A refractory case of CDK4-amplified spinal astrocytoma achieving complete response upon treatment with a Palbociclib-based regimen:a case report

• Published in: BMC cancer 2020-07, Vol.20 (1), p.630-6, Article 630
• Main Authors: Lin, Jietao, Yu, Ling, Fu, Yuanfeng, Chen, Hanrui, Zheng, Xinting, Wang, Shutang, Gao, Chan, Cao, Yang, Lin, Lizhu
• Format: Article
• Language: English
• Subjects: Adult; Angiogenesis; Antiangiogenic agents; Antineoplastic Combined Chemotherapy Protocols - pharmacology; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Astrocytoma; Astrocytoma - genetics; Astrocytoma - pathology; Astrocytoma - therapy; Bevacizumab; Bevacizumab - pharmacology; Bevacizumab - therapeutic use; Cancer therapies; Case Report; Case reports; Cell cycle; Chemoradiotherapy; Chemoradiotherapy, Adjuvant - methods; Chemotherapy; Chemotherapy, Adjuvant - methods; Cyclin-dependent kinase 4; Cyclin-Dependent Kinase 4 - antagonists & inhibitors; Cyclin-Dependent Kinase 4 - genetics; Cyclin-dependent kinases; Disease; Disease Progression; Drug Resistance, Neoplasm - drug effects; Drug Resistance, Neoplasm - genetics; FDA approval; Gene Amplification; Genetic disorders; Growth factors; High-Throughput Nucleotide Sequencing; Humans; Hybridization; Kinases; Liposarcoma; Magnetic resonance imaging; Male; Medical imaging; Medical prognosis; Molecular Targeted Therapy - methods; Monoclonal antibodies; Mutation; Nervous system; Next-generation sequencing; Palbociclib; Patients; Piperazines - pharmacology; Piperazines - therapeutic use; Pyridines - pharmacology; Pyridines - therapeutic use; Spinal astrocytoma; Spinal cord; Spinal Cord - pathology; Spinal Cord - surgery; Spinal Cord Neoplasms - genetics; Spinal Cord Neoplasms - pathology; Spinal Cord Neoplasms - therapy; Surgery; Targeted cancer therapy; Targeted therapy; Therapeutic applications; Treatment Outcome; Tumors
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-020-07061-3

Spinal cord astrocytoma is a rare neoplasm, and patients usually recur within months after surgery. There is currently a lack of consensus regarding post-operative treatment. Clinical data on the activity of systemic treatment like chemoradiotherapy and anti-angiogenic agents also remained scant. Next-generation sequencing (NGS) -based genomic profiling thus may help identify potential treatment options for a subset of patients that harbor actionable genetic alterations. We reported for the first time a refractory case of grade III spinal cord astrocytoma that underwent two surgeries but eventually progressed following post-operative chemoradiotherapy plus bevacizumab. Hybridization capture-based NGS using a 381-gene panel disclosed cyclin dependent kinase 4 (CDK4) amplification and after receiving a triplet regimen containg palbociclib for 15 months, the patient achieved complete response. This case demonstrated the importance of genetic profiling and the benefit of a multi-modality treatment strategy in cancer management.