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Current Treatment Options for Malignant Peripheral Nerve Sheath Tumors

  • Sarcoma (SH Okuno, Section Editor)
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Opinion statement

Malignant peripheral nerve sheath tumors (MPNST) are aggressive soft tissue sarcomas characterized by high risk of local recurrence and distant metastasis. The only known curative therapy is complete resection. Adjuvant radiation is recommended for larger lesions or those with more aggressive histology. Given the dismal prognosis in tumors that cannot be cured by surgery alone and the lack of systemic therapy with proven benefit, targeted therapies based on knowledge of activation of the Ras pathway and downstream effectors have been trialed in MPNST, thus far without proven benefit. However, novel or combination therapies based on recent preclinical advances are highly desirable and are the subject of ongoing clinical trials.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Widemann BC. Current status of sporadic and neurofibromatosis type 1-associated malignant peripheral nerve sheath tumors. Curr Oncol Rep. 2009;11(4):322–8.

    Article  PubMed  Google Scholar 

  2. Ducatman BS et al. Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases. Cancer. 1986;57(10):2006–21.

    Article  CAS  PubMed  Google Scholar 

  3. Evans DG et al. Malignant peripheral nerve sheath tumours in neurofibromatosis 1. J Med Genet. 2002;39(5):311–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Meany H, Widemann BC, Ratner N. Malignant peripheral nerve sheath tumors: prognostic and diagnostic markers and therapeutic targets. In: Neurofibromatosis Type 1. Berlin: Springer; 2012. p. 445–67. An updated overall review of MPNST biology and potential targets.

    Chapter  Google Scholar 

  5. Cichowski K, Jacks T. NF1 tumor suppressor gene function: narrowing the GAP. Cell. 2001;104(4):593–604.

    Article  CAS  PubMed  Google Scholar 

  6. Carli M et al. Pediatric malignant peripheral nerve sheath tumor: the Italian and German soft tissue sarcoma cooperative group. J Clin Oncol. 2005;23(33):8422–30.

    Article  PubMed  Google Scholar 

  7. Stucky CC et al. Malignant peripheral nerve sheath tumors (MPNST): the Mayo Clinic experience. Ann Surg Oncol. 2012;19(3):878–85. Recent, large, single-institution retrospective review to evaluate prognostic variables in this rare tumor type.

    Article  PubMed  Google Scholar 

  8. Beert E et al. Atypical neurofibromas in neurofibromatosis type 1 are premalignant tumors. Genes Chromosom Cancer. 2011;50(12):1021–32.

    Article  CAS  PubMed  Google Scholar 

  9. Kourea HP et al. Deletions of the INK4A gene occur in malignant peripheral nerve sheath tumors but not in neurofibromas. Am J Pathol. 1999;155(6):1855–60.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Nielsen GP et al. Malignant transformation of neurofibromas in neurofibromatosis 1 is associated with CDKN2A/p16 inactivation. Am J Pathol. 1999;155(6):1879–84.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Wong WW et al. Malignant peripheral nerve sheath tumor: analysis of treatment outcome. Int J Radiat Oncol Biol Phys. 1998;42(2):351–60.

    Article  CAS  PubMed  Google Scholar 

  12. Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol. 2002;20(3):791–6.

    Article  PubMed  Google Scholar 

  13. Kolberg M. Survival meta-analyses for >1800 malignant peripheral nerve sheath tumor patients with and without neurofibromatosis type 1. Neuro Oncol. 2013;15(2):135–47. This analysis examines survival in MPNST and demonstrates improved survival NF1-associated MPNST compared to sporadic tumors, contrary to historical data.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Johannessen CM et al. TORC1 is essential for NF1-associated malignancies. Curr Biol. 2008;18(1):56–62.

