Research Project on DIPG, Diffuse Intrinsic Pontine Glioma
by Genessa Kahn
Definition- Diffuse intrinsic pontine gliomas (DIPGs) are aggressive and difficult to treat brain tumors found at the base of the brain. They are glial tumors, arising from glial tissue, that normally help support and protect the brain's neurons. These tumors are found in an area of the brainstem called the pons, which controls many of the body's most vital functions such as breathing, blood pressure, and heart rate. DIPGs are most commonly found in younger children at a median age of 6.8 years (from 0-26.8 years of age). The average survival after initial diagnosis is less than a year (9~11 months).
The symptoms of DIPG usually develop exceptionally quickly before the diagnosis of DIPG, reflecting the quick and insidious development of these tumors. Most patients begin encountering various clinical presentations less than three months, usually less than three weeks, prior to diagnosis.
The most common symptoms include:
Issues controlling facial and eye movements, speech, chewing, and swallowing
Weakness in limbs
Problems with walking and coordination
Diagnosis- Doctors usually stage DIPG tumors based on MRI or biopsy results. Low-grade DIPG tumor cells, or in stages I or II, are closer to normal cells. High-grade DIPG tumor cells, or in stages III or IV, are more aggressive cancers.
Methods of diagnosis:
Computerized tomography scan (CT or CAT scan) – a diagnostic imaging procedure that uses a combination of several scans to show the inside of the body. These scans are more detailed than general X-rays, and can even be used to create 3 dimensional images. Magnetic resonance imaging (MRI) – a diagnostic procedure that uses radiology, a type of imaging technology, to produce detailed images of structures and processes within the body. MRI provides greater detail than CT scans, and allows for an easier distinguishing of tumors, swelling potentially related to tumors, and normal tissue.
Biopsy – Given the current developments, it has now been possible to safely biopsy DIPG. Biopsies allow doctors to test for abnormalities, and determine if they may have been caused by cancer, by simply extracting a sample of cells or tissue for examination.
Treatments:
Radiation therapy – Radiation is the only treatment proved with limited efficacy in prolonging progression-free survival. It uses radiation to damage or kill cancer cells and shrink tumors. Limited-field radiation is known to produce reactions in around 90 percent of DIPG patients. However, these are temporary responses, often lasting on average for about six to nine months. In addition, the side effects from radiation significantly impact the quality of patients’ lives.
Experimental chemotherapy – Chemotherapy and biologic therapy in combination with radiation therapy is currently being studied as a potential treatment for DIPG. However, it has been found that routine chemotherapy does not impact survival rates. Agents targeting other biological or molecular pathways has also been shown to be ineffective. More studies in underlying tumor biology and molecular mechanisms are needed.
Surgery — Surgery is rarely used to diagnose DIPG due to the risks involved in surgery in this area of the brain. There are cases where a biopsy can be obtained safely, but the use of surgery to remove the tumor is very rare. Depending on the location of the DIPG, surgery is usually not considered an option.
Outlook- Brain tumors remain the most common cause of cancer-related death in children, and DIPG is the leading cause of death from pediatric brain tumors. There is still no effective treatment and no chance of survival. Only 10% of children with DIPG survive for 2 years following their diagnosis, and less than 1% survive for 5 years. The median survival time is 9 months from diagnosis.
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DIPG Biological Review
Aziz-Bose R, Monje M. Diffuse intrinsic pontine glioma: molecular landscape and emerging therapeutic targets. Curr Opin Oncol. 2019 Nov;31(6):522-530.
Pollack IF, Agnihotri S, Broniscer A. Childhood brain tumors: current management, biological insights, and future directions. J Neurosurg Pediatr. 2019 Mar 1;23(3):261-273.
Valer JA, Sánchez-de-Diego C, Pimenta-Lopes C, Rosa JL, Ventura F. ACVR1 Function in Health and Disease. Cells. 2019 Oct 31;8(11):1366.
Rashed WM, Maher E, Adel M, Saber O, Zaghloul MS. Pediatric diffuse intrinsic pontine glioma: where do we stand? Cancer Metastasis Rev. 2019 Dec;38(4):759-770.
Duchatel RJ, Jackson ER, Alvaro F, Nixon B, Hondermarck H, Dun MD. Signal Transduction in Diffuse Intrinsic Pontine Glioma. Proteomics. 2019 Nov;19(21-22):e1800479.
Gwak HS, Park HJ. Developing chemotherapy for diffuse pontine intrinsic gliomas (DIPG). Crit Rev Oncol Hematol. 2017 Dec;120:111-119.
Vitanza NA, Monje M. Diffuse Intrinsic Pontine Glioma: From Diagnosis to Next-Generation Clinical Trials. Curr Treat Options Neurol. 2019 Jul 10;21(8):37.
Lu VM, Power EA, Zhang L, Daniels DJ. Liquid biopsy for diffuse intrinsic pontine glioma: an update. J Neurosurg Pediatr. 2019 Sep 6:1-8.
Kuzan-Fischer CM, Souweidane MM. The intersect of neurosurgery with diffuse intrinsic pontine glioma. J Neurosurg Pediatr. 2019 Dec 1;24(6):611-621.
Wang SS, Bandopadhayay P, Jenkins MR. Towards Immunotherapy for Pediatric Brain Tumors. Trends Immunol. 2019 Aug;40(8):748-761.
Jones C, Karajannis MA, Jones DTW, Kieran MW, Monje M, Baker SJ, Becher OJ, Cho YJ, Gupta N, Hawkins C, Hargrave D, Haas-Kogan DA, Jabado N, Li XN, Mueller S, Nicolaides T, Packer RJ, Persson AI, Phillips JJ, Simonds EF, Stafford JM, Tang Y, Pfister SM, Weiss WA. Pediatric high-grade glioma: biologically and clinically in need of new thinking. Neuro Oncol. 2017 Feb 1;19(2):153-161.
