miRNA Profiling: How to Bypass the Current Difficulties in the Diagnosis and Treatment of Sarcomas

Sarcomas are divided into a group with specific alterations and a second presenting a complex karyotype, sometimes difficult to diagnose or with few therapeutic options available. We assessed if miRNA profiling by TaqMan low density arrays could predict the response of undifferentiated rhabdomyosarcoma (RMS) and osteosarcoma to treatment. We showed that miRNA signatures in response to a therapeutic agent (chemotherapy or the mTOR inhibitor RAD-001) were cell and drug specific on cell lines and a rat osteosarcoma model. This miRNA signature was related to cell or tumour sensitivity to this treatment and might be not due to chromosomal aberrations, as revealed by a CGH array analysis of rat tumours. Strikingly, miRNA profiling gave promising results for patient rhabdomyosarcoma, discriminating all types of RMS: (Pax+) or undifferentiated alveolar RMS as well as embryonal RMS. As highlighted by these results, miRNA profiling emerges as a potent molecular diagnostic tool for complex karyotype sarcomas

Immune and Genetic Signatures of Breast Carcinomas Triggering Anti-Yo–Associated Paraneoplastic Cerebellar Degeneration

International audienceBackground and Objectives Paraneoplastic cerebellar degeneration (PCD) with anti-Yo antibodies is a cancer-related autoimmune disease directed against neural antigens expressed by tumor cells. A putative trigger of the immune tolerance breakdown is genetic alteration of Yo antigens. We aimed to identify the tumors' genetic and immune specificities involved in Yo-PCD pathogenesis. Methods Using clinicopathologic data, immunofluorescence (IF) imaging, and whole-transcriptome analysis, 22 breast cancers (BCs) associated with Yo-PCD were characterized in terms of oncologic characteristics, genetic alteration of Yo antigens, differential gene expression profiles, and morphofunctional specificities of their in situ antitumor immunity by comparing them with matched control BCs. Results Yo-PCD BCs were invasive carcinoma of no special type, which early metastasized to lymph nodes. They overexpressed human epidermal growth factor receptor 2 (HER2) but were hormone receptor negative. All Yo-PCD BCs carried at least 1 genetic alteration (variation or gain in copy number) on CDR2L, encoding the main Yo antigen that was found aberrantly overexpressed in Yo-PCD BCs. Analysis of the differentially expressed genes found 615 upregulated and 54 downregulated genes in Yo-PCD BCs compared with HER2-driven control BCs without PCD. Ontology enrichment analysis found significantly upregulated adaptive immune response pathways in Yo-PCD BCs. IF imaging confirmed an intense immune infiltration with an overwhelming predominance of immunoglobulin G-plasma cells. Discussion These data confirm the role of genetic alterations of Yo antigens in triggering the immune tolerance breakdown but also outline a specific biomolecular profile in Yo-PCD BCs, suggesting a cancer-specific pathogenesis

Inhibition of Chondrosarcoma Growth by mTOR Inhibitor in an In Vivo Syngeneic Rat Model

BACKGROUND: Chondrosarcomas are the second most frequent primary malignant type of bone tumor. No effective systemic treatment has been identified in advanced or adjuvant phases for chondrosarcoma. The aim of the present study was to determine the antitumor effects of doxorubicin and everolimus, an mTOR inhibitor on chondrosarcoma progression. METHODS AND FINDINGS: Doxorubin and/or everolimus were tested in vivo as single agent or in combination in the rat orthotopic Schwarm chondrosarcoma model, in macroscopic phase, as well as with microscopic residual disease. Response to everolimus and/or doxorubicin was evaluated using chondrosarcoma volume evolution (MRI). Histological response was evaluated with % of tumor necrosis, tumor proliferation index, metabolism quantification analysis between the treated and control groups. Statistical analyses were performed using chi square, Fishers exact test. Doxorubicin single agent has no effect of tumor growth as compared to no treatment; conversely, everolimus single agent significantly inhibited tumor progression in macroscopic tumors with no synergistic additive effect with doxorubicin. Everolimus inhibited chondrosarcoma proliferation as evaluated by Ki67 expression did not induce the apoptosis of tumor cells; everolimus reduced Glut1 and 4EBP1 expression. Importantly when given in rats with microscopic residual diseases, in a pseudo neoadjuvant setting, following R1 resection of the implanted tumor, everolimus significantly delayed or prevented tumor recurrence. CONCLUSIONS: MTOR inhibitor everolimus blocks cell proliferation, Glut1 expression and HIF1a expression, and prevents in vivo chondrosarcoma tumor progression in both macroscopic and in adjuvant phase post R1 resection. Taken together, our preclinical data indicate that mTOR inhibitor may be effective as a single agent in treating chondrosarcoma patients. A clinical trial evaluating mTOr inhibitor as neo-adjuvant and adjuvant therapy in chondrosarcoma patients is being constructed

