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Caccese M, Desideri I, Villani V, Simonelli M, Buglione M, Chiesa S, Franceschi E, Gaviani P, Stasi I, Caserta C, Brugnara S, Lolli I, Bennicelli E, Bini P, Cuccu AS, Scoccianti S, Padovan M, Gori S, Bonetti A, Giordano P, Pellerino A, Gregucci F, Riva N, Cinieri S, Internò V, Santoni M, Pernice G, Dealis C, Stievano L, Paiar F, Magni G, De Salvo GL, Zagonel V, Lombardi G. REGOMA-OSS: a large, Italian, multicenter, prospective, observational study evaluating the efficacy and safety of regorafenib in patients with recurrent glioblastoma. ESMO Open 2024; 9:102943. [PMID: 38492275 PMCID: PMC10959650 DOI: 10.1016/j.esmoop.2024.102943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND In the randomized phase II REGOMA trial, regorafenib showed promising activity in patients with recurrent glioblastoma. We conducted a large, multicenter, prospective, observational study to confirm the REGOMA data in a real-world setting. PATIENTS AND METHODS The major inclusion criteria were histologically confirmed diagnosis of glioblastoma according to the World Health Organization (WHO) 2016 classification and relapse after radiotherapy with concurrent/adjuvant temozolomide treatment, good performance status [Eastern Cooperative Oncology Group performance status (ECOG PS 0-1)] and good liver function. Regorafenib was administered at the standard dose of 160 mg/day for 3 weeks on/1 week off. Brain magnetic resonance imaging was carried out within 14 days before starting regorafenib and every 8-12 weeks. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective response rate, disease control rate (DCR), safety and health-related quality of life. The Response Assessment in Neuro-Oncology (RANO) criteria were used for response evaluation and Common Terminology Criteria for Adverse Events (CTCAE) version 5 for assessment of adverse events (AEs). RESULTS From September 2020 to October 2022, 190 patients with recurrent glioblastoma were enrolled from 30 cancer centers in Italy: their median age was 58.5 years [interquartile range (IQR) 53-67 years], 68% were male and 85 (44.7%) were in optimal clinical condition (ECOG PS 0). The number of patients taking steroids at baseline was 113 (60%); the second surgery was carried out in 39 (20.5%). O6-methylguanine-DNA methyltransferase (MGMT) was methylated in 80 patients (50.3%) and 147 (92.4%) of the patients analyzed had isocitrate dehydrogenase (IDH) wild type. The median follow-up period was 20 months (IQR 15.6-25.5 months). The median OS was 7.9 months ([95% confidence interval (CI) 6.5-9.2 months] and the median PFS was 2.6 months (95% CI 2.3-2.9 months). Radiological response was partial response and stable disease in 13 (7.3%) and 26 (14.6%) patients, respectively, with a DCR of 21.9%. The median number of regorafenib cycles per patient was 3 (IQR 2.0-4.0). Grade 3-4 drug-related adverse events were reported in 22.6% of patients. A dose reduction due to AEs was required in 36% of patients. No deaths were considered as treatment-related AEs. CONCLUSIONS This large, real-world observational study showed similar OS with better tolerability of regorafenib in patients with relapsed glioblastoma compared with the REGOMA study.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua.