Lowe BR, Maxham LA, Hamey JJ, Wilkins MR, Partridge JF. Histone H3 Mutations: An Updated View of Their Role in Chromatin Deregulation and Cancer. Cancers (Basel). 2019 May 13;11(5):660.
Lu QR, Qian L, Zhou X. Developmental origins and oncogenic pathways in malignant brain tumors. Wiley Interdiscip Rev Dev Biol. 2019 Jul;8(4):e342.
Meel MH, Schaper SA, Kaspers GJL, Hulleman E. Signaling pathways and mesenchymal transition in pediatric high-grade glioma. Cell Mol Life Sci. 2018 Mar;75(5):871-887.
Sekimata K, Sato T, Sakai N. ALK2: A Therapeutic Target for Fibrodysplasia Ossificans Progressiva and Diffuse Intrinsic Pontine Glioma. Chem Pharm Bull (Tokyo). 2020;68(3):194-200.
Lapin DH, Tsoli M, Ziegler DS. Genomic Insights into Diffuse Intrinsic Pontine Glioma. Front Oncol. 2017 Mar 28;7:57.
Bailey CP, Figueroa M, Mohiuddin S, Zaky W, Chandra J. Cutting Edge Therapeutic Insights Derived from Molecular Biology of Pediatric High-Grade Glioma and Diffuse Intrinsic Pontine Glioma (DIPG). Bioengineering (Basel). 2018 Oct 18;5(4):88.
Hu J, Western S, Kesari S. Brainstem Glioma in Adults. Front Oncol. 2016 Aug 9;6:180.
Hashizume R. Epigenetic Targeted Therapy for Diffuse Intrinsic Pontine Glioma. Neurol Med Chir (Tokyo). 2017 Jul 15;57(7):331-342.
Loveson KF, Fillmore HL. Intersection of Brain Development and Paediatric Diffuse Midline Gliomas: Potential Role of Microenvironment in Tumour Growth. Brain Sci. 2018 Nov 16;8(11):200.
Cohen KJ, Jabado N, Grill J. Diffuse intrinsic pontine gliomas-current management and new biologic insights. Is there a glimmer of hope? Neuro Oncol. 2017 Aug 1;19(8):1025-1034.
Rutka JT. Malignant Brain Tumours in Children : Present and Future Perspectives. J Korean Neurosurg Soc. 2018 May;61(3):402-406.
Mathew RK, Rutka JT. Diffuse Intrinsic Pontine Glioma : Clinical Features, Molecular Genetics, and Novel Targeted Therapeutics. J Korean Neurosurg Soc. 2018 May;61(3):343-351.
Clymer J, Kieran MW. The Integration of Biology Into the Treatment of Diffuse Intrinsic Pontine Glioma: A Review of the North American Clinical Trial Perspective. Front Oncol. 2018 May 18;8:169.
Cooney TM, Lubanszky E, Prasad R, Hawkins C, Mueller S. Diffuse midline glioma: review of epigenetics. J Neurooncol. 2020 Aug 17.
Filbin MG, Suvà ML. Gliomas Genomics and Epigenomics: Arriving at the Start and Knowing It for the First Time. Annu Rev Pathol. 2016 May 23;11:497-521.
Infinger LK, Stevenson CB. Re-Examining the Need for Tissue Diagnosis in Pediatric Diffuse Intrinsic Pontine Gliomas: A Review. Curr Neuropharmacol. 2017;15(1):129-133.
Lulla RR, Saratsis AM, Hashizume R. Mutations in chromatin machinery and pediatric high-grade glioma. Sci Adv. 2016 Mar 18;2(3):e1501354.
Vitanza NA, Cho YJ. Advances in the biology and treatment of pediatric central nervous system tumors. Curr Opin Pediatr. 2016 Feb;28(1):34-9.
DIPG Clinical Trials
Fleischhack G, Massimino M, Warmuth-Metz M, Khuhlaeva E, Janssen G, Graf N, Rutkowski S, Beilken A, Schmid I, Biassoni V, Gorelishev SK, Kramm C, Reinhard H, Schlegel PG, Kortmann RD, Reuter D, Bach F, Iznaga-Escobar NE, Bode U. Nimotuzumab and radiotherapy for treatment of newly diagnosed diffuse intrinsic pontine glioma (DIPG): a phase III clinical study. J Neurooncol. 2019 May;143(1):107-113.
Mueller S, Jain P, Liang WS, Kilburn L, Kline C, Gupta N, Panditharatna E, Magge SN, Zhang B, Zhu Y, Crawford JR, Banerjee A, Nazemi K, Packer RJ, Petritsch CK, Truffaux N, Roos A, Nasser S, Phillips JJ, Solomon D, Molinaro A, Waanders AJ, Byron SA, Berens ME, Kuhn J, Nazarian J, Prados M, Resnick AC. A pilot precision medicine trial for children with diffuse intrinsic pontine glioma-PNOC003: A report from the Pacific Pediatric Neuro-Oncology Consortium. Int J Cancer. 2019 Oct 1;145(7):1889-1901.
Izzuddeen Y, Gupta S, Haresh KP, Sharma D, Giridhar P, Rath GK. Hypofractionated radiotherapy with temozolomide in diffuse intrinsic pontine gliomas: a randomized controlled trial. J Neurooncol. 2020 Jan;146(1):91-95.
Souweidane MM, Kramer K, Pandit-Taskar N, Zhou Z, Haque S, Zanzonico P, Carrasquillo JA, Lyashchenko SK, Thakur SB, Donzelli M, Turner RS, Lewis JS, Cheung NV, Larson SM, Dunkel IJ. Convection-enhanced delivery for diffuse intrinsic pontine glioma: a single-centre, dose-escalation, phase 1 trial. Lancet Oncol. 2018 Aug;19(8):1040-1050.