Alterations in Homologous Recombination-Related Genes and Distinct Platinum Response in Metastatic Triple-Negative Breast Cancers: A Subgroup Analysis of the ProfiLER-01 Trial

International audienc

Profils d'expression des microARN dans les sarcomes : des données brutes aux applications cliniques

Sarcomas are malignant soft tissue tumors, accounting for 1% of adult tumors and 8% of all pediatric malignancies. Sarcomas are rare, and display a variety of histological subtypes and clinical characteristics. Therefore, everyday management is difficult in terms of diagnosis,prognosis and treatment. Recently, the development of pangenomic molecular techniquesimproved the clinical management of sarcomas, but the use of microRNAs as biomarkers is still being investigated.In the present work, we studied the value of microRNA expression profiles inrhabdomyosarcomas and osteosarcomas. Raw data of expression profiles were obtained using amedium throughput technology based on quantitative PCR. We first developed an analysismethodology to gain accurate, reproducible and relevant expression data, starting fromheterogeneous samples. Furthermore, we showed that microRNA expression profiles canimprove the clinical management of both sarcoma entities: they are helpful to upgrade the fine nosological classification of rhabdomyosarcomas, and they are able to predict the response of osteosarcomas to neoadjuvant chemotherapy. Searching for new clinical applications tomicroRNA expression profiles must be pursued.Les sarcomes sont des tumeurs malignes des tissus conjonctifs, représentant moins de 1%des tumeurs malignes de l’adulte, mais près de 8% de l’ensemble des cancers pédiatriques. Enraison de leur rareté, de leur grande variété histologique et de leur potentiel évolutifhétérogène, les sarcomes sont des pathologies difficiles à traiter, tant sur le plan diagnostique,pronostique que thérapeutique. Ces dernières années, l’avènement de techniques d’analyse pangénomiques par biologie moléculaire a permis d’améliorer la prise en charge clinique des sarcomes, mais les microARN sont des biomarqueurs émergents encore peu utilisés. au cours de c e travail de thèse, nous avons cjhoisi d'étudier la valeur des profils d'expression des micrfoARN dans les rhabdomyosarcomes et les ostéosarcomes. Les données brutes des profils d'expression ont été obtenues à l'aidre d'une technologie à moyen débit basée sur des réactions de PCR quantitative. Nous avons tout d'abord développé une méthodologie d'ananlyse permettant d'obtenir des données d'expression précises, reproductibles et à forte valeur ajoutée, à partir de matériel biologique hétérogène.. Dans un second temps, nous avons montré que les profils d'expression de microARN permettent d'améliorer la prise en charge clinique des deuc types de sarcomes étudiés : il est possible d'affiner la classification nosologique des rhabdomyosarcomes, et de prédire la réponse des ostéosarcomes à la chimiothérapie néo-adjuvante. La recherche de nouvelles applications cliniques liées aux profils d'expression des micorARN doit donc être poursuivie, et peut désormais l'être grâce à l'outil robuste que nous avons développé au cours de cette thèse

Expression profiles of microRNAs in sarcomas : from raw data to clinical applications

