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  • 1
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO)
    Kurzfassung: BRAF V600 mutation is detected in 5%-10% of pediatric high-grade gliomas (pHGGs), and effective treatments are limited. In previous trials, dabrafenib as monotherapy or in combination with trametinib demonstrated activity in children and adults with relapsed/refractory BRAF V600–mutant HGG. METHODS This phase II study evaluated dabrafenib plus trametinib in patients with relapsed/refractory BRAF V600–mutant pHGG. The primary objective was overall response rate (ORR) by independent review by Response Assessment in Neuro-Oncology criteria. Secondary objectives included ORR by investigator determination, duration of response (DOR), progression-free survival, overall survival (OS), and safety. RESULTS A total of 41 pediatric patients with previously treated BRAF V600–mutant HGG were enrolled. At primary analysis, median follow-up was 25.1 months, and 51% of patients remained on treatment. Sixteen of 20 discontinuations were due to progressive disease in this relapsed/refractory pHGG population. Independently assessed ORR was 56% (95% CI, 40 to 72). Median DOR was 22.2 months (95% CI, 7.6 months to not reached [NR]). Fourteen deaths were reported. Median OS was 32.8 months (95% CI, 19.2 months to NR). The most common all-cause adverse events (AEs) were pyrexia (51%), headache (34%), and dry skin (32%). Two patients (5%) had AEs (both rash) leading to discontinuation. CONCLUSION In relapsed/refractory BRAF V600–mutant pHGG, dabrafenib plus trametinib improved ORR versus previous trials of chemotherapy in molecularly unselected patients with pHGG and was associated with durable responses and encouraging survival. These findings suggest that dabrafenib plus trametinib is a promising targeted therapy option for children and adolescents with relapsed/refractory BRAF V600–mutant HGG.
    Materialart: Online-Ressource
    ISSN: 0732-183X , 1527-7755
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    Sprache: Englisch
    Verlag: American Society of Clinical Oncology (ASCO)
    Publikationsdatum: 2023
    ZDB Id: 2005181-5
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  • 2
    In: European Journal of Cancer, Elsevier BV, Vol. 114 ( 2019-06), p. 27-35
    Materialart: Online-Ressource
    ISSN: 0959-8049
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    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2019
    ZDB Id: 1120460-6
    ZDB Id: 1468190-0
    ZDB Id: 82061-1
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  • 3
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 28, No. 19 ( 2010-07-01), p. 3182-3190
    Kurzfassung: The biologic behavior of intracranial ependymoma is unpredictable on the basis of current staging approaches. We aimed at the identification of recurrent genetic aberrations in ependymoma and evaluated their prognostic significance to develop a molecular staging system that could complement current classification criteria. Patients and Methods As a screening cohort, we studied a cohort of 122 patients with ependymoma before standardized therapy by using array-based comparative genomic hybridization. DNA copy-number aberrations identified as possible prognostic markers were validated in an independent cohort of 170 patients with ependymoma by fluorescence in situ hybridization analysis. Copy-number aberrations were correlated with clinical, histopathologic, and survival data. Results In the screening cohort, age at diagnosis, gain of 1q, and homozygous deletion of CDKN2A comprised the most powerful independent indicators of unfavorable prognosis. In contrast, gains of chromosomes 9, 15q, and 18 and loss of chromosome 6 were associated with excellent survival. On the basis of these findings, we developed a molecular staging system comprised of three genetic risk groups, which was then confirmed in the validation cohort. Likelihood ratio tests and multivariate Cox regression also demonstrated the clear improvement in predictive accuracy after the addition of these novel genetic markers. Conclusion Genomic aberrations in ependymomas are powerful independent markers of disease progression and survival. By adding genetic markers to established clinical and histopathologic variables, outcome prediction can potentially be improved. Because the analyses can be conducted on routine paraffin-embedded material, it will now be possible to prospectively validate these markers in multicenter clinical trials on population-based cohorts.
