC9435485 DOI: 10.1093/neuonc/noac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cross-sectional tumor measures are traditional clinical trial endpoints; however volumetric measures may better assess tumor growth. We determined the correlation and compared the prognostic impact of cross-sectional and volumetric measures of progressive disease (PD) among patients with DIPG. METHODS Imaging and clinical data were abstracted from the International DIPG Registry. Tumor volume and cross-sectional product (CP) were measured with mint Lesion™ software using manual contouring. Correlation between CP and volume (segmented and mathematical [ellipsoid] model) thresholds of PD were assessed by linear regression. Landmark analyses determined differences in survival (via log-rank) between patients classified as PD versus non-PD by CP and volumetric measurements at 1, 3, 5, 7, and 9 months postradiotherapy (RT). Hazard ratios (HR) for survival after these time points were calculated by Cox regression. RESULTS A total of 312 MRIs (46 patients) were analyzed. Comparing change from the previous smallest measure, CP increase of 25% (PD) correlated with a segmented volume increase of 30% (R2 = 0.710), rather than 40% (spherical model extrapolation). CP-determined PD predicted survival at 1 month post-RT (HR = 2.77), but not other time points. Segmented volumetric-determined PD (40% threshold) predicted survival at all imaging timepoints (HRs = 2.57, 2.62, 3.35, 2.71, 16.29), and 30% volumetric PD threshold predicted survival at 1, 3, 5, and 9 month timepoints (HRs = 2.57, 2.62, 4.65, 5.54). Compared to ellipsoid volume, segmented volume demonstrated superior survival associations. CONCLUSIONS Segmented volumetric assessments of PD correlated better with survival than CP or ellipsoid volume at most time points. Semiautomated tumor volume likely represents a more accurate, prognostically-relevant measure of disease burden in DIPG.
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Affiliation(s)
| | | | - Adam Lane
- Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - Maryam Fouladi
- Pediatric Neuro-Oncology Program, Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - John W Glod
- Cancer for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert J Greiner
- Division of Oncology, Penn State Health Children’s Hospital, Hershey, Pennsylvania, USA
| | - Lindsey M Hoffman
- Division of Oncology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Trent R Hummel
- Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lindsay Kilburn
- Division of Oncology, Children’s National Medical Center, Washington, DC, USA
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Jane E Minturn
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Roger Packer
- Division of Oncology, Children’s National Medical Center, Washington, DC, USA
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia,School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | - Brooklyn Chaney
- Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Katie Black
- Brain Tumor Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - James L Leach
- Corresponding Author: James L. Leach, MD, Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue Cincinnati, OH 45229, USA ()
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11
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Meany HJ, Widemann BC, Hinds PS, Bagatell R, Shusterman S, Stern E, Jayaprakash N, Peer CJ, Figg WD, Hall OM, Sissung TM, Kim A, Fox E, London WB, Rodriguez-Galindo C, Minturn JE, Dome JS. Phase 1 study of sorafenib and irinotecan in pediatric patients with relapsed or refractory solid tumors. Pediatr Blood Cancer 2021; 68:e29282. [PMID: 34383370 DOI: 10.1002/pbc.29282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sorafenib,an orally bioavailable, multitarget tyrosine kinase inhibitor, and irinotecan, a topoisomerase I inhibitor, have demonstrated activity in pediatric and adult malignancies. We evaluated the toxicity, pharmacokinetic (PK), and pharmacogenomic (PGX) profile of sorafenib with irinotecan in children with relapsed or refractory solid tumors and assessed the feasibility of incorporating patient-reported outcome (PRO) measures as an adjunct to traditional endpoints. METHODS Sorafenib, continuous oral twice daily dosing, was administered with irinotecan, orally, once daily days 1-5, repeated every 21 days (NCT01518413). Based on tolerability, escalation of sorafenib followed by escalation of irinotecan was planned. Three patients were initially enrolled at each dose level. Sorafenib and irinotecan PK analyses were performed during cycle 1. PRO measurements were collected during cycles 1 and 2. RESULTS Fifteen patients were evaluable. Two of three patients at dose level 2 experienced dose-limiting toxicity (DLT), grade 3 diarrhea, and grade 3 hyponatremia. Therefore, dose level 1 was expanded to 12 patients and two patients had DLT, grade 4 thrombocytopenia, grade 3 elevated lipase. Nine of 15 (60%) patients had a best response of stable disease with four patients receiving ≥6 cycles. CONCLUSIONS The recommended dose for pediatric patients was sorafenib 150 mg/m2 /dose twice daily with irinotecan 70 mg/m2 /dose daily × 5 days every 21 days. This oral outpatient regimen was well tolerated and resulted in prolonged disease stabilization. There were no significant alterations in the PK profile of either agent when administered in combination. Patients were willing and able to report their subjective experiences with this regimen.
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Affiliation(s)
- Holly J Meany
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Pamela S Hinds
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.,Division of Nursing, Children's National Hospital, Washington, District of Columbia
| | - Rochelle Bagatell
- Perelman School of Medicine, Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Suzanne Shusterman
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts
| | - Emily Stern
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia
| | - Nalini Jayaprakash
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cody J Peer
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William D Figg
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - O Morgan Hall
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tristan M Sissung
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Aerang Kim
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Elizabeth Fox
- Perelman School of Medicine, Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts
| | - Carlos Rodriguez-Galindo
- Departments of Oncology and Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jane E Minturn
- Perelman School of Medicine, Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Dome
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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12
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Minturn JE, Mochizuki AY, Partap S, Belasco JB, Lange BJ, Li Y, Phillips PC, Gibbs IC, Fisher PG, Fisher MJ, Janss AJ. A Pilot Study of Low-Dose Craniospinal Irradiation in Patients With Newly Diagnosed Average-Risk Medulloblastoma. Front Oncol 2021; 11:744739. [PMID: 34540703 PMCID: PMC8443797 DOI: 10.3389/fonc.2021.744739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose Medulloblastoma is one of the most common malignant brain tumors in children. To date, the treatment of average-risk (non-metastatic, completely resected) medulloblastoma includes craniospinal radiation therapy and adjuvant chemotherapy. Modern treatment modalities and now risk stratification of subgroups have extended the survival of these patients, exposing the long-term morbidities associated with radiation therapy. Prior to advances in molecular subgrouping, we sought to reduce the late effects of radiation in patients with average-risk medulloblastoma. Methods We performed a single-arm, multi-institution study, reducing the dose of craniospinal irradiation by 25% to 18 Gray (Gy) with the goal of maintaining the therapeutic efficacy as described in CCG 9892 with maintenance chemotherapy. Results Twenty-eight (28) patients aged 3-30 years were enrolled across three institutions between April 2001 and December 2010. Median age at enrollment was 9 years with a median follow-up time of 11.7 years. The 3-year relapse-free (RFS) and overall survival (OS) were 79% (95% confidence interval [CI] 58% to 90%) and 93% (95% CI 74% to 98%), respectively. The 5-year RFS and OS were 71% (95% CI 50% to 85%) and 86% (95% CI 66% to 94%), respectively. Toxicities were similar to those seen in other studies; there were no grade 5 toxicities. Conclusions Given the known neurocognitive adverse effects associated with cranial radiation therapy, studies to evaluate the feasibility of dose reduction are needed. In this study, we demonstrate that select patients with average-risk medulloblastoma may benefit from a reduced craniospinal radiation dose of 18 Gy without impacting relapse-free or overall survival. Clinical Trial Registration ClinicalTrials.gov identifier: NCT00031590
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Affiliation(s)
- Jane E Minturn
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Aaron Y Mochizuki
- Department of Pediatrics, Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Neurology and Neurological Sciences, Division of Child Neurology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA, United States
| | - Sonia Partap
- Department of Neurology and Neurological Sciences, Division of Child Neurology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA, United States
| | - Jean B Belasco
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Beverly J Lange
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Yimei Li
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Peter C Phillips
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Iris C Gibbs
- Department of Neurology and Neurological Sciences, Division of Child Neurology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA, United States.,Department of Radiation Oncology, Stanford University Cancer Center, Palo Alto, CA, United States
| | - Paul G Fisher
- Department of Neurology and Neurological Sciences, Division of Child Neurology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA, United States
| | - Michael J Fisher
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Anna J Janss
- Department of Pediatrics, Division of Hematology/Oncology, Children's Healthcare of Atlanta, Atlanta, GA, United States
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13
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Erker C, Lane A, Chaney B, Leary S, Minturn JE, Bartels U, Packer RJ, Dorris K, Gottardo NG, Warren KE, Broniscer A, Mark WK, Zhu X, White P, Dexheimer P, Black K, Asher A, DeWire-Shottmiller M, Hansford JR, Gururangan S, Nazarian J, Ziegler DS, Sandler E, Wagner L, Koschmann C, Fuller C, Drissi R, Jones BV, Leach J, Fouladi M. Characteristics of Patients ≥ 10 Years of Age with Diffuse Intrinsic Pontine Glioma: A Report from the International DIPG Registry. Neuro Oncol 2021; 24:141-152. [PMID: 34114629 DOI: 10.1093/neuonc/noab140] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND DIPG generally occurs in young school-age children, although can occur in adolescents and young adults. The purpose of this study was to describe clinical, radiological, pathologic, and molecular characteristics in patients ≥10 years of age with DIPG enrolled in the International DIPG Registry (IDIPGR). METHODS Patients ≥10 years of age at diagnosis enrolled in the IDIPGR with imaging confirmed DIPG diagnosis were included. The primary outcome was overall survival (OS) categorized as long-term survivors (LTS) (≥24 months) or short-term survivors (STS) (<24 months). RESULTS Among 1010 patients, 208 (21%) were ≥10 years of age at diagnosis; 152 were eligible with a median age of 12 years [range 10-26.8]. Median OS was 13 [2-82] months. The 1-, 3- and 5- years OS was 61.9%, 3.7%, and 1.5%, respectively. The 18/152 (11.8%) LTS were more likely to be older (P<0.01) and present with longer symptom duration (P<0.01). Biopsy and/or autopsy were performed in 50 (33%) patients; 77%, 61%, 33%, and 6% of patients tested had H3K27M (H3F3A or HIST1H3B), TP53, ATRX, and ACVR1 mutations/genome alterations, respectively. Two of 18 patients with IDH1 testing were IDH1-mutant and one was a LTS. The presence or absence of H3 alterations did not affect survival. CONCLUSION Patients ≥10 years old with DIPG have a median survival of 13 months. LTS present with longer symptom duration and are likely to be older at presentation compared to STS. ATRX mutation rates were higher in this population than the general DIPG population.
