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Zou H, Poore B, Brown EE, Qian J, Xie B, Asimakidou E, Razskazovskiy V, Ayrapetian D, Sharma V, Xia S, Liu F, Chen A, Guan Y, Li Z, Wanggou S, Saulnier O, Ly M, Fellows-Mayle W, Xi G, Tomita T, Resnick AC, Mack SC, Raabe EH, Eberhart CG, Sun D, Stronach BE, Agnihotri S, Kohanbash G, Lu S, Herrup K, Rich JN, Gittes GK, Broniscer A, Hu Z, Li X, Pollack IF, Friedlander RM, Hainer SJ, Taylor MD, Hu B. A neurodevelopmental epigenetic programme mediated by SMARCD3-DAB1-Reelin signalling is hijacked to promote medulloblastoma metastasis. Nat Cell Biol 2023; 25:493-507. [PMID: 36849558 PMCID: PMC10014585 DOI: 10.1038/s41556-023-01093-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/17/2023] [Indexed: 03/01/2023]
Abstract
How abnormal neurodevelopment relates to the tumour aggressiveness of medulloblastoma (MB), the most common type of embryonal tumour, remains elusive. Here we uncover a neurodevelopmental epigenomic programme that is hijacked to induce MB metastatic dissemination. Unsupervised analyses of integrated publicly available datasets with our newly generated data reveal that SMARCD3 (also known as BAF60C) regulates Disabled 1 (DAB1)-mediated Reelin signalling in Purkinje cell migration and MB metastasis by orchestrating cis-regulatory elements at the DAB1 locus. We further identify that a core set of transcription factors, enhancer of zeste homologue 2 (EZH2) and nuclear factor I X (NFIX), coordinates with the cis-regulatory elements at the SMARCD3 locus to form a chromatin hub to control SMARCD3 expression in the developing cerebellum and in metastatic MB. Increased SMARCD3 expression activates Reelin-DAB1-mediated Src kinase signalling, which results in a MB response to Src inhibition. These data deepen our understanding of how neurodevelopmental programming influences disease progression and provide a potential therapeutic option for patients with MB.
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Affiliation(s)
- Han Zou
- Xiangya School of Medicine, Central South University, Changsha, China
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Changsha, China
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley Poore
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Emily E Brown
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jieqi Qian
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Bin Xie
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Evridiki Asimakidou
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Vladislav Razskazovskiy
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Deanna Ayrapetian
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Vaibhav Sharma
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Shunjin Xia
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Fei Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Apeng Chen
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Yongchang Guan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Zhengwei Li
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Siyi Wanggou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Olivier Saulnier
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Ly
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy Fellows-Mayle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Guifa Xi
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tadanori Tomita
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Adam C Resnick
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen C Mack
- Department of Developmental Neurobiology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Eric H Raabe
- Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles G Eberhart
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dandan Sun
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Beth E Stronach
- Office of Research, University of Pittsburgh Health Sciences, Pittsburgh, PA, USA
| | - Sameer Agnihotri
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Gary Kohanbash
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Songjian Lu
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karl Herrup
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jeremy N Rich
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - George K Gittes
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alberto Broniscer
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zhongliang Hu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Changsha, China
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah J Hainer
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
| | - Michael D Taylor
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Baoli Hu
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- John G. Rangos Sr Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Nayak L, Standifer N, Dietrich J, Clarke JL, Dunn GP, Lim M, Cloughesy T, Gan HK, Flagg E, George E, Gaffey S, Hayden J, Holcroft C, Wen PY, Macri M, Park AJ, Ricciardi T, Ryan A, Schwarzenberger P, Venhaus R, de los Reyes M, Durham NM, Creasy T, Huang RY, Kaley T, Reardon DA. Circulating Immune Cell and Outcome Analysis from the Phase II Study of PD-L1 Blockade with Durvalumab for Newly Diagnosed and Recurrent Glioblastoma. Clin Cancer Res 2022; 28:2567-2578. [PMID: 35395080 PMCID: PMC9940445 DOI: 10.1158/1078-0432.ccr-21-4064] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/15/2022] [Accepted: 04/05/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE PD-L1 is upregulated in glioblastoma and supports immunosuppression. We evaluated PD-L1 blockade with durvalumab among glioblastoma cohorts and investigated potential biomarkers. PATIENTS AND METHODS MGMT unmethylated newly diagnosed patients received radiotherapy plus durvalumab (cohort A; n = 40). Bevacizumab-naïve, recurrent patients received durvalumab alone (cohort B; n = 31) or in combination with standard bevacizumab (cohort B2; n = 33) or low-dose bevacizumab (cohort B3; n = 33). Bevacizumab-refractory patients received durvalumab plus bevacizumab (cohort C; n = 22). Primary endpoints were: OS-12 (A), PFS-6 (B, B2, B3), and OS-6 (C). Exploratory biomarkers included: a systematic, quantitative, and phenotypic evaluation of circulating immune cells; tumor mutational burden (TMB); and tumor immune activation signature (IAS). RESULTS No cohort achieved the primary efficacy endpoint. Outcome was comparable among recurrent, bevacizumab-naïve cohorts. No unexpected toxicities were observed. A widespread reduction of effector immune cell subsets was noted among recurrent patients compared with newly diagnosed patients that was partially due to dexamethasone use. A trend of increased CD8+Ki67+ T cells at day 15 was noted among patients who achieved the primary endpoint and were not on dexamethasone. Neither TMB nor IAS predicted outcome. CONCLUSIONS Patients with recurrent glioblastoma have markedly lower baseline levels of multiple circulating immune cell subsets compared with newly diagnosed patients. An early increase in systemic Ki67+CD8+ cells may warrant further evaluation as a potential biomarker of therapeutic benefit among patients with glioblastoma undergoing checkpoint therapy. Dexamethasone decreased immune cell subsets. PD-L1 blockade and combination with standard or reduced dose bevacizumab was ineffective.
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Affiliation(s)
- Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nathan Standifer
- Integrated Bioanalysis, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, South San Francisco, CA
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Jennifer L. Clarke
- Departments of Neurology and Neurosurgery, University of California San Francisco, San Francisco, CA
| | - Gavin P. Dunn
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Hui K. Gan
- Department of Medical Oncology, Austin Health, Melbourne, AU
| | - Elizabeth Flagg
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA
| | - Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sarah Gaffey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Julia Hayden
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | | | | | - Melissa de los Reyes
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Nicholas M. Durham
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Todd Creasy
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Raymond Y. Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA
| | - Thomas Kaley
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - David A. Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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A multi-center prospective study of re-irradiation with bevacizumab and temozolomide in patients with bevacizumab refractory recurrent high-grade gliomas. J Neurooncol 2021; 155:297-306. [PMID: 34689306 DOI: 10.1007/s11060-021-03875-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Survival is dismal for bevacizumab refractory high-grade glioma patients. We prospectively investigated the efficacy of re-irradiation, bevacizumab, and temozolomide in bevacizumab-naïve and bevacizumab-exposed recurrent high-grade glioma, without volume limitations, in a single arm trial. METHODS Recurrent high-grade glioma patients were stratified based on WHO grade (4 vs. < 4) and prior exposure to bevacizumab (yes vs. no). Eligible patients received radiation using a simultaneous integrated boost technique (55 Gy to enhancing disease, 45 Gy to non-enhancing disease in 25 fractions) with bevacizumab 10 mg/kg every 2 weeks IV and temozolomide 75 mg/m2 daily followed by maintenance bevacizumab 10 mg/kg every 2 weeks and temozolomide 50 mg/m2 daily for 6 weeks then a 2 week holiday until progression. Primary endpoint was overall survival. Quality of life was studied using FACT-Br and FACT-fatigue scales. RESULTS Fifty-four patients were enrolled. The majority (n = 36, 67%) were bevacizumab pre-exposed GBM. Median OS for all patients was 8.5 months and 7.9 months for the bevacizumab pre-exposed GBM group. Patients ≥ 36 months from initial radiation had a median OS of 13.3 months compared to 7.5 months for those irradiated < 36 months earlier (p < 0.01). FACT-Br and FACT-Fatigue scores initially declined during radiation but returned to pretreatment baseline. Treatment was well tolerated with 5 patients experiencing > grade 3 lymphopenia and 2 with > grade 3 thrombocytopenia. No radiographic or clinical radiation necrosis occurred. CONCLUSIONS Re-irradiation with bevacizumab and temozolomide is a safe and feasible salvage treatment for patients with large volume bevacizumab-refractory high-grade glioma. Patients further from their initial radiotherapy may derive greater benefit with this regimen.
