Phase II Study of Nonmetastatic Desmoplastic Medulloblastoma in Children Younger Than 4 Years of Age: A Report of the Children's Oncology Group (ACNS1221)

Lucie Lafay-Cousin, Eric Bouffet, Douglas Strother, Vasilisa Rudneva, Cynthia Hawkins, Charles Eberhart, Craig Horbinski, Linda Heier, Mark Souweidane, Chris Williams-Hughes, Arzu Onar-Thomas, Catherine A. Billups, Maryam Fouladi, Paul Northcott, Giles Robinson, Amar Gajjar

Research output: Contribution to journalArticle

Abstract

PURPOSE: Nodular desmoplastic medulloblastoma (ND) and medulloblastoma with extensive nodularity (MBEN) have been associated with a more favorable outcome in younger children. However, treatment-related neurotoxicity remains a significant concern in this vulnerable group of patients. PATIENTS AND METHODS: ACNS1221 was a prospective single-arm trial of conventional chemotherapy for nonmetastatic ND and MBEN based on a modified HIT SKK 2000 regimen excluding intraventricular methotrexate, aiming to achieve similar outcome (2-year progression-free survival [PFS] ≥ 90%) with reduced treatment-related neurotoxicity. Secondary objectives included feasibility of timely central pathology review and evaluation of tumor molecular profile. RESULTS: Twenty-five eligible patients (15 males and 10 females; median age, 18.7 months) were enrolled. Eighteen patients had ND and 7 had MBEN histology. Three patients had residual disease at baseline. The study closed early because of a higher than expected relapse rate. Twelve patients experienced relapse-local (n= 6), distant (n = 3), and combined (n = 3)-at a median of 9.8 months from diagnosis (range, 8.9-13.7 months), and 2 patients died of disease. Two-year PFS and overall survival rates were 52% (95% CI, 32.4% to 71.6%) and 92% (95% CI, 80.8% to 100.0%) respectively. Patients older than 12 months of age (P = .036) and ND histology (P = .005) were associated with worse PFS. No patients with MBEN histology experienced relapse. All tumor samples clustered within the sonic hedgehog (SHH) group. Methylation analysis delineated 2 subgroups, SHH-I and SHH-II, which were associated with 2-year PFS rates of 30.0% (95% CI, 1.6% to 58.4%) and 66.7% (95% CI, 44.0% to 89.4%), respectively (P = .099). CONCLUSION: The proposed modified regimen of conventional systemic chemotherapy without serial intraventricular methotrexate injection failed to achieve the targeted 2-year PFS of 90%. With this cohort, we prospectively confirmed the existence of two SHH subgroups and observed a trend toward worse outcome for SHH-I patients.

Original languageEnglish (US)
Pages (from-to)223-231
Number of pages9
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume38
Issue number3
DOIs
StatePublished - Jan 20 2020

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Lafay-Cousin, L., Bouffet, E., Strother, D., Rudneva, V., Hawkins, C., Eberhart, C., Horbinski, C., Heier, L., Souweidane, M., Williams-Hughes, C., Onar-Thomas, A., Billups, C. A., Fouladi, M., Northcott, P., Robinson, G., & Gajjar, A. (2020). Phase II Study of Nonmetastatic Desmoplastic Medulloblastoma in Children Younger Than 4 Years of Age: A Report of the Children's Oncology Group (ACNS1221). Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 38(3), 223-231. https://doi.org/10.1200/JCO.19.00845