SDHx mutations and temozolomide in malignant pheochromocytoma and paraganglioma

Author:

Perez Kimberly12ORCID,Jacene Heather234,Hornick Jason L25,Ma Chao1,Vaz Nuno4,Brais Lauren K1,Alexander Holly1ORCID,Baddoo William1,Astone Kristina1ORCID,Esplin Edward D6ORCID,Garcia John6ORCID,Halperin Daniel M7ORCID,Kulke Matthew H8ORCID,Chan Jennifer A12

Affiliation:

1. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA

2. Harvard Medical School, Boston, Massachusetts, USA

3. Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts, USA

4. Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA

5. Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA

6. Invitae Corporation, San Francisco, California, USA

7. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

8. Section of Hematology and Oncology, Boston University and Boston Medical Center, Boston, Massachusetts, USA

Abstract

Malignant pheochromocytomas (PHEOs)/paragangliomas (PGLs) are rare tumors for which clinical outcomes remain poorly defined and therapeutic options are limited. Approximately 27% carry pathogenic germline succinate dehydrogenase (SDHx) mutations; the presence of such mutations has been correlated with response to temozolomide (TMZ). We aimed to investigate the association between germline mutations in SDHx and response to TMZ. We retrospectively identified patients with metastatic malignant PHEO/PGLs treated with TMZ- based chemotherapy at Dana-Farber Cancer Institute between 2003 and 2020. The correlation between response by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and PET Response Criteria in Solid Tumors (PERCIST) and the presence of SDHx mutations in the germline and tumor was evaluated. Nineteen patients received TMZ. Seventeen underwent germline assessment: 9 (53%) carried a pathogenic SDHx germline mutation. Fifteen patients were evaluable for response by RECIST 1.1: 6 (40%) partial response, 4 (27%) stable disease, and 5 (33%) progressive disease. Overall median progression-free survival was 2.2 years. Three-year overall survival (OS) was 58%. Median PFS was 1.3 years and 5.5 years for carriers and non-carriers, respectively and OS was 1.5 years and not estimable for carriers and non-carriers, respectively. The response by PERCIST criteria in nine patients correlated with the RECIST 1.1 assessment. Our series represents one of the largest analyses of patients with malignant PHEOs/PGLs treated with TMZ who have available germline data. The incidence of pathogenic germline SDHx mutations was similar to what has been previously published, though our analysis suggests that there may be a limited association between response to TMZ and pathogenic germline SDHx mutations.

Publisher

Bioscientifica

Subject

Cancer Research,Endocrinology,Oncology,Endocrinology, Diabetes and Metabolism

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