    Article  CAS  PubMed  Google Scholar 

  15. Endo M et al. Prognostic significance of AKT/mTOR and MAPK pathways and antitumor effect of mTOR inhibitor in NF1-related and sporadic malignant peripheral nerve sheath tumors. Clin Cancer Res. 2013;19(2):450–61. This study examined activation profiles of the AKT/mTOR and MAPK pathways in tumor specimens and correlated these results with prognosis. The study also assessed the in vitro activity of everolimus, which demonstrated antitumor activity in MPNST cell lines, providing insight into potential therapeutic pathways.

    Article  CAS  PubMed  Google Scholar 

  16. Bottillo I et al. Germline and somatic NF1 mutations in sporadic and NF1-associated malignant peripheral nerve sheath tumours. J Pathol. 2009;217(5):693–701.

    Article  CAS  PubMed  Google Scholar 

  17. Pasmant E et al. Identification of genes potentially involved in the increased risk of malignancy in NF1-microdeleted patients. Mol Med. 2011;17(1–2):79–87.

    CAS  PubMed Central  PubMed  Google Scholar 

  18. Watson MA et al. Gene expression profiling reveals unique molecular subtypes of Neurofibromatosis Type I-associated and sporadic malignant peripheral nerve sheath tumors. Brain Pathol. 2004;14(3):297–303.

    Article  CAS  PubMed  Google Scholar 

  19. Brekke HR et al. Genomic changes in chromosomes 10, 16, and X in malignant peripheral nerve sheath tumors identify a high-risk patient group. J Clin Oncol. 2010;28(9):1573–82.

    Article  PubMed  Google Scholar 

  20. Ferner R et al. Evaluation of (18)fluorodeoxyglucose positron emission tomography ((18)FDG PET) in the detection of malignant peripheral nerve sheath tumours arising from within plexiform neurofibromas in neurofibromatosis 1. J Neurol Neurosurg Psychiatry. 2000;68(3):353–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Benz MR et al. Quantitative F18-fluorodeoxyglucose positron emission tomography accurately characterizes peripheral nerve sheath tumors as malignant or benign. Cancer. 2010;116(2):451–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Ferner R et al. [18F] 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a diagnostic tool for neurofibromatosis 1 (NF1) associated malignant peripheral nerve sheath tumours (MPNSTs): a long-term clinical study. Ann Oncol. 2008;19(2):390–4.

    Article  CAS  PubMed  Google Scholar 

  23. Bensaid BGF, Mognetti T, Galoisy-Guibal L, Pinson S, Drouet A, Combemale P. Utility of 18 FDG positron emission tomography in detection of sarcomatous transformation in neurofibromatosis type 1. Ann Dermatol Venereol. 2007;134(10 Pt 1):735–41.

    Article  CAS  PubMed  Google Scholar 

  24. Bredella MA et al. Value of PET in the assessment of patients with neurofibromatosis Type 1. Am J Roentgenol. 2007;189(4):928–35.

    Article  Google Scholar 

  25. Scaife CL, Pisters PW. Combined-modality treatment of localized soft tissue sarcomas of the extremities. Surg Oncol Clin N Am. 2003;12(2):355–68.

    Article  PubMed  Google Scholar 

  26. Pisters PW et al. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14(5):1679–89.

    CAS  PubMed  Google Scholar 

  27. Gupta G, Mammis A, Maniker A. Malignant peripheral nerve sheath tumors. Neurosurg Clin N Am. 2008;19(4):533–43. v.

    Article  PubMed  Google Scholar 

  28. Yang JC et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.

    CAS  PubMed  Google Scholar 

  29. Kahn J et al. Radiation therapy in management of sporadic and neurofibromatosis type 1-associated malignant peripheral nerve sheath tumors. Front Oncol. 2014;4:324.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Ferner RE, Gutmann DH. International consensus statement on malignant peripheral nerve sheath tumors in neurofibromatosis. Cancer Res. 2002;62(5):1573–7.