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Affiliation(s)
- Craig Erker
- Department of Pediatrics, Dalhousie University and IWK Health Center, Halifax, NS, Canada
| | - Adam Lane
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Brooklyn Chaney
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Sarah Leary
- Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jane E Minturn
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA
| | - Ute Bartels
- Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Division of Oncology
| | - Roger J Packer
- Department of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, DC
| | - Kathleen Dorris
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Nicholas G Gottardo
- Princess Margaret Hospital for Children and The University of Western Australia, Perth, Western Australia, Australia
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, MA, USA
| | - Alberto Broniscer
- Department of Oncology, St. Jude Children's Research Hospital, and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - W Kieran Mark
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA
| | - Xiaoting Zhu
- Brain Tumor Center, Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Electrical Engineering and Computer Science, University of Cincinnati College of Engineering and Applied Science, Cincinnati, OH.,Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Peter White
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center and University of Cincinnati
| | - Phillip Dexheimer
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center and University of Cincinnati
| | - Katie Black
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Anthony Asher
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Mariko DeWire-Shottmiller
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Jordan R Hansford
- Royal Children's Hospital, Melbourne; Murdoch Children's Research Institute; Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Sridharan Gururangan
- Preston A. Wells Center for Brain Tumor Therapy, UF Health Shands Hospital, Gainesville, FL
| | - Javad Nazarian
- Center for Genetic Medicine, Children's National Hospital, Washington D.C., and Department of Oncology, University Children's Hospital, Zurich
| | - David S Ziegler
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW and Kids Cancer Centre, Sydney's Children Hospital, Randwick, Sydney NSW, Australia; and School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Eric Sandler
- Department of Pediatrics, Wolfson Children's Hospital and Nemours Children's Specialty Care, Jacksonville, FL
| | - Lars Wagner
- Division of Pediatric Hematology/Oncology, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
| | - Carl Koschmann
- Department of Pediatrics, C.S. Mott Children's Hospital and University of Michigan School of Medicine, Ann Arbor, MI
| | - Christine Fuller
- Department of Pathology, Upstate Medical University, Syracuse, NY
| | - Rachid Drissi
- Center for Childhood Cancer & Blood Disorders, Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Columbus, OH
| | - Blaise V Jones
- Division of Radiology, Cincinnati Children's Hospital Medical Center
| | - James Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center
| | - Maryam Fouladi
- The Ohio State University College of Medicine, Columbus, OH.,Pediatric Neuro-Oncology Program, Nationwide Children's Hospital, Columbus, OH
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14
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Leach JL, Roebker J, Schafer A, Baugh J, Chaney B, Fuller C, Fouladi M, Lane A, Doughman R, Drissi R, DeWire-Schottmiller M, Ziegler DS, Minturn JE, Hansford JR, Wang SS, Monje-Deisseroth M, Fisher PG, Gottardo NG, Dholaria H, Packer R, Warren K, Leary SES, Goldman S, Bartels U, Hawkins C, Jones BV. MR imaging features of diffuse intrinsic pontine glioma and relationship to overall survival: report from the International DIPG Registry. Neuro Oncol 2021; 22:1647-1657. [PMID: 32506137 DOI: 10.1093/neuonc/noaa140] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 12/18/2022] Open
Abstract
BACKGROUND This study describes imaging features of diffuse intrinsic pontine glioma (DIPG) and correlates with overall survival (OS) and histone mutation status in the International DIPG Registry (IDIPGR). METHODS Four hundred cases submitted to the IDIPGR with a local diagnosis of DIPG and baseline MRI were evaluated by consensus review of 2 neuroradiologists; 43 cases were excluded (inadequate imaging or alternative diagnoses). Agreement between reviewers, association with histone status, and univariable and multivariable analyses relative to OS were assessed. RESULTS On univariable analysis imaging features significantly associated with worse OS included: extrapontine extension, larger size, enhancement, necrosis, diffusion restriction, and distant disease. On central review, 9.5% of patients were considered not to have DIPG. There was moderate mean agreement of MRI features between reviewers. On multivariable analysis, chemotherapy, age, and distant disease were predictors of OS. There was no difference in OS between wild-type and H3 mutated cases. The only imaging feature associated with histone status was the presence of ill-defined signal infiltrating pontine fibers. CONCLUSIONS Baseline imaging features are assessed in the IDIPGR. There was a 9.5% discordance in DIPG diagnosis between local and central review, demonstrating need for central imaging confirmation for prospective trials. Although several imaging features were significantly associated with OS (univariable), only age and distant disease were significant on multivariable analyses. There was limited association of imaging features with histone mutation status, although numbers are small and evaluation exploratory.
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Affiliation(s)
- James L Leach
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James Roebker
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Austin Schafer
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua Baugh
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Brooklyn Chaney
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine Fuller
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maryam Fouladi
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam Lane
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Renee Doughman
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachid Drissi
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Jane E Minturn
- Division of Oncology, Children's Hospital of Philadelphia, Pennsylvania
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital; Murdoch Children's Research Institute; University of Melbourne, Melbourne, Australia
| | - Stacie S Wang
- Children's Cancer Centre, Royal Children's Hospital; Murdoch Children's Research Institute; University of Melbourne, Melbourne, Australia
| | | | - Paul G Fisher
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California
| | | | - Hetal Dholaria
- Department of Oncology, Perth Children's Hospital, Perth, AU
| | - Roger Packer
- Division of Oncology, Children's National Medical Center, Washington, DC
| | - Katherine Warren
- Dana-Farber Cancer Institute, Boston Children's Cancer and Blood Disorders Center, Harvard Cancer Center, Boston Massachusetts
| | - Sarah E S Leary
- Cancer and Blood Disorders Center, Seattle Children's, Seattle, Washington
| | - Stewart Goldman
- Division of Oncology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ute Bartels
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, CA
| | - Cynthia Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, CA
| | - Blaise V Jones
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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15
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Lazow MA, Fuller C, Lane A, DeWire-Schottmiller MD, Bandopadhayay P, Bartels U, Bouffet E, Cheng S, Cohen KJ, Cooney TM, Coven SL, Dholaria H, Diez B, Dorris K, El-Ayadi M, El-Sheikh A, Fisher PG, Lombardi MG, Greiner RJ, Goldman S, Gottardo N, Gururangan S, Hansford JR, Hassall T, Hawkins C, Kilburn L, Koschmann CJ, Leary SE, Ma J, Minturn JE, Monje-Deisseroth M, Packer RJ, Samson Y, Sandler ES, Sevlever G, Tinkle C, Tsui K, Wagner LM, Zaghloul M, Ziegler DS, Chaney B, Black K, Asher A, Drissi R, Fouladi M, Jones BV, Leach JL. DIPG-46. NON-DIPG PATIENTS ENROLLED IN THE INTERNATIONAL DIPG REGISTRY: HISTOPATHOLOGIC EVALUATION OF CENTRAL NEURO-IMAGING REVIEW. Neuro Oncol 2020. [PMCID: PMC7715769 DOI: 10.1093/neuonc/noaa222.092] [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
INTRODUCTION The role of diagnostic biopsy in diffuse intrinsic pontine glioma (DIPG) remains in question. Distinguishing radiographically between DIPG and other pontine tumors with more favorable prognosis and different therapy is critically important. METHODS Cases submitted to the International DIPG registry with histopathologic data were analyzed. Central imaging review was performed by two neuro-radiologists; all cases with imaging features or histopathology suggestive of alternative diagnoses were re-reviewed. Imaging features suggestive of alternative diagnoses included non-pontine origin, <50% pontine involvement (without typical DIPG pattern on follow-up), focally exophytic morphology, sharply-defined margins, or marked diffusion restriction throughout. RESULTS Among 297 patients with pathology from biopsy and/or autopsy available, 27 (9%) had histologic diagnoses not consistent with DIPG, commonly embryonal tumors (n=9) and pilocytic astrocytomas (n=11). 163 patients had diagnostic MRI available for central neuroimaging review. Among 81 patients classified as characteristic of DIPG, 80 (99%) had histopathology consistent with DIPG (diffuse midline glioma, H3K27M-mutant, glioblastoma, anaplastic astrocytoma, diffuse astrocytoma). Among 63 patients classified as likely DIPG, but with unusual imaging features, 59 (94%) had histopathology consistent with DIPG. 19 patients had imaging features suggestive of another diagnosis, including 13 with non-pontine tumor origin; the remaining 6 all had histopathology not consistent with DIPG. Association between central imaging review and histopathology was significant (p<0.001). CONCLUSIONS The important role and accuracy of central neuroimaging review in diagnosing or excluding DIPG is demonstrated. In patients with pontine tumors for which DIPG is felt unlikely radiographically, biopsy may be considered to guide diagnosis and treatment.
