1
|
Lazow MA, Schafer A, DeWire-Schottmiller MD, Lane A, Boué DR, Osorio DS, Finlay JL, Wright E, Rush S, Hoffman LM, Reuss J, Hummel TR, Salloum R, de Blank PM, Smiley NP, Sutton ME, Asher A, Stevenson CB, Drissi R, Fouladi M, Fuller C. LGG-31. CHARACTERIZING TEMPORAL GENOMIC HETEROGENEITY IN PEDIATRIC LOW GRADE GLIOMAS: ANALYSIS OF AN EXPANDED MULTI-INSTITUTIONAL COHORT WITH 101 PAIRED TUMOR SAMPLES. Neuro Oncol 2020. [PMCID: PMC7715389 DOI: 10.1093/neuonc/noaa222.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Recent discoveries have provided valuable insight into the genomic landscape of pediatric low grade gliomas (LGGs) at diagnosis, facilitating molecularly targeted treatment. However, little is known about their temporal and therapy-related genomic heterogeneity. An adequate understanding of the evolution of pediatric LGGs’ genomic profiles over time is critically important in guiding decisions about targeted therapeutics and diagnostic biopsy at recurrence.
METHODS
Fluorescence in situ hybridization, mutation-specific immunohistochemistry, and exome analyses were performed on paired tumor samples from primary diagnostic and subsequent surgeries.
RESULTS
101 tumor samples from 48 patients (43 with 2 specimens, 5 with 3 specimens) from 3 institutions underwent testing. BRAF fusion and BRAFV600E status were conserved in 100% and 97% of paired specimens, respectively. No loss or gain of IDH1 mutations or FGFR1, NTRK2, MYB, or MYBL1 rearrangements were detected over time. Histologic diagnosis remained the same in all tumors, with no acquired H3K27M mutations or malignant transformation. CDKN2A deletions were acquired in 7 patients (including 3 who received chemotherapy [2 with temozolomide] and 1 who received radiation), and were associated with a trend toward shorter time to progression (median: 5.5 vs. 13.0 months [p=0.08]).
CONCLUSIONS
Most targetable genetic alterations in pediatric LGGs, including BRAF alterations, are conserved at recurrence and following chemotherapy or radiation. However, CDKN2A deletion acquisition was demonstrated and may define a higher risk group. Given potential for targeted therapies for tumors acquiring CDKN2A deletions, performing a biopsy at recurrence may be indicated in certain patients, especially those with rapid progression.
Collapse
Affiliation(s)
- Margot A Lazow
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Austin Schafer
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Adam Lane
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | | | - Sarah Rush
- Akron Children’s Hospital, Akron, OH, USA
| | | | - Jamie Reuss
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Trent R Hummel
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Ralph Salloum
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Peter M de Blank
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Mary E Sutton
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anthony Asher
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Rachid Drissi
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Maryam Fouladi
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine Fuller
- Cincininati Children’s Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Lazow MA, Lawson SA, Salloum R, Hummel TR, Smiley NP, DeWire-Schottmiller MD, Fouladi M, de Blank PM. LGG-30. TRAMETINIB-ASSOCIATED HYPONATREMIA IN A CHILD WITH LOW GRADE GLIOMA IS NOT SEEN FOLLOWING TREATMENT WITH ALTERNATIVE MEK INHIBITOR. Neuro Oncol 2020. [PMCID: PMC7715810 DOI: 10.1093/neuonc/noaa222.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Molecularly targeted therapy with MEK inhibitors is increasingly being incorporated into the treatment of pediatric low-grade gliomas (LGGs). Trametinib is an orally available MEK1/2 inhibitor that has demonstrated tumor control in LGGs with BRAF alterations. Safe expansion of MEK inhibitor therapy within the pediatric patient population demands adequate understanding of and surveillance for potential MEK-inhibitor specific toxicities, especially among young children. Hyponatremia has been reported in adult patients receiving BRAF/MEK inhibitor combination treatment as well as in two pediatric patients with known diabetes insipidus treated with trametinib monotherapy. To our knowledge, single-agent trametinib has not previously been reported to be associated with hyponatremia in children in the absence of an underlying endocrinopathy. We present a case of hyponatremia associated with trametinib use in an infant with progressive LGG without known endocrine dysfunction, which recurred after significant dose reduction. Therapy with an alternative MEK1/2 inhibitor, binimetinib, provided excellent tumor response without hyponatremia. Hyponatremia is a rare but serious side effect of trametinib, even without underlying pituitary dysfunction. Infants and patients lacking the ability to quickly regulate fluid intake in response to osmolality changes are at particular risk of suffering severe consequences from hyponatremia and should be monitored closely with initiation of trametinib. Switching to a different drug within the same class may offer an alternative to significant dose reduction or discontinuation due to this toxicity.
