Abstract A20: hTERT promoter hypermethylation is a cancer signature which predicts survival and response to targeted therapy in pediatric nervous system tumors
Authors: castelo-branco Pedro , Choufani Sanaa , Mack Stephen , Gallagher Denis , Zhang Cindy , Lipman Tatiana , Zhukova Nataliya , Walker Erin J. , Merino Diana , Jonathan Jonathan D. , Elizabeth Cynthia , Alon Noa , Zhang Libo , Hovestadt Volker , Kool Marcel , Jones David TW , Croul Sidney , Hawkins Cynthia , Hitzler Johann , Wang Jean C.Y. , Malkin David , Baruchel Sylvain , Dirks Peter B. , Pfister Stefan , Taylor Michael , Weksberg Rosanna , Tabori Uri 
Published: May 2015

Abstract
Purpose: Defining grade of malignancy and disease progression is a major goal in pediatric neurooncology. Since telomerase is a hallmark of cancer, we examined whether promoter methylation of hTERT, the catalytic subunit of telomerase, can be a biomarker for malignancy, response to therapy and patient outcome.
Patients and methods: Whole genome methylation arrays (discovery cohort n=280), Sequenom and pyrosequencing of hTERT promoter (validation cohort, n=219) were performed on patient samples and normal tissues. Correlation between hTERT promoter methylation, telomere maintenance and patient outcome was performed.
Results: Using the discovery cohort, we uncovered a specific region upstream-of-the transcription-start-site (UTSS) of hTERT that is hypermethylated in 100% of malignant neoplasms that express hTERT and unmethylated in normal tissues and in low grade tumors lacking hTERT expression. In the validation cohort, this biomarker had positive and negative predictive values of 1.0 and 0.93, respectively. UTSS methylation increased in tumors as they evolved from low to high grade and from primary to metastatic. Furthermore, UTSS methylation was able to identify which low grade neoplasms would progress to malignant cancers. Ependymomas with and without UTSS methylation had 5-year overall survival of 51+/-10% and 95+/-5% respectively (p=0.0008). Finally, UTSS methylation could predict which tumors would respond to targeted therapy with telomerase inhibitor.
Conclusion: Hypermethylation of a specific region in the hTERT promoter is a cancer signature. It positively correlates with higher hTERT expression, tumor progression and poor prognosis. hTERT UTSS methylation may also represent a diagnostic tool and a therapeutic target for pediatric nervous system tumors.
Citation Format: Pedro castelo-branco, Sanaa Choufani, Stephen Mack, Denis Gallagher, Cindy Zhang, Tatiana Lipman, Nataliya Zhukova, Erin J. Walker, Diana Merino, Jonathan D. Jonathan, Cynthia Elizabeth, Noa Alon, Libo Zhang, Volker Hovestadt, Marcel Kool, David TW Jones, Sidney Croul, Cynthia Hawkins, Johann Hitzler, Jean C.Y. Wang, David Malkin, Sylvain Baruchel, Peter B. Dirks, Stefan Pfister, Michael Taylor, Rosanna Weksberg, Uri Tabori. hTERT promoter hypermethylation is a cancer signature which predicts survival and response to targeted therapy in pediatric nervous system tumors. [abstract]. In: Proceedings of the AACR Special Conference on Pediatric Cancer at the Crossroads: Translating Discovery into Improved Outcomes; Nov 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;74(20 Suppl):Abstract nr A20.