Qayed M, Cash T, Tighiouart M, MacDonald TJ, Goldsmith KC, Tanos R, Kean L, Watkins B, Suessmuth Y, Wetmore C, Katzenstein HM. A phase I study of sirolimus in combination with metronomic therapy (CHOAnome) in children with recurrent or refractory solid and brain tumors. Pediatr Blood Cancer. 2020 Apr;67(4):e28134.
Porkholm M, Raunio A, Vainionpää R, Salonen T, Hernesniemi J, Valanne L, Satopää J, Karppinen A, Oinas M, Tynninen O, Pentikäinen V, Kivivuori SM. Molecular alterations in pediatric brainstem gliomas. Pediatr Blood Cancer. 2018 Jan;65(1).
Tejada S, Alonso M, Patiño A, Fueyo J, Gomez-Manzano C, Diez-Valle R. Phase I Trial of DNX-2401 for Diffuse Intrinsic Pontine Glioma Newly Diagnosed in Pediatric Patients. Neurosurgery. 2018 Nov 1;83(5):1050-1056.
Heiss JD, Jamshidi A, Shah S, Martin S, Wolters PL, Argersinger DP, Warren KE, Lonser RR. Phase I trial of convection-enhanced delivery of IL13-Pseudomonas toxin in children with diffuse intrinsic pontine glioma. J Neurosurg Pediatr. 2018 Dec 7;23(3):333-342.
Su JM, Murray JC, McNall-Knapp RY, Bowers DC, Shah S, Adesina AM, Paulino AC, Jo E, Mo Q, Baxter PA, Blaney SM. A phase 2 study of valproic acid and radiation, followed by maintenance valproic acid and bevacizumab in children with newly diagnosed diffuse intrinsic pontine glioma or high-grade glioma. Pediatr Blood Cancer. 2020 Jun;67(6):e28283.
Broniscer A, Jia S, Mandrell B, Hamideh D, Huang J, Onar-Thomas A, Gajjar A, Raimondi SC, Tatevossian RG, Stewart CF. Phase 1 trial, pharmacokinetics, and pharmacodynamics of dasatinib combined with crizotinib in children with recurrent or progressive high-grade and diffuse intrinsic pontine glioma. Pediatr Blood Cancer. 2018 Jul;65(7):e27035.
Osorio DS, Patel N, Ji L, Sposto R, Stanek J, Gardner SL, Allen JC, Cornelius A, McCowage GB, Termuhlen A, Dunkel IJ, Comito M, Garvin J, Finlay JL. Pre-irradiation intensive induction and marrow-ablative consolidation chemotherapy in young children with newly diagnosed high-grade brainstem gliomas: report of the "head-start" I and II clinical trials. J Neurooncol. 2018 Dec;140(3):717-725.
Becher OJ, Gilheeney SW, Khakoo Y, Lyden DC, Haque S, De Braganca KC, Kolesar JM, Huse JT, Modak S, Wexler LH, Kramer K, Spasojevic I, Dunkel IJ. A phase I study of perifosine with temsirolimus for recurrent pediatric solid tumors. Pediatr Blood Cancer. 2017 Jul;64(7).
Amsbaugh MJ, Mahajan A, Thall PF, McAleer MF, Paulino AC, Grosshans D, Khatua S, Ketonen L, Fontanilla H, McGovern SL. A Phase 1/2 Trial of Reirradiation for Diffuse Intrinsic Pontine Glioma. Int J Radiat Oncol Biol Phys. 2019 May 1;104(1):144-148.
Becher OJ, Millard NE, Modak S, Kushner BH, Haque S, Spasojevic I, Trippett TM, Gilheeney SW, Khakoo Y, Lyden DC, De Braganca KC, Kolesar JM, Huse JT, Kramer K, Cheung NV, Dunkel IJ. A phase I study of single-agent perifosine for recurrent or refractory pediatric CNS and solid tumors. PLoS One. 2017 Jun 5;12(6):e0178593.
Morgenstern PF, Zhou Z, Wembacher-Schröder E, Cina V, Tsiouris AJ, Souweidane MM. Clinical tolerance of corticospinal tracts in convection-enhanced delivery to the brainstem. J Neurosurg. 2018 Dec 21;131(6):1812-1818.
Manley PE, Trippett T, Smith AA, Macy ME, Leary SES, Boklan J, Cohen KJ, Goldman S, Kilburn LB, Dhall G, Devin J, Herzog CE, Partap S, Fauchet F, Badreddine E, Bernard JP, Chi SN. A phase 1/2 dose-finding, safety, and activity study of cabazitaxel in pediatric patients with refractory solid tumors including tumors of the central nervous system. Pediatr Blood Cancer. 2018 Sep;65(9):e27217.
Ceschin R, Kocak M, Vajapeyam S, Pollack IF, Onar-Thomas A, Dunkel IJ, Poussaint TY, Panigrahy A. Quantifying radiation therapy response using apparent diffusion coefficient (ADC) parametric mapping of pediatric diffuse intrinsic pontine glioma: a report from the pediatric brain tumor consortium. J Neurooncol. 2019 May;143(1):79-86.
Fried I, Lossos A, Ben Ami T, Dvir R, Toledano H, Ben Arush MW, Postovski S, Abu Kuidar A, Yalon M, Weintraub M, Benifla M. Preliminary results of immune modulating antibody MDV9300 (pidilizumab) treatment in children with diffuse intrinsic pontine glioma. J Neurooncol. 2018 Jan;136(1):189-195.
Wang ZJ, Rao L, Bhambhani K, Miller K, Poulik J, Altinok D, Sood S. Diffuse intrinsic pontine glioma biopsy: a single institution experience. Pediatr Blood Cancer. 2015 Jan;62(1):163-5.