Collapse
Affiliation(s)
- Margot A Lazow
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah A Lawson
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Ralph Salloum
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Trent R Hummel
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Maryam Fouladi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Peter M de Blank
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
4
|
Lazow MA, Hoffman L, Schafer A, Osorio DS, Boué DR, Rush S, Wright E, Lane A, DeWire-Schottmiller MD, Smolarek T, Sipple J, Taggert H, Reuss J, Salloum R, Hummel TR, de Blank P, Pillay-Smiley N, Sutton ME, Asher A, Stevenson CB, Drissi R, Finlay JL, Fouladi M, Fuller C. Characterizing temporal genomic heterogeneity in pediatric low-grade gliomas. Acta Neuropathol Commun 2020; 8:182. [PMID: 33153497 PMCID: PMC7643477 DOI: 10.1186/s40478-020-01054-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022] Open
Abstract
Recent discoveries have provided valuable insight into the genomic landscape of pediatric low-grade gliomas (LGGs) at diagnosis, facilitating molecularly targeted treatment. However, little is known about their temporal and therapy-related genomic heterogeneity. An adequate understanding of the evolution of pediatric LGGs' genomic profiles over time is critically important in guiding decisions about targeted therapeutics and diagnostic biopsy at recurrence. Fluorescence in situ hybridization, mutation-specific immunohistochemistry, and/or targeted sequencing were performed on paired tumor samples from primary diagnostic and subsequent surgeries. Ninety-four tumor samples from 45 patients (41 with two specimens, four with three specimens) from three institutions underwent testing. Conservation of BRAF fusion, BRAFV600E mutation, and FGFR1 rearrangement status was observed in 100%, 98%, and 96% of paired specimens, respectively. No loss or gain of IDH1 mutations or NTRK2, MYB, or MYBL1 rearrangements were detected over time. Histologic diagnosis remained the same in all tumors, with no acquired H3K27M mutations or malignant transformation. Changes in CDKN2A deletion status at recurrence occurred in 11 patients (42%), with acquisition of hemizygous CDKN2A deletion in seven and loss in four. Shorter time to progression and shorter time to subsequent surgery were observed among patients with acquired CDKN2A deletions compared to patients without acquisition of this alteration [median time to progression: 5.5 versus 16.0 months (p = 0.048); median time to next surgery: 17.0 months versus 29.0 months (p = 0.031)]. Most targetable genetic aberrations in pediatric LGGs, including BRAF alterations, are conserved at recurrence and following chemotherapy or irradiation. However, changes in CDKN2A deletion status over time were demonstrated. Acquisition of CDKN2A deletion may define a higher risk subgroup of pediatric LGGs with a poorer prognosis. Given the potential for targeted therapies for tumors harboring CDKN2A deletions, biopsy at recurrence may be indicated in certain patients, especially those with rapid progression.
Collapse
|
5
|
Gilligan LA, DeWire-Schottmiller MD, Fouladi M, DeBlank P, Leach JL. Tumor Response Assessment in Diffuse Intrinsic Pontine Glioma: Comparison of Semiautomated Volumetric, Semiautomated Linear, and Manual Linear Tumor Measurement Strategies. AJNR Am J Neuroradiol 2020; 41:866-873. [PMID: 32354716 DOI: 10.3174/ajnr.a6555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/26/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE 2D measurements of diffuse intrinsic pontine gliomas are limited by variability, and volumetric response criteria are poorly defined. Semiautomated 2D measurements may improve consistency; however, the impact on tumor response assessments is unknown. The purpose of this study was to compare manual 2D, semiautomated 2D, and volumetric measurement strategies for diffuse intrinsic pontine gliomas. MATERIALS AND METHODS This study evaluated patients with diffuse intrinsic pontine gliomas through a Phase I/II trial (NCT02607124). Clinical 2D cross-product values were derived from manual linear measurements (cross-product = long axis × short axis). By means of dedicated software (mint Lesion), tumor margins were traced and maximum cross-product and tumor volume were automatically derived. Correlation and bias between methods were assessed, and response assessment per measurement strategy was reported. RESULTS Ten patients (median age, 7.6 years) underwent 58 MR imaging examinations. Correlation and mean bias (95% limits) of percentage change in tumor size from prior examinations were the following: clinical and semiautomated cross-product, r = 0.36, -1.5% (-59.9%, 56.8%); clinical cross-product and volume, r = 0.61, -2.1% (-52.0%, 47.8%); and semiautomated cross-product and volume, r = 0.79, 0.6% (-39.3%, 38.1%). Stable disease, progressive disease, and partial response rates per measurement strategy were the following: clinical cross-product, 82%, 18%, 0%; semiautomated cross-product, 54%, 42%, 4%; and volume, 50%, 46%, 4%, respectively. CONCLUSIONS Manual 2D cross-product measurements may underestimate tumor size and disease progression compared with semiautomated 2D and volumetric measurements.
Collapse
Affiliation(s)
- L A Gilligan
- From the Departments of Radiology (L.A.G., J.L.L.).,Department of Graduate Medical Education (L.A.G., M.D.D.-S.), Mount Carmel Health System, Columbus, Ohio
| | - M D DeWire-Schottmiller
- and Cancer and Blood Diseases Institute (M.D.D.-S., M.F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Graduate Medical Education (L.A.G., M.D.D.-S.), Mount Carmel Health System, Columbus, Ohio
| | - M Fouladi
- and Cancer and Blood Diseases Institute (M.D.D.-S., M.F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,and Departments of Pediatrics (M.F., P.D.)
| | - P DeBlank
- and Departments of Pediatrics (M.F., P.D.)
| | - J L Leach
- From the Departments of Radiology (L.A.G., J.L.L.) .,Radiology (J.L.L.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|