    Materialart: Online-Ressource
    ISSN: 0732-183X , 1527-7755
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    Sprache: Englisch
    Verlag: American Society of Clinical Oncology (ASCO)
    Publikationsdatum: 2010
    ZDB Id: 2005181-5
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  • 4
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 28, No. 35 ( 2010-12-10), p. 5188-5196
    Kurzfassung: The role of TP53 mutations in the tumorigenesis of sporadic medulloblastoma (MB) and the value of TP53 mutation status as a prognostic marker are not yet definitely elucidated. A recent report identified TP53 mutations in MB as an adverse prognostic marker. Hence, the current study was conducted to validate the prognostic role of TP53 mutation in MB and to understand its contribution to tumorigenesis. Methods A comprehensive genetic analysis of 310 MB samples was performed by screening for TP53 mutations and further relating the TP53 mutation status to p53 immunostaining, cytogenetic aberrations, and clinical variables. Results Mutation analysis of TP53 revealed mutations in 21 (6.8%) of 310 samples. Germline TP53 mutations were found in two patients with a history suggestive of a hereditary cancer syndrome. TP53 mutation status was not associated with unfavorable prognosis (P = .63) and was not linked to 17p allelic loss but was over-represented in the prognostically favorable WNT subgroup of MB as defined by CTNNB1 mutation (seven of 35 TP53-mutated tumors v 14 of 271 TP53 wild-type tumors; P = .005) and in tumors carrying high-level MYCN amplification (seven of 21 TP53-mutated tumors v 14 of 282 TP53 wild-type tumors; P = .001). Conclusion The contradictory results in the recent literature concerning the prognostic value of TP53 mutation might be explained by different frequencies of WNT MBs, different frequencies of patients with Li-Fraumeni syndrome, and different cumulative doses of alkylating drugs applied in these studies.
    Materialart: Online-Ressource
    ISSN: 0732-183X , 1527-7755
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    Sprache: Englisch
    Verlag: American Society of Clinical Oncology (ASCO)
    Publikationsdatum: 2010
    ZDB Id: 2005181-5
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  • 5
    In: Cell, Elsevier BV, Vol. 148, No. 1-2 ( 2012-01), p. 59-71
    Materialart: Online-Ressource
    ISSN: 0092-8674
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    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2012
    ZDB Id: 187009-9
    ZDB Id: 2001951-8
    SSG: 12
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  • 6
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 74, No. 19_Supplement ( 2014-10-01), p. 3094-3094
    Kurzfassung: Since it has become evident that histopathological grading of ependymoma according to the WHO classification of CNS tumors is not capable of accurately classifying patients into meaningful strata, a broadly accepted molecular classification scheme with prognostic significance is desperately needed. In recent years, ependymomas were classified into molecular subgroups based on transcriptomic alterations. In tumors localized within the posterior fossa, two distinct biological entities of ependymoma were delineated by several studies (designated posterior fossa A and posterior fossa B), which show striking differences in genetic characteristics and clinical outcome. A similar consensus for supratentorial and spinal ependymoma is lacking. We studied genome-wide DNA methylation (Illumina HumanMethylation450 (450k) array) in 180 primary ependymal tumors (80 with corresponding gene expression profiling data generated by Affymetrix 133plus2.0 arrays), including ependymomas (posterior fossa, supratentorial, spinal), subependymomas (SE), myxopapillary ependymoma (MPE), pineal parenchymal tumors of intermediate differentiation (PPTID), and papillary tumors of the pineal region (PTPR). We performed hierarchical clustering to identify robust molecular subgroups. Independent gene expression profiling datasets from previously published ependymoma studies (Johnson et al.; Wani et al.; Witt et al.) were used as validation cohorts. DNA methylation data showed that ependymal brain tumors can be classified into eight molecular subgroups. Notably, MPE, SE, PPTID and PTPR tumors formed robust distinct clusters, as did posterior fossa Group A and Group B ependymomas. Supratentorial ependymomas can be classified into two principle molecular subgroups, one of which displays a dismal prognosis, and comprises predominantly children and infants, and is associated with highly recurrent gene fusion. Notably, a