Subgroup and subtype-specific outcomes in adult medulloblastoma

Hallie Coltin; Lakshmikirupa Sundaresan; Kyle S. Smith; Patryk Skowron; Luca Massimi; Charles G. Eberhart; Karisa C. Schreck; Nalin Gupta; William A. Weiss; Daniela Tirapelli; Carlos Carlotti; Kay K.W. Li; Marina Ryzhova; Andrey Golanov; Olga Zheludkova; Oksana Absalyamova; Konstantin Okonechnikov; Damian Stichel; Andreas von Deimling; Caterina Giannini; Scott Raskin; Erwin G. Van Meir; Jennifer A. Chan; Daniel Fults; Lola B. Chambless; Seung Ki Kim; Alexandre Vasiljevic; Cecile Faure-Conter; Rajeev Vibhakar; Shin Jung; Sarah Leary; Jaume Mora; Roger E. McLendon; Ian F. Pollack; Peter Hauser; Wieslawa A. Grajkowska; Joshua B. Rubin; Marie Lise C. van Veelen; Pim J. French; Johan M. Kros; Linda M. Liau; Stefan M. Pfister; Marcel Kool; Noriyuki Kijima; Michael D. Taylor; Roger J. Packer; Paul A. Northcott; Andrey Korshunov; Vijay Ramaswamy

doi:10.1007/s00401-021-02358-4

Subgroup and subtype-specific outcomes in adult medulloblastoma

Hallie Coltin, Lakshmikirupa Sundaresan, Kyle S. Smith, Patryk Skowron, Luca Massimi, Charles G. Eberhart, Karisa C. Schreck, Nalin Gupta, William A. Weiss, Daniela Tirapelli, Carlos Carlotti, Kay K.W. Li, Marina Ryzhova, Andrey Golanov, Olga Zheludkova, Oksana Absalyamova, Konstantin Okonechnikov, Damian Stichel, Andreas von Deimling, Caterina GianniniScott Raskin, Erwin G. Van Meir, Jennifer A. Chan, Daniel Fults, Lola B. Chambless, Seung Ki Kim, Alexandre Vasiljevic, Cecile Faure-Conter, Rajeev Vibhakar, Shin Jung, Sarah Leary, Jaume Mora, Roger E. McLendon, Ian F. Pollack, Peter Hauser, Wieslawa A. Grajkowska, Joshua B. Rubin, Marie Lise C. van Veelen, Pim J. French, Johan M. Kros, Linda M. Liau, Stefan M. Pfister, Marcel Kool, Noriyuki Kijima, Michael D. Taylor, Roger J. Packer, Paul A. Northcott, Andrey Korshunov, Vijay Ramaswamy^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

36 Citations (Scopus)

Abstract

Medulloblastoma, a common pediatric malignant central nervous system tumour, represent a small proportion of brain tumours in adults. Previously it has been shown that in adults, Sonic Hedgehog (SHH)-activated tumours predominate, with Wingless-type (WNT) and Group 4 being less common, but molecular risk stratification remains a challenge. We performed an integrated analysis consisting of genome-wide methylation profiling, copy number profiling, somatic nucleotide variants and correlation of clinical variables across a cohort of 191 adult medulloblastoma cases identified through the Medulloblastoma Advanced Genomics International Consortium. We identified 30 WNT, 112 SHH, 6 Group 3, and 41 Group 4 tumours. Patients with SHH tumours were significantly older at diagnosis compared to other subgroups (p < 0.0001). Five-year progression-free survival (PFS) for WNT, SHH, Group 3, and Group 4 tumours was 64.4 (48.0–86.5), 61.9% (51.6–74.2), 80.0% (95% CI 51.6–100.0), and 44.9% (95% CI 28.6–70.7), respectively (p = 0.06). None of the clinical variables (age, sex, metastatic status, extent of resection, chemotherapy, radiotherapy) were associated with subgroup-specific PFS. Survival among patients with SHH tumours was significantly worse for cases with chromosome 3p loss (HR 2.9, 95% CI 1.1–7.6; p = 0.02), chromosome 10q loss (HR 4.6, 95% CI 2.3–9.4; p < 0.0001), chromosome 17p loss (HR 2.3, 95% CI 1.1–4.8; p = 0.02), and PTCH1 mutations (HR 2.6, 95% CI 1.1–6.2; p = 0.04). The prognostic significance of 3p loss and 10q loss persisted in multivariable regression models. For Group 4 tumours, chromosome 8 loss was strongly associated with improved survival, which was validated in a non-overlapping cohort (combined cohort HR 0.2, 95% CI 0.1–0.7; p = 0.007). Unlike in pediatric medulloblastoma, whole chromosome 11 loss in Group 4 and chromosome 14q loss in SHH was not associated with improved survival, where MYCN, GLI2 and MYC amplification were rare. In sum, we report unique subgroup-specific cytogenetic features of adult medulloblastoma, which are distinct from those in younger patients, and correlate with survival disparities. Our findings suggest that clinical trials that incorporate new strategies tailored to high-risk adult medulloblastoma patients are urgently needed.

