Abstract
Pleomorphic xanthoastrocytoma (PXA) is a World Health Organization Grade 2 glioma that is uncommon (<1 % all adult gliomas) and seen primarily in children and young adults. PXA has been demonstrated to manifest the V600E BRAF mutation in nearly 70 % of all tumors, a mutation that constitutively activates the BRAF/MEK signaling pathway. Assess response and toxicity of a BRAF inhibitor, vemurafenib, in recurrent PXA manifesting the V600E mutation. Four adults [2 males; 2 female: median age 45 years (range 34–53)] with surgery, radiation and alkylator refractory recurrent PXA demonstrating the BRAF mutation (V600E) were treated with vemurafenib. A cycle of vemurafenib was defined as 4 weeks of continuous therapy. All toxicities seen were grade 2 and included arthralgia, photosensitivity, fatigue and nausea (1 patient each). The median number of cycles of therapy was 5 (range 2–10). Radiographic response was progressive disease in 1, stable disease in 2 and partial response in 1. Median progression free survival was 5 months (range 2–10 months). Median overall survival was 8 months (range 4–14 months). In this small retrospective series of select patients with recurrent PXA manifesting the BRAF V600E activating mutation, vemurafenib appears to have single agent activity with manageable toxicity. Confirmation in a larger series of similar patients is required.
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Perkins SM, Mitra N, Fei W, Shinohara ET (2012) Patterns of care and outcome of patients with pleomorphic xanthoastrocytoma: a SEER analysis. J Neurooncol 110(1):99–104. doi:10.1007/s11060-012-0930-8
Yu S, He L, Zhuang X, Luo B (2001) Pleomorphic xanthoastrocytoma: MR imaging findings in 19 patients. Acta Radiol 52(2):223–228. doi:10.1258.ar.2010.100221
Goncalves VT, Reis F, Queiroz Lde S, Francea M Jr (2013) Pleomorphic xanthoastrocytoma: magnetic resonance imaging findings in a series of cases with histopathological confirmation. Arq Neuropsiquiatr 71(1):35–39
Vu TM, Luibinas SV, Gonzales M, Drummond KJ (2012) Malignant potential of pleomorphic xanthoastrocytoma. J Clin Neurosci 19(1):12–20. doi:10.1016/jocn.2011.07.015
Marrucci G, Morandi L (2011) Assessment of MGMT promoter methylation status is pleomorphic xanthoastrocytoma. J Neurooncol 105(2):397–400. doi:10.1007/s11060-011-0605-6
Pignatti F, van den Bent MJ, Curran D et al (2002) Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20:2076–2084
Horbinski C (2013) To BRAF or not BRAF: is that even a question anymore? J Neuropathol Exp Neurol 72(1):207. doi:10.1097/NEN.0b013e318279fdb
Lin A, Rodiguez FJ, Karajannis MA et al (2012) BRAF alterations in primary glial and glioneuronal neoplasms of the central nervous system with identification of 2 novel KIAA1549:BRAF fusion variants. J Neuropathol Exp Neurol 71(1):66–71. doi:10.1097/NEN.0b013e31823f2cb0
Myung JK, Cho H, Park CK, Kim SK, Lee SK, Lee SH, Park SH (2012) Analysis of the BRAF(V600E) mutation in central nervous system tumors. Transl Oncol 5(6):430–436
Schindler G, Capper D, Meyer J, Janzarik W, Omran H, Herold-Mende C (2011) Analysis of BRAF V600E mutation in 1,320 nervous system tumors reveals high mutation frequencies in pleomorphic xanthoastrocytoma, ganglioglioma and extra-cerebellar pilocytic astrocytoma. Acta Neuropathol 121(3):397–405. doi:10.1007/s00401-0011-0802-6
Dias-Santagata D, Lam Q, Vernovsky K, Lennerz JK, Borger DR, Batchelor TT et al (2011) BRAF V600E mutations are common in pleomorphic xanthoastrocytoma: diagnostic and therapeutic implications. PLoS One 6(3):e17948. doi:10.1371/journal.pone.0017948
Marko NF, Weil RJ (2013) The molecular biology of WHO grade II gliomas. Neurosurg Focus 34(2):E1. doi:10.3171/2012.12.FOCUS12283
MacDonald DR, Cascino TL, Schold SC et al (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280
Chapman PB, Hauschild A, Robert C et al (2011) Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 364:2506–2507
Flaherty KT, Infante JR, Daud A et al (2012) Combined BRAF and MEK inhibition in melanoma with BRAF V600E mutations. N Engl J Med 367:1694–1703
Kim KB, Kefford R, Paclick AC et al (2013) Phase II study of the MEK1/MEK2 inhibitor trametinib in patients with metastatic BRAF-mutant cutaneous melanoma previously treated with or without a BRAF inhibitor. J Clin Oncol 31:482–489
Trunzer K, Pavlick A, Schuchter L, Gonzalez R, McArthur G et al (2013) Pharmacodynamic effects and mechanisms of resistance to vemurafenib in patients with metastatic melanoma. J Clin Oncol 31(14):1767–1774
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Chamberlain, M.C. Salvage therapy with BRAF inhibitors for recurrent pleomorphic xanthoastrocytoma: a retrospective case series. J Neurooncol 114, 237–240 (2013). https://doi.org/10.1007/s11060-013-1176-5
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DOI: https://doi.org/10.1007/s11060-013-1176-5