Les sarcomes sont des tumeurs malignes des tissus conjonctifs, représentant moins de 1%des tumeurs malignes de l’adulte, mais près de 8% de l’ensemble des cancers pédiatriques. Enraison de leur rareté, de leur grande variété histologique et de leur potentiel évolutifhétérogène, les sarcomes sont des pathologies difficiles à traiter, tant sur le plan diagnostique,pronostique que thérapeutique. Ces dernières années, l’avènement de techniques d’analyse pangénomiques par biologie moléculaire a permis d’améliorer la prise en charge clinique des sarcomes, mais les microARN sont des biomarqueurs émergents encore peu utilisés. au cours de c e travail de thèse, nous avons cjhoisi d'étudier la valeur des profils d'expression des micrfoARN dans les rhabdomyosarcomes et les ostéosarcomes. Les données brutes des profils d'expression ont été obtenues à l'aidre d'une technologie à moyen débit basée sur des réactions de PCR quantitative. Nous avons tout d'abord développé une méthodologie d'ananlyse permettant d'obtenir des données d'expression précises, reproductibles et à forte valeur ajoutée, à partir de matériel biologique hétérogène.. Dans un second temps, nous avons montré que les profils d'expression de microARN permettent d'améliorer la prise en charge clinique des deuc types de sarcomes étudiés : il est possible d'affiner la classification nosologique des rhabdomyosarcomes, et de prédire la réponse des ostéosarcomes à la chimiothérapie néo-adjuvante. La recherche de nouvelles applications cliniques liées aux profils d'expression des micorARN doit donc être poursuivie, et peut désormais l'être grâce à l'outil robuste que nous avons développé au cours de cette thèse.Sarcomas are malignant soft tissue tumors, accounting for 1% of adult tumors and 8% of all pediatric malignancies. Sarcomas are rare, and display a variety of histological subtypes and clinical characteristics. Therefore, everyday management is difficult in terms of diagnosis,prognosis and treatment. Recently, the development of pangenomic molecular techniquesimproved the clinical management of sarcomas, but the use of microRNAs as biomarkers is still being investigated.In the present work, we studied the value of microRNA expression profiles inrhabdomyosarcomas and osteosarcomas. Raw data of expression profiles were obtained using amedium throughput technology based on quantitative PCR. We first developed an analysismethodology to gain accurate, reproducible and relevant expression data, starting fromheterogeneous samples. Furthermore, we showed that microRNA expression profiles canimprove the clinical management of both sarcoma entities: they are helpful to upgrade the fine nosological classification of rhabdomyosarcomas, and they are able to predict the response of osteosarcomas to neoadjuvant chemotherapy. Searching for new clinical applications tomicroRNA expression profiles must be pursued

Recent Advances on Immunohistochemistry and Molecular Biology for the Diagnosis of Adnexal Sweat Gland Tumors

International audienceCutaneous sweat gland tumors are a subset of adnexal neoplasms that derive or differentiate into the sweat apparatus. Their great diversity, rarity, and complex terminology make their pathological diagnosis challenging. Recent findings have revealed a wide spectrum of oncogenic drivers, several of which are of diagnostic interest for pathologists. Most of these molecular alterations are represented by gene fusions, which are shared with other homologous neoplasms occurring in organs containing exocrine glands, such as salivary and breast glands, which show similarities to the sweat apparatus. This review aims to provide a synthesis of the most recent immunohistochemical and molecular markers used for the diagnosis of sweat gland tumors and to highlight their relationship with similar tumors in other organs. It will cover adenoid cystic carcinoma (NFIB, MYB, and MYBL1 fusion), cutaneous mixed tumor (PLAG1 fusion), cylindroma and spiradenoma and their carcinomas thereof (NF-κB activation through CYLD inactivation or ALKP1 hotspot mutation), hidradenoma and hidradenocarcinoma (MAML2 fusion), myoepithelioma (EWSR1 and FUS fusion), poroma and porocarcinoma (YAP1, MAML2, and NUTM1 fusion), secretory carcinoma (ETV6, NTRK3 fusion), tubular adenoma and syringo-cystadenoma papilliferum (HRAS and BRAF activating mutations). Sweat gland tumors for which there are no known molecular abnormalities will also be briefly discussed, as well as potential future developments

Attempting to Solve the Pigmented Epithelioid Melanocytoma (PEM) Conundrum PRKAR1A Inactivation Can Occur in Different Genetic Backgrounds (Common, Blue, and Spitz Subgroups) With Variation in Their Clinicopathologic Characteristics