Original language	English
Pages (from-to)	859-871
Number of pages	13
Journal	Acta Neuropathologica
Volume	142
Issue number	5
Early online date	18 Aug 2021
DOIs	https://doi.org/10.1007/s00401-021-02358-4
Publication status	Published - Nov 2021

Bibliographical note

Acknowledgements:
HC was supported by a Garron Family Cancer Centre Research Fellowship. MDT is supported by operating funds from the National Institutes for Health (5R01CA159859-08 and R01NS106155-01) and the Pediatric Brain Tumor Foundation. V.R. and M.D.T. are supported by a Stand Up To Cancer (SU2C) St. Baldrick’s Pediatric Dream Team translational research grant (SU2C-AACR-DT1113). VR is supported by operating funds from the Canadian Institutes for Health Research, the Canadian Cancer Society Research Institute, the C.R. Younger Foundation, the Garron Family Cancer Centre, Meagan’s Walk, b.r.a.i.n.child and Nelina’s Hope. This study was partially funded with support provided by the Government of Ontario, Ministry of Research, Innovation and Science, and the Princess Margaret Cancer Foundation and support from the Princess Margaret Cancer Centre-OICR Translational Genomics Laboratory. EGVM is supported by operating funds from the National Institutes of Health (R01NS096236 and R01CA235162).

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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Coltin, H., Sundaresan, L., Smith, K. S., Skowron, P., Massimi, L., Eberhart, C. G., Schreck, K. C., Gupta, N., Weiss, W. A., Tirapelli, D., Carlotti, C., Li, K. K. W., Ryzhova, M., Golanov, A., Zheludkova, O., Absalyamova, O., Okonechnikov, K., Stichel, D., von Deimling, A., ... Ramaswamy, V. (2021). Subgroup and subtype-specific outcomes in adult medulloblastoma. Acta Neuropathologica, 142(5), 859-871. https://doi.org/10.1007/s00401-021-02358-4

@article{170b7f767d2d466c82574c2d24de8429,

title = "Subgroup and subtype-specific outcomes in adult medulloblastoma",

abstract = "Medulloblastoma, a common pediatric malignant central nervous system tumour, represent a small proportion of brain tumours in adults. Previously it has been shown that in adults, Sonic Hedgehog (SHH)-activated tumours predominate, with Wingless-type (WNT) and Group 4 being less common, but molecular risk stratification remains a challenge. We performed an integrated analysis consisting of genome-wide methylation profiling, copy number profiling, somatic nucleotide variants and correlation of clinical variables across a cohort of 191 adult medulloblastoma cases identified through the Medulloblastoma Advanced Genomics International Consortium. We identified 30 WNT, 112 SHH, 6 Group 3, and 41 Group 4 tumours. Patients with SHH tumours were significantly older at diagnosis compared to other subgroups (p < 0.0001). Five-year progression-free survival (PFS) for WNT, SHH, Group 3, and Group 4 tumours was 64.4 (48.0–86.5), 61.9% (51.6–74.2), 80.0% (95% CI 51.6–100.0), and 44.9% (95% CI 28.6–70.7), respectively (p = 0.06). None of the clinical variables (age, sex, metastatic status, extent of resection, chemotherapy, radiotherapy) were associated with subgroup-specific PFS. Survival among patients with SHH tumours was significantly worse for cases with chromosome 3p loss (HR 2.9, 95% CI 1.1–7.6; p = 0.02), chromosome 10q loss (HR 4.6, 95% CI 2.3–9.4; p < 0.0001), chromosome 17p loss (HR 2.3, 95% CI 1.1–4.8; p = 0.02), and PTCH1 mutations (HR 2.6, 95% CI 1.1–6.2; p = 0.04). The prognostic significance of 3p loss and 10q loss persisted in multivariable regression models. For Group 4 tumours, chromosome 8 loss was strongly associated with improved survival, which was validated in a non-overlapping cohort (combined cohort HR 0.2, 95% CI 0.1–0.7; p = 0.007). Unlike in pediatric medulloblastoma, whole chromosome 11 loss in Group 4 and chromosome 14q loss in SHH was not associated with improved survival, where MYCN, GLI2 and MYC amplification were rare. In sum, we report unique subgroup-specific cytogenetic features of adult medulloblastoma, which are distinct from those in younger patients, and correlate with survival disparities. Our findings suggest that clinical trials that incorporate new strategies tailored to high-risk adult medulloblastoma patients are urgently needed.",

