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The PTEN Tumor Suppressor Gene in Soft Tissue Sarcoma

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The PTEN Tumor Suppressor Gene in Soft Tissue Sarcoma cancers Review The PTEN Tumor Suppressor Gene in Soft Tissue Sarcoma Sioletic Stefano 1,* and Scambia Giovanni 2,3 1 UOC Anatomia Patologica, San Camillo De Lellis, 02100 Rieti, Italy 2 UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy 3 Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy * Correspondence: [email protected] Received: 15 June 2019; Accepted: 8 August 2019; Published: 14 August 2019 Abstract: Soft tissue sarcoma (STS) is a rare malignancy of mesenchymal origin classified into more than 50 different subtypes with distinct clinical and pathologic features. Despite the poor prognosis in the majority of patients, only modest improvements in treatment strategies have been achieved, largely due to the rarity and heterogeneity of these tumors. Therefore, the discovery of new prognostic and predictive biomarkers, together with new therapeutic targets, is of enormous interest. Phosphatase and tensin homolog (PTEN) is a well-known tumor suppressor that commonly loses its function via mutation, deletion, transcriptional silencing, or protein instability, and is frequently downregulated in distinct sarcoma subtypes. The loss of PTEN function has consequent alterations in important pathways implicated in cell proliferation, survival, migration, and genomic stability. PTEN can also interact with other tumor suppressors and oncogenic signaling pathways that have important implications for the pathogenesis in certain STSs. The aim of the present review is to summarize the biological significance of PTEN in STS and its potential role in the development of new therapeutic strategies. Keywords: PTEN; Soft tissue sarcoma; liposarcoma; leiomyosarcoma; malignant peripheral nerve sheath tumor; undifferentiated pleomorphic sarcoma; myxofibrosarcoma; gastrointestinal stromal tumor; epithelioid sarcoma; synovial sarcoma 1. Introduction Soft tissue sarcomas (STSs) constitute a heterogeneous group of rare solid tumors of mesenchymal tissue origin, with more than 50 different histological subtypes and distinct clinical and pathological features [1]. Collectively, these tumors account for approximately 1% of all adult malignancies and 15% of pediatric malignancies. The therapeutic options are determined based on the histology (subtype, grade), localization, resectability, and presence or absence of metastases. The mainstay treatment of the primary STS is wide local excision with or without complementary radiotherapy (RT) to improve local control and eventually chemotherapy [2]. In specific groups of sarcomas (high grade, >5 cm, and deep-seated), adjuvant chemotherapy with anthracyclines and ifosfamide is a standard choice of treatment [3]. The most common sites of origin are the extremities; however, STSs can arise in any part of the body, including the abdomen and head and neck region [4]. They most commonly metastasize to the lungs and less frequently to the liver peritoneum and bones. Their relatively low incidence, compared to other solid tumors, and their heterogeneity, make it difficult to study and evaluate a high number of specific subtypes of STS. These difficulties limit Cancers 2019, 11, 1169; doi:10.3390/cancers11081169 www.mdpi.com/journal/cancers Cancers 2019,, 11,, 1169x 22 of of 23 22 ability to conduct traditional clinical trials, establish advanced drug development, and determine therationale ability treatment to conduct strategies traditional in the clinical advanced trials, stage. establish advanced drug development, and determine rationaleThe current treatment therapies strategies allow in thea local advanced control stage. in about 80–90% of patients; however, approximately half ofThe the current patients therapies with high-grade allow a local tumors control develo in aboutp metastatic 80–90% disease of patients; [5], with however, an estimated approximately 3-year halfsurvival of the range patients from with 20% high-gradeto 45% [6]. tumors develop metastatic disease [5], with an estimated 3-year survivalThe rangesystematic from 20% therapy to 45% in [6 ].locally advanced and metastatic STS is based on standard chemotherapyThe systematic with therapyanthracycline in locally (e.g., advanced doxorubicin). and metastatic Although STS there is based is no formal on standard demonstration chemotherapy that withmulti-agent anthracycline chemotherapy (e.g., doxorubicin). is more effective Although than there single-agent is no formal chemotherapy demonstration in terms that multi-agent of overall chemotherapysurvival (OS), anthracyclines is more effective plus than ifosfamide single-agent is considered, chemotherapy in most in ca