title: Potential evolution of neurosurgical treatment paradigms for craniopharyngioma based on genomic and transcriptomic characteristics.
abstract: The recent genomic and transcriptomic characterization of human craniopharyngiomas has provided important insights into the pathogenesis of these tumors and supports that these tumor types are distinct entities. Critically, the insights provided by these data offer the potential for the introduction of novel therapies and surgical treatment paradigms for these tumors, which are associated with high morbidity rates and morbid conditions. Mutations in the CTNNB1 gene are primary drivers of adamantinomatous craniopharyngioma (ACP) and lead to the accumulation of β-catenin protein in a subset of the nuclei within the neoplastic epithelium of these tumors. Dysregulation of epidermal growth factor receptor (EGFR) and of sonic hedgehog (SHH) signaling in ACP suggest that paracrine oncogenic mechanisms may underlie ACP growth and implicate these signaling pathways as potential targets for therapeutic intervention using directed therapies. Recent work shows that ACP cells have primary cilia, further supporting the potential importance of SHH signaling in the pathogenesis of these tumors. While further preclinical data are needed, directed therapies could defer, or replace, the need for radiation therapy and/or allow for less aggressive surgical interventions. Furthermore, the prospect for reliable control of cystic disease without the need for surgery now exists. Studies of papillary craniopharyngioma (PCP) are more clinically advanced than those for ACP. The vast majority of PCPs harbor the BRAFv600emutation. There are now 2 reports of patients with PCP that had dramatic therapeutic responses to targeted agents. Ongoing clinical and research studies promise to not only advance our understanding of these challenging tumors but to offer new approaches for patient management.
authors.affiliation: Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; and.
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Robinson
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston Children's Hospital, Harvard Institute of Medicine, Boston, Massachusetts.
authors.forename: Sandro
authors.initials: S
authors.lastname: Santagata
authors.affiliation: Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; and.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Hankinson
mesh_terms: D003397:Craniopharyngioma / Q000175:diagnosis / Q000235:genetics* / Q000601:surgery; D066246:ErbB Receptors / Q000235:genetics; D023281:Genomics / Q000639:trends*; D006801:Humans; D019635:Neurosurgical Procedures / Q000639:trends*; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000601:surgery; D059467:Transcriptome / Q000235:genetics*; D016896:Treatment Outcome
chemical_list: C512478:EGFR protein, human; D066246:ErbB Receptors
keywords: ACP = adamantinomatous craniopharyngioma; BRAF; CTNNB1; EGF = epidermal growth factor; EGFR = EGF receptor; PCP = papillary craniopharyngioma; SHH = sonic hedgehog; adamantinomatous craniopharyngioma; craniopharyngioma genomics; craniopharyngioma transcriptomics; papillary craniopharyngioma