Chemoradiotherapy With Temozolomide Vs. Radiotherapy Alone in Patients With IDH Wild-type and TERT Promoter Mutation WHO Grade II/III Gliomas: A Prospective Randomized Study

Abstract TERT promoter mutation is associated with 1p/19q codeletion and favorable prognosis in IDH-mutated gliomas. Prognostic and diagnostic significance of TERT promoter mutation is well-recognized in IDH-wildtype glioblastomas, but not in IDH-mutated gliomas. We investigated prognostic efficacy of TERT mutation in a cohort of 560 Japanese IDH-mutated adult gliomas. The molecular status of IDH, TERT and 1p/19q and patient clinical data including Karnofsky performance status (KPS) were collected in all cases. TERT mutations and 1p/19q codeletions were found in 303 and 285 cases, respectively. The patient cohort was divided into four groups by a combination of the 1p/19q and TERT status. The characteristics of 1p/19q intact-TERT mutated group (Astro-TERT group, n=24) were compared with those of 1p/19q intact-TERT wild (Astro-group, n=251) or 1p/19q codeleted-TERT mutated (Oligo-group, n=279) cases. Astro-TERT group with any grade showed intermediate overall survival between the Oligo-group and Astro-group although the survival differences were not statistically significant (median overall survival (OS) not reached (NR) versus NR, and 106 months, respectively. p >0.05). We further conducted subgroup analysis by adjusting KPS and WHO grade as Cox regression analysis for survival indicated the unfavorable survival impact of KPS < 90 and WHO grade IV. In the subgroup with favorable KPS (90–100) and grade II-III (n=438), The OS of Astro-TERT group (median NR) was significantly longer survival than that of Astro-group (median 120.2 months, p=0.032), and was comparable with that of the Oligo-group (median NR, p >0.05). On the other hand, OS of none of the molecular groups significantly differ in poorer KPS subgroups (p >0.05). In grade IV tumors, the OS of the Astro-TERT group (NR) was comparable with that of Astro-group (29 months, p=0.19) rather than Oligo-group (NR, p=0.051). Thus, TERT promoter status provides a valuable prognostic information for IDH-mutated grade II-III gliomas in the current molecular diagnostic system.

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Predicting TERT promoter mutation using MR images in patients with wild-type IDH1 glioblastoma

Diagnostic and Interventional Imaging ◽

10.1016/j.diii.2019.02.010 ◽

2019 ◽

Vol 100 (7-8) ◽

pp. 411-419 ◽

Cited By ~ 7

Author(s):

K. Yamashita ◽

R. Hatae ◽

A. Hiwatashi ◽

O. Togao ◽

K. Kikuchi ◽

...

Keyword(s):

Tert Promoter Mutation ◽

Wild Type ◽

Mr Images ◽

Promoter Mutation ◽

Tert Promoter

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Clinical, radiologic & prognostic profile of IDH wild type diffuse astrocytic glioma with molecular features of glioblastoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2557 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2557-2557

Author(s):

Oluwatosin Akintola ◽

Wesley Samore ◽

Maria Martinez-Lage Alvarez ◽

Elizabeth Robins Gerstner

Keyword(s):

Clinical Trials ◽

Methylation Status ◽

Diffuse Astrocytoma ◽

Tert Promoter Mutation ◽

Promoter Mutation ◽

Who Grade ◽

Egfr Amplification ◽

Astrocytic Glioma ◽

Molecular Features ◽

Tert Promoter

2557 Background: In 2018, The Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) recommended that IDH-wildtype diffuse astrocytic glioma Grade II/III with either EGFR amplification, combined whole chromosome 7 gain and whole chromosome 10 loss (+7/−10), or TERT promoter mutation should receive an integrated histological and molecular grade classification: Diffuse astrocytic glioma, IDH-wildtype with molecular features of glioblastoma, WHO grade IV. The natural history, radiologic characteristics and standard management for these patients has not been well described. They are typically excluded from clinical trials for WHO Grade IV gliomas. Methods: Adults diagnosed at Massachusetts General Hospital with IDH wildtype diffuse astrocytoma and EGFR amplification or TERT promoter mutation from 2011-2019 were identified. Demographics, functional status, radiologic features, MGMT promoter methylation status, time to progression, and overall survival were collected retrospectively. Qualitative MRI data was analyzed using the VASARI feature set. Response assessment was performed using the RANO criteria. Results: 50 patients were identified (table). 37/50 patients received standard Stupp protocol, 2/50 received hypofractionated radiotherapy with temozolomide, 6/50 received radiotherapy alone, and 1 patient received a MEK inhibitor. None were enrolled in clinical trials at diagnosis. mPFS was 10 months in the 47/50 with confirmed progression and mOS in the patients with confirmed deaths (40/50) was 17.5 months (4-47). 9/50 patients are alive with survival ranging 6-52 months. Conclusions: Outcomes for patients with molecularly defined GBM were variable. Analysis of the cohort to characterize factors that led to the observed variability is in progress. More studies on molecularly defined glioblastomas are required to better understand their behavior and to provide guidance for their inclusion or exclusion in clinical trials. [Table: see text]

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Molecular and clinical heterogeneity of adult diffuse low-grade IDH wild-type gliomas: assessment of TERT promoter mutation and chromosome 7 and 10 copy number status allows superior prognostic stratification

Acta Neuropathologica ◽

10.1007/s00401-017-1781-z ◽

2017 ◽

Vol 134 (6) ◽

pp. 957-959 ◽

Cited By ~ 41

Author(s):

Maarten M. J. Wijnenga ◽

Hendrikus J. Dubbink ◽

Pim J. French ◽

Nathalie E. Synhaeve ◽

Winand N. M. Dinjens ◽

...