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Ramezani S, Vousooghi N, Joghataei MT, Chabok SY. The Role of Kinase Signaling in Resistance to Bevacizumab Therapy for Glioblastoma Multiforme. Cancer Biother Radiopharm 2020; 34:345-354. [PMID: 31411929 DOI: 10.1089/cbr.2018.2651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most malignant primary brain tumor and is characterized by vascular hyperplasia, necrosis, and high cell proliferation. Despite current standard therapies, including surgical resection and chemoradiotherapy, GBM patients survive for only about 15 months after diagnosis. Recently, the U.S. Food and Drug Administration (FDA) has approved an antiangiogenesis medication for recurrent GBM-bevacizumab-which has improved progression-free survival in GBM patients. Although bevacizumab has resulted in significant early clinical benefit, it inescapably predisposes tumor to relapse that can be represented as an infiltrative phenotype. Fundamentally, bevacizumab antagonizes the vascular endothelial growth factor A (VEGFA), which is consistently released on both endothelial cells (ECs) and GBM cells. Actually, VEGFA inhibition on the ECs leads to the suppression of vascular progression, permeability, and the vasogenic edema. However, the consequence of the VEGFA pathway blockage on the GBM cells remains controversial. Nevertheless, a piece of evidence supports the relationship between bevacizumab application and compensatory activation of kinase signaling within GBM cells, leading to a tumor cell invasion known as the main mechanism of bevacizumab-induced tumor resistance. A complete understanding of kinase responses associated with tumor invasion in bevacizumab-resistant GBMs offers new therapeutic opportunities. Thus, this study aimed at presenting a brief overview of preclinical and clinical data of the tumor invasion and resistance induced by bevacizumab administration in GBMs, with a focus on the kinase responses during treatment. The novel therapeutic strategies to overcome this resistance by targeting protein kinases have also been summarized.
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Affiliation(s)
- Sara Ramezani
- 1Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,2Guilan Road Trauma Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasim Vousooghi
- 3Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,4Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,5Research Center for Cognitive and Behavioral Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- 6Department of Neuroscience, School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.,7Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Yousefzadeh Chabok
- 1Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,2Guilan Road Trauma Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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5
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Tea MN, Poonnoose SI, Pitson SM. Targeting the Sphingolipid System as a Therapeutic Direction for Glioblastoma. Cancers (Basel) 2020; 12:cancers12010111. [PMID: 31906280 PMCID: PMC7017054 DOI: 10.3390/cancers12010111] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023] Open
Abstract
Glioblastoma (GBM) is the most commonly diagnosed malignant brain tumor in adults. The prognosis for patients with GBM remains poor and largely unchanged over the last 30 years, due to the limitations of existing therapies. Thus, new therapeutic approaches are desperately required. Sphingolipids are highly enriched in the brain, forming the structural components of cell membranes, and are major lipid constituents of the myelin sheaths of nerve axons, as well as playing critical roles in cell signaling. Indeed, a number of sphingolipids elicit a variety of cellular responses involved in the development and progression of GBM. Here, we discuss the role of sphingolipids in the pathobiology of GBM, and how targeting sphingolipid metabolism has emerged as a promising approach for the treatment of GBM.
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Affiliation(s)
- Melinda N. Tea
- Centre for Cancer Biology, University of South Australia and SA Pathology, UniSA CRI Building, North Tce, Adelaide, SA 5001, Australia;
| | - Santosh I. Poonnoose
- Department of Neurosurgery, Flinders Medical Centre, Adelaide, SA 5042, Australia;
| | - Stuart M. Pitson
- Centre for Cancer Biology, University of South Australia and SA Pathology, UniSA CRI Building, North Tce, Adelaide, SA 5001, Australia;
- Adelaide Medical School and School of Biological Sciences, University of Adelaide, SA 5001, Australia
- Correspondence: ; Tel.: +61-8-8302-7832; Fax: +61-8-8302-9246
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Cloughesy TF, Drappatz J, de Groot J, Prados MD, Reardon DA, Schiff D, Chamberlain M, Mikkelsen T, Desjardins A, Ping J, Holland J, Weitzman R, Wen PY. Phase II study of cabozantinib in patients with progressive glioblastoma: subset analysis of patients with prior antiangiogenic therapy. Neuro Oncol 2019; 20:259-267. [PMID: 29036345 PMCID: PMC5777491 DOI: 10.1093/neuonc/nox151] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Cabozantinib is a potent, multitarget inhibitor of MET and vascular endothelial growth factor receptor 2 (VEGFR2). This open-label, phase II trial evaluated cabozantinib in patients with recurrent or progressive glioblastoma (GBM). Methods Patients were initially enrolled to a starting cabozantinib dose of 140 mg/day, but the starting dose was amended to 100 mg/day because of safety concerns. Treatment continued until disease progression or unacceptable toxicity. The primary endpoint was objective response rate, assessed by an independent radiology facility using modified Response Assessment in Neuro-Oncology criteria. Additional endpoints included duration of response, 6-month and median progression-free survival, overall survival, glucocorticoid use, and safety. Results Among 222 patients enrolled, 70 had received prior antiangiogenic therapy. Herein, we report results in this subset of 70 patients. The objective response rate was 4.3%, and the median duration of response was 4.2 months. The proportion of patients alive and progression free at 6 months was 8.5%. Median progression-free survival was 2.3 months, and median overall survival was 4.6 months. The most common adverse events reported in all patients, regardless of dose group, included fatigue (74.3%), diarrhea (47.1%), increased alanine aminotransferase (37.1%), headache (35.7%), hypertension (35.7%), and nausea (35.7%); overall, 34 (48.6%) patients experienced adverse events that resulted in dose reductions. Conclusions Cabozantinib treatment appeared to have modest clinical activity with a 4.3% response rate in patients who had received prior antiangiogenic therapy for GBM. Clinical Trials Registration Number NCT00704288 (https://www.clinicaltrials.gov/ct2/show/NCT00704288)
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Affiliation(s)
- Timothy F Cloughesy
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Jan Drappatz
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - John de Groot
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Michael D Prados
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - David A Reardon
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - David Schiff
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Marc Chamberlain
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Tom Mikkelsen
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Annick Desjardins
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Jerry Ping
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Jaymes Holland
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Ron Weitzman
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
| | - Patrick Y Wen
- The Ronald Reagan UCLA Medical Center, Los Angeles, California (T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (P.Y.W., J.D.); The University of Texas MD Anderson Cancer Center, Houston, Texas (J.dG.); University of California San Francisco, San Francisco, California (M.D.P.); Duke University, Durham, North Carolina (D.A.R., A.D.); Neuro-Oncology Center, University of Virginia Health System, Charlottesville, Virginia (D.S.); University of Washington, Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle, Washington (M.C.); Henry Ford Health System, Detroit, Michigan (T.M.); Exelixis, South San Francisco, California (J.P., J.H., R.W.)
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7
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Hu AX, Adams JJ, Vora P, Qazi M, Singh SK, Moffat J, Sidhu SS. EPH Profiling of BTIC Populations in Glioblastoma Multiforme Using CyTOF. Methods Mol Biol 2019; 1869:155-168. [PMID: 30324522 DOI: 10.1007/978-1-4939-8805-1_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The ability to elucidate the phenotype of brain tumor initiating cell (BTIC) in the context of bulk tumor in glioblastoma multiforme (GBM) provides significant therapeutic benefits for therapeutic evaluation. For the identification of such an elusive and rare subpopulation of cells, a single cell analysis technology with deep profiling capabilities known as Mass Cytometry (CyTOF) can prove to be highly useful. CyTOF circumvents the spectral overlap limitations of traditional flow cytometry by replacing fluorophores with metal isotope tags, allowing the accurate detection of significantly more parameters at the same time. In this chapter, we demonstrate that synthetic antibodies can be conjugated with metal isotope tags for CyTOF analysis, resulting in the development of a highly tailored, custom multi-parameter panel. This toolset was used to stain patient-derived GBM cells, which was analyzed via CyTOF. Analysis software viSNE and SPADE were applied to study the co-expression patterns of the Eph Receptor (EphR) family and several putative BTIC markers in GBM, resulting in the identification of a distinct group of cells consistent with a BTIC subpopulation. This approach can be readily adapted to the detection of cancer stem-like cells in other cancer types.