| | - I Desideri
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence
| | - V Villani
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - M Simonelli
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan
| | - M Buglione
- Radiation Oncology Unit, ASST Spedali Civili of Brescia, Brescia
| | - S Chiesa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - E Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna
| | - P Gaviani
- Neuro-Oncological Unit, Istituto Neurologico Carlo Besta, Milan
| | - I Stasi
- Division of Medical Oncology, Civil Hospital, Livorno
| | - C Caserta
- Medical Oncology Department, Santa Maria Hospital, Terni
| | - S Brugnara
- Department of Medical Oncology, Santa Chiara Hospital, Trento
| | - I Lolli
- Oncology Unit of National Institute of Gastroenterology 'S. De Bellis', Research Hospital, Castellana Grotte, Bari
| | - E Bennicelli
- Ospedale Policlinico San Martino, Oncologia Medica 2, Genoa
| | - P Bini
- Neuroncology Unit, IRCCS 'C. Mondino Foundation', University of Pavia, Pavia
| | - A S Cuccu
- Medical Oncology, Sassari Hospital, Sassari
| | - S Scoccianti
- Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - S Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella
| | - A Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago
| | - P Giordano
- Oncology Unit, Ospedale del Mare, Naples
| | - A Pellerino
- Division of Neuro-Oncology, Department of Neuroscience, City of Health and Science and University of Turin, Turin
| | - F Gregucci
- Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti
| | - N Riva
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola
| | - S Cinieri
- Oncology Unit, Ospedale Perrino, Brindisi
| | - V Internò
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari
| | - M Santoni
- Oncology Unit, Macerata Hospital, Macerata
| | - G Pernice
- Oncology Unit, Fondazione Istituto G. Giglio, Cefalù
| | - C Dealis
- Health Directorate, Azienda Sanitaria dell'Alto Adige, Bolzano
| | - L Stievano
- Department of Oncology, Ospedale Civile, Rovigo
| | - F Paiar
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa
| | - G Magni
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G L De Salvo
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
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Korbecki J, Bosiacki M, Gutowska I, Chlubek D, Baranowska-Bosiacka I. Biosynthesis and Significance of Fatty Acids, Glycerophospholipids, and Triacylglycerol in the Processes of Glioblastoma Tumorigenesis. Cancers (Basel) 2023; 15:cancers15072183. [PMID: 37046844 PMCID: PMC10093493 DOI: 10.3390/cancers15072183] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
One area of glioblastoma research is the metabolism of tumor cells and detecting differences between tumor and healthy brain tissue metabolism. Here, we review differences in fatty acid metabolism, with a particular focus on the biosynthesis of saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) by fatty acid synthase (FASN), elongases, and desaturases. We also describe the significance of individual fatty acids in glioblastoma tumorigenesis, as well as the importance of glycerophospholipid and triacylglycerol synthesis in this process. Specifically, we show the significance and function of various isoforms of glycerol-3-phosphate acyltransferases (GPAT), 1-acylglycerol-3-phosphate O-acyltransferases (AGPAT), lipins, as well as enzymes involved in the synthesis of phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylserine (PS), phosphatidylinositol (PI), and cardiolipin (CL). This review also highlights the involvement of diacylglycerol O-acyltransferase (DGAT) in triacylglycerol biosynthesis. Due to significant gaps in knowledge, the GEPIA database was utilized to demonstrate the significance of individual enzymes in glioblastoma tumorigenesis. Finally, we also describe the significance of lipid droplets in glioblastoma and the impact of fatty acid synthesis, particularly docosahexaenoic acid (DHA), on cell membrane fluidity and signal transduction from the epidermal growth factor receptor (EGFR).
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Affiliation(s)
- Jan Korbecki
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
- Department of Anatomy and Histology, Collegium Medicum, University of Zielona Góra, Zyty 28 Str., 65-046 Zielona Góra, Poland
| | - Mateusz Bosiacki
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
- Department of Functional Diagnostics and Physical Medicine, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Żołnierska 54 Str., 71-210 Szczecin, Poland
| | - Izabela Gutowska
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Irena Baranowska-Bosiacka
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
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Bevacizumab in real-life patients with recurrent glioblastoma: benefit or futility? J Neurol 2023; 270:2702-2714. [PMID: 36813928 DOI: 10.1007/s00415-023-11600-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Angiogenesis plays a key role in glioblastoma, but most anti-angiogenic therapy trials have failed to change the poor outcome of this disease. Despite this, and because bevacizumab is known to alleviate symptoms, it is used in daily practice. We aimed to assess the real-life benefit in terms of overall survival, time to treatment failure, objective response, and clinical benefit in patients with recurrent glioblastoma treated with bevacizumab. METHODS This was a monocentric, retrospective study including patients treated between 2006 and 2016 in our institution. RESULTS 202 patients were included. The median duration of bevacizumab treatment was 6 months. Median time to treatment failure was 6.8 months (95%CI 5.3-8.2) and median overall survival was 23.7 months (95%CI 20.6-26.8). Fifty percent of patients had a radiological response at first MRI evaluation, and 56% experienced symptom amelioration. Grade 1/2 hypertension (n = 34, 17%) and grade one proteinuria (n = 20, 10%) were the most common side effects. CONCLUSIONS This study reports a clinical benefit and an acceptable toxicity profile in patients with recurrent glioblastoma treated with bevacizumab. As the panel of therapies is still very limited for these tumors, this work supports the use of bevacizumab as a therapeutic option.