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Affiliation(s)
- Margot A Lazow
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine Fuller
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Lane
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Ute Bartels
- Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | | | | | - Blanca Diez
- Fundacion para Lucha contra las Enfermedes Neurologicas de Infantes, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Stewart Goldman
- Ann & Robert H, Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | | | | | - Tim Hassall
- Queensland Children’s Hospital, South Brisbane, Australia
| | | | | | | | | | - Jie Ma
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jane E Minturn
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | | | - Gustavo Sevlever
- Fundacion para Lucha contra las Enfermedes Neurologicas de Infantes, Buenos Aires, Argentina
| | | | - Karen Tsui
- Starship Children’s Health, Auckland, New Zealand
| | - Lars M Wagner
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Brooklyn Chaney
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Katie Black
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anthony Asher
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Rachid Drissi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Maryam Fouladi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Blaise V Jones
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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16
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Hocking MC, Parish-Morris J, Schultz RT, Minturn JE, Brodsky C, Shabason EK, Herrington JD. Diminished social attention in pediatric brain tumor survivors: Using eye tracking technology during naturalistic social perception. Neuropsychology 2020; 34:350-358. [PMID: 31999166 DOI: 10.1037/neu0000623] [Citation(s) in RCA: 7] [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] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The etiology of pediatric brain tumor survivor (PBTSs) social difficulties is not well understood. A model of social competence for youth with brain disorder and evidence from youth with autism spectrum disorder (ASD) suggests that diminished social attention may underlie social deficits in PBTSs. This study used eye tracking technology to compare visual social attention in PBTSs, youth with ASD, and typically developing (TD) youth. METHODS Participants included 90 age-, gender-, and IQ-matched youth (N = 30 per group). PBTSs were at least 5 years from diagnosis and 2 years from the completion of tumor-directed therapy. Participants' eye gaze patterns were recorded while watching an established social play paradigm that presented videos of children engaging in either interactive or parallel play. Group differences in proportional gaze duration toward social versus nonsocial areas of interest were compared. Medical correlates of social attention in PBTSs were evaluated. RESULTS Groups significantly differed in gaze preference across conditions, with PBTSs looking less at social areas of interest than TD youth and in a manner comparable to youth with ASD. Among PBTSs, multimodal tumor-directed therapy was associated with reduced gaze preference for faces. CONCLUSIONS This study provides the first evidence of disrupted social attention in PBTSs, with parallels to the social attention deficits observed in ASD. Findings offer a new way to conceptualize the social difficulties of PBTSs and could guide interventions aimed at improving PBTS social adjustment by increasing visual attention to socially relevant information during social interactions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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17
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Cooney T, Lane A, Bartels U, Bouffet E, Goldman S, Leary SES, Foreman NK, Packer RJ, Broniscer A, Minturn JE, Shih CS, Chintagumpala M, Hassall T, Gottardo NG, Dholaria H, Hoffman L, Chaney B, Baugh J, Doughman R, Leach JL, Jones BV, Fouladi M, Warren KE, Monje M. Contemporary survival endpoints: an International Diffuse Intrinsic Pontine Glioma Registry study. Neuro Oncol 2019; 19:1279-1280. [PMID: 28821206 DOI: 10.1093/neuonc/nox107] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Tabitha Cooney
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Adam Lane
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Ute Bartels
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Eric Bouffet
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Stewart Goldman
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Sarah E S Leary
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Nicholas K Foreman
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Roger J Packer
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Alberto Broniscer
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Jane E Minturn
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Chie-Schin Shih
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Murali Chintagumpala
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Tim Hassall
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Nicholas G Gottardo
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Hetal Dholaria
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Lindsey Hoffman
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Brooklyn Chaney
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Joshua Baugh
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Renee Doughman
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - James L Leach
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Blaise V Jones
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Maryam Fouladi
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Katherine E Warren
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Michelle Monje
- Departments of Neurology, Neurosurgery and Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California; Department of Pediatrics, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Departments of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Departments of Pediatrics, University of Colorado and Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Denver, Colorado; Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington D.C.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Section of Pediatric Hematology/Oncology, Riley Children's Hospital, Indianapolis, Indiana; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Lady Cilento Children's Hospital, Brisbane, Australia; Princess Margaret Hospital for Children and Telethon Kid's Institute, Subiaco, Australia; Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
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18
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Brodsky C, Shabason EK, Minturn JE, Blum N, Schultz R, Herrington JD, Hocking M. Facial processing abilities and social functioning in pediatric brain tumor survivors, children with autism spectrum disorder, and typically developing children. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
157 Background: Pediatric brain tumor survivors (PBTS) often experience late effects in social functioning that mirror those seen in children with autism spectrum disorder (ASD). This study evaluated group differences in facial processing abilities and social functioning between school-aged PBTS, children with ASD, and typically developing children (TDC). Methods: PBTS(n=40;65% male; mean age=13.9 years; mean age at diagnosis=5.8 years)were at least 5 years from tumor diagnosis,2 years from end of tumor-directed therapy and absent a multi-system genetic disorder or developmental delay before tumor diagnosis. Participants completed measures of IQ, facial affect/identity recognition(Victoria/Yale Face Processing Battery), and social functioning(Children’s Communication Checklist-2, Vineland Adaptive Behavior Scales,2nd Ed. and Social Responsiveness Scale, 2nd Ed.).PBTS data were compared to a previously collected sample of age, gender, and IQ-matched children with ASD(n=41)and TDC (n=39).One-way ANOVA evaluated differences between groups with Tukey post-hoc tests.Results: IQ for PBTS(m=100.9; SD=16.27),ASD(m=100.17; SD=17.09),and TDC(m=104.72; SD=14.0)were all in the average range.One-way ANOVA revealed group differences for facial identity recognition[ F (2,114)=4.8 η²=.09 , p=.01],facial affect recognition[ F (2, 114)=3.8 , η²=.07, p=.024],and all social functioning measures[ p=.000].Tukey tests revealed PBTS facial affect recognition to be significantly worse than TDC(p < .05)and more comparable to youth with ASD for both facial affect and identity recognition.PBTS also showed worse social functioning than TDC and better than ASD youth across social measures( p’s < .01).Conclusions: Findings suggest PBTS demonstrate impairments in facial affect and identity recognition and social functioning compared to TDC.PBTS facial processing abilities appear similar to those of youth with ASD.PBTS may benefit from multi-disciplinary interventions similar to those used in ASD to improve social functioning. Screening facial processing abilities may identify those at higher risk for social functioning deficits.
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Affiliation(s)
- Cole Brodsky
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Nathan Blum
- Children's Hospital of Philadelphia, Philadelphia, PA
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19
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Nasrallah MP, Nasrallah IM, Prelack MS, Johnson MO, Lewis TB, Rubenstein M, Minturn JE, Desai A, Marcotte P, Santi M, Martinez-Lage M. 19-Year-Old Male with Headaches and a Possible Seizure. Brain Pathol 2017; 27:557-558. [PMID: 28585383 DOI: 10.1111/bpa.12529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- MacLean P Nasrallah
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ilya M Nasrallah
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marisa S Prelack
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Margaret O Johnson
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Travis B Lewis
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael Rubenstein
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jane E Minturn
- Division of Oncology/Neuro-Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Arati Desai
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul Marcotte
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Maria Martinez-Lage
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Shabason EK, Brodsky C, Baran J, Hobbie W, Minturn JE, Blum N, Hocking M. Prevalence of attention-deficit/hyperactivity disorder in pediatric brain tumor survivors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10572 Background: Pediatric brain tumor survivors (PBTS) often have neurodevelopmental late effects, including attention and concentration deficits, which may impact cognitive and academic functioning. Such symptoms are also seen in attention-deficit/hyperactivity disorder (ADHD), which affects ~5-8% of children and adolescents. This study examined the prevalence of ADHD diagnosis and ADHD medication use in PBTS and identified higher risk subsets of patients. Methods: A retrospective chart review was completed of PBTS (n = 106), diagnosed from 1999-2013, who were at least 2 years from the end of tumor-directed therapy (surgery, chemotherapy and/or radiation therapy) and without a multi-system genetic disorder or severe developmental delay prior to brain tumor diagnosis. Subjects were already screened for or enrolled in 3 other studies of PBTS late effects. Statistical analysis involved chi-squared analysis. Results: Among the 106 patients, 55.7% were male, with an average age at time of brain tumor diagnosis of 5.9 years (0-12.2 years). The most common tumor types were glioma (51.9% with 47.2% low grade, 4.7% high grade), medulloblastoma (13.2%) and ependymoma (11.3%), with 50% of tumors supratentorial, 46.2% infratentorial and 3.8% either extending or multifocal across the tentorium. Of the patients, 42.5% received radiation therapy, 38.7% chemotherapy and 86.8% surgery. Nineteen patients (17.9%) had ADHD diagnoses, and 20 (18.9%) had been on ADHD medications. Clinical factors associated with an ADHD diagnosis were supratentorial vs. infratentorial tumors (28.3% vs. 6.1%, p = 0.013), no radiation therapy vs. radiation therapy (27.9% vs. 4.4%, p = 0.002) and no chemotherapy vs. chemotherapy (24.6% vs. 7.3%, p = 0.024). ADHD diagnosis was not associated with age of brain tumor diagnosis or surgical treatment. Conclusions: Our study suggests that PBTS have over twice the ADHD prevalence as the general population, most notably in patients with supratentorial tumors or without a history of radiation therapy or chemotherapy. The results suggest that a closer look at this population is warranted and that select patients may benefit from behavioral or pharmacologic ADHD treatments to optimize functioning.
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Affiliation(s)
| | - Cole Brodsky
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie Baran
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Wendy Hobbie
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Nathan Blum
- The Children's Hospital of Philadelphia, Philadelphia, PA
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21
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Armstrong CL, Petersen J, Fisher MJ, Lustig RA, Minturn JE, Belasco JB, Amedoro S, Bolton C, Phillips PC, Hill-Kayser CE. RO-10PROSPECTIVE SLOPES OVER EIGHT YEARS IN COGNITIVE MARKERS OF PHOTON RADIOTHERAPY FOR PEDIATRIC BRAIN TUMORS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Shah AC, Minturn JE, Li Y, Belasco JB, Phillips PC, Kang TI, Cole KA, Waanders AJ, Pollack R, Didomenico C, Wildes C, Fisher MJ. Carboplatin Rechallenge After Hypersensitivity Reactions in Pediatric Patients With Low-Grade Glioma. Pediatr Blood Cancer 2016; 63:21-6. [PMID: 26235452 DOI: 10.1002/pbc.25697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The high prevalence of carboplatin hypersensitivity reactions (HSR) significantly affects the treatment of pediatric patients with low-grade glioma (LGG). Rechallenging patients is an option that must balance the risks of repeat allergic reaction to the benefits of retaining an effective anti-tumor regimen. PROCEDURE We performed a retrospective review of children with LGG treated with carboplatin and vincristine between October 2000 and April 2013, who had a documented HSR to carboplatin. Patients were re-exposed to carboplatin using either precautionary measures (prolonged infusion time and premedication with H1 antagonists, H2 antagonists, and corticosteroids), a desensitization protocol, or both. RESULTS We report the results of our institutional experience of carboplatin re-exposure using both premedication with a prolonged infusion time and a desensitization protocol. Overall, 40 of 55 (73%) patients were successfully rechallenged with carboplatin, including 19 of 25 (76%) patients who underwent desensitization. CONCLUSION Our results demonstrate re-exposure to be a safe alternative to abandoning carboplatin for patients with a hypersensitivity reaction. We propose a clinical algorithm for treatment.