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Affiliation(s)
- Amy X Hu
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, ON, Canada.
| | - Jarrett J Adams
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, ON, Canada
| | - Parvez Vora
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Maleeha Qazi
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Sheila K Singh
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON, Canada
| | - Jason Moffat
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, ON, Canada
- Canadian Institute for Advanced Research, Toronto, ON, Canada
| | - Sachdev S Sidhu
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, ON, Canada
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8
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Lamballe F, Toscano S, Conti F, Arechederra M, Baeza N, Figarella-Branger D, Helmbacher F, Maina F. Coordination of signalling networks and tumorigenic properties by ABL in glioblastoma cells. Oncotarget 2018; 7:74747-74767. [PMID: 27732969 PMCID: PMC5342699 DOI: 10.18632/oncotarget.12546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/29/2016] [Indexed: 12/31/2022] Open
Abstract
The cytoplasmic tyrosine kinase ABL exerts positive or negative effects in solid tumours according to the cellular context, thus functioning as a “switch modulator”. The therapeutic effects of drugs targeting a set of signals encompassing ABL have been explored in several solid tumours. However, the net contribution of ABL inhibition by these agents remains elusive as these drugs also act on other signalling components. Here, using glioblastoma (GBM) as a cellular paradigm, we report that ABL inhibition exacerbates mesenchymal features as highlighted by down-regulation of epithelial markers and up-regulation of mesenchymal markers. Cells with permanent ABL inhibition exhibit enhanced motility and invasive capabilities, while proliferation and tumorigenic properties are reduced. Intriguingly, permanent ABL inhibition also interferes with GBM neurosphere formation and with expression of stemness markers in sphere-cultured GBM cells. Furthermore, we show that the molecular and biological characteristics of GBM cells with impaired ABL are reversible by restoring ABL levels, thus uncovering a remarkable plasticity of GBM cells to ABL threshold. A phospho-signalling screen revealed that loss of tumorigenic and self-renewal properties in GBM cells under permanent ABL inhibition coincide with drastic changes in the expression and/or phosphorylation levels of multiple signalling components. Our findings identify ABL as a crucial player for migration, invasion, proliferation, tumorigenic, and stem-cell like properties of GBM cells. Taken together, this work supports the notion that the oncogenic role of ABL in GBM cells is associated with its capability to coordinate a signalling setting that determines tumorigenic and stem-cell like properties.
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Affiliation(s)
- Fabienne Lamballe
- Aix-Marseille Université, CNRS, Developmental Biology Institute of Marseille (IBDM), Parc Scientifique de Luminy, Marseille, France
| | - Sara Toscano
- Aix-Marseille Université, CNRS, Developmental Biology Institute of Marseille (IBDM), Parc Scientifique de Luminy, Marseille, France
| | - Filippo Conti
- Aix-Marseille Université, CNRS, Developmental Biology Institute of Marseille (IBDM), Parc Scientifique de Luminy, Marseille, France
| | - Maria Arechederra
- Aix-Marseille Université, CNRS, Developmental Biology Institute of Marseille (IBDM), Parc Scientifique de Luminy, Marseille, France
| | - Nathalie Baeza
- Aix-Marseille Université, Inserm, CRO2 UMR S911, Marseille, France
| | | | - Françoise Helmbacher
- Aix-Marseille Université, CNRS, Developmental Biology Institute of Marseille (IBDM), Parc Scientifique de Luminy, Marseille, France
| | - Flavio Maina
- Aix-Marseille Université, CNRS, Developmental Biology Institute of Marseille (IBDM), Parc Scientifique de Luminy, Marseille, France
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9
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Tipping M, Eickhoff J, Ian Robins H. Clinical outcomes in recurrent glioblastoma with bevacizumab therapy: An analysis of the literature. J Clin Neurosci 2017; 44:101-106. [PMID: 28711289 DOI: 10.1016/j.jocn.2017.06.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/22/2017] [Indexed: 12/31/2022]
Abstract
Bevacizumab (BEV) is a common treatment for recurrent glioblastoma (GBM). After progression on BEV, there is no consensus on subsequent therapy, as multiple chemotherapy trials have failed to demonstrate discernible activity for salvage. A previous review (995 patients) estimated a progression free survival (PFS) on BEV of 4.2months (SD±2.1) with an overall survival (OS) after progression on BEV at 3.8months (SD±1). We endeavored to establish a more rigorous historical control, both as a benchmark for efficacy, and a prognostic tool for clinical practice. A comprehensive literature review was performed utilizing PubMed and societal presentation abstracts. A total 2388 patients from 53 arms of 42 studies were analyzed in three groups: 1) thirty-two studies in which survival post-BEV was determined by subtracting PFS from OS (2045 patients): PFS on BEV=4.38months (95% CI 4.09-4.68); OS post-BEV=3.36months (95% CI 3.12-3.66); 2) two studies (94 patients) in which OS post-BEV is reported: OS=3.26 (95% CI 2.39-4.42); 3) eight studies of salvage therapy after progression on BEV (249 patients): of OS post-BEV=4.46months (95% CI 3.68-5.54). These estimates provide a firm historical control for PFS on BEV, as well as OS after disease progression on BEV therapy.
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Affiliation(s)
- Matthew Tipping
- Department of Medicine University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, United States
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, United States; University of Wisconsin Carbone Cancer Center, UWSMPH, United States
| | - H Ian Robins
- University of Wisconsin Carbone Cancer Center, UWSMPH, United States; Departments of Medicine, Human Oncology and Neurology, K4/534 Clinical Science Center, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, United States.
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10
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Inhibition of radiation-induced glioblastoma invasion by genetic and pharmacological targeting of MDA-9/Syntenin. Proc Natl Acad Sci U S A 2016; 114:370-375. [PMID: 28011764 DOI: 10.1073/pnas.1616100114] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Glioblastoma multiforme (GBM) is an intractable tumor despite therapeutic advances, principally because of its invasive properties. Radiation is a staple in therapeutic regimens, although cells surviving radiation can become more aggressive and invasive. Subtraction hybridization identified melanoma differentiation-associated gene 9 [MDA-9/Syntenin; syndecan-binding protein (SDCBP)] as a differentially regulated gene associated with aggressive cancer phenotypes in melanoma. MDA-9/Syntenin, a highly conserved double-PDZ domain-containing scaffolding protein, is robustly expressed in human-derived GBM cell lines and patient samples, with expression increasing with tumor grade and correlating with shorter survival times and poorer response to radiotherapy. Knockdown of MDA-9/Syntenin sensitizes GBM cells to radiation, reducing postradiation invasion gains. Radiation induces Src and EGFRvIII signaling, which is abrogated through MDA-9/Syntenin down-regulation. A specific inhibitor of MDA-9/Syntenin activity, PDZ1i (113B7), identified through NMR-guided fragment-based drug design, inhibited MDA-9/Syntenin binding to EGFRvIII, which increased following radiation. Both genetic (shmda-9) and pharmacological (PDZ1i) targeting of MDA-9/Syntenin reduced invasion gains in GBM cells following radiation. Although not affecting normal astrocyte survival when combined with radiation, PDZ1i radiosensitized GBM cells. PDZ1i inhibited crucial GBM signaling involving FAK and mutant EGFR, EGFRvIII, and abrogated gains in secreted proteases, MMP-2 and MMP-9, following radiation. In an in vivo glioma model, PDZ1i resulted in smaller, less invasive tumors and enhanced survival. When combined with radiation, survival gains exceeded radiotherapy alone. MDA-9/Syntenin (SDCBP) provides a direct target for therapy of aggressive cancers such as GBM, and defined small-molecule inhibitors such as PDZ1i hold promise to advance targeted brain cancer therapy.
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11
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Aniceto N, Freitas AA, Bender A, Ghafourian T. Simultaneous Prediction of four ATP-binding Cassette Transporters’ Substrates Using Multi-label QSAR. Mol Inform 2016; 35:514-528. [DOI: 10.1002/minf.201600036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/11/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Natália Aniceto
- Medway School of Pharmacy; Universities of Kent and Greenwich; Anson Building, Central Avenue, Chatham Maritime, Chatham Kent postCode/>ME4 4TB UK
| | - Alex A. Freitas
- School of Computing; University of Kent; Canterbury CT2 7NF UK
| | - Andreas Bender
- Centre for Molecular Science Informatics, Department of Chemistry; University of Cambridge; Lensfield Road Cambridge CB2 1EW UK
| | - Taravat Ghafourian
- School of Life Sciences, JMS Building; University of Sussex; Brighton BN1 9QG UK
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12
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A combination of tyrosine kinase inhibitors, crizotinib and dasatinib for the treatment of glioblastoma multiforme. Oncotarget 2016; 6:37948-64. [PMID: 26517812 PMCID: PMC4741976 DOI: 10.18632/oncotarget.5698] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/06/2015] [Indexed: 12/25/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor. Despite the advances in surgery, radiotherapy and chemotherapy, patient survival averages only 14.6 months. In most GBM tumors, tyrosine kinases show increased activity and/or expression and actively contribute to the development, recurrence and onset of treatment resistance; making their inhibition an appealing therapeutic strategy. We compared the cytotoxicity of 12 tyrosine kinase inhibitors in vitro. A combination of crizotinib and dasatinib emerged as the most cytotoxic across established and primary human GBM cell lines. The combination treatment induced apoptotic cell death and polyploidy. Furthermore, the combination treatment led to the altered expression and localization of several tyrosine kinase receptors such as Met and EGFR and downstream effectors as such as SRC. Furthermore, the combination treatment reduced the migration and invasion of GBM cells and prevented endothelial cell tube formation in vitro. Overall, our study demonstrated the broad specificity of a combination of crizotinib and dasatinib across multiple GBM cell lines. These findings provide insight into the development of alternative therapy for the treatment of GBM.
