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Ohmura K, Tomita H, Hara A. Peritumoral Edema in Gliomas: A Review of Mechanisms and Management. Biomedicines 2023; 11:2731. [PMID: 37893105 PMCID: PMC10604286 DOI: 10.3390/biomedicines11102731] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Treating malignant glioma is challenging owing to its highly invasive potential in healthy brain tissue and the formation of intense surrounding edema. Peritumoral edema in gliomas can lead to severe symptoms including neurological dysfunction and brain herniation. For the past 50 years, the standard treatment for peritumoral edema has been steroid therapy. However, the discovery of cerebral lymphatic vessels a decade ago prompted a re-evaluation of the mechanisms involved in brain fluid regulation and the formation of cerebral edema. This review aimed to describe the clinical features of peritumoral edema in gliomas. The mechanisms currently known to cause glioma-related edema are summarized, the limitations in current cerebral edema therapies are discussed, and the prospects for future cerebral edema therapies are presented. Further research concerning edema surrounding gliomas is needed to enhance patient prognosis and improve treatment efficacy.
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Affiliation(s)
- Kazufumi Ohmura
- Department of Tumor Pathology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan; (K.O.)
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan; (K.O.)
- Center for One Medicine Innovative Translational Research, Institute for Advanced Study, Gifu University, Gifu 501-1193, Japan
| | - Akira Hara
- Department of Tumor Pathology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan; (K.O.)
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2
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Cocola C, Magnaghi V, Abeni E, Pelucchi P, Martino V, Vilardo L, Piscitelli E, Consiglio A, Grillo G, Mosca E, Gualtierotti R, Mazzaccaro D, La Sala G, Di Pietro C, Palizban M, Liuni S, DePedro G, Morara S, Nano G, Kehler J, Greve B, Noghero A, Marazziti D, Bussolino F, Bellipanni G, D'Agnano I, Götte M, Zucchi I, Reinbold R. Transmembrane Protein TMEM230, a Target of Glioblastoma Therapy. Front Cell Neurosci 2021; 15:703431. [PMID: 34867197 PMCID: PMC8636015 DOI: 10.3389/fncel.2021.703431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Glioblastomas (GBM) are the most aggressive tumors originating in the brain. Histopathologic features include circuitous, disorganized, and highly permeable blood vessels with intermittent blood flow. These features contribute to the inability to direct therapeutic agents to tumor cells. Known targets for anti-angiogenic therapies provide minimal or no effect in overall survival of 12–15 months following diagnosis. Identification of novel targets therefore remains an important goal for effective treatment of highly vascularized tumors such as GBM. We previously demonstrated in zebrafish that a balanced level of expression of the transmembrane protein TMEM230/C20ORF30 was required to maintain normal blood vessel structural integrity and promote proper vessel network formation. To investigate whether TMEM230 has a role in the pathogenesis of GBM, we analyzed its prognostic value in patient tumor gene expression datasets and performed cell functional analysis. TMEM230 was found necessary for growth of U87-MG cells, a model of human GBM. Downregulation of TMEM230 resulted in loss of U87 migration, substratum adhesion, and re-passaging capacity. Conditioned media from U87 expressing endogenous TMEM230 induced sprouting and tubule-like structure formation of HUVECs. Moreover, TMEM230 promoted vascular mimicry-like behavior of U87 cells. Gene expression analysis of 702 patients identified that TMEM230 expression levels distinguished high from low grade gliomas. Transcriptomic analysis of patients with gliomas revealed molecular pathways consistent with properties observed in U87 cell assays. Within low grade gliomas, elevated TMEM230 expression levels correlated with reduced overall survival independent from tumor subtype. Highest level of TMEM230 correlated with glioblastoma and ATP-dependent microtubule kinesin motor activity, providing a direction for future therapeutic intervention. Our studies support that TMEM230 has both glial tumor and endothelial cell intracellular and extracellular functions. Elevated levels of TMEM230 promote glial tumor cell migration, extracellular scaffold remodeling, and hypervascularization and abnormal formation of blood vessels. Downregulation of TMEM230 expression may inhibit both low grade glioma and glioblastoma tumor progression and promote normalization of abnormally formed blood vessels. TMEM230 therefore is both a promising anticancer and antiangiogenic therapeutic target for inhibiting GBM tumor cells and tumor-driven angiogenesis.