author = "Hallie Coltin and Lakshmikirupa Sundaresan and Smith, {Kyle S.} and Patryk Skowron and Luca Massimi and Eberhart, {Charles G.} and Schreck, {Karisa C.} and Nalin Gupta and Weiss, {William A.} and Daniela Tirapelli and Carlos Carlotti and Li, {Kay K.W.} and Marina Ryzhova and Andrey Golanov and Olga Zheludkova and Oksana Absalyamova and Konstantin Okonechnikov and Damian Stichel and {von Deimling}, Andreas and Caterina Giannini and Scott Raskin and {Van Meir}, {Erwin G.} and Chan, {Jennifer A.} and Daniel Fults and Chambless, {Lola B.} and Kim, {Seung Ki} and Alexandre Vasiljevic and Cecile Faure-Conter and Rajeev Vibhakar and Shin Jung and Sarah Leary and Jaume Mora and McLendon, {Roger E.} and Pollack, {Ian F.} and Peter Hauser and Grajkowska, {Wieslawa A.} and Rubin, {Joshua B.} and {van Veelen}, {Marie Lise C.} and French, {Pim J.} and Kros, {Johan M.} and Liau, {Linda M.} and Pfister, {Stefan M.} and Marcel Kool and Noriyuki Kijima and Taylor, {Michael D.} and Packer, {Roger J.} and Northcott, {Paul A.} and Andrey Korshunov and Vijay Ramaswamy",

note = "Acknowledgements: HC was supported by a Garron Family Cancer Centre Research Fellowship. MDT is supported by operating funds from the National Institutes for Health (5R01CA159859-08 and R01NS106155-01) and the Pediatric Brain Tumor Foundation. V.R. and M.D.T. are supported by a Stand Up To Cancer (SU2C) St. Baldrick{\textquoteright}s Pediatric Dream Team translational research grant (SU2C-AACR-DT1113). VR is supported by operating funds from the Canadian Institutes for Health Research, the Canadian Cancer Society Research Institute, the C.R. Younger Foundation, the Garron Family Cancer Centre, Meagan{\textquoteright}s Walk, b.r.a.i.n.child and Nelina{\textquoteright}s Hope. This study was partially funded with support provided by the Government of Ontario, Ministry of Research, Innovation and Science, and the Princess Margaret Cancer Foundation and support from the Princess Margaret Cancer Centre-OICR Translational Genomics Laboratory. EGVM is supported by operating funds from the National Institutes of Health (R01NS096236 and R01CA235162). {\textcopyright} 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2021",

