@article{RascheKortuemRaabetal.2019,
  author    = {Rasche, Leo and Kort{\"u}m, K. Martin and Raab, Marc S. and Weinhold, Niels},
  title     = {The impact of tumor heterogeneity on diagnostics and novel therapeutic strategies in multiple myeloma},
  series = {International Journal of Molecular Sciences},
  volume    = {20},
  journal   = {International Journal of Molecular Sciences},
  number    = {5},
  issn      = {1422-0067},
  doi       = {10.3390/ijms20051248},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-285402},
  year      = {2019},
  abstract  = {Myeloma is characterized by extensive inter-patient genomic heterogeneity due to multiple different initiating events. A recent multi-region sequencing study demonstrated spatial differences, with progression events, such as TP53 mutations, frequently being restricted to focal lesions. In this review article, we describe the clinical impact of these two types of tumor heterogeneity. Target mutations are often dominant at one site but absent at other sites, which poses a significant challenge to personalized therapy in myeloma. The same holds true for high-risk subclones, which can be locally restricted, and as such not detectable at the iliac crest, which is the usual sampling site. Imaging can improve current risk classifiers and monitoring of residual disease, but does not allow for deciphering the molecular characteristics of tumor clones. In the era of novel immunotherapies, the clinical impact of heterogeneity certainly needs to be re-defined. Yet, preliminary observations indicate an ongoing impact of spatial heterogeneity on the efficacy of monoclonal antibodies. In conclusion, we recommend combining molecular tests with imaging to improve risk prediction and monitoring of residual disease. Overcoming intra-tumor heterogeneity is the prerequisite for curing myeloma. Novel immunotherapies are promising but research addressing their impact on the spatial clonal architecture is highly warranted.},
  language  = {en}
}
@article{DaViaSolimandoGaritanoTrojaolaetal.2019,
  author    = {Da Vi{\`a}, Matteo Claudio and Solimando, Antonio Giovanni and Garitano-Trojaola, Andoni and Barrio, Santiago and Munawar, Umair and Strifler, Susanne and Haertle, Larissa and Rhodes, Nadine and Vogt, Cornelia and Lapa, Constantin and Beilhack, Andreas and Rasche, Leo and Einsele, Hermann and Kort{\"u}m, K. Martin},
  title     = {CIC Mutation as a Molecular Mechanism of Acquired Resistance to Combined BRAF-MEK Inhibition in Extramedullary Multiple Myeloma with Central Nervous System Involvement},
  series = {The Oncologist},
  volume    = {25},
  journal   = {The Oncologist},
  number    = {2},
  doi       = {10.1634/theoncologist.2019-0356},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-219549},
  pages     = {112-118},
  year      = {2019},
  abstract  = {Combined MEK-BRAF inhibition is a well-established treatment strategy in BRAF-mutated cancer, most prominently in malignant melanoma with durable responses being achieved through this targeted therapy. However, a subset of patients face primary unresponsiveness despite presence of the activating mutation at position V600E, and others acquire resistance under treatment. Underlying resistance mechanisms are largely unknown, and diagnostic tests to predict tumor response to BRAF-MEK inhibitor treatment are unavailable. Multiple myeloma represents the second most common hematologic malignancy, and point mutations in BRAF are detectable in about 10\% of patients. Targeted inhibition has been successfully applied, with mixed responses observed in a substantial subset of patients mirroring the widespread spatial heterogeneity in this genomically complex disease. Central nervous system (CNS) involvement is an extremely rare, extramedullary form of multiple myeloma that can be diagnosed in less than 1\% of patients. It is considered an ultimate high-risk feature, associated with unfavorable cytogenetics, and, even with intense treatment applied, survival is short, reaching less than 12 months in most cases. Here we not only describe the first patient with an extramedullary CNS relapse responding to targeted dabrafenib and trametinib treatment, we furthermore provide evidence that a point mutation within the capicua transcriptional repressor (CIC) gene mediated the acquired resistance in this patient.},
  language  = {en}
}