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Affiliation(s)
- Cinzia Cocola
- Institute for Biomedical Technologies, National Research Council, Milan, Italy.,Consorzio Italbiotec, Milan, Italy
| | - Valerio Magnaghi
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Edoardo Abeni
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Paride Pelucchi
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Valentina Martino
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Laura Vilardo
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Eleonora Piscitelli
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Arianna Consiglio
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Giorgio Grillo
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Ettore Mosca
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Roberta Gualtierotti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gina La Sala
- Institute of Biochemistry and Cell Biology, Italian National Research Council, Rome, Italy
| | - Chiara Di Pietro
- Institute of Biochemistry and Cell Biology, Italian National Research Council, Rome, Italy
| | - Mira Palizban
- Department of Gynecology and Obstetrics, University Hospital of Münster, Münster, Germany
| | - Sabino Liuni
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Giuseppina DePedro
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - James Kehler
- National Institutes of Health, NIDDK, Laboratory of Cell and Molecular Biology, Bethesda, MD, United States
| | - Burkhard Greve
- Department of Radiation Therapy and Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Alessio Noghero
- Lovelace Biomedical Research Institute, Albuquerque, NM, United States.,Department of Oncology, University of Turin, Orbassano, Italy
| | - Daniela Marazziti
- Institute of Biochemistry and Cell Biology, Italian National Research Council, Rome, Italy
| | - Federico Bussolino
- Department of Oncology, University of Turin, Orbassano, Italy.,Laboratory of Vascular Oncology Candiolo Cancer Institute - IRCCS, Candiolo, Italy
| | - Gianfranco Bellipanni
- Department of Biology, Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, PA, United States
| | - Igea D'Agnano
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Martin Götte
- Department of Gynecology and Obstetrics, University Hospital of Münster, Münster, Germany
| | - Ileana Zucchi
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Rolland Reinbold
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
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3
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Shimazu K, Inoue M, Sugiyama S, Fukuda K, Yoshida T, Taguchi D, Uehara Y, Kuriyama S, Tanaka M, Miura M, Nanjyo H, Iwabuchi Y, Shibata H. Curcumin analog, GO-Y078, overcomes resistance to tumor angiogenesis inhibitors. Cancer Sci 2018; 109:3285-3293. [PMID: 30024080 PMCID: PMC6172066 DOI: 10.1111/cas.13741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022] Open
Abstract
Tumor angiogenesis inhibition is one of the most potent strategies in cancer chemotherapy. From past clinical studies, inhibition of the vascular endothelial growth factor pathway successfully treats malignant tumors. However, vascular endothelial growth factor inhibitors alone cannot cure tumors. Moreover, resistance to small molecule inhibitors has also been reported. Herein, we show the antiangiogenic potential of a newly synthesized curcumin analog, GO-Y078, that possibly functions through inhibition of actin stress fiber formation, resulting in mobility inhibition; this mechanism is different from that of vascular endothelial growth factor inhibition. In addition, we examined the detailed mechanism of action of the antiangiogenesis potential of GO-Y078 using human umbilical venous epithelial cells resistant to angiogenesis inhibitors (HUVEC-R). GO-Y078 inhibited the growth and mobility of HUVEC-R at 0.75 μmol/L concentration. Expression analyses by microarray and RT-PCR showed that expressions of genes including that of fibronectin 1 were significantly suppressed. Among these genes, fibronectin 1 is abundantly expressed and, therefore, seems to be a good target for GO-Y078. In a knockdown experiment using Si-oligo of fibronectin 1 (FN1), FN1 expression was decreased to half of that in mock experiments as well as GO-Y078. Knockdown of FN1 resulted in the suppression of HUVEC-R growth at 24 hours after treatment. Fibronectin is a key molecule contributing to angiogenesis that could be inhibited by GO-Y078. Thus, resistance to vascular endothelial growth factor inhibition can be overcome using GO-Y078.