significant number of ependymomas previously classified by histology as WHO Grade II/III look like SE by methylation, and also have extremely good survival. In summary, using genome-wide DNA methylation and transcriptome analysis we could decipher robust molecular subgroups of ependymal brain tumors including supratentorial ependymoma. Diagnoses of tumors with challenging histopathological features can now be supported by this technology. Hence, this approach offers the possibility to replace the unambiguous histological grading system that is currently in use with a robust molecular classification that readily distinguishes biologically, genetically, and clinically meaningful subgroups of ependymal brain tumors. Citation Format: Hendrik Witt, Martin Sill, Khalida Wani, Steve Mack, David Capper, Stephanie Heim, Pascal Johann, Sally Lambert, Marina Rhyzova, Volker Hovestadt, Theophilos Tzaridis, Kristian Pajtler, Sebastian Bender, Till Milde, Paul A. Northcott, Andreas E. Kulozik, Olaf Witt, Peter Lichter, V Peter Collins, Andreas von Deimling, Marcel Kool, Michael D. Taylor, Martin Hasselblatt, David TW Jones, Andrey Korshunov, Ken Aldape, Stefan Pfister. Epigenetic classification of ependymal brain tumors across age groups. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3094. doi:10.1158/1538-7445.AM2014-3094
    Materialart: Online-Ressource
    ISSN: 0008-5472 , 1538-7445
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    Sprache: Englisch
    Verlag: American Association for Cancer Research (AACR)
    Publikationsdatum: 2014
    ZDB Id: 2036785-5
    ZDB Id: 1432-1
    ZDB Id: 410466-3
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  • 7
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 71, No. 8_Supplement ( 2011-04-15), p. 3453-3453
    Kurzfassung: Despite intensive radio- and chemotherapy, incompletely resectable ependymomas are associated with a poor prognosis, and novel treatments have been difficult to develop due to the lack of appropriate pre-clinical models. We here report on the generation of a first pre-clinical ependymoma model (termed DKFZ-EP1NS) with long term self-renewal capacity, and the use of histonedeacetylase-inhibitors (HDACi) in the treatment of highly aggressive ependymoma cells. We were able to isolate ependymoma cells and grow them in spheres using serum-free neurosphere media conditions. We then characterized them for genetic aberrations, marker expression and tumorigeneity in an orthotopic xenotransplant model. The DKFZ-EP1NS cells were kept under neurosphere culture conditions for up to 9 months, displaying long term self-renewal. Freezing for storage and thawing was routinely possible. Genetic aberrations (loss at 1p36, chromosome 9 incl. homozygous deletion at CDKN2A and 14q) found in the DKFZ-EP1NS corresponded to the aberrations discovered in the primary ependymoma and subsequent recurrent tumors of the patient. DKFZ-EP1NS cells display several markers associated with normal stem cells as well as cancer stem cells. Orthotopically transplanted mice displayed first tumors after 9 months in the striatum of the brain, and tumors phenotypically recapitulated the original tumor. Serial transplantation yielded secondary tumors in half the time. Subcutaneous or intraperitoneal transplantation did not recapitulate the original intracranial histopathological phenotype, indicating that the orthotopic niche is required for the induction of the chracteristic phenotype. Although the cells were resistant to commonly used chemotherapeutic agents, they responded to HDACi-treatment in vitro at doses comparable to peak plasma levels in patients. In vitro-treatment of DKFZ-EP1NS cells with the HDACi Vorinostat led to morphological changes resembling neuronal differentiation. Indeed, neuronal markers showed a marked upregulation as measured by quantitative RT-PCR. Finally, stem cell-specific properties such as the neurosphere initiation capacity were lost upon treatment with Vorinostat in vitro. In summary, we were able to establish a first ependymoma cell line with stem cell-like properties recapitulating human disease in an orthotopic xenograft model, allowing for pre-clinical evaluation of drugs targeting the cancer stem cell compartment in ependymoma. Our data derived from applying well known drugs to this in vitro-model suggest that Vorinostat may have differentiation potential in the treatment of ependymoma cells resistant to conventional chemotherapeutic drugs in vivo as well. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3453. doi:10.1158/1538-7445.AM2011-3453
    Materialart: Online-Ressource
    ISSN: 0008-5472 , 1538-7445