Veldhuijzen van Zanten SEM, El-Khouly FE, Jansen MHA, Bakker DP, Sanchez Aliaga E, Haasbeek CJA, Wolf NI, Zwaan CM, Vandertop WP, van Vuurden DG, Kaspers GJL. A phase I/II study of gemcitabine during radiotherapy in children with newly diagnosed diffuse intrinsic pontine glioma. J Neurooncol. 2017 Nov;135(2):307-315.
Jansen MH, Veldhuijzen van Zanten SEM, van Vuurden DG, Huisman MC, Vugts DJ, Hoekstra OS, van Dongen GA, Kaspers GL. Molecular Drug Imaging: 89Zr-Bevacizumab PET in Children with Diffuse Intrinsic Pontine Glioma. J Nucl Med. 2017 May;58(5):711-716.
Singh R, Zhou Z, Tisnado J, Haque S, Peck KK, Young RJ, Tsiouris AJ, Thakur SB, Souweidane MM. A novel magnetic resonance imaging segmentation technique for determining diffuse intrinsic pontine glioma tumor volume. J Neurosurg Pediatr. 2016 Nov;18(5):565-572.
Kilburn LB, Kocak M, Baxter P, Poussaint TY, Paulino AC, McIntyre C, Lemenuel-Diot A, Lopez-Diaz C, Kun L, Chintagumpala M, Su JM, Broniscer A, Baker JN, Hwang EI, Fouladi M, Boyett JM, Blaney SM. A pediatric brain tumor consortium phase II trial of capecitabine rapidly disintegrating tablets with concomitant radiation therapy in children with newly diagnosed diffuse intrinsic pontine gliomas. Pediatr Blood Cancer. 2018 Feb;65(2):10.1002/pbc.26832.
Pearson AD, Federico SM, Aerts I, Hargrave DR, DuBois SG, Iannone R, Geschwindt RD, Wang R, Haluska FG, Trippett TM, Geoerger B. A phase 1 study of oral ridaforolimus in pediatric patients with advanced solid tumors. Oncotarget. 2016 Dec 20;7(51):84736-84747.
Patay Z, Merchant TE, Nguyen R, Pierson CR, Onar-Thomas A, Broniscer A. Treatment-Related Noncontiguous Radiologic Changes in Children With Diffuse Intrinsic Pontine Glioma Treated With Expanded Irradiation Fields and Antiangiogenic Therapy. Int J Radiat Oncol Biol Phys. 2017 Dec 1;99(5):1295-1305.
Ivasyk I, Morgenstern PF, Wembacher-Schroeder E, Souweidane MM. Influence of an intratumoral cyst on drug distribution by convection-enhanced delivery: case report. J Neurosurg Pediatr. 2017 Sep;20(3):256-260.
Svolos P, Reddick WE, Edwards A, Sykes A, Li Y, Glass JO, Patay Z. Measurable Supratentorial White Matter Volume Changes in Patients with Diffuse Intrinsic Pontine Glioma Treated with an Anti-Vascular Endothelial Growth Factor Agent, Steroids, and Radiation. AJNR Am J Neuroradiol. 2017 Jun;38(6):1235-1241.
Guisado DI, Singh R, Minkowitz S, Zhou Z, Haque S, Peck KK, Young RJ, Tsiouris AJ, Souweidane MM, Thakur SB. A Novel Methodology for Applying Multivoxel MR Spectroscopy to Evaluate Convection-Enhanced Drug Delivery in Diffuse Intrinsic Pontine Gliomas. AJNR Am J Neuroradiol. 2016 Jul;37(7):1367-73.
Salloum R, Hummel TR, Kumar SS, Dorris K, Li S, Lin T, Daryani VM, Stewart CF, Miles L, Poussaint TY, Stevenson C, Goldman S, Dhall G, Packer R, Fisher P, Pollack IF, Fouladi M, Boyett J, Drissi R. A molecular biology and phase II study of imetelstat (GRN163L) in children with recurrent or refractory central nervous system malignancies: a pediatric brain tumor consortium study. J Neurooncol. 2016 Sep;129(3):443-451.
DIPG CAR-T Cell Therapy
Mount CW, Majzner RG, Sundaresh S, Arnold EP, Kadapakkam M, Haile S, Labanieh L, Hulleman E, Woo PJ, Rietberg SP, Vogel H, Monje M, Mackall CL. Potent antitumor efficacy of anti-GD2 CAR T cells in H3-K27M+ diffuse midline gliomas. Nat Med. 2018 May;24(5):572-579.
Chheda ZS, Kohanbash G, Okada K, Jahan N, Sidney J, Pecoraro M, Yang X, Carrera DA, Downey KM, Shrivastav S, Liu S, Lin Y, Lagisetti C, Chuntova P, Watchmaker PB, Mueller S, Pollack IF, Rajalingam R, Carcaboso AM, Mann M, Sette A, Garcia KC, Hou Y, Okada H. Novel and shared neoantigen derived from histone 3 variant H3.3K27M mutation for glioma T cell therapy. J Exp Med. 2018 Jan 2;215(1):141-157.
Wang SS, Bandopadhayay P, Jenkins MR. Towards Immunotherapy for Pediatric Brain Tumors. Trends Immunol. 2019 Aug;40(8):748-761.
Schuelke MR, Wongthida P, Thompson J, Kottke T, Driscoll CB, Huff AL, Shim KG, Coffey M, Pulido J, Evgin L, Vile RG. Diverse immunotherapies can effectively treat syngeneic brainstem tumors in the absence of overt toxicity. J Immunother Cancer. 2019 July17;7(1):188.