termsses, the of treatment overall survival of choice (OS), [7]. anthracyclinesDue to the limited plus number ifosfamide of cases, is considered, most of the inclin mostical trials, cases, up the until treatment the last of decade, choice were [7]. Due organized to the limitedwithout numberconsidering of cases, the underlying most of the distinctive clinical trials, mole upcular until events, the last with decade, some werenotable organized exceptions, without such consideringas imatinib in the gastrointestinal underlying distinctive stromal tumors molecular [8]. Re events,cently, several with some clinical notable trials exceptions,tried to address such this as imatinibissue, focusing in gastrointestinal on a more stromalhistology- tumors and [ 8molecular-based]. Recently, several clinical clinical approach trials tried [9–11]. to address A recent this issue,multicenter focusing clinical on a moretrial histology-used a histology-driven and molecular-based neoadjuvant clinical approachchemotherapy [9–11]. regimen, A recent multicenterconcluding clinicalthat further trial studies used a histology-drivenare necessary to neoadjuvantanalyze the highly chemotherapy specific group regimen, of STSs concluding [10]. Sarcomas that further are studieswidely arebelieved necessary to develop to analyze as a the result highly of specificgenetic groupalterations of STSs in [mesenchymal10]. Sarcomas progenitor/stem are widely believed cells, to developbut the asprecise a result ofcellular genetic origin alterations of inmost mesenchymal of theseprogenitor tumors /stemremains cells, unknown. but the precise Based cellular on originmolecular/cytogenetic of most of these evaluation, tumors remains these unknown. tumors can Based be divided on molecular into two/cytogenetic main categories: evaluation, sarcomas these tumorswith specific can be dividedand distinct into twogenetic main alterations categories: sarcomasand sarcomas with specificdisplaying and distinctmultiple genetic and alterationsunspecific andcomplex sarcomas karyotypic displaying abnormalities multiple and(Figure unspecific 1). complex karyotypic abnormalities (Figure1). Figure 1. TypesTypes of molecular alterations in soft tissue sarcomas. The firstfirst group of tumors can bebe subcategorizedsubcategorized into three furtherfurther subgroups:subgroups: (1) (1) sarcomas, accounting for 15–20% of cases, carrying a recurrentrecurrent translocation such as FUS-CHOP in myxoid liposarcoma (MLPS) and SS18-SSX in synovial sarcoma (SS) (Figure 2 2A);A); (2)(2) sarcomassarcomas withwith mutationsmutations on specificspecific genes, such as c-KIT or platelet-derivedplatelet-derived growth factor receptors (PDGFR) mutation in gastrointestinal stromal tumor (GIST) (Figure 22B);B); (3)(3) sarcomassarcomas withwith distinctdistinct amplification,amplification, suchsuch asas the 12q14-15 amplicon in well-diwell-differentiatedfferentiated liposarcomaliposarcoma (WDLPS). DediDedifferentiatedfferentiated liposarcoma (LPS) (DDLPS) is a high-gradehigh-grade sarcoma with complexcomplex genomic alterations, but shares the same amplicon of WDLPS. The second group of sarcomas accounts for 50–60% of all tumors and harbors a highly complex profile profile represented by several genegene losses and gains of numerous chromosomes or chromosome regions and amplifications.amplifications. These tumors are mainly represented by leiomyosarcomaleiomyosarcoma (LMS), myxofibrosarcomamyxofibrosarcoma (MFS), (MFS), malignant malignant peripheral peripheral nerve sheathnerve tumorsheath (MPNST), tumor and(MPNST), unclassified and pleomorphicunclassified pleomorphic sarcoma (UPS). sarcoma (UPS). Cancers 2019, 11, 1169 3 of 22 Cancers 2019, 11, x 3 of 23 Figure 2.2. ((A)) Adapted from [12] [12] common translocations associated with subgroups of soft tissuetissue sarcomas. ( (BB)) Adapted Adapted from from [13] [13] distinctive molecular abnormalities in major soft tissue sarcomasarcoma subtypes. (C(C)) Phosphatase Phosphatase and and tensin tensin homolog homolog (PTEN) (PTEN) gene alterationsgene alterations (mutations (mutations and deep and deletions) deep ratedeletions) of the rate most of frequent the most sarcoma frequent subtypes sarcoma according subtypes toaccording the Cancer to the Genome Cancer Atlas Genome (TCGA) Atlas study (TCGA) [14] (adapted from www.cbioportal.org). study [14] (adapted from www.cbioportal.org). The refined understanding of the mechanisms that drive tumorigenesis in some STSs, in addition The refined understanding of the mechanisms that drive tumorigenesis in some STSs, in to enrichment of the diagnostic classification, has made the identification of potential targets possible addition to enrichment of the diagnostic classification, has made the identification
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