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Affiliation(s)
- Kazuhiro Shimazu
- Department of Clinical OncologyGraduate School of MedicineAkita UniversityAkitaJapan
| | - Masahiro Inoue
- Department of Clinical OncologyGraduate School of MedicineAkita UniversityAkitaJapan
| | | | - Koji Fukuda
- Department of Clinical OncologyGraduate School of MedicineAkita UniversityAkitaJapan
| | - Taichi Yoshida
- Department of Clinical OncologyGraduate School of MedicineAkita UniversityAkitaJapan
| | - Daiki Taguchi
- Department of Clinical OncologyGraduate School of MedicineAkita UniversityAkitaJapan
| | | | - Sei Kuriyama
- Department of Molecular Medicine and BiochemistryAkita UniversityAkitaJapan
| | - Masamitsu Tanaka
- Department of Molecular Medicine and BiochemistryAkita UniversityAkitaJapan
| | - Masatomo Miura
- Department of PharmacyAkita University HospitalAkitaJapan
| | - Hiroshi Nanjyo
- Department of Clinical PathologyAkita University HospitalAkitaJapan
| | - Yoshiharu Iwabuchi
- Department of Organic ChemistryGraduate School of PharmaceuticsTohoku UniversitySendaiJapan
| | - Hiroyuki Shibata
- Department of Clinical OncologyGraduate School of MedicineAkita UniversityAkitaJapan
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4
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Bohn JP, Pall G, Stockhammer G, Steurer M. Targeted Therapies for the Treatment of Brain Metastases in Solid Tumors. Target Oncol 2017; 11:263-75. [PMID: 26822319 DOI: 10.1007/s11523-015-0414-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Brain metastases are a major cause of morbidity and mortality in cancer patients. While the mainstay treatment comprises surgery and radiation therapy, the role of systemic agents remains controversial. In general, it has been presumed that poor blood-brain barrier (BBB) penetration and inherently more resistant metastatic brain disease preclude a favorable systemic treatment approach. However, a better understanding of tumor biology and the subsequent development of targeted drugs have reawakened interest in systemic therapy. Despite still limited brain distribution, a variety of targeted drugs have demonstrated activity in brain metastases in early clinical trials. Nevertheless, disease progression commonly occurs, and it remains to be elucidated whether limited CNS drug distribution or the acquisition of resistant metastatic clones must be held responsible for this prognosis. Moreover, micrometastatic brain disease beyond an intact BBB-and ultimately prevention of brain metastasis formation-may generally remain inaccessible for first-generation targeted agents with poor CNS penetration. To overcome limited brain distribution and possibly emerging acquired resistance, highly potent next-generation targeted drugs with enhanced CNS distribution have been developed. In view of this emerging but yet undefined role of targeted therapies in the treatment of brain metastases from solid tumors, this review aims to summarize the current knowledge from clinical trials and discusses clinically relevant obstacles to overcome.
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Affiliation(s)
- Jan-Paul Bohn
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
| | - Georg Pall
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Guenther Stockhammer
- Department of Neurology and Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Steurer
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
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Craveiro RB, Ehrhardt M, Velz J, Olschewski M, Goetz B, Pietsch T, Dilloo D. The anti-neoplastic activity of Vandetanib against high-risk medulloblastoma variants is profoundly enhanced by additional PI3K inhibition. Oncotarget 2017; 8:46915-46927. [PMID: 28159923 PMCID: PMC5564532 DOI: 10.18632/oncotarget.14911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/26/2016] [Indexed: 12/26/2022] Open
Abstract
Medulloblastoma is comprised of at least four molecular subgroups with distinct clinical outcome (WHO classification 2016). SHH-TP53-mutated as well as MYC-amplified Non-WNT/Non-SHH medulloblastoma show the worst prognosis.Here we present evidence that single application of the multi-kinase inhibitor Vandetanib displays anti-neoplastic efficacy against cell lines derived from high-risk SHH-TP53-mutated and MYC-amplified Non-WNT/Non-SHH medulloblastoma. The narrow target spectrum of Vandetanib along with a favourable toxicity profile renders this drug ideal for multimodal treatment approaches. In this context our investigation documents that Vandetanib in combination with the clinically available PI3K inhibitor GDC-0941 leads to enhanced cytotoxicity against MYC-amplified and SHH-TP53-mutated medulloblastoma. In line with these findings we show for MYC-amplified medulloblastoma a profound reduction in activity of the oncogenes STAT3 and AKT. Furthermore, we document that Vandetanib and the standard chemotherapeutic Etoposide display additive anti-neoplastic efficacy in the investigated medulloblastoma cell lines that could be further enhanced by PI3K inhibition. Of note, the combination of Vandetanib, GDC-0941 and Etoposide results in MYC-amplified and SHH-TP53-mutated cell lines in complete loss of cell viability. Our findings therefore provide a rational to further evaluate Vandetanib in combination with PI3K inhibitors as well as standard chemotherapeutics in vivo for the treatment of most aggressive medulloblastoma variants.