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Chen TC, da Fonseca CO, Levin D, Schönthal AH. The Monoterpenoid Perillyl Alcohol: Anticancer Agent and Medium to Overcome Biological Barriers. Pharmaceutics 2021; 13:2167. [PMID: 34959448 PMCID: PMC8709132 DOI: 10.3390/pharmaceutics13122167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 12/20/2022] Open
Abstract
Perillyl alcohol (POH) is a naturally occurring monoterpenoid related to limonene that is present in the essential oils of various plants. It has diverse applications and can be found in household items, including foods, cosmetics, and cleaning supplies. Over the past three decades, it has also been investigated for its potential anticancer activity. Clinical trials with an oral POH formulation administered to cancer patients failed to realize therapeutic expectations, although an intra-nasal POH formulation yielded encouraging results in malignant glioma patients. Based on its amphipathic nature, POH revealed the ability to overcome biological barriers, primarily the blood-brain barrier (BBB), but also the cytoplasmic membrane and the skin, which appear to be characteristics that critically contribute to POH's value for drug development and delivery. In this review, we present the physicochemical properties of POH that underlie its ability to overcome the obstacles placed by different types of biological barriers and consequently shape its multifaceted promise for cancer therapy and applications in drug development. We summarized and appraised the great variety of preclinical and clinical studies that investigated the use of POH for intranasal delivery and nose-to-brain drug transport, its intra-arterial delivery for BBB opening, and its permeation-enhancing function in hybrid molecules, where POH is combined with or conjugated to other therapeutic pharmacologic agents, yielding new chemical entities with novel mechanisms of action and applications.
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Affiliation(s)
- Thomas C. Chen
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Clovis O. da Fonseca
- Department of Neurological Surgery, Federal Hospital of Ipanema, Rio de Janeiro 22411-020, Brazil;
| | | | - Axel H. Schönthal
- Department of Molecular Microbiology & Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
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Regorafenib in Recurrent Glioblastoma Patients: A Large and Monocentric Real-Life Study. Cancers (Basel) 2021; 13:cancers13184731. [PMID: 34572958 PMCID: PMC8471957 DOI: 10.3390/cancers13184731] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/18/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary In the last years, treatments for recurrent glioblastoma patients have shown limited efficacy in terms of OS. In the REGOMA trial, regorafenib demonstrated encouraging results in this setting of population. Indeed, in this randomized, phase 2 study the OS was significantly improved in the regorafenib arm compared with the standard lomustine treatment. Noteworthy, based on the REGOMA trial results, regorafenib was included in the NCCN 2021 guidelines as a preferred regimen for recurrent glioblastoma patients. To date, no studies have analyzed the impact of regorafenib in patients treated outside of clinical trials. We performed a large study in order to evaluate the safety and efficacy of regorafenib in the real-life population of recurrent GBM patients. Our results were superimposable to the ones reported in the REGOMA trial and regorafenib should be considered as an interesting drug in a population with a very poor prognosis and an unmet clinical need. Abstract Despite multimodal treatment with surgery and radiochemotherapy, the prognosis of glioblastoma remains poor, and practically all glioblastomas relapse. To date, no standard treatment exists for recurrent glioblastoma patients and traditional therapies have showed limited efficacy. Regorafenib