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    Sprache: Englisch
    Verlag: American Association for Cancer Research (AACR)
    Publikationsdatum: 2011
    ZDB Id: 2036785-5
    ZDB Id: 1432-1
    ZDB Id: 410466-3
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  • 8
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 71, No. 8_Supplement ( 2011-04-15), p. 4699-4699
    Kurzfassung: Pilocytic astrocytoma (PA) is the most common brain tumor in children. Underlying genetic driver aberrations can currently be determined for 75-80% of cases. In particular, we and others have recently shown that tandem duplication at 7q34, resulting in BRAF fusion genes and constitutive activation of the MAPK signaling pathway, is a hallmark genetic lesion in PA development. Alternative mechanisms of MAPK activation include BRAF and KRAS point mutations, RAF1 fusions, and Neurofibromatosis-associated NF1 mutations. In order to examine more precisely the spectrum of alterations in PA, we screened 79 tumor samples for RAF fusion genes and mutations in KRAS, NRAS, PTPN11, BRAF and RAF1. We used multiplex and long-distance inverse (LDI) PCR to identify BRAF and RAF1 fusion genes and direct sequencing for detailed breakpoint mapping. Strikingly, LDI-PCR revealed a novel BRAF fusion gene with an uncharacterized gene, FAM131B, as a partner. Array-based comparative genomic hybridization (aCGH), revealed an interstitial deletion of ∼2.5 Mb as a novel mechanism forming the FAM131B-BRAF fusion. As with the more common duplication, this deletion removes the N-terminal auto-inhibitory domain of BRAF kinase, resulting in constitutive kinase activity. Functional characterization of the novel fusion gene demonstrated constitutive MEK phosphorylation potential and transforming activity in NIH 3T3 cells. The same fusion gene was also identified in one PA in an additional series from Cambridge, UK (n=7, with no previously identified alteration). Furthermore, we have detected a larger deletion at 7q in one additional case from our series, in which the alternative fusion partner is currently being identified. Overall, gene fusions targeting RAF kinases were identified in 68% (54/79) of PA. Detailed analysis of genomic DNA mapped 96% (52/54) of the breakpoints to the same breakpoint cluster region in intron 8 of the BRAF gene. Moreover, we identified the first non-intronic breakpoint in exon 8 of BRAF and two novel SRGAP3-RAF1 fusion variants. BRAF, KRAS or NF1 mutations were observed as alternative mechanisms of MAPK activation in 9 tumors in which no RAF duplication was detected, as well as in two cases in our series which concomitantly harbored two or even three hits in the MAPK pathway. In summary, we have identified a novel, recurrent BRAF fusion gene resulting in MAPK pathway activation in PA caused by a genomic deletion rather than amplification at 7q34, suggesting the possibility of further undiscovered fusion variants targeting RAF genes in this and other tumor types. Being a hallmark of PA tumorigenesis, these RAF fusion genes are expected to have clinical utility as both a specific marker for PA and a tumor-specific therapeutic target, which offers promise for applying novel treatment strategies in the near future. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4699. doi:10.1158/1538-7445.AM2011-4699
    Materialart: Online-Ressource
    ISSN: 0008-5472 , 1538-7445
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    Sprache: Englisch
    Verlag: American Association for Cancer Research (AACR)
    Publikationsdatum: 2011
    ZDB Id: 2036785-5
    ZDB Id: 1432-1
    ZDB Id: 410466-3
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  • 9
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 72, No. 8_Supplement ( 2012-04-15), p. 4872-4872
    Kurzfassung: Introduction: The International Cancer Genome Consortium (ICGC) is a worldwide network aiming to provide comprehensive molecular genetic profiles of 50 clinically and societally important tumors. A major focus of the ICGC PedBrain Tumor project is medulloblastoma (MB) - the most common malignant brain tumor in childhood. Importantly, recent work has shown that MB is not a single disease, but is in fact comprised of 4 distinct molecular subgroups (WNT, SHH, Group 3, Group 4). Using an integrative next-generation sequencing-based approach, we have investigated tumorigenic events underlying medulloblastoma, with the aim of identifying novel diagnostic or prognostic markers, and therapeutic targets. Methods: The whole genome of 50 tumor-normal DNA pairs, plus the whole exome or 2,500 target genes in a further 100 sample