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Affiliation(s)
- Amish C Shah
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jane E Minturn
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yimei Li
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Biostatistics and Epidemiology, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jean B Belasco
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter C Phillips
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tammy I Kang
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristina A Cole
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela J Waanders
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosanna Pollack
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Concetta Didomenico
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cynthia Wildes
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Meany HJ, Dome J, Hinds PS, Bagatell R, Shusterman S, Widemann BC, Stern E, London WB, Kim A, Fox E, Rodriguez-Galindo C, Minturn JE. Phase 1 study of sorafenib and irinotecan in pediatric patients with relapsed or refractory solid tumors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jeffrey Dome
- Children's National Medical Center, Washington, DC
| | | | | | | | - Brigitte C. Widemann
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Emily Stern
- Children's National Medical Center, Washington, DC
| | - Wendy B. London
- Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| | - AeRang Kim
- Children's National Medical Center, Washington, DC
| | - Elizabeth Fox
- The Children's Hospital of Philadelphia, Philadelphia, PA
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24
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Hill-Kayser CE, Lustig RA, Minturn JE, Both S, Waanders AJ, Belasco JB, Armstrong C, Phillips P, Fisher MJ. Proton radiation for treatment of infratentorial brain tumors in infants and very young children. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Stefan Both
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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25
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Hill-Kayser CE, Paltin I, Lustig RA, Fisher MJ, Both S, Belasco JB, Cole KA, Waanders AJ, Phillips P, Minturn JE. Outcomes after proton radiotherapy for localized childhood ependymoma (EP). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Iris Paltin
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Stefan Both
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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26
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Abstract
OPINION STATEMENT Gliomas are the most common brain tumor in children and represent nearly 50 % of all pediatric central nervous system (CNS) tumors. They are a heterogeneous group of diseases, ranging from highly malignant and frequently fatal to histologically benign and curable by surgery alone. A uniform treatment approach to these tumors is not practical, due to their histological and biological heterogeneity. Low-grade gliomas (LGGs) are best treated with maximally safe surgical resection, generally achievable for hemispheric or cerebellar locations. Patients with deep midline, optic pathway/hypothalamic, and brain stem locations should undergo subtotal resection or biopsy only. If a complete resection is not feasible, subtotal resection followed by adjuvant chemotherapy or radiotherapy is the standard approach; however, observation alone with serial neuroimaging is used in some asymptomatic, surgically inaccessible lesions. Chemotherapy is used first-line in cases of residual or progressive disease, to avoid or delay radiation therapy and its associated side effects. Regimens demonstrating objective responses and increased progression free survival (PFS) include carboplatin and vincristine (CV), thioguanine/procarbazine/CCNU/vincristine (TPCV), or weekly vinblastine. High-grade gliomas (HGGs) are less common in children than in adults, though are similar in their aggressive clinical behavior, resistance to therapy, and dismal outcomes. There is not a single "standard of care" therapy for non-metastatic HGGs, but generally accepted is an aggressive attempt at a complete surgical resection, followed by multimodality therapy with focal radiation and chemotherapy. The use of temozolomide (TMZ) during and following radiotherapy is common, though it appeared not to improve the outcome in a cooperative group clinical trial when compared to an historical control cohort. The angiogenesis inhibitor bevacizumab, used alone or in combination with irinotecan, is also commonly used as maintenance therapy after radiation. Current trials are prospectively comparing TMZ to newer agents (vorinostat, bevacizumab) in a randomized phase II trial. Brainstem gliomas are a unique category of childhood gliomas. Approximately 80 % of childhood brainstem gliomas arise within the pons as diffuse intrinsic pontine gliomas (DIPG). When biopsied, these are usually HGGs and carry a dismal prognosis. Standard therapy is focal radiation (54-58 Gy), preferably on a clinical trial testing concurrent chemotherapy or biologic agent. No standard chemotherapy agent has impacted survival. The remaining 20 % of brainstem gliomas are low-grade, arise in the midbrain, dorsal medulla, or cervicomedullary junction, and are indolent in nature with a much better prognosis. Improvement in the outcome of all childhood gliomas will require increased knowledge of the underlying biology of these tumors, in order to treat with more biologically based and precise therapies.
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Affiliation(s)
- Jane E Minturn
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, CTRB 4028, Philadelphia, PA, 19104, USA
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27
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Light JE, Koyama H, Minturn JE, Ho R, Simpson AM, Iyer R, Mangino JL, Kolla V, London WB, Brodeur GM. Clinical significance of NTRK family gene expression in neuroblastomas. Pediatr Blood Cancer 2012; 59:226-32. [PMID: 21990266 PMCID: PMC3258457 DOI: 10.1002/pbc.23343] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 06/30/2011] [Accepted: 08/17/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neuroblastomas (NBs) are characterized by clinical heterogeneity, from spontaneous regression to relentless progression. The pattern of NTRK family gene expression contributes to these disparate behaviors. TrkA/NTRK1 is expressed in favorable NBs that regress or differentiate, whereas TrkB/NTRK2 and its ligand brain-derived neurotrophic factor (BDNF) are co-expressed in unfavorable NBs, representing an autocrine survival pathway. We determined the significance of NTRK family gene expression in a large, representative set of primary NBs. PATIENTS AND METHODS We analyzed the expression of the following genes in 814 NBs using quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR): NTRK1, NTRK2, NTRK3, P75/NGFR, nerve growth factor (NGF), BDNF, IGFR1, and EGFR. Expression (high vs. low) was dichotomized by median expression value and compared to clinical and biological variables as well as outcome. RESULTS High NTRK1 expression was strongly correlated with favorable age, stage, MYCN status, histology, ploidy, risk group, and outcome (P < 0.0001 for all). However, it did not add significantly to the panel of prognostic variables currently used for cooperative group trials. NTRK2 expression was associated with risk factors but not with outcome. High NGF expression was also associated with most risk factors and weakly with unfavorable outcome. CONCLUSIONS High expression of NTRK1 is strongly associated with favorable risk factors and outcome in a large, representative population of NB patients. It did not add significantly to the current risk prediction algorithm, but it may contribute to future expression classifiers. Indeed, prospective assessment of NTRK1 and NTRK2 expression will identify tumors that would be candidates for NTRK-targeted therapy, either alone or in combination with conventional agents.
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Affiliation(s)
- Jennifer E Light
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Iyer R, Varela CR, Minturn JE, Ho R, Simpson AM, Light JE, Evans AE, Zhao H, Thress K, Brown JL, Brodeur GM. AZ64 inhibits TrkB and enhances the efficacy of chemotherapy and local radiation in neuroblastoma xenografts. Cancer Chemother Pharmacol 2012; 70:477-86. [PMID: 22623209 DOI: 10.1007/s00280-012-1879-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
Neuroblastoma is a common pediatric tumor characterized by clinical heterogeneity. Because it is derived from sympathetic neuroblasts, the NTRK family of neurotrophin receptors plays an integral role in neuroblastoma cell survival, growth, and differentiation. Indeed, high expression of NTRK1 is associated with favorable clinical features and outcome, whereas expression of NTRK2 and its ligand, brain-derived neurotrophic factor (BDNF), are associated with unfavorable features and outcome. AZ64 (Astra Zeneca) is a potent and selective inhibitor of the NTRK tyrosine kinases that blocks phosphorylation at nanomolar concentrations. To determine the preclinical activity of AZ64, we performed intervention trials in a xenograft model with NTRK2-overexpressing neuroblastomas. AZ64 alone significantly inhibited tumor growth compared to vehicle-treated animals (p = 0.0006 for tumor size). Furthermore, the combination of AZ64 with conventional chemotherapeutic agents, irinotecan and temozolomide (irino-temo), showed significantly enhanced anti-tumor efficacy compared to irino-temo alone [(p < 0.0001 for tumor size, p < 0.0005 for event-free survival (EFS)]. We also assessed the combination of AZ64 and local radiation therapy (RT) on a neuroblastoma hindlimb xenograft model, and the efficacy of local RT was significantly increased when animals were treated simultaneously with AZ64 (p < 0.0001 for tumor size, p = 0.0006 for EFS). We conclude that AZ64 can inhibit growth of NTRK-expressing neuroblastomas both in vitro and in vivo. More importantly, it can significantly enhance the efficacy of conventional chemotherapy as well as local RT, presumably by inhibition of the NTRK2/BDNF autocrine survival pathway.
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Affiliation(s)
- Radhika Iyer
- Division of Oncology, Children's Hospital of Philadelphia, PA 19104-4302, USA
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Warren KE, Gururangan S, Geyer JR, McLendon RE, Poussaint TY, Wallace D, Balis FM, Berg SL, Packer RJ, Goldman S, Minturn JE, Pollack IF, Boyett JM, Kun LE. A phase II study of O6-benzylguanine and temozolomide in pediatric patients with recurrent or progressive high-grade gliomas and brainstem gliomas: a Pediatric Brain Tumor Consortium study. J Neurooncol 2011; 106:643-9. [PMID: 21968943 DOI: 10.1007/s11060-011-0709-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 09/12/2011] [Indexed: 11/29/2022]
Abstract
To estimate the sustained (≥8 weeks) objective response rate in pediatric patients with recurrent or progressive high-grade gliomas (HGG, Stratum A) or brainstem gliomas (BSG, Stratum B) treated with the combination of O6-benzylguanine (O6BG) and temozolomide(®) (TMZ). Patients received O6BG 120 mg/m(2)/d IV followed by TMZ 75 mg/m(2)/d orally daily for 5 consecutive days of each 28-day course. The target objective response rate to consider the combination active was 17%. A two-stage design was employed. Forty-three patients were enrolled; 41 were evaluable for response, including 25 patients with HGG and 16 patients with BSG. The combination of O6BG and TMZ was tolerable, and the primary toxicities were myelosuppression and gastrointestinal symptoms. One sustained (≥8 weeks) partial response was observed in the HGG cohort; no sustained objective responses were observed in the BSG cohort. Long-term (≥6 courses) stable disease (SD) was observed in 4 patients in Stratum A and 1 patient in Stratum B. Of the 5 patients with objective response or long-term SD, 3 underwent central review with 2 reclassified as low-grade gliomas. The combination of O6BG and TMZ did not achieve the target response rate for activity in pediatric patients with recurrent or progressive HGG and BSG.