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Affiliation(s)
- Rogerio B Craveiro
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Michael Ehrhardt
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Julia Velz
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Martin Olschewski
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Barbara Goetz
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn, D-53105 Bonn, Germany
| | - Dagmar Dilloo
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University of Bonn Medical Center, D-53113 Bonn, Germany
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6
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Li Y, Hou M, Lu G, Ciccone N, Wang X, Zhang H. The Prognosis of Anti-Angiogenesis Treatments Combined with Standard Therapy for Newly Diagnosed Glioblastoma: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2016; 11:e0168264. [PMID: 28005980 PMCID: PMC5179058 DOI: 10.1371/journal.pone.0168264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 11/28/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Although bevacizumab (BV) has been approved as second-line therapy for recurrent glioblastoma (GB), the efficacy and safety of BV for patients with newly diagnosed GB remain unclear. METHODOLOGY/PRINCIPAL FINDINGS We systematically searched electronic databases (PubMed, EMBASE, OVID, etc.) to identify related studies published from January 1966 and August 2016. Eight randomized controlled trials including a total of 2,185 patients with GB were included. We found that the median progression-free survival (PFS) was higher in the BV group than in the standard therapy (ST) group (pooled hazard ratio, 0.73; 95%CI, 0.62-0.86; P = 0.0001). Compared with ST, BV improved the PFS rate at 6 months (OR 3.33, 95% CI 2.73-4.06, p<0.00001) and 12 months (OR 2.10, 95% CI 1.74-2.54, p<0.00001). There were no significant differences in median overall survival between the BV and ST groups (OR, 1.01; 95%CI, 0.83-1.23; P = 0.95). The BV group had higher survival rates at 6 months (OR, 1.41; 95% CI, 1.09-1.84; P = 0.01) and 12 months (OR, 1.23; 95% CI, 1.02-1.48; P = 0.03), but a low survival rate at the 36-month follow-up (OR, 0.57; 95% CI, 0.32-0.98; P = 0.04). For the incidence of adverse events, three adverse outcomes were found to be significantly different between BV and ST groups, including hypertension (8.37% vs. 1.62%, p<0.000001), proteinuria (7.65% vs. 0%, p<0.001), and fatigue (14.54% vs. 9.01%, p = 0.05). CONCLUSIONS/SIGNIFICANCE Our study indicates that combination of BV with ST for newly diagnosed GB did not improve the median overall survival but result in longer median PFS, maintaining the quality of life and functional status. However, the long-term use of BV is associated with a higher incidence of adverse events and mortality. STUDY REGISTRATION This research was registered at PROSPERO. (Registration Number: CRD42016038247).
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Affiliation(s)
- Yuping Li
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
- Neurosurgical Research, Department of Neurosurgery, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Mengzhuo Hou
- Neurosurgical Research, Department of Neurosurgery, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Guangyu Lu
- Department of Preventive Medicine, Medical College of Yangzhou University, Yangzhou University, China
- Institute of Public Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| | - Natalia Ciccone
- Neurosurgical Research, Department of Neurosurgery, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Xingdong Wang
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
- * E-mail:
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Lyu Y, Liu S, You H, Hou B, Wang Y, Ma W, Feng F. Evaluation of recurrent high-grade gliomas treated with bevacizumab: A preliminary report of 3D pseudocontinuous artery spin labeling. J Magn Reson Imaging 2016; 46:565-573. [PMID: 27902863 DOI: 10.1002/jmri.25558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate the role of cerebral blood flow (CBF) derived from a 3D fast spin echo (FSE) pseudocontinuous artery spin labeling (pcASL) sequence in evaluating the survival rate of recurrent high-grade gliomas (rHGGs) that were treated with bevacizumab (BEV). MATERIALS AND METHODS Sixteen patients with rHGGs who underwent 3T 3D FSE pcASL imaging 1-2 days before (baseline or pre-BEV) and within 1 month after BEV treatment initiation (post-BEV) were included in the study. Average (aCBF) and maximum (mCBF) cerebral blood flow of the enhancing tumor, their respective normalized values to contralateral normal-appearing white matter (rCBF_wm and mCBF_wm) and cerebellum (rCBF_cb and mCBF_cb), and the related changes between baseline and post-BEV were evaluated. Receiver operating characteristic (ROC) curve analysis was utilized to define the optimal cutoff perfusion values for overall survival (OS) and progression-free survival (PFS) stratification. Kaplan-Meier analysis with log-rank test was applied to assess and compare PFS and OS rates. RESULTS All the CBF measurements pre-BEV and post-BEV treatment were significantly different except mCBF. The CBF measurements (aCBF, rCBF_wm, rCBF_cb, mCBF_wm and mCBF_cb) pre-BEV all decreased post-BEV treatment. Cutoffs of aCBF (43.72 ml/100g/min) pre-BEV for OS, rCBF_cb (1.09) pre-BEV for PFS and OS, and ΔaCBF (-0.37) for PFS were found to be statistically significant in survival stratification (404 days vs. 140 days, P = 0.026; 251 days vs. 112 days, P = 0.044; 404 days vs. 194 days, P = 0.046; 267 days vs. 116 days, P = 0.048, respectively). CONCLUSION Three dimensional FSE pcASL can detect the decrease of perfusion in rHGGs treated with BEV and is a potential promising technique in stratifying survival rate of rHGGs under BEV treatment. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:565-573.