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13
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Bao X, Wang MW, Luo JM, Wang SY, Zhang YP, Zhang YJ. Optimization of Early Response Monitoring and Prediction of Cancer Antiangiogenesis Therapy via Noninvasive PET Molecular Imaging Strategies of Multifactorial Bioparameters. Theranostics 2016; 6:2084-2098. [PMID: 27698942 PMCID: PMC5039682 DOI: 10.7150/thno.13917] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 07/30/2016] [Indexed: 12/13/2022] Open
Abstract
Objective: Antiangiogenesis therapy (AAT) has provided substantial benefits regarding improved outcomes and survival for suitable patients in clinical settings. Therefore, the early definition of therapeutic effects is urgently needed to guide cancer AAT. We aimed to optimize the early response monitoring and prediction of AAT efficacy, as indicated by the multi-targeted anti-angiogenic drug sunitinib in U87MG tumors, using noninvasive positron emission computed tomography (PET) molecular imaging strategies of multifactorial bioparameters. Methods: U87MG tumor mice were treated via intragastric injections of sunitinib (80 mg/kg) or vehicle for 7 consecutive days. Longitudinal MicroPET/CT scans with 18F-FDG, 18F-FMISO, 18F-ML-10 and 18F-Alfatide II were acquired to quantitatively measure metabolism, hypoxia, apoptosis and angiogenesis on days 0, 1, 3, 7 and 13 following therapy initiation. Tumor tissues from a dedicated group of mice were collected for immunohistochemical (IHC) analysis of key biomarkers (Glut-1, CA-IX, TUNEL, ανβ3 and CD31) at the time points of PET imaging. The tumor sizes and mouse weights were measured throughout the study. The tumor uptake (ID%/gmax), the ratios of the tumor/muscle (T/M) for each probe, and the tumor growth ratios (TGR) were calculated and used for statistical analyses of the differences and correlations. Results: Sunitinib successfully inhibited U87MG tumor growth with significant differences in the tumor size from day 9 after sunitinib treatment compared with the control group (P < 0.01). The uptakes of 18F-FMISO (reduced hypoxia), 18F-ML-10 (increased apoptosis) and 18F-Alfatide II (decreased angiogenesis) in the tumor lesions significantly changed during the early stage (days 1 to 3) of sunitinib treatment; however, the uptake of 18F-FDG (increased glucose metabolism) was significantly different during the late stage. The PET imaging data of each probe were all confirmed via ex vivo IHC of the relevant biomarkers. Notably, the PET imaging of 18F-Alfatide II and 18F-FMISO was significantly correlated (all P < 0.05) with TGR, whereas the imaging of 18F-FDG and 18F-ML-10 was not significantly correlated with TGR. Conclusion: Based on the tumor uptake of the PET probes and their correlations with MVD and TGR, 18F-Alfatide II PET may not only monitor the early response but also precisely predict the therapeutic efficacy of the multi-targeted, anti-angiogenic drug sunitinib in U87MG tumors. In conclusion, it is feasible to optimize the early response monitoring and efficacy prediction of cancer AAT using noninvasive PET molecular imaging strategies of multifactorial bioparameters, such as angiogenesis imaging with 18F-Alfatide II, which represents an RGD-based probe.
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14
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Weathers SP, Han X, Liu DD, Conrad CA, Gilbert MR, Loghin ME, O'Brien BJ, Penas-Prado M, Puduvalli VK, Tremont-Lukats I, Colen RR, Yung WKA, de Groot JF. A randomized phase II trial of standard dose bevacizumab versus low dose bevacizumab plus lomustine (CCNU) in adults with recurrent glioblastoma. J Neurooncol 2016; 129:487-494. [PMID: 27406589 DOI: 10.1007/s11060-016-2195-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
Antiangiogenic therapy can rapidly reduce vascular permeability and cerebral edema but high doses of bevacizumab may induce selective pressure to promote resistance. This trial evaluated the efficacy of low dose bevacizumab in combination with lomustine (CCNU) compared to standard dose bevacizumab in patients with recurrent glioblastoma. Patients (N = 71) with recurrent glioblastoma who previously received radiation and temozolomide were randomly assigned 1:1 to receive bevacizumab monotherapy (10 mg/kg) or low dose bevacizumab (5 mg/kg) in combination with lomustine (90 mg/m(2)). The primary end point was progression-free survival (PFS) based on a blinded, independent radiographic assessment of post-contrast T1-weighted and non-contrast T2/FLAIR weighted magnetic resonance imaging (MRI) using RANO criteria. For 69 evaluable patients, median PFS was not significantly longer in the low dose bevacizumab + lomustine arm (4.34 months, CI 2.96-8.34) compared to the bevacizumab alone arm (4.11 months, CI 2.69-5.55, p = 0.19). In patients with first recurrence, there was a trend towards longer median PFS time in the low dose bevacizumab + lomustine arm (4.96 months, CI 4.17-13.44) compared to the bevacizumab alone arm (3.22 months CI 2.5-6.01, p = 0.08). The combination of low dose bevacizumab plus lomustine was not superior to standard dose bevacizumab in patients with recurrent glioblastoma. Although the study was not designed to exclusively evaluate patients at first recurrence, a strong trend towards improved PFS was seen in that subgroup for the combination of low dose bevacizumab plus lomustine. Further studies are needed to better identify such subgroups that may most benefit from the combination treatment.
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Affiliation(s)
- Shiao-Pei Weathers
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA.
| | - Xiaosi Han
- University of Alabama at Birmingham, 1020 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35294, USA
| | - Diane D Liu
- Department of Biostatistics, University of MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Charles A Conrad
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA.,Texas Oncology, 901 W. 38th Street, Austin, TX, 78705, USA
| | - Mark R Gilbert
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA.,National Institutes of Health, 9030 Old Georgetown Rd., Bethesda, MD, 20892, USA
| | - Monica E Loghin
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA
| | - Barbara J O'Brien
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA
| | - Marta Penas-Prado
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA.,M410 Starling Loving Hall, 320 W., 10th Avenue, Columbus, OH, 43210, USA
| | - Ivo Tremont-Lukats
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA.,Department of Neurosurgery, Houston Methodist Hospital, 6560 Fannin, Scurlock Suite 900, Houston, TX, 77030, USA
| | - Rivka R Colen
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St Unit 1482, Houston, TX, 77030, USA
| | - W K Alfred Yung
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA
| | - John F de Groot
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX, 77030, USA
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15
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Behling K, Maguire WF, Di Gialleonardo V, Heeb LEM, Hassan IF, Veach DR, Keshari KR, Gutin PH, Scheinberg DA, McDevitt MR. Remodeling the Vascular Microenvironment of Glioblastoma with α-Particles. J Nucl Med 2016; 57:1771-1777. [PMID: 27261519 DOI: 10.2967/jnumed.116.173559] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/26/2016] [Indexed: 12/22/2022] Open
Abstract
Tumors escape antiangiogenic therapy by activation of proangiogenic signaling pathways. Bevacizumab is approved for the treatment of recurrent glioblastoma, but patients inevitably develop resistance to this angiogenic inhibitor. We previously investigated targeted α-particle therapy with 225Ac-E4G10 as an antivascular approach and showed increased survival and tumor control in a high-grade transgenic orthotopic glioblastoma model. Here, we investigated changes in tumor vascular morphology and functionality caused by 225Ac-E4G10. METHODS We investigated remodeling of the tumor microenvironment in transgenic Ntva glioblastoma mice using a therapeutic 7.4-kBq dose of 225Ac-E4G10. Immunofluorescence and immunohistochemical analyses imaged morphologic changes in the tumor blood-brain barrier microenvironment. Multicolor flow cytometry quantified the endothelial progenitor cell population in the bone marrow. Diffusion-weighted MR imaged functional changes in the tumor vascular network. RESULTS The mechanism of drug action is a combination of remodeling of the glioblastoma vascular microenvironment, relief of edema, and depletion of regulatory T and endothelial progenitor cells. The primary remodeling event is the reduction of both endothelial and perivascular cell populations. Tumor-associated edema and necrosis were lessened, resulting in increased perfusion and reduced diffusion. Pharmacologic uptake of dasatinib into tumor was enhanced after α-particle therapy. CONCLUSION Targeted antivascular α-particle radiation remodels the glioblastoma vascular microenvironment via a multimodal mechanism of action and provides insight into the vascular architecture of platelet-derived growth factor-driven glioblastoma.