    CAS  PubMed  Google Scholar 

  31. Widemann B, et al. SARC006: phase II trial of chemotherapy in sporadic and neurofibromatosis type 1 (NF1)-associated high-grade malignant peripheral nerve sheath tumors (MPNSTs). J Clin Oncol. 2013; 31 (suppl; abstr 10522).

  32. Raney B et al. Treatment of children with neurogenic sarcoma experience at the children's hospital of Philadelphia, 1958–1984. Cancer. 1987;59(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  33. Li H et al. Epidermal growth factor receptor signaling pathways are associated with tumorigenesis in the Nf1:p53 mouse tumor model. Cancer Res. 2002;62(15):4507–13.

    CAS  PubMed  Google Scholar 

  34. Maki RG et al. Phase II study of sorafenib in patients with metastatic or recurrent sarcomas. J Clin Oncol. 2009;27(19):3133–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Chugh R et al. Phase II multicenter trial of imatinib in 10 histologic subtypes of sarcoma using a bayesian hierarchical statistical model. J Clin Oncol. 2009;27(19):3148–53.

    Article  CAS  PubMed  Google Scholar 

  36. Albritton K, et al. Phase II trial of erlotinib in metastatic or unresectable malignant peripheral nerve sheath tumor (MPNST). J Clin Oncol. 2006; 24 (suppl; abstr 9518).

  37. Schuetze S, et al. Results of a Sarcoma Alliance for Research through Collaboration (SARC) phase II trial of dasatinib in previously treated, high-grade, advanced sarcoma. J Clin Oncol. 2010; 28(15s (suppl; abstr 10009)).

  38. Johansson G et al. Effective in vivo targeting of the mammalian target of rapamycin pathway in malignant peripheral nerve sheath tumors. Mol Cancer Ther. 2008;7(5):1237–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Vogel KS et al. Mouse tumor model for neurofibromatosis Type 1. Science (New York, NY). 1999;286(5447):2176–9.

    Article  CAS  Google Scholar 

  40. Cichowski K et al. Mouse models of tumor development in neurofibromatosis type 1. Science. 1999;286(5447):2172–6.

    Article  CAS  PubMed  Google Scholar 

  41. Luo J, Solimini NL, Elledge SJ. Principles of cancer therapy: oncogene and non-oncogene addiction. Cell. 2009;136(5):823–37.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. De Raedt T et al. Exploiting cancer cell vulnerabilities to develop a combination therapy for ras-driven tumors. Cancer Cell. 2011;20(3):400–13. This study demonstrated that promotion of proteotoxic stress on the endoplasmic reticulum via Hsp90 inhibition in combination with mTOR inhibition resulted in irreparable damage to mitochondria and ER, which correlated with dramatic tumor shrinkage in a transgenic MPNST mouse model. This promising finding led to the rapid development of SARC023, a Phase I/II study of gantespib and sirolimus in MPNST.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Kim A, et al. SARC023: Phase I/II trial of ganetespib in combination with sirolimus for refractory sarcomas and malignant peripheral nerve sheath tumors (MPNST). J Clin Oncol. 2014; 32(5s (suppl; abstr TPS10603)).

  44. Malone CF et al. Defining key signaling nodes and therapeutic biomarkers in NF1-mutant cancers. Cancer Discov. 2014;4(9):1062–73. This study demonstrated that combined inhibition of mTOR and MEK induce tumor regression in vivo. In addition, 18FDG-PET was identified as a potential real-time indicator for target inhibition by these agents, and thus identifying a potential imaging biomarker for evaluation in clinical trials.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Diana Bradford and AeRang Kim declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to AeRang Kim MD, PhD.

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This article is part of the Topical Collection on Sarcoma

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Bradford, D., Kim, A. Current Treatment Options for Malignant Peripheral Nerve Sheath Tumors. Curr. Treat. Options in Oncol. 16, 12 (2015). https://doi.org/10.1007/s11864-015-0328-6

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