International audiencePigmented epithelioid melanocytoma is a rare cutaneous melanocytic proliferation considered high-grade melanocytoma in the 2018 WHO Classification of Skin Tumors. Little has been reported about the associated genetic drivers in addition to BRAF and MAP2K1 mutations or PRKCA gene fusions. Here, we present a series of 21 cases of PRKAR1A-inactivated melanocytic tumors in which we could assess the associated genetic background. We identified 9 different driver genes related to the common, Spitz, blue nevi, and PRKC-fused groups. Nine cases were associated with a canonical BRAF p.V600E mutation, a hallmark of the common nevus group. They occurred mainly in young adults. All were combined (biphenotypic) cases with a variable proportion of compound nevus. The pigmented epithelioid melanocytoma component was made of thin fascicules or isolated epithelioid cells covered by a dense hyperpigmented melanophage background and was predominantly located in the upper dermis. One such case was malignant. Six cases were associated with Spitz-related genetic anomalies ranging from HRAS or MAP2K1 mutations to gene fusions involving MAP3K8, MAP3K3, and RET. They occurred mainly in children and young adults. Morphologically, they showed large confluent junctional nests in a hyperplastic epidermis and a fascicular dermal component of spindled and epithelioid melanocytes with a frequent wedged silhouette. Intravascular invasion was observed in 4/6 cases. Five cases were associated with canonical mutations of the blue nevus group with 4 CYSLTR2 p.L129Q and 1 GNAQ p.Q209L mutations. They were removed mainly in adults and showed a frequent junctional component with epidermal hyperplasia. The dermal component showed dense fascicules of spindled and epithelioid melanocytes predominating over melanophages. One case occurred in a PRKCA-fused tumor in an adolescent with classic morphologic features. These results could potentially shift the concept of PRKAR1A-inactivated melanocytoma, changing from a rather unified model to a more complex one, including genetic subgroup variations with clinical and morphologic specificities. The genetic background of PRKAR1A-inactivated melanocytic tumors should be systematically explored to better understand the extent and clinical behavior of these complex lesions

Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reports

Abstract Background Renal cell carcinoma represents 3–5% of adult malignant tumors. Metastases are found in 30–40% of patients and brain metastases occurred in more than 10% of them. Despite significant progress in medical treatment, patients with brain metastases still have a limited survival. Cabozantinib, a tyrosine kinase inhibitor directed against vascular endothelial growth factor receptors, was recently registered for the treatment of metastatic renal cell carcinoma. Almost no data are, however, available on patients with brain metastases. Case presentation Case 1 is a 51-year-old man of North African origin; Case 2 is a 55-year-old European man. Case 1 and Case 2 had metastases of renal carcinoma at initial diagnosis and were treated with vascular endothelial growth factor receptors tyrosine kinase inhibitors. Case 1 had clear cell renal carcinoma and underwent nephrectomy; he then received several lines of tyrosine kinase inhibitor directed against vascular endothelial growth factor receptors and the mTor complex. During the second treatment a brain metastasis was diagnosed and treated with radiosurgery with rapid efficacy. Two years later he received nivolumab, an antibody directed against the programmed death-1 and programmed death-ligand 1 complex, but disease progression was observed with the reappearance of the brain metastasis together with neurologic symptoms. Cabozantinib was administered and induced a rapid clinical improvement as well as tumor regression in all sites including his brain. Sequencing of his tumor evidenced a mutation of the MET gene. Case 2 had a papillary renal carcinoma with brain metastases at time of diagnosis. After radiation of the brain tumors, a vascular endothelial growth factor receptor tyrosine kinase inhibitor was administered for 3 years. The disease was under control in all sites except in his brain; several new brain metastases requiring new radiation treatments developed. The disease finally progressed at all metastatic sites including his brain and he had several neurological symptoms. Cabozantinib was administered and rapidly induced a clinical improvement; a further computed tomography scan and brain magnetic resonance imaging showed significant tumor regressions. No MET gene mutation or amplification was observed in the tumor analysis. Conclusions These case reports indicate that cabozantinib was able, first, to reach brain tumors and second, to induce significant regressions in renal carcinoma brain metastases that were resistant to radiation as well as to previous systemic vascular endothelial growth factor receptor tyrosine kinase inhibitors