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Affiliation(s)
- Yuelei Lyu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Shuai Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Yu Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Wenbin Ma
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
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Metro G, Chiari R, Ricciuti B, Rebonato A, Lupattelli M, Gori S, Bennati C, Castrioto C, Floridi P, Minotti V, Chiarini P, Crinò L. Pharmacotherapeutic options for treating brain metastases in non-small cell lung cancer. Expert Opin Pharmacother 2015; 16:2601-13. [PMID: 26439599 DOI: 10.1517/14656566.2015.1094056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Central nervous system (CNS) metastases represent an important cause of morbidity and mortality in non-small cell lung cancer (NSCLC) patients. Local approaches of neurosurgery (usually for single brain lesions), whole brain radiotherapy, and stereotactic radiosurgery are often withheld for the treatment of NSCLC-derived brain metastases (BMs). However, systemic treatment is consistently emerging as an option for patients with asymptomatic BMs, which could allow for delaying cranial radiotherapy at symptomatic/radiological progression. AREAS COVERED Chemotherapy, monoclonal antibodies, tyrosine-kinase inhibitors (TKIs) for molecularly selected NSCLCs, such as epidermal growth factor receptor (EGFR)-mutant and anaplastic lymphoma kinase (ALK)-rearranged diseases, and immune checkpoint inhibitors are all systemic treatments that have shown activity against NSCLC-derived CNS metastases. Among these, EGFR- and ALK-TKIs will be discussed more in detail owing to their superior efficacy in this context. EXPERT OPINION Up-front systemic treatment should be considered for patients with asymptomatic, multiple BMs, as recently acknowledged by the European Society of Medical Oncology guidelines. Nevertheless, it must be emphasized that the best treatment strategy for NSCLC-derived BMs has to be defined within a multidisciplinary team.
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Affiliation(s)
- Giulio Metro
- a 1 Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy +39 07 55 78 41 85 ; +39 07 55 78 41 84 ;
| | - Rita Chiari
- a 1 Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy +39 07 55 78 41 85 ; +39 07 55 78 41 84 ;
| | - Biagio Ricciuti
- a 1 Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy +39 07 55 78 41 85 ; +39 07 55 78 41 84 ;
| | - Alberto Rebonato
- b 2 University of Perugia, Department of Diagnostic Imaging, Santa Maria della Misericordia Hospital , Perugia, Italy
| | - Marco Lupattelli
- c 3 Division of Radiotherapy, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy
| | - Stefania Gori
- d 4 Medical Oncology, Sacro Cuore-Don Calabria Hospital , Negrar, VR, Italy
| | - Chiara Bennati
- a 1 Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy +39 07 55 78 41 85 ; +39 07 55 78 41 84 ;
| | - Corrado Castrioto
- e 5 Division of Neurosurgery, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy
| | - Piero Floridi
- f 6 Neuroradiology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy
| | - Vincenzo Minotti
- a 1 Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy +39 07 55 78 41 85 ; +39 07 55 78 41 84 ;
| | - Pietro Chiarini
- f 6 Neuroradiology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy
| | - Lucio Crinò
- a 1 Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia , Perugia, Italy +39 07 55 78 41 85 ; +39 07 55 78 41 84 ;
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Zhang SD, Leung KL, McCrudden CM, Kwok HF. The Prognostic Significance of Combining VEGFA, FLT1 and KDR mRNA Expressions in Brain Tumors. J Cancer 2015; 6:812-8. [PMID: 26284131 PMCID: PMC4532977 DOI: 10.7150/jca.11975] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/12/2015] [Indexed: 02/07/2023] Open
Abstract