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Affiliation(s)
- Katja Behling
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William F Maguire
- Department of Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Lukas E M Heeb
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Iman F Hassan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Darren R Veach
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kayvan R Keshari
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip H Gutin
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - David A Scheinberg
- Department of Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Pharmacology, Weill Cornell Medical College, New York, New York; and
| | - Michael R McDevitt
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York .,Department of Medicine, Weill Cornell Medical College, New York, New York
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Abstract
INTRODUCTION Despite substantial improvements in standards of care, the most common aggressive pediatric and adult high-grade gliomas (HGG) carry uniformly fatal diagnoses due to unique treatment limitations, high recurrence rates and the absence of effective treatments following recurrence. Recent advancements in our understanding of the pathophysiology, genetics and epigenetics as well as mechanisms of immune surveillance during gliomagenesis have created new knowledge to design more effective and target-directed therapies to improve patient outcomes. AREAS COVERED In this review, the authors discuss the critical genetic, epigenetic and immunologic aberrations found in gliomas that appear rational and promising for therapeutic developments in the presence and future. The current state of the latest therapeutic developments including tumor-specific targeted drug therapies, metabolic targeting, epigenetic modulation and immunotherapy are summarized and suggestions for future directions are offered. Furthermore, they highlight contemporary issues related to the clinical development, such as challenges in clinical trials and toxicities. EXPERT OPINION The commitment to understanding the process of gliomagenesis has created a catalogue of aberrations that depict multiple mechanisms underlying this disease, many of which are suitable to therapeutic inhibition and are currently tested in clinical trials. Thus, future treatment endeavors will employ multiple treatment modalities that target disparate tumor characteristics personalized to the patient's individual tumor.
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Affiliation(s)
- Verena Staedtke
- a Department of Neurology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Ren-Yuan Bai
- b Department of Neurosurgery , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - John Laterra
- a Department of Neurology , Johns Hopkins Medical Institutions , Baltimore , MD , USA.,c Department of Oncology , Johns Hopkins Medical Institutions , Baltimore , MD , USA.,d Department of Neuroscience , Johns Hopkins Medical Institutions , Baltimore , MD , USA
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17
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Zorzan M, Giordan E, Redaelli M, Caretta A, Mucignat-Caretta C. Molecular targets in glioblastoma. Future Oncol 2016; 11:1407-20. [PMID: 25952786 DOI: 10.2217/fon.15.22] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Glioblastoma is the most lethal brain tumor. The poor prognosis results from lack of defined tumor margins, critical location of the tumor mass and presence of chemo- and radio-resistant tumor stem cells. The current treatment for glioblastoma consists of neurosurgery, followed by radiotherapy and temozolomide chemotherapy. A better understanding of the role of molecular and genetic heterogeneity in glioblastoma pathogenesis allowed the design of novel targeted therapies. New targets include different key-role signaling molecules and specifically altered pathways. The new approaches include interference through small molecules or monoclonal antibodies and RNA-based strategies mediated by siRNA, antisense oligonucleotides and ribozymes. Most of these treatments are still being tested yet they stay as solid promises for a clinically relevant success.
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Affiliation(s)
- Maira Zorzan
- Department of Molecular Medicine, University of Padova, Padova, Italy
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18
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Lee JK, Nam DOH, Lee J. Repurposing antipsychotics as glioblastoma therapeutics: Potentials and challenges. Oncol Lett 2016; 11:1281-1286. [PMID: 26893731 DOI: 10.3892/ol.2016.4074] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 05/29/2015] [Indexed: 12/30/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and most lethal primary brain tumor, with tragically little therapeutic progress over the last 30 years. Surgery provides a modest benefit, and GBM cells are resistant to radiation and chemotherapy. Despite significant development of the molecularly targeting strategies, the clinical outcome of GBM patients remains dismal. The challenges inherent in developing effective GBM treatments have become increasingly clear, and include resistance to standard treatments, the blood-brain barrier, resistance of GBM stem-like cells, and the genetic complexity and molecular adaptability of GBM. Recent studies have collectively suggested that certain antipsychotics harbor antitumor effects and have potential utilities as anti-GBM therapeutics. In the present review, the anti-tumorigenic effects and putative mechanisms of antipsychotics, and the challenges for the potential use of antipsychotic drugs as anti-GBM therapeutics are reviewed.
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Affiliation(s)
- Jin-Ku Lee
- Cancer Stem Cell Research Center, Department of Neurosurgery, Samsung Medical Center and Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - DO-Hyun Nam
- Cancer Stem Cell Research Center, Department of Neurosurgery, Samsung Medical Center and Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - Jeongwu Lee
- Department of Stem Cell Biology and Regenerative Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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19
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Gatson NTN, Weathers SPS, de Groot JF. ReACT Phase II trial: a critical evaluation of the use of rindopepimut plus bevacizumab to treat EGFRvIII-positive recurrent glioblastoma. CNS Oncol 2015; 5:11-26. [PMID: 26670466 DOI: 10.2217/cns.15.38] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Glioblastoma is the most deadly primary brain tumor in adults and has long represented a therapeutic challenge. Disease recurrence is inevitable, and the management of recurrent disease is complicated by spontaneous or induced tumor heterogeneity which confers resistance to therapy and increased oncogenicity. EGFR and the tumor-specific mutation EGFRvIII is commonly altered in glioblastoma making it an appealing therapeutic target. Immunotherapy is an emerging and promising therapeutic approach to glioma and the EGFRvIII vaccine, rindopepimut, is the first immunotherapeutic drug to enter Phase III clinical trials for glioblastoma. Rindopepimut activates a specific immune response against tumor cells harboring the EGFRvIII protein. This review evaluates the recently completed ReACT Phase II trial using rindopepimut plus bevacizumab in the setting of EGFRvIII-positive recurrent glioblastoma (Clinical Trials identifier: NCT01498328).
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Affiliation(s)
- Na Tosha N Gatson
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0431, Houston, TX 77054, USA
| | - Shiao-Pei S Weathers
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0431, Houston, TX 77054, USA
| | - John F de Groot
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0431, Houston, TX 77054, USA
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20
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Abstract
PURPOSE OF REVIEW A major recent clinical research focus for glioblastoma has been the therapeutic evaluation of antiangiogenic agents. Several vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitors and a soluble decoy VEGF receptor have demonstrated nominal benefit among patients. In contrast, bevacizumab, a humanized VEGF monoclonal antibody, exhibits evidence of apparent antitumor benefit, although these data remain controversial. In this review, we summarize how results of clinical trials evaluating bevacizumab to date influence the future of this therapeutic for recurrent and newly diagnosed glioblastoma patients. RECENT FINDINGS Recently reported, placebo-controlled phase III studies demonstrate a meaningful progression-free survival increment, but no overall survival benefit among newly diagnosed patients treated with bevacizumab. For unclear reasons, quality-of-life surveys from these studies revealed divergent results. Among recurrent patients, uncontrolled trials demonstrate improved overall radiographic response and progression-free survival rates, although the impact of bevacizumab on overall survival remains to be defined by an ongoing randomized phase III trial. SUMMARY The role of bevacizumab for glioblastoma remains uncertain but will likely be strongly influenced by results of a randomized phase III study among recurrent patients as well as further investigation of gene expression biomarker profiles to identify newly diagnosed patients more likely to derive survival benefit.
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21
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Alifieris C, Trafalis DT. Glioblastoma multiforme: Pathogenesis and treatment. Pharmacol Ther 2015; 152:63-82. [PMID: 25944528 DOI: 10.1016/j.pharmthera.2015.05.005] [Citation(s) in RCA: 501] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 12/12/2022]
Abstract
Each year, about 5-6 cases out of 100,000 people are diagnosed with primary malignant brain tumors, of which about 80% are malignant gliomas (MGs). Glioblastoma multiforme (GBM) accounts for more than half of MG cases. They are associated with high morbidity and mortality. Despite current multimodality treatment efforts including maximal surgical resection if feasible, followed by a combination of radiotherapy and/or chemotherapy, the median survival is short: only about 15months. A deeper understanding of the pathogenesis of these tumors has presented opportunities for newer therapies to evolve and an expectation of better control of this disease. Lately, efforts have been made to investigate tumor resistance, which results from complex alternate signaling pathways, the existence of glioma stem-cells, the influence of the blood-brain barrier as well as the expression of 0(6)-methylguanine-DNA methyltransferase. In this paper, we review up-to-date information on MGs treatment including current approaches, novel drug-delivering strategies, molecular targeted agents and immunomodulative treatments, and discuss future treatment perspectives.