DIPG Genomic Profiling
Nagaraja S, Quezada MA, Gillespie SM, Arzt M, Lennon JJ, Woo PJ, Hovestadt V, Kambhampati M, Filbin MG, Suva ML, Nazarian J, Monje M. Histone Variant and Cell Context Determine H3K27M Reprogramming of the Enhancer Landscape and Oncogenic State. Mol Cell. 2019 Dec 19;76(6):965-980.
Pollack IF, Agnihotri S, Broniscer A. Childhood brain tumors: current management, biological insights, and future directions. J Neurosurg Pediatr. 2019 Mar 1;23(3):261-273.
Mackay A, Burford A, Carvalho D, Izquierdo E, Fazal-Salom J, Taylor KR, Bjerke L, Clarke M, Vinci M, Nandhabalan M, Temelso S, Popov S, Molinari V, Raman P, Waanders AJ, Han HJ, Gupta S, Marshall L, Zacharoulis S, Vaidya S, Mandeville HC, Bridges LR, Martin AJ, Al-Sarraj S, Chandler C, Ng HK, Li X, Mu K, Trabelsi S, Brahim DH, Kisljakov AN, Konovalov DM, Moore AS, Carcaboso AM, Sunol M, de Torres C, Cruz O, Mora J, Shats LI, Stavale JN, Bidinotto LT, Reis RM, Entz-Werle N, Farrell M, Cryan J, Crimmins D, Caird J, Pears J, Monje M, Debily MA, Castel D, Grill J, Hawkins C, Nikbakht H, Jabado N, Baker SJ, Pfister SM, Jones DTW, Fouladi M, von Bueren AO, Baudis M, Resnick A, Jones C. Integrated Molecular Meta-Analysis of 1,000 Pediatric High-Grade and Diffuse Intrinsic Pontine Glioma. Cancer Cell. 2017 Oct 9;32(4):520-537.
Johung TB, Monje M. Diffuse Intrinsic Pontine Glioma: New Pathophysiological Insights and Emerging Therapeutic Targets. Curr Neuropharmacol. 2017;15(1):88-97.
Piunti A, Hashizume R, Morgan MA, Bartom ET, Horbinski CM, Marshall SA, Rendleman EJ, Ma Q, Takahashi YH, Woodfin AR, Misharin AV, Abshiru NA, Lulla RR, Saratsis AM, Kelleher NL, James CD, Shilatifard A. Therapeutic targeting of polycomb and BET bromodomain proteins in diffuse intrinsic pontine gliomas. Nat Med. 2017 Apr;23(4):493-500.
Castel D, Philippe C, Kergrohen T, Sill M, Merlevede J, Barret E, Puget S, Sainte-Rose C, Kramm CM, Jones C, Varlet P, Pfister SM, Grill J, Jones DTW, Debily MA. Transcriptomic and epigenetic profiling of 'diffuse midline gliomas, H3 K27M-mutant' discriminate two subgroups based on the type of histone H3 mutated and not supratentorial or infratentorial location. Acta Neuropathol Commun. 2018 Nov 5;6(1):117.
Gwak HS, Park HJ. Developing chemotherapy for diffuse pontine intrinsic gliomas (DIPG). Crit Rev Oncol Hematol. 2017 Dec;120:111-119.
Lu QR, Qian L, Zhou X. Developmental origins and oncogenic pathways in malignant brain tumors. Wiley Interdiscip Rev Dev Biol. 2019 Jul;8(4):
Pan C, Diplas BH, Chen X, Wu Y, Xiao X, Jiang L, Geng Y, Xu C, Sun Y, Zhang P, Wu W, Wang Y, Wu Z, Zhang J, Jiao Y, Yan H, Zhang L. Molecular profiling of tumors of the brainstem by sequencing of CSF-derived circulating tumor DNA. Acta Neuropathol. 2019 Feb;137(2):297-306.
Schuelke MR, Wongthida P, Thompson J, Kottke T, Driscoll CB, Huff AL, Shim KG, Coffey M, Pulido J, Evgin L, Vile RG. Diverse immunotherapies can effectively treat syngeneic brainstem tumors in the absence of overt toxicity. J Immunother Cancer. 2019 Jul 17;7(1):188.
Hoeman CM, Cordero FJ, Hu G, Misuraca K, Romero MM, Cardona HJ, Nazarian J, Hashizume R, McLendon R, Yu P, Procissi D, Gadd S, Becher OJ. ACVR1 R206H cooperates with H3.1K27M in promoting diffuse intrinsic pontine glioma pathogenesis. Nat Commun. 2019 Mar 4;10(1):1023.
Jain SU, Do TJ, Lund PJ, Rashoff AQ, Diehl KL, Cieslik M, Bajic A, Juretic N, Deshmukh S, Venneti S, Muir TW, Garcia BA, Jabado N, Lewis PW. PFA ependymoma-associated protein EZHIP inhibits PRC2 activity through a H3 K27M-like mechanism. Nat Commun. 2019 May 13;10(1):2146.
Chen LH, Pan C, Diplas BH, Xu C, Hansen LJ, Wu Y, Chen X, Geng Y, Sun T, Sun Y, Zhang P, Wu Z, Zhang J, Li D, Zhang Y, Wu W, Wang Y, Li G, Yang J, Wang X, Xu C, Wang S, Waitkus MS, He Y, McLendon RE, Ashley DM, Yan H, Zhang L. The integrated genomic and epigenomic landscape of brainstem glioma. Nat Commun. 2020 Jun 17;11(1):3077.
Pfaff E, El Damaty A, Balasubramanian GP, Blattner-Johnson M, Worst BC, Stark S, Witt H, Pajtler KW, van Tilburg CM, Witt R, Milde T, Jakobs M, Fiesel P, Frühwald MC, Hernáiz Driever P, Thomale UW, Schuhmann MU, Metzler M, Bochennek K, Simon T, Dürken M, Karremann M, Knirsch S, Ebinger M, von Bueren AO, Pietsch T, Herold-Mende C, Reuss DE, Kiening K, Lichter P, Eggert A, Kramm CM, Pfister SM, Jones DTW, Bächli H, Witt O. Brainstem biopsy in pediatric diffuse intrinsic pontine glioma in the era of precision medicine: the INFORM study experience. Eur J Cancer. 2019 Jun;114:27-35.
