Stem cell-related "self-renewal" signature and high epidermal growth factor receptor expression associated with resistance to concomitant chemoradiotherapy in glioblastoma.

Abstract

PURPOSE:

Glioblastomas are notorious for resistance to therapy, which has been attributed to DNA-repair proficiency, a multitude of deregulated molecular pathways, and, more recently, to the particular biologic behavior of tumor stem-like cells. Here, we aimed to identify molecular profiles specific for treatment resistance to the current standard of care of concomitant chemoradiotherapy with the alkylating agent temozolomide.

PATIENTS AND METHODS:

Gene expression profiles of 80 glioblastomas were interrogated for associations with resistance to therapy. Patients were treated within clinical trials testing the addition of concomitant and adjuvant temozolomide to radiotherapy.

RESULTS:

An expression signature dominated by HOX genes, which comprises Prominin-1 (CD133), emerged as a predictor for poor survival in patients treated with concomitant chemoradiotherapy (n = 42; hazard ratio = 2.69; 95% CI, 1.38 to 5.26; P = .004). This association could be validated in an independent data set. Provocatively, the HOX cluster was reminiscent of a "self-renewal" signature (P = .008; Gene Set Enrichment Analysis) recently characterized in a mouse leukemia model. The HOX signature and EGFR expression were independent prognostic factors in multivariate analysis, adjusted for the O-6-methylguanine-DNA methyltransferase (MGMT) methylation status, a known predictive factor for benefit from temozolomide, and age. Better outcome was associated with gene clusters characterizing features of tumor-host interaction including tumor vascularization and cell adhesion, and innate immune response.

CONCLUSION:

This study provides first clinical evidence for the implication of a "glioma stem cell" or "self-renewal" phenotype in treatment resistance of glioblastoma. Biologic mechanisms identified here to be relevant for resistance will guide future targeted therapies and respective marker development for individualized treatment and patient selection.

• Authors: Anastasia Murat, Eugenia Migliavacca, Thierry Gorlia, Wanyu L Lambiv, Tal Shay, Marie-France Hamou, Nicolas de Tribolet, Luca Regli, Wolfgang Wick, Mathilde C M Kouwenhoven, Johannes A Hainfellner, Frank L Heppner, Pierre-Yves Dietrich, Yitzhak Zimmer, J Gregory Cairncross, Robert-Charles Janzer, Eytan Domany, Mauro Delorenzi, Roger Stupp, Monika E Hegi
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 26 Issue 18 Pg. 3015-24 (Jun 20 2008) ISSN: 1527-7755 [Electronic] United States
• PMID: 18565887 (Publication Type: Clinical Trial, Phase II, Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents, Alkylating
• Dacarbazine
• ErbB Receptors
• Temozolomide

Topics

• Adult
• Adult Stem Cells (pathology)
• Aged
• Antineoplastic Agents, Alkylating (therapeutic use)
• Brain Neoplasms (enzymology, genetics, pathology, therapy)
• Combined Modality Therapy
• Dacarbazine (analogs & derivatives, therapeutic use)
• Drug Resistance, Neoplasm
• ErbB Receptors (biosynthesis, genetics)
• Gene Expression Profiling
• Genes, Homeobox
• Glioblastoma (enzymology, genetics, pathology, therapy)
• Humans
• Middle Aged
• Multigene Family
• Radiation Tolerance
• Temozolomide