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Affiliation(s)
| | - Dimitrios T Trafalis
- Laboratory of Pharmacology, Medical School, University of Athens, Athens, Greece.
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22
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Ilkhanizadeh S, Lau J, Huang M, Foster DJ, Wong R, Frantz A, Wang S, Weiss WA, Persson AI. Glial progenitors as targets for transformation in glioma. Adv Cancer Res 2015; 121:1-65. [PMID: 24889528 DOI: 10.1016/b978-0-12-800249-0.00001-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Glioma is the most common primary malignant brain tumor and arises throughout the central nervous system. Recent focus on stem-like glioma cells has implicated neural stem cells (NSCs), a minor precursor population restricted to germinal zones, as a potential source of gliomas. In this review, we focus on the relationship between oligodendrocyte progenitor cells (OPCs), the largest population of cycling glial progenitors in the postnatal brain, and gliomagenesis. OPCs can give rise to gliomas, with signaling pathways associated with NSCs also playing key roles during OPC lineage development. Gliomas can also undergo a switch from progenitor- to stem-like phenotype after therapy, consistent with an OPC-origin even for stem-like gliomas. Future in-depth studies of OPC biology may shed light on the etiology of OPC-derived gliomas and reveal new therapeutic avenues.
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Affiliation(s)
- Shirin Ilkhanizadeh
- Department of Neurology, University of California, San Francisco, California, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Jasmine Lau
- Department of Neurology, University of California, San Francisco, California, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Miller Huang
- Department of Neurology, University of California, San Francisco, California, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Daniel J Foster
- Department of Neurology, University of California, San Francisco, California, USA; Department of Neurological Surgery and Brain Tumor Research Center, University of California, San Francisco, California, USA; Sandler Neurosciences Center, University of California, San Francisco, California, USA
| | - Robyn Wong
- Department of Neurology, University of California, San Francisco, California, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Aaron Frantz
- Department of Neurology, University of California, San Francisco, California, USA; Department of Neurological Surgery and Brain Tumor Research Center, University of California, San Francisco, California, USA; Sandler Neurosciences Center, University of California, San Francisco, California, USA
| | - Susan Wang
- Department of Neurology, University of California, San Francisco, California, USA; Department of Neurological Surgery and Brain Tumor Research Center, University of California, San Francisco, California, USA; Sandler Neurosciences Center, University of California, San Francisco, California, USA
| | - William A Weiss
- Department of Neurology, University of California, San Francisco, California, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA; Department of Neurological Surgery and Brain Tumor Research Center, University of California, San Francisco, California, USA; Department of Neurology, University of California, San Francisco, California, USA
| | - Anders I Persson
- Department of Neurology, University of California, San Francisco, California, USA; Department of Neurological Surgery and Brain Tumor Research Center, University of California, San Francisco, California, USA; Sandler Neurosciences Center, University of California, San Francisco, California, USA.
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23
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Curry RC, Dahiya S, Alva Venur V, Raizer JJ, Ahluwalia MS. Bevacizumab in high-grade gliomas: past, present, and future. Expert Rev Anticancer Ther 2015; 15:387-97. [DOI: 10.1586/14737140.2015.1028376] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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24
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Rhun EL, Taillibert S, Chamberlain MC. The future of high-grade glioma: Where we are and where are we going. Surg Neurol Int 2015; 6:S9-S44. [PMID: 25722939 PMCID: PMC4338495 DOI: 10.4103/2152-7806.151331] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/15/2014] [Indexed: 01/12/2023] Open
Abstract
High-grade glioma (HGG) are optimally treated with maximum safe surgery, followed by radiotherapy (RT) and/or systemic chemotherapy (CT). Recently, the treatment of newly diagnosed anaplastic glioma (AG) has changed, particularly in patients with 1p19q codeleted tumors. Results of trials currenlty ongoing are likely to determine the best standard of care for patients with noncodeleted AG tumors. Trials in AG illustrate the importance of molecular characterization, which are germane to both prognosis and treatment. In contrast, efforts to improve the current standard of care of newly diagnosed glioblastoma (GB) with, for example, the addition of bevacizumab (BEV), have been largely disappointing and furthermore molecular characterization has not changed therapy except in elderly patients. Novel approaches, such as vaccine-based immunotherapy, for newly diagnosed GB are currently being pursued in multiple clinical trials. Recurrent disease, an event inevitable in nearly all patients with HGG, continues to be a challenge. Both recurrent GB and AG are managed in similar manner and when feasible re-resection is often suggested notwithstanding limited data to suggest benefit from repeat surgery. Occassional patients may be candidates for re-irradiation but again there is a paucity of data to commend this therapy and only a minority of selected patients are eligible for this approach. Consequently systemic therapy continues to be the most often utilized treatment in recurrent HGG. Choice of therapy, however, varies and revolves around re-challenge with temozolomide (TMZ), use of a nitrosourea (most often lomustine; CCNU) or BEV, the most frequently used angiogenic inhibitor. Nevertheless, no clear standard recommendation regarding the prefered agent or combination of agents is avaliable. Prognosis after progression of a HGG remains poor, with an unmet need to improve therapy.
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Affiliation(s)
- Emilie Le Rhun
- Department of Neuro-oncology, Roger Salengro Hospital, University Hospital, Lille, and Neurology, Department of Medical Oncology, Oscar Lambret Center, Lille, France, Inserm U-1192, Laboratoire de Protéomique, Réponse Inflammatoire, Spectrométrie de Masse (PRISM), Lille 1 University, Villeneuve D’Ascq, France
| | - Sophie Taillibert
- Neurology, Mazarin and Radiation Oncology, Pitié Salpétrière Hospital, University Pierre et Marie Curie, Paris VI, Paris, France
| | - Marc C. Chamberlain
- Department of Neurology and Neurological Surgery, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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25
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Taylor JW, Dietrich J, Gerstner ER, Norden AD, Rinne ML, Cahill DP, Stemmer-Rachamimov A, Wen PY, Betensky RA, Giorgio DH, Snodgrass K, Randall AE, Batchelor TT, Chi AS. Phase 2 study of bosutinib, a Src inhibitor, in adults with recurrent glioblastoma. J Neurooncol 2015; 121:557-63. [PMID: 25411098 PMCID: PMC4323868 DOI: 10.1007/s11060-014-1667-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
Tumor cell infiltration is a major mechanism of treatment escape in glioblastoma. Src is an intracellular tyrosine kinase that mediates tumor cell motility and invasiveness. We evaluated the efficacy and safety of bosutinib, a tyrosine kinase inhibitor that potently inhibits Src and Abl, in patients with recurrent glioblastoma. In this two-arm study, patients with histologically confirmed recurrent glioblastoma and ≤2 relapses, not previously treated with anti-vascular endothelial growth factor (VEGF) therapy, were administered oral bosutinib 400 mg daily. Arm A planned for 6 patients who were candidates for surgical resection to be given bosutinib for 7-9 days prior to resection. Arm B was a two-stage design phase 2 trial targeting 30 patients. The primary endpoint was progression-free survival at 6 months (PFS6) in Arm B. After 9 patients enrolled onto stage 1 of Arm B, 9 (100 %) patients progressed within 6 months. Therefore, the study met the pre-specified criteria for early closure and both Arms were closed. In Arm B, Median PFS was 7.71 weeks and median OS was 50 weeks. Best objective response was stable disease in one patient (11.1 %). Seven patients (77.8 %) had treatment-related AEs of any grade and 2 (22.2 %) were grade ≥3. Arm A was closed after 2 patients enrolled. Src activation was evident in all archival tumor samples. Bosutinib monotherapy does not appear to be effective in recurrent glioblastoma. However, Src remains a potential target based on its upregulation in tumor samples and role in glioma invasion.
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Affiliation(s)
- Jennie W Taylor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA,
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26
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Abstract
Despite decades of advancing science and clinical trials, average survival remains dismal for individuals with high-grade gliomas. Our understanding of the genetic and molecular aberrations that contribute to the aggressive nature of these tumors is continually growing, as is our ability to target such specific traits. Herein, we review the major classes of such targeted therapies, as well as the relevant clinical trial outcomes regarding their efficacy.