Hoffman LM, DeWire M, Ryall S, Buczkowicz P, Leach J, Miles L, Ramani A, Brudno M, Kumar SS, Drissi R, Dexheimer P, Salloum R, Chow L, Hummel T, Stevenson C, Lu QR, Jones B, Witte D, Aronow B, Hawkins CE, Fouladi M. Spatial genomic heterogeneity in diffuse intrinsic pontine and midline high-grade glioma: implications for diagnostic biopsy and targeted therapeutics. Acta Neuropathol Commun. 2016 Jan 4;4:1.
Filbin MG, Suvà ML. Gliomas Genomics and Epigenomics: Arriving at the Start and Knowing It for the First Time. Annu Rev Pathol. 2016 May 23;11:497-521.
Vitanza NA, Cho YJ. Advances in the biology and treatment of pediatric central nervous system tumors. Curr Opin Pediatr. 2016 Feb;28(1):34-9.
Chiang J, Diaz AK, Makepeace L, Li X, Han Y, Li Y, Klimo P Jr, Boop FA, Baker SJ, Gajjar A, Merchant TE, Ellison DW, Broniscer A, Patay Z, Tinkle CL. Clinical, imaging, and molecular analysis of pediatric pontine tumors lacking characteristic imaging features of DIPG. Acta Neuropathol Commun. 2020 Apr 23;8(1):57.
Mendez FM, Núñez FJ, Garcia-Fabiani MB, Haase S, Carney S, Gauss JC, Becher OJ, Lowenstein PR, Castro MG. Epigenetic reprogramming and chromatin accessibility in pediatric diffuse intrinsic pontine gliomas: a neural developmental disease. Neuro Oncol. 2020 Feb 20;22(2):195-206.
Roux A, Pallud J, Saffroy R, Edjlali-Goujon M, Debily MA, Boddaert N, Sanson M, Puget S, Knafo S, Adam C, Faillot T, Cazals-Hatem D, Mandonnet E, Polivka M, Dorfmüller G, Dauta A, Desplanques M, Gareton A, Pages M, Tauziede-Espariat A, Grill J, Bourdeaut F, Doz F, Dhermain F, Mokhtari K, Chretien F, Figarella-Branger D, Varlet P. High-grade gliomas in adolescents and young adults highlight histomolecular differences from their adult and pediatric counterparts. Neuro Oncol. 2020 Aug 17;22(8):1190-1202.
Deng L, Xiong P, Luo Y, Bu X, Qian S, Zhong W. Bioinformatics analysis of the molecular mechanism of diffuse intrinsic pontine glioma. Oncol Lett. 2016 Oct;12(4):2524-2530.
Azad TD, Jin MC, Bernhardt LJ, Bettegowda C. Liquid biopsy for pediatric diffuse midline glioma: a review of circulating tumor DNA and cerebrospinal fluid tumor DNA. Neurosurg Focus. 2020 Jan 1;48(1):
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Ren M, van Nocker S. In silico analysis of histone H3 gene expression during human brain development. Int J Dev Biol. 2016;60(4-6):167-73.
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Drug: Melphalan hydrochloride, The Johns Hopkins Hospital Baltimore, Maryland, United States
Other: Specialized tumor board recommendation, Radiation: Standard radiation therapy Rady Children's Hospital San Diego, California, United States, UCSF Helen Diller Family Comprehensive Cancer Center San Francisco, California, United States, Children's National Medical Center Washington, District of Columbia, United States
Drug: Nimotuzumab+CRT(concurrent IMRT and TMZ) The Third People's Hospital of Zhengzhou, Zhengzhou, Henan, China, Xiangya Hospital of Centre-south University
Changsha, Hunan, China, West China Hospital, Sichuan University Chengdu, Sichuan, China
Drug: Convection Enhanced Delivery (CED) of Nanoliposomal irinotecan (nal-IRI) University of California, San Francisco, California, United States
Radiation: Hypofractionated Radiotherapy, University of Cincinnati
Cincinnati, Ohio, United States
Drug: Gemcitabine, Children's Hospital Colorado, Aurora, Colorado, United States
Radiation: Palliative re-irradiation for progressive DIPG in children, Hadassah Medical Organization Jerusalem, Israel
Drug: Panobinostat Nanoparticle Formulation MTX110, Drug: Convection-Enhanced Delivery (CED), University of California, San Francisco, San Francisco, California, United States, Memorial Sloan Kettering Cancer Center New York, New York, United States
Other: Laboratory Biomarker Analysis, Radiation: Radiation Therapy, Drug: Temsirolimus, Drug: Vorinostat, M D Anderson Cancer Center
Houston, Texas, United States
Radiation: Palliative re-irradiation for progressive DIPG in children, Hadassah Medical Organization, Jerusalem, Israel
Drug: Panobinostat Nanoparticle Formulation MTX110, Drug: Convection-Enhanced Delivery (CED), University of California, San Francisco, California, United States, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Drug: Bevacizumab, Drug: Erlotinib, Drug: Temozolomide, Radiation: Radiation, Phoenix Children's Hospital Phoenix, Arizona, United States, Children's Hospital Los Angeles Los Angeles, California, United States, Stanford University/Lucile Packard Children's Hospital Palo Alto, California, United States
Other: Laboratory Biomarker Analysis, Radiation: Radiation Therapy, Drug: Temsirolimus, Drug: Vorinostat, M D Anderson Cancer Center
Houston, Texas, United States
Drug: vandetanib and dasatinib, St. Jude Children's Research Hospital
Memphis, Tennessee, United States
Radiation: re-irradiation, Alberta Children's Hospital Calgary, Alberta, Canada, Drug: PTC596, Radiation: Radiotherapy, Children's Hospital Colorado Aurora, Colorado, United States, Children's National Medical Center Washington, District of Columbia, United States, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
Drug: Crizotinib, Drug: Dasatinib, St. Jude Children's Research Hospital
Memphis, Tennessee, United States, Biological: K27M peptide, Drug: Nivolumab, Rady Children's Hospital-San Diego, San Diego, California, United States, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States, Children's National Medical Center, Washington, District of Columbia, United States