is an oral multi-targeted tyrosine kinase inhibitor showing encouraging benefits in recurrent GBM patients enrolled in the REGOMA trial. We performed a large study to investigate clinical outcomes and the safety of regorafenib in a real-life population of recurrent glioblastoma patients. Patients receiving regorafenib outside clinical trials at the Veneto Institute of Oncology were retrospectively reviewed. The major inclusion criteria were: histologically confirmed diagnosis of glioblastoma, prior first line therapy according to “Stupp protocol”, Eastern Cooperative Oncology Group (ECOG) performance status score ≤1. According to the original schedule, patients received regorafenib 160 mg once daily for the first 3 weeks of each 4-week cycle. The primary endpoints of the study were overall survival and safety. A total of 54 consecutive patients were enrolled. The median age was 56, MGMT methylated status was found in 28 out of 53 available patients (52.8%), IDH mutation in 5 (9.3%) and 22 patients were receiving steroids at baseline. The median overall survival was 10.2 months (95% CI, 6.4–13.9), the OS-12 was 43%. Age, MGMT methylation status and steroid use at baseline were not statistically significant on a multivariate analysis for OS. Patients reporting a disease control as best response to regorafenib demonstrated a significant longer survival (24.8 months vs. 6.2 months for patients with progressive disease, p = 0.0001). Grade 3 drug-related adverse events occurred in 10 patients (18%); 1 patient (2%) reported a grade 4 adverse event (rash maculo-papular). No death was considered to be drug-related. This study reported the first large “real-life” experience of regorafenib in recurrent glioblastoma. Overall, our results are close to the ones reported in the previous phase 2 study, despite the fact that we had a longer survival. We showed the encouraging activity and tolerability of this treatment in recurrent glioblastoma patients when used as a second-line treatment.
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Annavarapu S, Gogate A, Pham T, Davies K, Singh P, Robert N. Treatment patterns and outcomes for patients with newly diagnosed glioblastoma multiforme: a retrospective cohort study. CNS Oncol 2021; 10:CNS76. [PMID: 34378977 PMCID: PMC8461754 DOI: 10.2217/cns-2021-0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Aim: Investigate real-world outcomes and healthcare utilization of patients with glioblastoma multiforme (GBM) related to O6-methylguanine DNA methyltransferase (MGMT) promoter testing and methylation. Patients & methods: US Oncology Network data were analyzed for patients receiving first-line (1L) treatment for GBM. Results: Most patients received 1L radiation with temozolomide. Unadjusted median overall survival (OS) was higher in tested versus untested (median:18.1 vs 11.8 months) and in methylated versus unmethylated (median: 25.5 vs 12.4 months). Untested status, unmethylated MGMT and older age were associated with reduced OS and longer 1L treatment with increased OS. Similar findings were observed for progression-free survival. Utilization was similar between cohorts. Conclusion: In community oncology practices, MGMT methylation and testing were predictive of better survival in GBM. We studied the characteristics and survival of patients with newly diagnosed glioblastoma multiforme (GBM) in community-based oncology practices. These patients had received temozolomide and radiotherapy with surgery, which is the standard of care for GBM. We were interested in how patient survival was related to methylation of the O6-methylguanine DNA methyltransferase (MGMT) promoter. The study showed that patients with methylated versus unmethylated MGMT GBM survived longer. However, patients who were tested for methylation, whether MGMT was methylated or not, also survived longer. This may be because patients who get tested also get better care in general.