pairs from different histological and transcriptomic subgroups, was sequenced on an Illumina HiSeq platform. Sequencing-based high-resolution copy-number data was also generated for all cases. Results: Overall, a smaller number of non-synonymous somatic mutations was seen than in most adult malignancies. The number of somatic changes also clearly showed a positive correlation with patient age, suggesting either longer-term selection for more weakly transforming alterations, or the acquisition of additional passenger mutations in tumors which grew over a longer period. Whilst some point mutations and small InDels affected known MB or cancer-related genes (e.g. CTNNB1, PTCH1, MLL2), the vast majority were in genes which have not previously been implicated in medulloblastoma. Furthermore, even the most recurrently altered genes were mutated in & lt;20% of samples overall, although several showed a clear enrichment in distinct subgroups. Pathway analysis revealed chromatin modification as one of the most frequently altered cellular processes, with hits in multiple pathway members. Novel copy-number alterations were also identified. For example, a pattern of catastrophic chromosome shattering (‘chromothripsis’) was observed almost exclusively in the SHH tumor subgroup. Conclusion: Next-generation sequencing of this large tumor cohort has provided a number of new insights into this deadly pediatric tumor. The overriding pattern is one of enormous heterogeneity, but integration with molecular subgrouping shows clear enrichment of certain alterations. This first stage of the ICGC PedBrain project has demonstrated the power of next-gen sequencing approaches to reveal significant new insights, providing a number of novel targets for potential therapeutic intervention. It also, however, indicates the importance of personalised approaches to treatment optimisation, and shows the scale of the coming challenge in terms of functionally validating the huge number of novel mutations. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4872. doi:1538-7445.AM2012-4872
    Materialart: Online-Ressource
    ISSN: 0008-5472 , 1538-7445
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    Sprache: Englisch
    Verlag: American Association for Cancer Research (AACR)
    Publikationsdatum: 2012
    ZDB Id: 2036785-5
    ZDB Id: 1432-1
    ZDB Id: 410466-3
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  • 10
    In: Clinical Pharmacology & Therapeutics, Wiley, Vol. 110, No. 4 ( 2021-10), p. 1025-1037
    Kurzfassung: The purpose of this study was to identify key deficiencies in pediatric oncology early phase clinical trial protocols in Germany and to provide guidance for efficient trial protocol development. A systematic review of the response letters of German competent authorities (CAs) and Ethics Committees to phase I/II pediatric oncology trial submissions in the period from 2014 to 2019 was performed. Documents were requested from all five Society for Paediatric Oncology and Haematology in Germany (GPOH) phase I/II trial networks plus all nine German Innovative Therapies for Children with Consortium Cancer (ITCC) centers. A blinded dataset containing aggregated data from 33 studies was analyzed for validation. All deficiencies were reviewed, listed, and weighted using a structured matrix according to frequency, category, significance, and feasibility. In total, documents of 17 trials from 6 different sites were collected. Two hundred fifty deficiencies identified by the CAs were identified and categorized into eight categories. “Toxicity and safety” was the most prominent category (27.6%), followed by “Manufacturing and Import” (18%). The majority of deficiencies were categorized as minor and potential measures as easy to address, but an important group of major and difficult to implement deficiencies was also identified. The blinded validation dataset confirmed these findings. The majority of the EC deficiencies could be resolved by changing the wording in the patient‐facing documents. In conclusion, this study was able to detect a pattern of key deficiencies. Most of the shortcomings can be anticipated by minor changes in the protocol and increased awareness can prevent time‐consuming revisions, withdrawals, or even rejections. A corresponding guideline describing key regulatory aspects is provided.
    Materialart: Online-Ressource
    ISSN: 0009-9236 , 1532-6535
    URL: Issue
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    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2021
    ZDB Id: 2040184-X
    SSG: 15,3
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