Drug: Cilengitide dose escalation, Drug: Cilengitide, Radiation: Concomitant radiotherapy, Hôpital des Enfants, Groupe Hospitalier Bordeaux, France, Centre Oscar Lambret, Lille, France, Centre Léon Bérard, Lyon, France
Biological: Immunomodulatory DC vaccine to target DIPG and GBM, Shenzhen Geno-immune Medical Institute, Shenzhen, Guangdong, China, Shenzhen Children's Hospital, Shenzhen, Guangdong, China, Department of Neurosurgery, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
Drug: Indoximod, Radiation: Partial Radiation, Radiation: Full-dose RadiationAugusta University, Georgia Cancer Center Augusta, Georgia, United States, Emory University, Children's Heathcare of Atlanta
Druid Hills, Georgia, United States
Biological: Tumor Lysate Vaccine, Drug: Imiquimod, Radiation: Radiation therapy, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States
Drug: Crenolanib, St. Jude Children's Research Hospital Memphis, Tennessee, United States
Drug: Temozolomide, Drug: Bevacizumab, Drug: Irinotecan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Drug: ribociclib, Drug: Everolimus, Children's National Medical Center
Washington, District of Columbia, United States, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States, Levine Cancer Institute
Charlotte, North Carolina, United States
Drug: Marizomib, Drug: Panobinostat, Boston Children's HospitalBoston, Massachusetts, United States, Dana-Farber Cancer Institute Boston, Massachusetts, United States
Radiation: 3-Dimensional Conformal Radiation Therapy, Radiation: Intensity-Modulated Radiation Therapy, Other: Laboratory Biomarker Analysis, Drug: Vorinostat, Children's Hospital of Alabama, Birmingham, Alabama, United States, University of Alabama at Birmingham Cancer Center Birmingham, Alabama, United States, Providence Hospital Mobile, Alabama, United States
Biological: SCRI-CARB7H3(s); B7H3-specific chimeric antigen receptor (CAR) T cel, Seattle Children's Hospital Seattle, Washington, United States
Drug: Antineoplaston therapy (Atengenal + Astugenal), Burzynski Clinic
Houston, Texas, United States
Drug: GD2 CAR T cells, Drug: Fludarabine, Drug: Cyclophosphamide Lucile Packard Children's Hospital (LPCH) Stanford, California, United States
Drug: Abemaciclib, Phoenix Children's Hospital Phoenix, Arizona, United States Children's Hospital Colorado Aurora, Colorado, United States Children's Healthcare of Atlanta, Egleston, Atlanta, Georgia, United States Children's Healthcare of Atlanta, Scottish Rite Atlanta, Georgia, United States
Procedure: Diffusion Tensor Imaging, Procedure: Diffusion Weighted Imaging, Procedure: Dynamic Contrast-Enhanced Magnetic Resonance Imaging, Children's Hospital Los Angeles Los Angeles, California, United States, Lucile Packard Children's Hospital Stanford University Palo Alto, California, United States Children's Hospital Colorado Aurora, Colorado, United States
Drug: ONC201, UCSF, Benioff Children's Hospital San Francisco, California, United States, Miami Cancer Institute Miami, Florida, United States, Children's Healthcare of Atlanta, Emory University School of Medicine Atlanta, Georgia, United States
Drug: LBH589, Children's Hospital Los Angeles
Los Angeles, California, United States, Stanford University and Lucile Packard Children's Hospital Palo Alto, California, United States, Children's National Medical Center Washington, District of Columbia, United States
Biological: DNX-2401, Clinica Universidad de Navarra Pamplona, Navarra, Spain
Drug: Adavosertib, Other: Laboratory Biomarker Analysis, Other: Pharmacological Study, Radiation: Radiation Therapy Children's Hospital of Alabama
Birmingham, Alabama, United States, Children's Hospital Los Angeles
Los Angeles, California, United States, Children's Hospital of Orange County
Orange, California, United States
Procedure: adjuvant therapy, Biological: pegylated interferon alfa National Institutes of Health Clinical Center, 9000 Rockville Pike Bethesda, Maryland, United States
Drug: DSP-7888, National Hospital Organization Nagoya Medical Center
Nagoya, Aichi, Japan Kanagawa Children's Medical Center Yokohama, Kanagawa, Japan, Osaka University Hospital Suita, Osaka, Japan
Biological: TTRNA-DC vaccines with GM-CSF, Biological: TTRNA-xALT, Drug: Cyclophosphamide + Fludarabine Lymphodepletive Conditioning, UF Health Shands Children's Hospital Gainesville, Florida, United States
Drug: GDC-0084, Radiation: radiation therapy, St. Jude Children's Research Hospital
Memphis, Tennessee, United States
Biological: nimotuzumab (anti EGFR humanized monoclonal antibody) Children's Hospital/University of Colorado Denver, Colorado, United States Children's National Medical Center Washington, District of Columbia, United States, University of Florida Shands Cancer Center Gainesville, Florida, United States
Drug: Fimepinostat, Procedure: Therapeutic Conventional Surgery, Rady Children's Hospital San Diego, California, United States, University of California, San Francisco
San Francisco, California, United States, University of Florida Gainesville, Florida, United States
Genetic: (C7R)-GD2.CART cells, Drug: Cyclophosphamide, Drug: Fludarabine, Texas Children's Hospital Houston, Texas, United States
Radiation: Radiation Therapy, Orlando Health Orlando, Florida, United States, University of Texas MD Anderson Cancer Center Houston, Texas, United States