month = nov,

doi = "10.1007/s00401-021-02358-4",

language = "English",

volume = "142",

pages = "859--871",

journal = "Acta Neuropathologica",

issn = "0001-6322",

publisher = "Springer-Verlag",

number = "5",

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Coltin, H, Sundaresan, L, Smith, KS, Skowron, P, Massimi, L, Eberhart, CG, Schreck, KC, Gupta, N, Weiss, WA, Tirapelli, D, Carlotti, C, Li, KKW, Ryzhova, M, Golanov, A, Zheludkova, O, Absalyamova, O, Okonechnikov, K, Stichel, D, von Deimling, A, Giannini, C, Raskin, S, Van Meir, EG, Chan, JA, Fults, D, Chambless, LB, Kim, SK, Vasiljevic, A, Faure-Conter, C, Vibhakar, R, Jung, S, Leary, S, Mora, J, McLendon, RE, Pollack, IF, Hauser, P, Grajkowska, WA, Rubin, JB, van Veelen, MLC , French, PJ , Kros, JM, Liau, LM, Pfister, SM, Kool, M, Kijima, N, Taylor, MD, Packer, RJ, Northcott, PA, Korshunov, A & Ramaswamy, V 2021, 'Subgroup and subtype-specific outcomes in adult medulloblastoma', Acta Neuropathologica, vol. 142, no. 5, pp. 859-871. https://doi.org/10.1007/s00401-021-02358-4

TY - JOUR

T1 - Subgroup and subtype-specific outcomes in adult medulloblastoma

AU - Coltin, Hallie

AU - Sundaresan, Lakshmikirupa

AU - Smith, Kyle S.

AU - Skowron, Patryk

AU - Massimi, Luca

AU - Eberhart, Charles G.

AU - Schreck, Karisa C.

AU - Gupta, Nalin

AU - Weiss, William A.

AU - Tirapelli, Daniela

AU - Carlotti, Carlos

AU - Li, Kay K.W.

AU - Ryzhova, Marina

AU - Golanov, Andrey

AU - Zheludkova, Olga

AU - Absalyamova, Oksana

AU - Okonechnikov, Konstantin

AU - Stichel, Damian

AU - von Deimling, Andreas

AU - Giannini, Caterina

AU - Raskin, Scott

AU - Van Meir, Erwin G.

AU - Chan, Jennifer A.

AU - Fults, Daniel

AU - Chambless, Lola B.

AU - Kim, Seung Ki

AU - Vasiljevic, Alexandre

AU - Faure-Conter, Cecile

AU - Vibhakar, Rajeev

AU - Jung, Shin

AU - Leary, Sarah

AU - Mora, Jaume

AU - McLendon, Roger E.

AU - Pollack, Ian F.

AU - Hauser, Peter

AU - Grajkowska, Wieslawa A.

AU - Rubin, Joshua B.

AU - van Veelen, Marie Lise C.

AU - French, Pim J.

AU - Kros, Johan M.

AU - Liau, Linda M.

AU - Pfister, Stefan M.

AU - Kool, Marcel

AU - Kijima, Noriyuki

AU - Taylor, Michael D.

AU - Packer, Roger J.

AU - Northcott, Paul A.

AU - Korshunov, Andrey

AU - Ramaswamy, Vijay

N1 - Acknowledgements: HC was supported by a Garron Family Cancer Centre Research Fellowship. MDT is supported by operating funds from the National Institutes for Health (5R01CA159859-08 and R01NS106155-01) and the Pediatric Brain Tumor Foundation. V.R. and M.D.T. are supported by a Stand Up To Cancer (SU2C) St. Baldrick’s Pediatric Dream Team translational research grant (SU2C-AACR-DT1113). VR is supported by operating funds from the Canadian Institutes for Health Research, the Canadian Cancer Society Research Institute, the C.R. Younger Foundation, the Garron Family Cancer Centre, Meagan’s Walk, b.r.a.i.n.child and Nelina’s Hope. This study was partially funded with support provided by the Government of Ontario, Ministry of Research, Innovation and Science, and the Princess Margaret Cancer Foundation and support from the Princess Margaret Cancer Centre-OICR Translational Genomics Laboratory. EGVM is supported by operating funds from the National Institutes of Health (R01NS096236 and R01CA235162). © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2021/11