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Affiliation(s)
- Justin T Jordan
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02215, USA
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27
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Batchelor TT, Reardon DA, de Groot JF, Wick W, Weller M. Antiangiogenic therapy for glioblastoma: current status and future prospects. Clin Cancer Res 2014; 20:5612-9. [PMID: 25398844 PMCID: PMC4234180 DOI: 10.1158/1078-0432.ccr-14-0834] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glioblastoma is characterized by high expression levels of proangiogenic cytokines and microvascular proliferation, highlighting the potential value of treatments targeting angiogenesis. Antiangiogenic treatment likely achieves a beneficial impact through multiple mechanisms of action. Ultimately, however, alternative proangiogenic signal transduction pathways are activated, leading to the development of resistance, even in tumors that initially respond. The identification of biomarkers or imaging parameters to predict response and to herald resistance is of high priority. Despite promising phase II clinical trial results and patient benefit in terms of clinical improvement and longer progression-free survival, an overall survival benefit has not been demonstrated in four randomized phase III trials of bevacizumab or cilengitide in newly diagnosed glioblastoma or cediranib or enzastaurin in recurrent glioblastoma. However, future studies are warranted. Predictive markers may allow appropriate patient enrichment, combination with chemotherapy may ultimately prove successful in improving overall survival, and novel agents targeting multiple proangiogenic pathways may prove effective.
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Affiliation(s)
- Tracy T Batchelor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts.
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wolfgang Wick
- Neurooncology, University Clinic Heidelberg and German Cancer Consortium (DKTK), German Cancer Research Center, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland
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28
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Hu J, Muller KA, Furnari FB, Cavenee WK, VandenBerg SR, Gonias SL. Neutralizing the EGF receptor in glioblastoma cells stimulates cell migration by activating uPAR-initiated cell signaling. Oncogene 2014; 34:4078-88. [PMID: 25347738 PMCID: PMC4411189 DOI: 10.1038/onc.2014.336] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/03/2014] [Accepted: 09/14/2014] [Indexed: 12/13/2022]
Abstract
In glioblastoma (GBM), the EGF receptor (EGFR) and Src family kinases (SFKs) contribute to an aggressive phenotype. EGFR may be targeted therapeutically; however, resistance to EGFR-targeting drugs such as Erlotinib and Gefitinib develops quickly. In many GBMs, a truncated form of the EGFR (EGFRvIII) is expressed. Although EGFRvIII is constitutively active and promotes cancer progression, its activity is attenuated compared with EGF-ligated wild-type EGFR, suggesting that EGFRvIII may function together with other signaling receptors in cancer cells to induce an aggressive phenotype. In this study, we demonstrate that in EGFRvIII-expressing GBM cells, the urokinase receptor (uPAR) functions as a major activator of SFKs, controlling phosphorylation of downstream targets, such as p130Cas and Tyr-845 in the EGFR in vitro and in vivo. When EGFRvIII expression in GBM cells was neutralized, either genetically or by treating the cells with Gefitinib, paradoxically, the cells demonstrated increased cell migration. The increase in cell migration was explained by a compensatory increase in expression of urokinase-type plasminogen activator, which activates uPAR-dependent cell signaling. GBM cells that were selected for their ability to grow in vivo in the absence of EGFRvIII also demonstrated increased cell migration, due to activation of the uPAR signaling system. The increase in GBM cell migration, induced by genetic or pharmacologic targeting of the EGFR, was blocked by Dasatinib, highlighting the central role of SFKs in uPAR-promoted cell migration. These results suggest that compensatory activation of uPAR-dependent cell signaling, in GBM cells treated with targeted therapeutics, may adversely affect the course of the disease by promoting cell migration, which may be associated with tumor progression.
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Affiliation(s)
- J Hu
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - K A Muller
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - F B Furnari
- 1] Department of Pathology, University of California San Diego, La Jolla, CA, USA [2] The Ludwig Institute for Cancer Research, University of California San Diego, La Jolla, CA, USA
| | - W K Cavenee
- 1] The Ludwig Institute for Cancer Research, University of California San Diego, La Jolla, CA, USA [2] Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - S R VandenBerg
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - S L Gonias
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
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29
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Lee JK, Joo KM, Lee J, Yoon Y, Nam DH. Targeting the epithelial to mesenchymal transition in glioblastoma: the emerging role of MET signaling. Onco Targets Ther 2014; 7:1933-44. [PMID: 25364264 PMCID: PMC4211615 DOI: 10.2147/ott.s36582] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Glioblastoma multiforme (GBM) is the most common human primary brain malignancy and has a dismal prognosis. Aggressive treatments using maximal surgical resection, radiotherapy, and temozolomide result in median survival of only 14.6 months in patients with GBM. Numerous clinical approaches using small molecule inhibitors have shown disappointing results because of the genetic heterogeneity of GBM. The epithelial to mesenchymal transition (EMT) is a crucial biological process occurring in the early development stages of many species. However, cancer cells often obtain the ability to invade and metastasize through the EMT, which triggers the scattering of cells. The hepatocyte growth factor (HGF)/MET signaling pathway is indicative of the EMT during both embryogenesis and the invasive growth of tumors, because HGF potently induces mesenchymal transition in epithelial-driven cells. Activation of MET signaling or co-overexpression of HGF and MET frequently represents aggressive growth and poor prognosis of various cancers, including GBM. Thus, efforts to treat cancers by inhibiting MET signaling using neutralizing antibodies or small molecule inhibitors have progressed during the last decade. In this review, we discuss HGF/MET signaling in the development of diseases, including cancers, as well as updates on MET inhibition therapy.
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Affiliation(s)
- Jin-Ku Lee
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea ; Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeung Min Joo
- Department of Anatomy and Cell Biology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeongwu Lee
- Department of Stem Cell Biology and Regenerative Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yeup Yoon
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea ; Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
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30
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Rahman R, Hempfling K, Norden AD, Reardon DA, Nayak L, Rinne ML, Beroukhim R, Doherty L, Ruland S, Rai A, Rifenburg J, LaFrankie D, Alexander BM, Huang RY, Wen PY, Lee EQ. Retrospective study of carmustine or lomustine with bevacizumab in recurrent glioblastoma patients who have failed prior bevacizumab. Neuro Oncol 2014; 16:1523-9. [PMID: 24958095 DOI: 10.1093/neuonc/nou118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Currently, there are no known effective treatments for recurrent glioblastoma once patients have progressed on a bevacizumab-containing regimen. We examined the efficacy of adding nitrosoureas to bevacizumab in patients who progressed while on an initial bevacizumab-containing regimen. METHODS In this retrospective study, we identified adult patients with histologically confirmed glioblastoma (WHO grade IV) who were treated with lomustine or carmustine in combination with bevacizumab as a second or third regimen after failing an alternative initial bevacizumab-containing regimen. Response rate (RR), 6-month progression free survival (PFS6), and progression-free survival (PFS) were assessed for each treatment. RESULTS Forty-two patients were identified (28 males) with a median age of 49 years (range, 24-78 y). Of 42 patients, 28 received lomustine (n = 22) or carmustine (n = 6) with bevacizumab as their second bevacizumab-containing regimen, and 14 received lomustine (n = 11) or carmustine (n = 3) as their third bevacizumab-containing regimen. While the median PFS for the initial bevacizumab-containing regimen was 16.3 weeks, the median PFS for the nitrosourea-containing bevacizumab regimen was 6.3 weeks. Patients had an RR of 44% and a PFS6 rate of 26% during the initial bevacizumab regimen and an RR of 0% and a PFS6 rate of 3% during the nitrosourea-containing bevacizumab regimen. There was increased grade 3-4 toxicity (45% vs 19%, P = .010) during the nitrosourea-containing bevacizumab regimen relative to the initial bevacizumab regimen. Median overall survival was 18.7 weeks from initiation of the nitrosourea-containing bevacizumab regimen. CONCLUSION The addition of lomustine or carmustine to bevacizumab after a patient has already progressed on a bevacizumab-containing regimen does not appear to provide benefit for most patients and is associated with additional toxicity with the doses used in this cohort.