Keyword(s):

Copy Number ◽

Chromosome 7 ◽

Low Grade ◽

Tert Promoter Mutation ◽

Clinical Heterogeneity ◽

Wild Type ◽

Promoter Mutation ◽

Copy Number Status ◽

Tert Promoter ◽

Prognostic Stratification

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PATH-19. TERT PROMOTER MUTATION, NOT H3K27M MUTATION IS A PROGNOSTIC FACTOR FOR ADULT THALAMIC GLIOMAS

Neuro-Oncology ◽

10.1093/neuonc/noab196.471 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi118-vi119

Author(s):

Masayuki Nitta ◽

Yoshihiro Muragaki ◽

Takashi Komori ◽

kenta Masui ◽

Taiichi Saito ◽

...

Keyword(s):

Prognostic Factor ◽

Tumor Resection ◽

Pathological Diagnosis ◽

Diffuse Glioma ◽

Idh Mutation ◽

Tert Promoter Mutation ◽

Promoter Mutation ◽

Who Grade ◽

Tert Promoter ◽

H3k27m Mutation

Abstract Purpose Thalamic diffuse glioma is classified as WHO grade 4 as Diffuse midline glioma, H3K27M mutation if H3K27M mutation was found regardless of its histological findings, but the significance of H3K27M mutation is not clear compared with pediatric cases. We aimed to find genetic prognostic factors in adult thalamic diffuse gliomas. METHODS Pathological diagnosis, genetic abnormalities, and clinical course of adult newly diagnosed thalamic gliomas diagnosed and treated at our institution from July 2007 to March 2020 were retrospectively analyzed. RESULTS The number of cases was 41 (24 males, 17 females), median age was 47 years (20-75 years). Tumor localization was 20 cases on the left, 14 cases on the right, and 7 cases on both sides. The pathological diagnosis was GBM 15 cases, DMG 15 cases, AA-IDH WT 7 cases, DA-IDH WT 4 cases, all of which were IDH wild type, and none of them had IDH mutation and 1p/19q co-deletion. H3K27M mutations were found in 15 cases and TERT promoter mutations were found in 12 cases, both of which were completely mutually exclusive. Tumor resection and biopsy was performed in 33 and 8 cases, respectively, and the median removal rate was 95% for those who underwent tumor resection. The median PFS and OS of all cases were 14.3 months and 38 months, respectively, and the median OS by pathological diagnosis was GBM 12.4 months, DMG 47.4 months, AA-IDH WT 37.3 months, DA-IDH WT not reached. The median OS in the H3K27M mutant group (47.4 months) was significantly better (p=0.02) than that in the TERT promoter mutation group (13.5 months). CONCLUSION There was no IDH mutation in adult thalamic gliomas, the H3K27M mutation and the TERT promoter mutation were mutually exclusive. The H3K27M mutation was not a prognostic factor, but the TERT promoter mutation was the strongest prognostic factor.

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TB-06 Eribulin prolongs survival in an orthotopic xenograft mouse model of malignant meningioma

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.030 ◽

2020 ◽

Vol 2 (Supplement_3) ◽

pp. ii7-ii7

Author(s):

Tomoyuki Nakano ◽

Kenji Fujimoto ◽

Takamune Achiha ◽

Hideyuki Arita ◽

Mami Yasukawa ◽

...

Keyword(s):

Cell Lines ◽

Intraperitoneal Administration ◽

Tert Promoter Mutation ◽

Malignant Meningioma ◽

Promoter Mutation ◽

Who Grade ◽

Orthotopic Xenograft ◽

Tert Promoter ◽

Meningioma Cell

Abstract Meningioma is the most common intracranial tumor, and its prognosis is typically favorable. However, patients of malignant meningioma (WHO grade III) most often experience recurrence, undergo multiple surgical treatments, and have poor prognosis. No effective therapy for malignant meningioma has been established yet. We recently reported an efficacy of eribulin (Haraven®) for glioblastoma. Eribulin is considered to target TERT, which is frequently mutated in its promoter. Since TERT promoter mutation is also found in malignant meningioma, this study aims at investigating the anti-tumor effect of eribulin against TERT promoter mutation-harboring human malignant meningioma cell lines in vitro and in vivo. Two meningioma cell lines IOMM-Lee and HKBMM were used in this study. In the viability assay and the flow cytometry, eribulin strongly inhibited cell proliferation by cell cycle arrest. Apoptotic cell death in malignant meningioma cell lines was confirmed by vital dye assay and immunoblotting. Moreover, wound healing assay revealed the suppression of tumor cell migration after eribulin exposure. To assess the effect of eribulin in vivo, orthotopic xenograft mouse models of both malignant meningioma cell lines were constructed. The intraperitoneal administration of eribulin significantly prolonged the survival of meningioma cell lines implanted in the brain (p<0.0001). Furthermore, apoptosis was histologically observed in brain tumor tissue by immunohistochemistry. Thus, this study suggests that eribulin is a potential therapeutic agent for treating malignant meningioma.

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