Scientific article

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

Published inJournal of clinical oncology, vol. 26, no. 18, p. 3015-3024
Publication date2008

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.

  • 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
  • Gene Expression Profiling
  • Genes, Homeobox
  • Glioblastoma/enzymology/genetics/pathology/therapy
  • Humans
  • Middle Aged
  • Multigene Family
  • Radiation Tolerance
  • Receptor, Epidermal Growth Factor/biosynthesis/genetics
Citation (ISO format)
MURAT, Anastasia et al. Stem cell-related ‘self-renewal’ signature and high epidermal growth factor receptor expression associated with resistance to concomitant chemoradiotherapy in glioblastoma. In: Journal of clinical oncology, 2008, vol. 26, n° 18, p. 3015–3024. doi: 10.1200/JCO.2007.15.7164
Main files (1)
Article (Accepted version)
ISSN of the journal0732-183X

Technical informations

Creation06/11/2009 9:51:00 AM
First validation06/11/2009 9:51:00 AM
Update time03/14/2023 3:06:35 PM
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