Y1 - 2021/11

N2 - Medulloblastoma, a common pediatric malignant central nervous system tumour, represent a small proportion of brain tumours in adults. Previously it has been shown that in adults, Sonic Hedgehog (SHH)-activated tumours predominate, with Wingless-type (WNT) and Group 4 being less common, but molecular risk stratification remains a challenge. We performed an integrated analysis consisting of genome-wide methylation profiling, copy number profiling, somatic nucleotide variants and correlation of clinical variables across a cohort of 191 adult medulloblastoma cases identified through the Medulloblastoma Advanced Genomics International Consortium. We identified 30 WNT, 112 SHH, 6 Group 3, and 41 Group 4 tumours. Patients with SHH tumours were significantly older at diagnosis compared to other subgroups (p < 0.0001). Five-year progression-free survival (PFS) for WNT, SHH, Group 3, and Group 4 tumours was 64.4 (48.0–86.5), 61.9% (51.6–74.2), 80.0% (95% CI 51.6–100.0), and 44.9% (95% CI 28.6–70.7), respectively (p = 0.06). None of the clinical variables (age, sex, metastatic status, extent of resection, chemotherapy, radiotherapy) were associated with subgroup-specific PFS. Survival among patients with SHH tumours was significantly worse for cases with chromosome 3p loss (HR 2.9, 95% CI 1.1–7.6; p = 0.02), chromosome 10q loss (HR 4.6, 95% CI 2.3–9.4; p < 0.0001), chromosome 17p loss (HR 2.3, 95% CI 1.1–4.8; p = 0.02), and PTCH1 mutations (HR 2.6, 95% CI 1.1–6.2; p = 0.04). The prognostic significance of 3p loss and 10q loss persisted in multivariable regression models. For Group 4 tumours, chromosome 8 loss was strongly associated with improved survival, which was validated in a non-overlapping cohort (combined cohort HR 0.2, 95% CI 0.1–0.7; p = 0.007). Unlike in pediatric medulloblastoma, whole chromosome 11 loss in Group 4 and chromosome 14q loss in SHH was not associated with improved survival, where MYCN, GLI2 and MYC amplification were rare. In sum, we report unique subgroup-specific cytogenetic features of adult medulloblastoma, which are distinct from those in younger patients, and correlate with survival disparities. Our findings suggest that clinical trials that incorporate new strategies tailored to high-risk adult medulloblastoma patients are urgently needed.

AB - Medulloblastoma, a common pediatric malignant central nervous system tumour, represent a small proportion of brain tumours in adults. Previously it has been shown that in adults, Sonic Hedgehog (SHH)-activated tumours predominate, with Wingless-type (WNT) and Group 4 being less common, but molecular risk stratification remains a challenge. We performed an integrated analysis consisting of genome-wide methylation profiling, copy number profiling, somatic nucleotide variants and correlation of clinical variables across a cohort of 191 adult medulloblastoma cases identified through the Medulloblastoma Advanced Genomics International Consortium. We identified 30 WNT, 112 SHH, 6 Group 3, and 41 Group 4 tumours. Patients with SHH tumours were significantly older at diagnosis compared to other subgroups (p < 0.0001). Five-year progression-free survival (PFS) for WNT, SHH, Group 3, and Group 4 tumours was 64.4 (48.0–86.5), 61.9% (51.6–74.2), 80.0% (95% CI 51.6–100.0), and 44.9% (95% CI 28.6–70.7), respectively (p = 0.06). None of the clinical variables (age, sex, metastatic status, extent of resection, chemotherapy, radiotherapy) were associated with subgroup-specific PFS. Survival among patients with SHH tumours was significantly worse for cases with chromosome 3p loss (HR 2.9, 95% CI 1.1–7.6; p = 0.02), chromosome 10q loss (HR 4.6, 95% CI 2.3–9.4; p < 0.0001), chromosome 17p loss (HR 2.3, 95% CI 1.1–4.8; p = 0.02), and PTCH1 mutations (HR 2.6, 95% CI 1.1–6.2; p = 0.04). The prognostic significance of 3p loss and 10q loss persisted in multivariable regression models. For Group 4 tumours, chromosome 8 loss was strongly associated with improved survival, which was validated in a non-overlapping cohort (combined cohort HR 0.2, 95% CI 0.1–0.7; p = 0.007). Unlike in pediatric medulloblastoma, whole chromosome 11 loss in Group 4 and chromosome 14q loss in SHH was not associated with improved survival, where MYCN, GLI2 and MYC amplification were rare. In sum, we report unique subgroup-specific cytogenetic features of adult medulloblastoma, which are distinct from those in younger patients, and correlate with survival disparities. Our findings suggest that clinical trials that incorporate new strategies tailored to high-risk adult medulloblastoma patients are urgently needed.

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Subgroup and subtype-specific outcomes in adult medulloblastoma

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