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Affiliation(s)
| | | | - Trang Pham
- McKesson Specialty Health, The Woodlands, TX 77380, USA
| | - Kalatu Davies
- McKesson Specialty Health, The Woodlands, TX 77380, USA
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Detti B, Scoccianti S, Teriaca MA, Maragna V, Lorenzetti V, Lucidi S, Bellini C, Greto D, Desideri I, Livi L. Bevacizumab in recurrent high-grade glioma: a single institution retrospective analysis on 92 patients. Radiol Med 2021; 126:1249-1254. [PMID: 34081269 PMCID: PMC8370943 DOI: 10.1007/s11547-021-01381-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND High-grade gliomas are among the most aggressive central nervous system primary tumors, with a high risk of recurrence and a poor prognosis. Re-operation, re-irradiation, chemotherapy are options in this setting. No-best therapy has been established. Bevacizumab was approved on the basis of two Phase 2 trials that evaluated its efficacy in patients with recurrent glioblastoma. MATERIALS AND METHODS We have retrospectively review data of patients with high-grade glioma treated at our institution that undergone radiological or histological progression after at least one systemic treatment for recurrent disease. Bevacizumab was administered alone or in combination with chemotherapy until disease progression or unacceptable toxicity. Bevacizumab regimen was analyzed to assess PFS and OS. Histological, molecular and clinical features of the entire cohort were collected. RESULTS We reviewed data from 92 patients, treated from April 2009 to November 2019, with histologically confirmed diagnosis of high-grade gliomas and recurrent disease. A PFS of 55.2%, 22.9% and 9.6% was observed at 6, 12 and 24 months, respectively. Performance status, age at diagnosis (< 65 or > 65 ys.) and use of corticosteroids during bevacizumab therapy were strongly associated with PFS. The OS was 74.9% at 6 months, 31.7% at 12 months, 10.1% at 24 months. In our cohort, 51.1% were long-term responders (PFS > 6 months). Globally, bevacizumab treatment was well tolerated. CONCLUSION Our analysis confirms the efficacy of bevacizumab in recurrent high-grade glioma patients with an acceptable toxicity profile, in keeping with its known safety in the literature.
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Affiliation(s)
- Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Maria Ausilia Teriaca
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy.
| | - Virginia Maragna
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Victoria Lorenzetti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Sara Lucidi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Chiara Bellini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
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Carpenter AB, Carpenter AM, Aiken R, Hanft S. Oncolytic virus in gliomas: a review of human clinical investigations. Ann Oncol 2021; 32:968-982. [PMID: 33771666 DOI: 10.1016/j.annonc.2021.03.197] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022] Open
Abstract
Gliomas remain one of the more frustrating targets for oncologic therapy. Glioma resistance to conventional therapeutics is a product of their immune-privileged milieu behind the blood-brain barrier, in addition to their suppressive effect on the immune response itself. Taking the lead from the growing success of immunotherapy for systemic cancers, such as lung cancer and melanoma, immunotherapeutics has emerged as a major player in the potential treatment of gliomas, with oncolytic viruses in particular showing significant promise as evidenced by the recent Breakthrough and Fast Tract Designations for PVSRIPO and DNX2401. This review serves as a useful and updated compendium of the completed human clinical investigations for several oncolytic viruses in the treatment of gliomas.
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Affiliation(s)
- A B Carpenter
- Georgetown University School of Medicine, Washington, USA.
| | - A M Carpenter
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, USA
| | - R Aiken
- Gerald J. Glasser Brain Tumor Center, Atlantic Healthcare, Summit, USA
| | - S Hanft
- Department of Neurological Surgery, Westchester Medical Center, New York Medical College, Valhalla, USA
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Abstract
PURPOSE OF REVIEW This review seeks to inform oncology clinicians and researchers about the development of novel immunotherapies for the treatment of glioblastoma. An enumeration of ongoing and recently completed clinical trials will be discussed with special attention given to current technologies implemented to overcome central nervous system-specific challenges including barriers to the peripheral immune system, impaired antigen presentation, and T cell dysfunction. RECENT FINDINGS The success of immunotherapy in other solid cancers has served as a catalyst to explore its application in glioblastoma, which has limited response to other treatments. Recent developments include multi-antigen vaccines that seek to overcome the heterogeneity of glioblastoma, as well as immune checkpoint inhibitors, which could amplify the adaptive immune response and may have promise in combinatorial approaches. Additionally, oncolytic and retroviruses have opened the door to a plethora of combinatorial approaches aiming to leverage their immunogenicity and/or ability to carry therapeutic transgenes. Treatment of glioblastoma remains a serious challenge both with regard to immune-based as well as other therapeutic strategies. The disease has proven to be highly resistant to treatment due to a combination of tumor heterogeneity, adaptive expansion of resistant cellular subclones, evasion of immune surveillance, and manipulation of various signaling pathways involved in tumor progression and immune response. Immunotherapeutics that are efficacious in other cancer types have unfortunately not enjoyed the same success in glioblastoma, illustrating the challenging and complex nature of this disease and demonstrating the need for development of multimodal treatment regimens utilizing the synergistic qualities of immune-mediated therapies.