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Affiliation(s)
- Katherine E Warren
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
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Haas-Kogan DA, Banerjee A, Poussaint TY, Kocak M, Prados MD, Geyer JR, Fouladi M, Broniscer A, Minturn JE, Pollack IF, Packer RJ, Boyett JM, Kun LE. Phase II trial of tipifarnib and radiation in children with newly diagnosed diffuse intrinsic pontine gliomas. Neuro Oncol 2011; 13:298-306. [PMID: 21339191 DOI: 10.1093/neuonc/noq202] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We performed a phase II study to assess the efficacy and toxicity of tipifarnib, a farnesyltransferase inhibitor, administered with radiation therapy (RT) in children with newly diagnosed diffuse intrinsic pontine gliomas. Children 3-21 years old with pontine gliomas (BSGs) were treated with concurrent tipifarnib and RT, followed by adjuvant tipifarnib. Tipifarnib was taken orally twice daily (125 mg/m(2)/dose) during RT; after RT, it was taken at 200 mg/m(2) twice daily for 21 days, in 28-day cycles. Initial and follow-up neuroimaging was centrally reviewed. Forty eligible patients (median age, 5.5 years; range, 3.3-16.5 years) had a median progression-free survival of 6.8 months (range, 0.2-18.6 months) and median overall survival of 8.3 months (range, 0.2-18.6 months). Kaplan-Meier estimates (± standard error) of 1-year progression-free and overall survival were 12.9% ±4.9% and 34.3% ±7.4%, respectively. A single patient remained on tipifarnib without progression at the completion of the study, two years after initiation of treatment. Seven patients were without disease progression for at least six months, three of whom remained controlled for more than a year. The most frequent toxicity was grade 3 lymphopenia. We documented a single instance of "pseudoprogression" by neuroimaging review. We found no discordance among 3 approaches to defining disease progression: as interpreted by treating institutions (based on clinical status and/or imaging) and by central review (using bi-dimensional tumor "area" versus volumetric measurements). For children with diffuse BSGs, tipifarnib administered with irradiation offered no clinical advantage over historical controls. Biopsies and molecular analyses of pediatric BSGs are vital for identification of new agents and for rational use of targeted agents.
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Long PM, Stradecki HM, Minturn JE, Wesley UV, Jaworski DM. Differential aminoacylase expression in neuroblastoma. Int J Cancer 2011; 129:1322-30. [PMID: 21128244 DOI: 10.1002/ijc.25798] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 11/09/2010] [Indexed: 12/18/2022]
Abstract
Neuroblastoma, a cancer of the sympathetic nervous system, is the most common extracranial solid tumor in children. MYCN amplification and increased BDNF/TrkB signaling are features of high-risk tumors; yet, only ˜25% of malignant tumors display these features. Thus, the identification of additional biomarkers and therapeutic targets is essential. As aminoacylase 1 (ACY1), an amino acid deacetylase, is a putative tumor suppressor in small cell lung and renal cell carcinomas, we investigated whether it or the other family members aspartoacylase (ASPA, aminoacylase 2) or aminoacylase 3 (ACY3) could serve a similar function in neuroblastoma. Aminoacylase expression was examined in TrkB-positive, MYCN-amplified (SMS-KCNR and SK-N-BE) and TrkB-negative, non-MYCN-amplified (SK-N-AS, SK-N-SH, SH-SY5Y and SH-EP) neuroblastoma cell lines. Each aminoacylase exhibited distinct spatial localization (i.e., cytosolic ACY1, membrane-associated ASPA and nuclear ACY3). When SK-N-SH cells were treated with neural differentiation agents (e.g., retinoic acid and cAMP) in media containing 10% serum, ACY1 was the only aminoacylase whose expression was upregulated. ASPA was primarily expressed in SH-EP cells of a glial sublineage. ACY3 was more highly expressed in the TrkB-positive, MYCN-amplified lines. All three aminoacylases were expressed in normal human adrenal gland, a common site of neuroblastoma origin, but only ACY1 and ACY3 displayed detectable expression in primary neuroblastoma tumor. Bioinformatics data mining of Kaplan-Meier survival revealed that high ACY3 expression is correlated with poor prognosis, whereas low expression of ACY1 or ASPA is correlated with poor prognosis. These data suggest that aminoacylase expression is dysregulated in neuroblastoma.
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Affiliation(s)
- Patrick M Long
- Department of Anatomy and Neurobiology, University of Vermont College of Medicine, Burlington, VT 05405, USA
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Ho R, Minturn JE, Simpson AM, Iyer R, Light JE, Evans AE, Brodeur GM. The effect of P75 on Trk receptors in neuroblastomas. Cancer Lett 2011; 305:76-85. [PMID: 21419569 DOI: 10.1016/j.canlet.2011.02.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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: 07/15/2010] [Revised: 02/09/2011] [Accepted: 02/10/2011] [Indexed: 01/04/2023]
Abstract
Neuroblastomas (NBs) with favorable outcome usually express TrkA, whereas unfavorable NBs frequently express TrkB and its cognate ligand BDNF. P75 (p75(LNTR), NGFR, TNFRSF16) binds NGF-related neurotrophins with low affinity and usually is coexpressed with Trk receptors in NBs. Here, we investigated the importance of p75 coexpression with Trk receptors in NBs. We transfected p75 into two Trk-null NB cell lines, SH-SY5Y and NLF that were also engineered to stably express TrkA or TrkB. Cell numbers were compared between single (Trk alone) and double (Trk+p75) transfectants, and proliferation was assessed by flow cytometry. P75 coexpression had little effect on cell growth in Trk NB cells in the absence of ligand, but it increased sensitivity and greatly enhanced the effect of cognate ligand. Exogenous NGF induced greater phosphorylation of TrkA and AKT. This was associated with increased cell number in TrkA/p75 cells compared to TrkA cells (p<0.01), which was due to increased proliferation in TrkA/p75 cells (p<0.05), followed by differentiation. Exogenous BDNF also increased cell number in TrkB/p75 compared to TrkB cells (p<0.01), due to an increase in proliferation, but without differentiation. Coexpression of p75 also increased specificity of Trk-expressing cells to ligand. NT3-induced phosphorylation of TrkA and AKT was reduced in TrkA/p75 cells. NT3-induced phosphorylation of TrkB (as well as AKT and MAPK) was also reduced with p75 coexpression. Our results suggest that p75 plays an important role in enhancing both the sensitivity of Trk receptors to low levels of ligand, as well as increasing the specificity of Trks to their cognate ligands. It also enhances ligand-induced differentiation in TrkA/p75 but not TrkB/p75 cells.
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Affiliation(s)
- Ruth Ho
- Division of Oncology, The Children's Hospital of Philadelphia, PA 19104, United States
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Minturn JE, Evans AE, Villablanca JG, Yanik GA, Park JR, Shusterman S, Groshen S, Hellriegel ET, Bensen-Kennedy D, Matthay KK, Brodeur GM, Maris JM. Phase I trial of lestaurtinib for children with refractory neuroblastoma: a new approaches to neuroblastoma therapy consortium study. Cancer Chemother Pharmacol 2011; 68:1057-65. [PMID: 21340605 DOI: 10.1007/s00280-011-1581-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 01/31/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE TrkB acts as an oncogenic kinase in a subset of human neuroblastomas. Lestaurtinib, a multi-kinase inhibitor with potent activity against Trk kinases, has demonstrated activity in preclinical models of neuroblastoma. METHODS Patients with refractory high-risk neuroblastoma received lestaurtinib twice daily for 5 days out of seven in 28-day cycles, starting at 70% of the adult recommended Phase 2 dose. Lestaurtinib dose was escalated using a 3 + 3 design. Pharmacokinetics and plasma phospho-TrkB inhibitory activity were evaluated in the first cycle. RESULTS Forty-seven subjects were enrolled, and 10 dose levels explored starting at 25 mg/M(2)/dose BID. Forty-six subjects were evaluable for response, and 42 subjects were fully evaluable for determination of dose escalation. Asymptomatic and reversible grade 3-4 transaminase elevation was dose limiting in 4 subjects. Reversible pancreatitis (grade 2) was observed in 3 subjects after prolonged treatment at higher dose levels. Other toxicities were mild and reversible. Pharmacokinetic analyses revealed rapid drug absorption, however inter-patient variability was large. Plasma inhibition of phospho-TrkB activity was observed 1 h post-dosing at 85 mg/M(2) with uniform inhibition at 120 mg/M(2). There were two partial responses and nine subjects had prolonged stable disease at dose levels ≥ 5, (median: 6 cycles). A biologically effective and recommended phase 2 dose of 120 mg/M(2)/dose BID was established. CONCLUSIONS Lestaurtinib was well tolerated in patients with refractory neuroblastoma, and a dose level sufficient to inhibit TrkB activity was established. Safety and signs of activity at the higher dose levels warrant further evaluation in neuroblastoma.