Drug: Savolitinib, Children's Hospital Los Angeles Los Angeles, California, United States, Lucile Packard Children's Hospital Stanford University Palo Alto, California, United States, Children's Hospital Colorado Aurora, Colorado, United States
Drug: Infusate with MTX110 and gadolinium, Device: Convection-Enhanced Delivery (CED), Columbia University Irving Medical Center New York, New York, United States
Drug: REGN2810 (monotherapy), Drug: REGN2810 (maintenance), Radiation: Conventional or hypofractionated, Radiation: Re-irradiation, Children's Hospital Los Angeles (CHLA) Los Angeles, California, United States, Rady Children's Hospital
San Diego, California, United States, UCSF Benioff Children's Hospital
San Francisco, California, United States
Radiation: 3-Dimensional Conformal Radiation Therapy, Radiation: Intensity-Modulated Radiation Therapy, Other: Laboratory Biomarker Analysis, Children's Hospital Los Angeles Los Angeles, California, United States, Lucile Packard Children's Hospital Stanford University Palo Alto, California, United States, Children's National Medical Center Washington, District of Columbia, United States
Drug: Valproic acid, Drug: Bevacizumab, Radiation: Radiation therapy, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, United States, Children's Medical Center Dallas, Center for Cancer and Blood Disorders Dallas, Texas, United States, Cook Children's Medical Center Fort Worth, Texas, United States, Texas Children's Hospital Houston, Texas, United States
Drug: temozolomide, Procedure: adjuvant therapy, Radiation: radiation therapy, Comprehensive Cancer Center at University of Alabama at Birmingham, Birmingham, Alabama, United States, University of South Alabama Cancer Research Institute Mobile, Alabama, United States, Phoenix Children's Hospital Phoenix, Arizona, United States
Other: Specialized tumor board recommendation, University of California, San Diego Rady Children's Hospital San Diego, California, United States, University of California, San Francisco San Francisco, California, United States, Children's National Medical Center Washington, District of Columbia, United States
Drug: Mebendazole, Drug: Vincristine, Drug: Carboplatin, Cohen Children's Medical Center of New York New Hyde Park, New York, United States
Drug: CLR 131, Lucile Packard Children's Hospital Palo Alto, California, United States, Texas Children's Hospital Houston, Texas, United States, University of Wisconsin Hospital and Clinics Madison, Wisconsin, United States
Drug: INCB7839, Children's Hospital Los Angeles, Los Angeles, California, United States, Lucile Packard Children Hospital Stanford University Palo Alto, California, United States, Children's Hospital Colorado Aurora, Colorado, United States
Biological: APX005M treatment for recurrent or refractory primary malignant CNS tumor patients, Biological: APX005M treatment for newly diagnosed DIPG patients, Children's Hospital Los Angeles, Los Angeles, California, United States, Lucile Packard Children Hospital Stanford University Palo Alto, California, United States, Children's Hospital Colorado Aurora, Colorado, United States
Drug: Everolimus, Other: Laboratory Biomarker Analysis, Other: Pharmacological Study, Drug: Ribociclib, Children's Hospital Los Angeles,Los Angeles, California, United States, Lucile Packard Children Hospital Stanford University Palo Alto, California, United States, Children's Hospital Colorado Aurora, Colorado, United States
Other: Laboratory Biomarker Analysis, Biological: Sargramostim, Biological: Wild-type Reovirus, Mayo Clinic Rochester, Minnesota, United States
Drug: BXQ-350, Cincinnati Children's Hospital Medical Center Cincinnati, Ohio, United States, Nationwide Children's Columbus, Ohio, United States
Drug: 9-ING-41, Drug: Irinotecan, University of Chicago
Chicago, Illinois, United States, Levine Cancer Center Charlotte, North Carolina, United States, Brown University Providence, Rhode Island, United States
Drug: Palbociclib, Drug: Temozolomide, Drug: Irinotecan, Children's of Alabama
Birmingham, Alabama, United States, Phoenix Children's Hospital, Phoenix, Arizona, United States, Children's Hospital Los Angeles, Los Angeles, California, United States
Drug: Indoximod, Drug: Temozolomide, Radiation: Conformal Radiation, Children's Hospital Colorado, Aurora, Colorado, United States, Arnold Palmer Hospital for Children, Orlando, Florida, United States, Children's Heathcare of Atlanta
Atlanta, Georgia, United States
Drug: SIACI of Erbitux and Bevacizumab, Weill Cornell Medical College/New York Presbyterian Hospital New York, New York, United States
Background on Genessa Kahn
November 2020
Genessa Kahn is currently a sophomore at Townsend Harris High School at Queens College, which is ranked #1 in New York High Schools and #5 in the United States High Schools according to US News. Genessa has been a dedicated Girl Scout since 2014, and has undertaken numerous awards such as the Girl Scout Silver Award and the Girl Scout Bronze Award. After hearing the stories of teens her age who had combatted Diffuse Intrinsic Pontine Glioma, DIPG, Genessa became quite interested in the research being done regarding DIPG, and thus partnered with ICAN on her Girl Scout Gold Award project to help develop an ICAN DIPG webpage. She strives to bring awareness regarding pediatric cancers to young people and students so they develop understanding for their peers.
For this, I am dedicating my project to all DIPG patients and their parents, as well as all the neuro-oncologists around the world who are assisting in the development of DIPG clinical trials.—Genessa Kahn