Tumor cells require angiogenesis to deliver nutrients and oxygen to support their fast growth and metabolism. The vascular endothelial growth factor (VEGF) pathway plays an important role in promoting angiogenesis, including tumor-induced angiogenesis. Recent clinical trials have demonstrated the benefit of targeting VEGF in the treatment of glioblastoma. However, the prognostic significance of the expression of VEGFA and its receptors VEGFR1 (FLT1) and VEGFR2 (KDR) are still largely elusive. In the present study, we aimed to investigate the prognostic significance of these three factors, alone or in combination, in glioma patients. Gene mRNA expression was extracted from three independent brain tumor cohorts totaling 242 patients and the association between gene expression and survival was tested. We found that when VEGFA, FLT1 and KDR expressions were considered alone, only VEGFA demonstrated a significant association with patient survival. Patients with high expression of both VEGFA and either receptor had significantly worse survival than patients expressing both factors at a low level. Importantly, we found that those patients whose tumors overexpressed all three genes had a significantly shorter survival compared to those patients with a low level expression of these genes. Our results suggest that a high level expression of VEGFA and its receptors, both FLT1 and KDR, may be required for brain tumor progression, and that these three factors should be considered together as a prognostic indicator for brain tumor patients.
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Affiliation(s)
- Shu-Dong Zhang
- 2. Center for Cancer Research & Cell Biology and School of Pharmacy, Queen's University Belfast, BT9 7BL, Belfast, United Kingdom
| | - Ka Lai Leung
- 1. Faculty of Health Sciences, University of Macau, Avenida de Universidade, Macau SAR
- 2. Center for Cancer Research & Cell Biology and School of Pharmacy, Queen's University Belfast, BT9 7BL, Belfast, United Kingdom
| | - Cian M. McCrudden
- 2. Center for Cancer Research & Cell Biology and School of Pharmacy, Queen's University Belfast, BT9 7BL, Belfast, United Kingdom
| | - Hang Fai Kwok
- 1. Faculty of Health Sciences, University of Macau, Avenida de Universidade, Macau SAR
- 2. Center for Cancer Research & Cell Biology and School of Pharmacy, Queen's University Belfast, BT9 7BL, Belfast, United Kingdom
- 3. Cancer Research UK Cambridge Institute, University of Cambridge, CB2 0RE, Cambridge, United Kingdom
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Hsu CH, Lober RM, Li MD, Partap S, Murphy PA, Barnes PD, Fisher PG, Yeom KW. Decreased tumor apparent diffusion coefficient correlates with objective response of pediatric low-grade glioma to bevacizumab. J Neurooncol 2015; 122:491-6. [PMID: 25758812 DOI: 10.1007/s11060-015-1754-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/02/2015] [Indexed: 11/25/2022]
Abstract
Recent small, retrospective series suggest bevacizumab may be a therapeutic option for recurrent pediatric low-grade glioma (LGG). Assessment of therapeutic responses is complicated by the unpredictable natural history of these tumors. Because diffusion-weighted imaging quantifies microscopic water motion affected by cellular density and histologic features, we hypothesized that it may be helpful in monitoring therapeutic response of LGG to bevacizumab. We retrospectively reviewed eight consecutive patients, median age 4.8 (range 2.3-12.3) years at initiation of bevacizumab therapy for recurrent or refractory LGG. Patients received 10 mg/kg/dose every 2 weeks (median 16 doses/therapy course). Mean apparent diffusion coefficient (ADC) was measured and analyzed in respect to tumor volume. Following the first treatment course, seven of eight patients had reduced tumor volume (≥25 %) and ADC. The median decrease in tumor volume was 47% (range -6 to 78 %) and the median decrease in ADC was 14 % (range -5 to 30 %). The ADC was significantly decreased during therapy, whereas the decrease in volume was seen only after therapy completion. There was a positive correlation between percent change in tumor volume and ADC (p < 0.05). We report a decrease in tumor ADC during initial bevacizumab therapy that is accompanied by a decrease in volume following therapy. Imaging changes in microscopic water motion associated with histology may be useful in monitoring the therapeutic response of LGG to bevacizumab.
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Affiliation(s)
- Christopher H Hsu
- Department of Oncology, Lucile Packard Children's Hospital, Stanford University, 750 Welch Rd Suite 317, Palo Alto, CA, 94304, USA
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