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Affiliation(s)
- Jane E Minturn
- Department of Pediatrics and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Parsons DW, Li M, Zhang X, Jones S, Leary RJ, Lin JCH, Boca SM, Carter H, Samayoa J, Bettegowda C, Gallia GL, Jallo GI, Binder ZA, Nikolsky Y, Hartigan J, Smith DR, Gerhard DS, Fults DW, VandenBerg S, Berger MS, Marie SKN, Shinjo SMO, Clara C, Phillips PC, Minturn JE, Biegel JA, Judkins AR, Resnick AC, Storm PB, Curran T, He Y, Rasheed BA, Friedman HS, Keir ST, McLendon R, Northcott PA, Taylor MD, Burger PC, Riggins GJ, Karchin R, Parmigiani G, Bigner DD, Yan H, Papadopoulos N, Vogelstein B, Kinzler KW, Velculescu VE. The genetic landscape of the childhood cancer medulloblastoma. Science 2011; 331:435-9. [PMID: 21163964 PMCID: PMC3110744 DOI: 10.1126/science.1198056] [Citation(s) in RCA: 558] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor of children. To identify the genetic alterations in this tumor type, we searched for copy number alterations using high-density microarrays and sequenced all known protein-coding genes and microRNA genes using Sanger sequencing in a set of 22 MBs. We found that, on average, each tumor had 11 gene alterations, fewer by a factor of 5 to 10 than in the adult solid tumors that have been sequenced to date. In addition to alterations in the Hedgehog and Wnt pathways, our analysis led to the discovery of genes not previously known to be altered in MBs. Most notably, inactivating mutations of the histone-lysine N-methyltransferase genes MLL2 or MLL3 were identified in 16% of MB patients. These results demonstrate key differences between the genetic landscapes of adult and childhood cancers, highlight dysregulation of developmental pathways as an important mechanism underlying MBs, and identify a role for a specific type of histone methylation in human tumorigenesis.
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Affiliation(s)
- D. Williams Parsons
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
- Texas Children’s Cancer Center and Departments of Pediatrics and Molecular and Human Genetics, Baylor College of Medicine, Houston TX 77030, USA
| | - Meng Li
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Xiaosong Zhang
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Siân Jones
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Rebecca J. Leary
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Jimmy Cheng-Ho Lin
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Simina M. Boca
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Hannah Carter
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21218, USA
| | - Josue Samayoa
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21218, USA
| | - Chetan Bettegowda
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Gary L. Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - George I. Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Zev A. Binder
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | | | | | - Doug R. Smith
- Beckman Coulter Genomics Inc., Danvers, MA 01923, USA
| | - Daniela S. Gerhard
- Office of Cancer Genomics, NCI, NIH, DHHS, Bethesda, Maryland 20892, USA
| | - Daniel W. Fults
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
| | - Scott VandenBerg
- Department of Pathology, Division of Neuropathology, University of California-San Diego, San Diego, CA, USA
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | | | - Sueli Mieko Oba Shinjo
- Department of Neurology, School of Medicine of University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos Clara
- Pio XII Foundation, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Peter C. Phillips
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jane E. Minturn
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jaclyn A. Biegel
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Alexander R. Judkins
- Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Adam C. Resnick
- Divisionof Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Phillip B. Storm
- Divisionof Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Tom Curran
- Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yiping He
- The Preston Robert Tisch Brain Tumor Center, The Pediatric Brain Tumor Foundation Institute, The Department of Pathology, and The Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - B. Ahmed Rasheed
- The Preston Robert Tisch Brain Tumor Center, The Pediatric Brain Tumor Foundation Institute, The Department of Pathology, and The Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Henry S. Friedman
- The Preston Robert Tisch Brain Tumor Center, The Pediatric Brain Tumor Foundation Institute, The Department of Pathology, and The Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Stephen T. Keir
- The Preston Robert Tisch Brain Tumor Center, The Pediatric Brain Tumor Foundation Institute, The Department of Pathology, and The Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Roger McLendon
- The Preston Robert Tisch Brain Tumor Center, The Pediatric Brain Tumor Foundation Institute, The Department of Pathology, and The Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Paul A. Northcott
- Division of Neurosurgery and Program in Developmental and Stem Cell Biology, Hospital for Sick Children, University of Toronto, Toronto, CA
| | - Michael D. Taylor
- Division of Neurosurgery and Program in Developmental and Stem Cell Biology, Hospital for Sick Children, University of Toronto, Toronto, CA
| | - Peter C. Burger
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Gregory J. Riggins
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Rachel Karchin
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21218, USA
| | - Giovanni Parmigiani
- Department of Biostatistics and Computational Biology Dana-Farber Cancer Institute and Department of Biostatistics Harvard School of Public Health, Boston, MA, USA
| | - Darell D. Bigner
- The Preston Robert Tisch Brain Tumor Center, The Pediatric Brain Tumor Foundation Institute, The Department of Pathology, and The Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Hai Yan
- The Preston Robert Tisch Brain Tumor Center, The Pediatric Brain Tumor Foundation Institute, The Department of Pathology, and The Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Nick Papadopoulos
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Bert Vogelstein
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Kenneth W. Kinzler
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Victor E. Velculescu
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
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Minturn JE, Janss AJ, Fisher PG, Allen JC, Patti R, Phillips PC, Belasco JB. A phase II study of metronomic oral topotecan for recurrent childhood brain tumors. Pediatr Blood Cancer 2011; 56:39-44. [PMID: 21108437 DOI: 10.1002/pbc.22690] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prognosis for recurrent or refractory brain tumors in children is poor with conventional therapies. Topotecan is a topoisomerase I inhibitor with good central nervous system (CNS) penetration following oral administration. Increased efficacy of topotecan has been demonstrated with prolonged low-dose daily treatment in pre-clinical models. To investigate further this drug delivered orally in pediatric CNS malignancies, a phase II study in children with recurrent or refractory brain tumors was performed. PROCEDURE Patients ≤ 21 years of age at diagnosis with a recurrent, progressive, or refractory primary CNS malignancy and measurable disease, were eligible. Patients enrolled into four strata: ependymoma (N = 4), high-grade glioma (HGG) (N = 6), brainstem glioma (BSG) (N = 13), and primitive neuroectodermal tumor (PNET) (N = 8). Oral topotecan was administered once daily at a dose of 0.8 mg/m(2)/day for 21 consecutive days repeated every 28 days. Response and toxicity profiles were evaluated. RESULTS Twenty-six patients were evaluable (median age 9.2 years; 10 males). Two objective responses were observed in PNET patients with disseminated tumor at study entry. These two patients remain alive and in remission 7 and 9.5 years off study. Four other patients (two BSG, one PNET, and one HGG) had stable disease (median 4.6 months). The most common toxicities were hematologic. CONCLUSIONS Daily oral topotecan at a dose of 0.8 mg/m(2)/day can be safely administered to children with recurrent or refractory brain tumors. This regimen identified activity in recurrent PNET. The prolonged progression free survival (PFS) in two PNET patients justifies consideration of this regimen in more advanced clinical trials.
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Affiliation(s)
- Jane E Minturn
- Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Norris RE, Minturn JE, Brodeur GM, Maris JM, Adamson PC. Abstract 5257: Preclinical evaluation of lestaurtinib (CEP-701) with the retinoids for neuroblastoma. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-5257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose
Lestaurtinib (CEP-701), a selective and potent inhibitor of the Trk family of receptor tyrosine kinases, has undergone initial clinical evaluation in children with relapsed neuroblastoma. We studied the interaction of CEP-701 with 13-cis retinoic acid (13cRA) and fenretinide (4HPR), two retiniods that have been studied in children with high-risk neuroblastoma.
Methods
In a panel of 5 neuroblastoma cell lines (CHP-134, IMR-5, E6-NBLS, SH-SY5Y, and the SH-SY5Y-BR6 line that has been engineered to express high levels of functional TrkB receptors), in vitro cytotoxicity was assessed following a 72-hour drug exposure using the sulforhodamine B assay. When appropriate, the combination index (CI) of Chou-Talalay was used to characterize the interaction of 13cRA (non-constant ratio) or 4HPR (constant ratio) with CEP-701.
Results
The median (range) IC50 of single agent CEP-701 across all cell lines was 0.09 (0.08-0.17) μM. The combination of 13cRA and CEP-701 resulted in additive to synergistic interactions in 4 of the 5 cell lines studied. Addition of 1 and 5 µM of 13cRA decreased the median (range) CEP-701 IC50 1.5-fold (1.1 to 2.8-fold) and 1.7-fold (1.5 to 1.8-fold), respectively. With 10 µM 13cRA, less than 50% of cells survived when combined with various concentrations of CEP-701. The combination of 4HPR and CEP-701 trended toward being antagonistic, with a median (range) CI at the ED50 of 1.3 (1.1-1.5).
Conclusions
The combination of 13cRA and CEP-701 was additive or synergistic in a spectrum of neuroblastoma cell lines, suggesting that these agents can be used together to eliminate minimal residual disease following intensive chemoradiotherapy for high-risk neuroblastoma.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5257.
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Affiliation(s)
| | | | | | - John M. Maris
- 1Children's Hospital of Philadelphia, Philadelphia, PA
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Iyer R, Evans AE, Qi X, Ho R, Minturn JE, Zhao H, Balamuth N, Maris JM, Brodeur GM. Lestaurtinib enhances the antitumor efficacy of chemotherapy in murine xenograft models of neuroblastoma. Clin Cancer Res 2010; 16:1478-85. [PMID: 20179224 DOI: 10.1158/1078-0432.ccr-09-1531] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Neuroblastoma, a common pediatric tumor of the sympathetic nervous system, is characterized by clinical heterogeneity. The Trk family neurotrophin receptors play an important role in this behavior. Expression of TrkA is associated with favorable clinical features and outcome, whereas TrkB expression is associated with an unfavorable prognosis. We wanted to determine if the Trk-selective inhibitor lestaurtinib had therapeutic efficacy in a preclinical neuroblastoma model. EXPERIMENTAL DESIGN We performed intervention trials of lestaurtinib alone or in combination with other agents in TrkB-overexpressing neuroblastoma xenograft models. RESULTS Lestaurtinib alone significantly inhibited tumor growth compared to vehicle-treated animals [P = 0.0004 for tumor size and P = 0.011 for event-free survival (EFS)]. Lestaurtinib also enhanced the antitumor efficacy of the combinations of topotecan plus cyclophosphamide (P < 0.0001 for size and P < 0.0001 for EFS) or irinotecan plus temozolomide (P = 0.011 for size and P = 0.012 for EFS). There was no additive benefit of combining either 13-cis-retinoic acid or fenretinide with lestaurtinib compared to lestaurtinib alone. There was dramatic growth inhibition combining lestaurtinib with bevacizumab (P < 0.0001), but this combination had substantial systemic toxicity. CONCLUSIONS We show that lestaurtinib can inhibit the growth of neuroblastoma both in vitro and in vivo and can substantially enhance the efficacy of conventional chemotherapy, presumably by inhibition of the Trk/brain-derived neurotrophic factor autocrine survival pathway. It may also enhance the efficacy of selected biological agents, but further testing is required to rule out unanticipated toxicities. Our data support the incorporation of Trk inhibitors, such as lestaurtinib, in clinical trials of neuroblastoma or other tumors relying on Trk signaling pathways for survival.
