Upfront biology-guided therapy in diffuse intrinsic pontine glioma: therapeutic, molecular, and biomarker outcomes from PNOC003

Authors

Cassie Kline, Children's Hospital of Philadelphia, Philadelphia, United States.
Payal Jain, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Lindsay Kilburn, Children's National Hospital, Washington, DC, United States.
Erin R. Bonner, The Wistar Institute, Philadelphia, PA, United States.
Nalin Gupta, University of California, San Francisco, San Francisco, CA, United States.
John R. Crawford, Children's Hospital of Orange County, orange, CA, United States.
Anu Banerjee, University of California, San Francisco, San Francisco, CA, United States.
Roger J. Packer, Children's National Health System, Washington, DC, United States.
Javier Villanueva-Meyer, University of California, San Francisco, San Francisco, CA, United States.
Tracy Luks, University of California, San Francisco, United States.
Yalan Zhang, University of California, San Francisco, San Francisco, CA, United States.
Madhuri Kambhampati, Children's National Hospital, Washington, DC, United States.
Jie Zhang, University of California, San Francisco, San Francisco, California, United States.
Sridevi Yadavilli, Children's National Hospital, Washington, DC, United States.
Bo Zhang, Children's Hospital of Philadelphia, United States.
Krutika S. Gaonkar, Children's Hospital of Philadelphia, Philadelphia, United States.
Jo Lynne Rokita, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.
Adam Kraya, Children's Hospital of Philadelphia, Philadelphia, United States.
John Kuhn, The University of Texas Health Science Center, San Antonio, TX, United States.
Winnie Liang, Translational Genomics Research Institute, Phoenix, AZ, United States.
Sara Byron, Translational Genomics Research Institute, Phoenix, AZ, United States.
Michael Berens, Translational Genomics Research Institute, Phoenix, AZ, United States.
Annette Molinaro, University of California, San Francisco, San Francisco, CA, United States.
Michael Prados, University of California, San Francisco, San Francisco, CA, United States.
Adam Resnick, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Sebastian M. Waszak, University of Oslo, Oslo, Norway.
Javad Nazarian, George Washington University, Washington DC.
Sabine Mueller, University of California, San Francisco, San Francisco, CA, United States.

Document Type

Journal Article

Publication Date

7-19-2022

Journal

Clinical cancer research : an official journal of the American Association for Cancer Research

DOI

10.1158/1078-0432.CCR-22-0803

Abstract

BACKGROUND: PNOC003 is a multi-center precision medicine trial for children and young adults with newly diagnosed diffuse intrinsic pontine glioma (DIPG). METHODS: Patients (3-25 years) were enrolled based on imaging consistent with DIPG. Biopsy tissue was collected for whole exome and mRNA sequencing. After radiation therapy (RT), patients were assigned up to four FDA-approved drugs based on molecular tumor board recommendations. H3K27M-mutant circulating tumor DNA (ctDNA) was longitudinally measured. Tumor tissue and matched primary cell lines were characterized using whole genome sequencing and DNA methylation profiling. When applicable, results were verified in an independent cohort from the Children's Brain Tumor Network (CBTN). RESULTS: Of 38 patients enrolled, 28 patients (median 6 years, 10 females) were reviewed by the molecular tumor board. Of those, 19 followed treatment recommendations. Median overall survival (OS) was 13.1 mo (95% CI 11.2, 18.4) with no difference between patients who followed recommendations and those who did not. H3K27M-mutant ctDNA was detected at baseline in 60% of cases tested and associated with response to RT and survival. Eleven cell lines were established, showing 100% fidelity of key somatic driver gene alterations in the primary tumor. In H3K27-altered DIPGs, TP53 mutations were associated with worse OS (TP53mut 11.1 mo [95% CI 8.7, 14]; TP53wt 13.3 mo [95% CI 11.8, NA]; p=3.4e-2), genome instability (p=3.1e-3), and RT resistance (p=6.4e-4). The CBTN cohort confirmed a negative association between TP53 status and clinical outcome. CONCLUSION: Upfront treatment-naïve biopsy provides insight into clinically relevant molecular alterations and prognostic biomarkers for H3K27-altered DIPGs.

Department

Pediatrics

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