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Affiliation(s)
- Abigail L. Mende
- Department of Neurological Surgery, University of California, Diller Family Cancer Research Building HD 472, Box 520, 1450 3rd Street San Francisco, Helen, CA 94158 USA
| | - Jessica D. Schulte
- Department of Neurological Surgery, University of California, Diller Family Cancer Research Building HD 472, Box 520, 1450 3rd Street San Francisco, Helen, CA 94158 USA
- Department of Neurology, University of California, San Francisco, CA USA
| | - Hideho Okada
- Department of Neurological Surgery, University of California, Diller Family Cancer Research Building HD 472, Box 520, 1450 3rd Street San Francisco, Helen, CA 94158 USA
- The Parker Institute for Cancer Immunotherapy, Diller Family Cancer Research Building HD 472, Box 520, 1450 3rd Street San Francisco, Helen, CA 94158 USA
- Cancer Immunotherapy Program, University of California, San Francisco, CA USA
| | - Jennifer L. Clarke
- Department of Neurological Surgery, University of California, Diller Family Cancer Research Building HD 472, Box 520, 1450 3rd Street San Francisco, Helen, CA 94158 USA
- Department of Neurology, University of California, San Francisco, CA USA
- Department of Clinical Neurology and Neurological Surgery, University of California San Francisco, Box 0372, 400 Parnassus Avenue, A895F, San Francisco, CA 94143-0372 USA
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Abstract
Twenty-five years ago, the cytotoxic drug irinotecan (IRT) was first approved in Japan for the treatment of cancer. For more than two decades, the IRT prodrug has largely contributed to the treatment of solid tumors worldwide. Nowadays, this camptothecin derivative targeting topoisomerase 1 remains largely used in combination regimen, like FOLFIRI and FOLFIRINOX, to treat metastatic or advanced solid tumors, such as colon, gastric and pancreatic cancers and others. This review highlights recent discoveries in the field of IRT and its derivatives, including analogues of the active metabolite SN38 (such as FL118), the recently approved liposomal form Nal-IRI and SN38-based immuno-conjugates currently in development (such as sacituzumab govitecan). New information about the IRT mechanism of action are presented, including the discovery of a new protein target, the single-stranded DNA-binding protein FUBP1. Significant progress has been made also to better understand and manage the main limiting toxicities of IRT, chiefly neutropenia and diarrhea. The role of drug-induced inflammation and dysbiosis is underlined and strategies to limit the intestinal toxicity of IRT are discussed (use of β-glucuronidase inhibitors, plant extracts, probiotics). The detailed knowledge of the metabolism of IRT has enabled the identification of potential biomarkers to guide patient selection and to limit drug-induced toxicities, but no robust IRT-specific therapeutic biomarker has been approved yet. IRT is a versatile chemotherapeutic agent which combines well with a variety of anticancer drugs. It offers a large range of drug combinations with cytotoxic agents, targeted products and immuno-active biotherapeutics, to treat a variety of advanced solid carcinoma, sarcoma and cancers with progressive central nervous system diseases. A quarter of century after its first launch, IRT remains an essential anticancer drug, largely prescribed, useful to many patients and scientifically inspiring.
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