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Affiliation(s)
- Radhika Iyer
- Division of Oncology and Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
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Brodeur GM, Minturn JE, Ho R, Simpson AM, Iyer R, Varela CR, Light JE, Kolla V, Evans AE. Trk receptor expression and inhibition in neuroblastomas. Clin Cancer Res 2009; 15:3244-50. [PMID: 19417027 DOI: 10.1158/1078-0432.ccr-08-1815] [Citation(s) in RCA: 226] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neuroblastoma, the most common and deadly solid tumor in children, exhibits heterogeneous clinical behavior, from spontaneous regression to relentless progression. Current evidence suggests that the TRK family of neurotrophin receptors plays a critical role in these diverse behaviors. Neuroblastomas expressing TrkA are biologically favorable and prone to spontaneous regression or differentiation, depending on the absence or presence of its ligand (NGF) in the microenvironment. In contrast, TrkB-expressing tumors frequently have MYCN amplification and are very aggressive and often fatal tumors. These tumors also express the TrkB ligand (BDNF), resulting in an autocrine or paracrine survival pathway. Exposure to BDNF promotes survival, drug resistance, and angiogenesis of TrkB-expressing tumors. Here we review the role of Trks in normal development, the different functions of Trk isoforms, and the major Trk signaling pathways. We also review the roles these receptors play in the heterogeneous biological and clinical behavior of neuroblastomas, and the activation of Trk receptors in other cancers. Finally we address the progress that has been made in developing targeted therapy with Trk-selective inhibitors to treat neuroblastomas and other tumors with activated Trk expression.
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Affiliation(s)
- Garrett M Brodeur
- Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4318, USA.
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Ho R, Minturn JE, Hishiki T, Zhao H, Wang Q, Cnaan A, Maris J, Evans AE, Brodeur GM. Proliferation of human neuroblastomas mediated by the epidermal growth factor receptor. Cancer Res 2005; 65:9868-75. [PMID: 16267010 DOI: 10.1158/0008-5472.can-04-2426] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuroblastoma is a common solid tumor of childhood that is derived from the neural crest. Expression of epidermal growth factor (EGF) receptors (EGFRs) has been associated with enhanced cell growth and aggressive behavior in other tumors. Here, we examined the expression profile of EGFRs in neuroblastoma cell lines and primary tumors. We found that all 13 neuroblastoma cell lines examined expressed EGFR1 (HER1), most at readily detectable levels. Low levels of other human EGFR family receptors were also detected in almost all cell lines. All primary tumors examined expressed readily detectable levels of HER1 and HER3 and lower levels of HER2 and HER4. EGF had a significant effect on the proliferation of neuroblastoma cell lines in vitro. EGF treatment (100 ng/mL) of the cell lines SY5Y and NLF significantly increased cell number (P < 0.01). EGF stimulated more cells to enter S and G2-M phase, as suggested by flow cytometry, indicating that EGF increases cell number by increasing proliferation, with no appreciable change in apoptosis. EGF exposure resulted in receptor autophosphorylation and activation of both the mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K)/AKT pathways. Exposure to 0.5 micromol/L ZD1839, a HER1-specific inhibitor, caused a 40% to 50% reduction in the number of SY5Y and NLF cells grown in medium containing 10% fetal bovine serum (P < 0.01). Even at 0.01 micromol/L, ZD1839 inhibited autophosphorylation of HER1 by EGF. At 0.1 micromol/L, it also blocked phosphorylation of AKT, but not MAPK, in NLF cells. Additional studies showed that the PI3K/AKT-specific inhibitor LY294002 had a more profound effect than the MAPK-specific inhibitor U0126 in blocking EGF-induced cell proliferation. This suggests that the PI3K/AKT pathway is the main signaling pathway responsible for the proliferation effects of EGF in neuroblastomas. Our results also indicate that ZD1839 is a potent inhibitor of neuroblastoma cell proliferation; therefore, it may be a useful, biologically based therapeutic agent for these tumors.
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Affiliation(s)
- Ruth Ho
- Division of Oncology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania 19104-4318, USA
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Ho R, Eggert A, Hishiki T, Minturn JE, Ikegaki N, Foster P, Camoratto AM, Evans AE, Brodeur GM. Resistance to chemotherapy mediated by TrkB in neuroblastomas. Cancer Res 2002; 62:6462-6. [PMID: 12438236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Neuroblastoma is a common childhood tumor derived from the peripheral nervous system. Favorable neuroblastomas usually express TrkA, the receptor for nerve growth factor (NGF), whereas unfavorable, MYCN-amplified neuroblastomas usually express TrkB and its ligand, brain-derived neurotrophic factor (BDNF). Here, we provide evidence that the TrkB-BDNF pathway is associated with enhanced survival and resistance to chemotherapy in neuroblastoma. We transfected the neuroblastoma line SH-SY5Y, which has endogenous expression of BDNF, with a full-length TrkB expression vector, and obtained clones with moderate or high levels of expression. Cells were exposed in vitro to chemotherapy agents used to treat neuroblastomas: doxorubicin, etoposide (VP16), and cisplatin. Chemoresistance was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay for cell survival and by ELISA for cell death. In all cases, the TrkB-expressing subclones were more resistant to treatment than the parent line. Furthermore, when the TrkB tyrosine kinase was blocked with the Trk-specific inhibitor CEP-2563, or by neutralizing antibody to BDNF, sensitivity to chemotherapy was significantly increased. We also found constitutive phosphorylation of AKT at the Ser-473 site in TrkB transfectants, whereas there was only a minimal level of constitutive phosphorylation of AKT in SY5Y cells. These results show that the TrkB-BDNF pathway provides a survival advantage when exposed to DNA-damaging reagents, and, therefore, this autocrine pathway may play an important role in mediating the drug-resistant phenotype associated with TrkB-expressing neuroblastomas. Activation of PI3K/AKT survival pathway may contribute to the increased drug resistance in TrkB-expressing neuroblastomas.
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Affiliation(s)
- Ruth Ho
- Division of Oncology, the Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pennsylvania 19104-4318, USA
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Minturn JE, Fryer HJ, Geschwind DH, Hockfield S. TOAD-64, a gene expressed early in neuronal differentiation in the rat, is related to unc-33, a C. elegans gene involved in axon outgrowth. J Neurosci 1995; 15:6757-66. [PMID: 7472434 PMCID: PMC6578000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Using two-dimensional gel electrophoresis we previously identified membrane-associated proteins that are upregulated over the course of neurogenesis. One of these, TOAD-64 (Turned On After Division, 64 kDa), is expressed immediately after neuronal birth and is dramatically downregulated in the adult. The gene encoding TOAD-64 has now been cloned, and its sequence shows homology to the unc-33 gene from C. elegans, mutations in which lead to aberrations in axon outgrowth. Northern and in situ hybridization show that TOAD-64 mRNA is enriched in the nervous system and is developmentally regulated in parallel with the protein. The expression of the TOAD-64 protein and gene coincident with initial neuronal differentiation and the downregulation when the majority of axon growth is complete suggests a role in axon elaboration. Three additional lines of evidence support this possibility: TOAD-64 is upregulated following neuronal induction of P19 and PC12 cells; the protein is found in lamellipodia and filopodia of growth cones; and axotomy of the sciatic nerve induces reexpression. While the sequence of TOAD-64 lacks a signal sequence and therefore is likely to encode a cytoplasmic protein, biochemical experiments demonstrate that the protein is tightly, but noncovalently, associated with membranes. The data presented here suggest that TOAD-64 could be a central element in the machinery underlying axonal outgrowth and pathfinding, perhaps playing a role in the signal transduction processes that permit growing axons to choose correct routes and targets.
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Affiliation(s)
- J E Minturn
- Section of Neurobiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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Black JA, Westenbroek R, Minturn JE, Ransom BR, Catterall WA, Waxman SG. Isoform-specific expression of sodium channels in astrocytes in vitro: immunocytochemical observations. Glia 1995; 14:133-44. [PMID: 7558240 DOI: 10.1002/glia.440140208] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The expression of sodium channel alpha-subunit isoforms in astrocytes cultured from P-0 rat spinal cord and P-7 rat optic nerve was examined utilizing immunocytochemical methods with antibodies generated against conserved and isoform-specific amino acid sequences of the rat brain sodium channel. In spinal cord cultures at 5 days in vitro (DIV), both stellate and flat astrocytes were immunostained with antibody SP20, which recognizes a conserved sequence common to sodium channel types I, II/IIA, and III. Antibody SP11-I, which is directed against a subtype-specific sequence in sodium channel I, did not yield detectable staining in spinal cord astrocytes. Antibody SP11-II, which is directed against a subtype-specific sequence in sodium channel II, immunostained both stellate and flat spinal cord astrocytes, although with less intensity than SP20. Antibody SP32-III, which is directed against a subtype-sequence in sodium channel III, immunostained stellate but not flat spinal cord astrocytes. SP20, SP11-II, and SP32-III staining persisted in stellate spinal cord astrocytes through 14-21 DIV, while SP20 and SP11-II immunostaining in flat spinal cord astrocytes was attenuated with time in culture. In optic nerve cultures at 5 DIV, SP20 staining was present in both stellate and flat astrocytes, but at reduced levels compared to spinal cord astrocytes. With increased time in culture SP20 staining was maintained in stellate optic nerve astrocytes but was gradually lost in flat optic nerve astrocytes. Stellate optic nerve astrocytes exhibited low levels of staining with SP11-I, SP11-II, and SP32-III. Flat optic nerve astrocytes lacked or displayed very low SP11-II staining, and SP11-I and SP32-III staining was not detectable. These observations demonstrate that cultures astrocytes are immunoreactive to antibodies generated against conserved and isotype-specific peptide sequences of rat brain sodium channels, and further suggest that there are different patterns of sodium channel expression between flat vs. stellate astrocytes and in astrocytes derived from different regions of the CNS.
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Affiliation(s)
- J A Black
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Abstract
To identify proteins involved in the early development of the mammalian cerebral cortex, we previously used two-dimensional gels to compare proteins synthesized at different stages in corticogenesis in the embryonic rat at embryonic day 14 (E14), E17, and E21. During this period, the cortex develops from a morphologically homogeneous population of proliferative precursor cells into a complex structure containing a diverse array of terminally differentiated neurons. Several proteins are up-regulated coincident with the generation of postmitotic neurons. Here we describe the purification, partial amino acid sequencing, and characterization of one of these proteins, TOAD-64 (Turned On After Division; 64 kDa), using polyclonal antisera to two synthetic peptides from the protein. This analysis reveals that TOAD-64 is a 64,000 Da protein that increases in abundance over the period of corticogenesis and then subsequently decreases to very low levels in the adult. The protein is neural specific and is expressed by postmitotic neurons as they begin their migration out of the ventricular zone into the developing cortical plate. It is expressed in advance of most other neuronal proteins. Progenitor cells do not express TOAD-64. Therefore, this protein is a marker for postmitotic cells that have made a commitment to a neuronal phenotype. The extremely early expression, the relative abundance in newly born neurons, as well as the restriction in expression to the period of initial neuronal differentiation suggest that TOAD-64 may be a key structural protein for early neuronal function.
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Affiliation(s)
- J E Minturn
- Section of Neurobiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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Affiliation(s)
- J A Black
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510
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Abstract
Immunocytochemical and electrophysiological methods were used to examine the effect of retinal ablation on the expression of sodium channels within optic nerve astrocytes in situ and in vitro. Enucleation was performed at postnatal day 3 (P3), and electron microscopy of the enucleated optic nerves at P28-P40 revealed complete degeneration of retinal ganglion axons, resulting in optic nerves composed predominantly of astrocytes. In contrast to control (non-enucleated) optic nerve astrocytes, which exhibited distinct sodium channel immunoreactivity following immunostaining with antibody 7493, the astrocytes in enucleated optic nerves did not display sodium channel immunoreactivity in situ. Cultures obtained from enucleated optic nerves consisted principally (greater than 90%) of glial fibrillary acidic protein (GFAP)+/A2B5- ("type-1") astrocytes, as determined by indirect immunofluorescence; GFAP+/A2B5+ ("type-2") astrocytes were not present, nor were GFAP-/A2B5+ (O-2A) progenitor cells. Sodium channel immunoreactivity was not present in GFAP+/A2B5- astrocytes obtained from enucleated optic nerves; in contrast, GFAP+/A2B5- astrocytes from control optic nerves exhibited 7493 immunostaining for the first 4-6 days in culture. Sodium current expression, studied using whole-cell patch-clamp recording, was attenuated in cultured astrocytes derived from enucleated optic nerves. Whereas 39 of 50 type-1 astrocytes cultured from intact optic nerves showed measurable sodium currents at 1-7 days in vitro, sodium currents were present in only 6 of 38 astrocytes cultured from enucleated optic nerves. Mean sodium current densities in astrocytes from the enucleated optic nerves (0.66 +/- 0.3 pA/pF) were significantly smaller than in astrocytes from control optic nerves (7.15 +/- 1.1 pA/pF). The h infinity-curves of sodium currents were similar in A2B5- astrocytes from enucleated and control rat optic nerves. These results suggest that there is neuronal modulation of sodium channel expression in type-1 optic nerve astrocytes, and that, following chronic loss of axonal association in vivo, sodium channel expression is down-regulated in this population of optic nerve astrocytes.
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Affiliation(s)
- J E Minturn
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06510
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Sontheimer H, Minturn JE, Ransom BR, Black JA, Cornell-Bell AH, Waxman SG. Cell coupling is restricted to subpopulations of astrocytes cultured from rat hippocampus and optic nerve. Ann N Y Acad Sci 1991; 633:592-6. [PMID: 1789588 DOI: 10.1111/j.1749-6632.1991.tb15672.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- H Sontheimer
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06510
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Minturn JE, Sontheimer H, Black JA, Angelides KJ, Ransom BR, Ritchie JM, Waxman SG. Membrane-associated sodium channels and cytoplasmic precursors in glial cells. Immunocytochemical, electrophysiological, and pharmacological studies. Ann N Y Acad Sci 1991; 633:255-71. [PMID: 1724129 DOI: 10.1111/j.1749-6632.1991.tb15619.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J E Minturn
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06510
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Sontheimer H, Minturn JE, Black JA, Ransom BR, Waxman SG. Two types of Na(+)-currents in cultured rat optic nerve astrocytes: changes with time in culture and with age of culture derivation. J Neurosci Res 1991; 30:275-87. [PMID: 1665865 DOI: 10.1002/jnr.490300202] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [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: 12/28/2022]
Abstract
Na+ channel expression was studied in cultures of rat optic nerve astrocytes using whole-cell voltage-clamp recordings. Astrocytes from postnatal day 7 rat optic nerve (RON) expressed two distinct types of Na+ currents, which had significantly different h infinity curves. Stellate, GFAP+/A2B5+ astrocytes showed currents with h infinity curve midpoints close to -65 mV, similar to Na+ currents in most neurons. In contrast, flat fibroblast-like GFAP+/A2B5- astrocytes showed Na+ currents with h infinity midpoints around -85 mV, almost 20 mV more hyperpolarized than in neurons or A2B5+ astrocytes. Interestingly, Na+ current expression was maintained in A2B5+ astrocytes but began to decrease in A2B5- astrocytes after 6 days in vitro (DIV) and fell to or below the level of detection (i.e., 1 pA/pF) at 12 DIV. Astrocytes cultured from neonatal rats (P0) are almost exclusively GFAP+/A2B5-. These cells did not display measurable Na+ currents when studied at 2 DIV; however, Na+ current was observed after 5 DIV in A2B5- astrocytes from these neonatal (P0) cultures. These findings were substantiated by immunocytochemical experiments using 7493, an antibody raised against purified rat brain Na+ channels; in P0-derived astrocyte cultures 7493 antibody staining was initially lacking (up to 3 DIV), but it was prominent in cultures after 5 DIV, suggesting that Na+ current expression in RON astrocytes occurs postnatally.
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Affiliation(s)
- H Sontheimer
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06510
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Sontheimer H, Minturn JE, Black JA, Waxman SG, Ransom BR. Specificity of cell-cell coupling in rat optic nerve astrocytes in vitro. Proc Natl Acad Sci U S A 1990; 87:9833-7. [PMID: 2263634 PMCID: PMC55268 DOI: 10.1073/pnas.87.24.9833] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Intercellular coupling was studied in cultured rat optic nerve astrocytes individually characterized by A2B5 antibody staining. The presence of cell coupling was assessed by injecting single cells with the low molecular weight fluorescent dye Lucifer yellow and noting dye passage into adjacent cells; cell coupling was also studied by analyzing the decay phase of current transients recorded in response to small voltage steps using whole-cell patch-clamp recording. Cell coupling was restricted to A2B5- astrocytes, the majority of which had a flat fibroblast-like appearance and was never observed in A2B5+ stellate-shaped astrocytes. Furthermore, A2B5- astrocytes showed coupling only to A2B5- and never to A2B5+ astrocytes. Analysis of current transients provided an additional indicator for cell coupling. Astrocytes that showed dye coupling to at least one neighboring cell required the sum of two exponential functions to fit current transients, whereas a single exponential function sufficed to fit transients in cells that were not dye coupled. The specificity of cell coupling in cultured rat optic nerve astrocytes suggests that predominantly A2B5- astrocytes comprise a coupled glial syncytium; this physiological feature of these cells may be a specialized adaptation for "spatial buffering," the transport of K+ away from areas of focal extracellular accumulation. On the other hand, A2B5+ astrocytes form an uncoupled subpopulation of rat optic nerve glial cells that may serve different functions.
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Affiliation(s)
- H Sontheimer
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510
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Minturn JE, Black JA, Angelides KJ, Waxman SG. Sodium channel expression detected with antibody 7493 in A2B5+ and A2B5- astrocytes from rat optic nerve in vitro. Glia 1990; 3:358-67. [PMID: 2172163 DOI: 10.1002/glia.440030507] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Astrocytes cultured from neonatal rat optic nerve can be classified into two subtypes, distinguished by their morphology (stellate or fibroblast-like) and their ability to bind monoclonal antibody A2B5. The presence of sodium channels in astrocytes cultured from rat optic nerve was demonstrated by indirect immunofluorescence with polyclonal antibody 7493, which is directed against purified rat brain sodium channel protein. Astrocytes cultured from postnatal day 7 (P7) rat optic nerves exhibited sodium channel immunostaining on both A2B5+ and A2B5- astrocytes up to 6 days in vitro (DIV). Staining was distributed throughout the cytoplasm and cell processes, with areas of greater intensity in the perinuclear region. At 6 DIV, the A2B5-/GFAP+ cells exhibited a loss of sodium channel immunostaining, while the A2B5+/GFAP+ cells continued to display 7493 immunoreactivity. This sodium channel staining pattern persisted for up to 28 DIV (the longest time point examined). Astrocyte cultures derived from PO rat optic nerves exhibited sodium channel immunoreactivity during the first 6 DIV. The P0 astrocyte cultures, in which, the vast majority of cells are A2B5-/GFAP+, displayed a similar staining pattern to those astrocytes with corresponding phenotype derived from P7 optic nerves. P0-derived A2B5- astrocytes showed loss of 7493 immunostaining at 6 DIV, while the rare (less than 1% of cells) A2B5+/GFAP+ cells continued to express sodium channels reactive to 7493. The reduction of sodium channel immunoreactivity in A2B5- but not A2B5+, astrocytes from both P0 and P7 optic nerves after a similar latency (approximately 6 DIV) suggests that the loss of immunostaining may result from the absence of neuronal associations in the culture environment, rather than an intrinsic biologically timed change in astrocytic expression of sodium channels.
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Affiliation(s)
- J E Minturn
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06510
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