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Affiliation(s)
- Rifaquat Rahman
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Kelly Hempfling
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Andrew D Norden
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - David A Reardon
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Lakshmi Nayak
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Mikael L Rinne
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Rameen Beroukhim
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Lisa Doherty
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Sandra Ruland
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Arun Rai
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Jennifer Rifenburg
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Debra LaFrankie
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Brian M Alexander
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Raymond Y Huang
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Patrick Y Wen
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Eudocia Q Lee
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
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31
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The role of targeted therapies in the management of progressive glioblastoma. J Neurooncol 2014; 118:557-99. [DOI: 10.1007/s11060-013-1339-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/28/2013] [Indexed: 12/28/2022]
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Magnuson W, Ian Robins H, Mohindra P, Howard S. Large volume reirradiation as salvage therapy for glioblastoma after progression on bevacizumab. J Neurooncol 2014; 117:133-9. [PMID: 24469853 DOI: 10.1007/s11060-014-1363-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
Outcomes after bevacizumab failure for recurrent glioblastoma (GBM) are poor. Our analysis of 16 phase II trials (n = 995) revealed a median overall survival (OS) of 3.8 months (±1.0 month SD) after bevacizumab failure with no discernible activity of salvage chemotherapy. Thus, the optimal treatment for disease progression after bevacizumab has yet to be elucidated. This study evaluated the efficacy of reirradiation for patients with GBM after progression on bevacizumab. An IRB approved retrospective (2/2008-5/2013) analysis was performed of 23 patients with recurrent GBM (after standard radiotherapy/temozolomide) treated with bevacizumab (10 mg/kg) every 2 weeks until progression (median age 53 years; median KPS 80; median progression free survival on bevacizumab 3.7 months). Within 7-14 days of progression on bevacizumab, patients initiated reirradiation to a dose of 54 Gy in 27 fractions using pulsed-reduced dose rate (PRDR) radiotherapy. The median planning target volume was 424 cm(3). At the start of reirradiation, bevacizumab (10 mg/kg) was given every 4 weeks for two additional cycles. The median OS and 6 month OS after bevacizumab failure was 6.9 months and 65 %, respectively. Reirradiation was well tolerated with no symptomatic grade 3-4 toxicities. Favorable outcomes of reirradiation after bevacizumab failure in patients with recurrent GBM suggest its role as a treatment option for large volume recurrences not amenable to stereotactic radiosurgery. As PRDR is easily accomplished from a technological standpoint, we are in the process of expanding this approach to a multi-institutional cooperative group trial.
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Affiliation(s)
- William Magnuson
- Department of Radiation Oncology, University of Wisconsin, Madison, WI, USA
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33
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Wiestler B, Radbruch A, Osswald M, Combs SE, Jungk C, Winkler F, Bendszus M, Unterberg A, Platten M, Wick W, Wick A. Towards optimizing the sequence of bevacizumab and nitrosoureas in recurrent malignant glioma. J Neurooncol 2014; 117:85-92. [PMID: 24458956 DOI: 10.1007/s11060-013-1356-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/31/2013] [Indexed: 12/24/2022]
Abstract
Studies on the monoclonal VEGF-A antibody bevacizumab gave raise to questions regarding the lack of an overall survival benefit, the optimal timing in the disease course and potential combination and salvage therapies. We retrospectively assessed survival, radiological progression type on bevacizumab and efficacy of salvage therapies in 42 patients with recurrent malignant gliomas who received bevacizumab and nitrosourea sequentially. 15 patients received bevacizumab followed by nitrosourea at progression and 27 patients vice versa. Time to treatment failure, defined as time from initiation of one to failure of the other treatment, was similar in both groups (9.6 vs. 9.2 months, log rank p = 0.19). Progression-free survival on nitrosoureas was comparable in both groups, while progression-free survival on bevacizumab was longer in the group receiving bevacizumab first (5.3 vs. 4.1 months, log rank p = 0.03). Survival times were similar for patients with grade III (n = 9) and grade IV (n = 33) tumors. Progression-free survival on bevacizumab for patients developing contrast-enhancing T1 progression was longer than for patients who displayed a non-enhancing T2 progression. However, post-progression survival times after bevacizumab failure were not different. Earlier treatment with bevacizumab was not associated with better outcome in this series. The fact that earlier as compared to later bevacizumab treatment does not result in a different time to treatment failure highlights the challenge for first-line or recurrence trials with bevacizumab to demonstrate an overall survival benefit if crossover of bevacizumab-naïve patients after progression occurs.
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Affiliation(s)
- Benedikt Wiestler
- Department of Neurooncology, University Hospital Heidelberg and National Center for Tumor Diseases, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Ahluwalia MS, Patel M, Peereboom DM. Role of tyrosine kinase inhibitors in the management of high-grade gliomas. Expert Rev Anticancer Ther 2014; 11:1739-48. [DOI: 10.1586/era.11.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Bruno A, Pagani A, Magnani E, Rossi T, Noonan DM, Cantelmo AR, Albini A. Inflammatory angiogenesis and the tumor microenvironment as targets for cancer therapy and prevention. Cancer Treat Res 2014; 159:401-426. [PMID: 24114493 DOI: 10.1007/978-3-642-38007-5_23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In addition to aberrant transformed cells, tumors are tissues that contain host components, including stromal cells, vascular cells (ECs) and their precursors, and immune cells. All these constituents interact with each other at the cellular and molecular levels, resulting in the production of an intricate and heterogeneous complex of cells and matrix defined as the tumor microenvironment. Several pathways involved in these interactions have been investigated both in pathological and physiological scenarios, and diverse molecules are currently targets of chemotherapeutic and preventive drugs. Many phytochemicals and their derivatives show the ability to inhibit tumor progression, angiogenesis, and metastasis, exerting effects on the tumor microenvironment. In this review, we will outline the principal players and mechanisms involved in the tumor microenvironment network and we will discuss some interesting compounds aimed at interrupting these interactions and blocking tumor insurgence and progression. The considerations provided will be crucial for the design of new preventive approaches to the reduction in cancer risk that need to be applied to large populations composed of apparently healthy individuals.
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Affiliation(s)
- Antonino Bruno
- Polo Scientifico e Tecnologico, MultiMedica Onlus, Milano, Italy
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36
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DRR regulates AKT activation to drive brain cancer invasion. Oncogene 2013; 33:4952-60. [PMID: 24141773 DOI: 10.1038/onc.2013.436] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/02/2013] [Accepted: 08/12/2013] [Indexed: 01/12/2023]
Abstract
Glioblastoma (GBM) is the most common and invasive adult brain cancer. The rapid invasion of cancer cells into the normal brain is a major cause of treatment failure, yet the mechanisms that regulate this process are poorly understood. We have identified a novel mechanism of brain cancer invasion. We show that downregulated in renal cell carcinoma (DRR), which is newly expressed in invasive gliomas, recruits AKT to focal adhesions. This DRR- induced pathological relocalization of AKT bypasses commonly altered upstream signaling events and leads to AKT activation and invasion. We also developed an oligonucleotide therapeutic that reduces DRR expression and prevents glioma invasion in an in vivo preclinical model of the disease. Our findings identify DRR as a novel GBM target and show that oligonucleotides targeting DRR is a novel therapeutic approach for the treatment of DRR-positive GBMs.
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Liu WM, Huang P, Kar N, Burgett M, Muller-Greven G, Nowacki AS, Distelhorst CW, Lathia JD, Rich JN, Kappes JC, Gladson CL. Lyn facilitates glioblastoma cell survival under conditions of nutrient deprivation by promoting autophagy. PLoS One 2013; 8:e70804. [PMID: 23936469 PMCID: PMC3732228 DOI: 10.1371/journal.pone.0070804] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
Members of the Src family kinases (SFK) can modulate diverse cellular processes, including division, death and survival, but their role in autophagy has been minimally explored. Here, we investigated the roles of Lyn, a SFK, in promoting the survival of human glioblastoma tumor (GBM) cells in vitro and in vivo using lentiviral vector-mediated expression of constitutively-active Lyn (CA-Lyn) or dominant-negative Lyn (DN-Lyn). Expression of either CA-Lyn or DN-Lyn had no effect on the survival of U87 GBM cells grown under nutrient-rich conditions. In contrast, under nutrient-deprived conditions (absence of supplementation with L-glutamine, which is essential for growth of GBM cells, and FBS) CA-Lyn expression enhanced survival and promoted autophagy as well as inhibiting cell death and promoting proliferation. Expression of DN-Lyn promoted cell death. In the nutrient-deprived GBM cells, CA-Lyn expression enhanced AMPK activity and reduced the levels of pS6 kinase whereas DN-Lyn enhanced the levels of pS6 kinase. Similar results were obtained in vitro using another cultured GBM cell line and primary glioma stem cells. On propagation of the transduced GBM cells in the brains of nude mice, the CA-Lyn xenografts formed larger tumors than control cells and autophagosomes were detectable in the tumor cells. The DN-Lyn xenografts formed smaller tumors and contained more apoptotic cells. Our findings suggest that on nutrient deprivation in vitro Lyn acts to enhance the survival of GBM cells by promoting autophagy and proliferation as well as inhibiting cell death, and Lyn promotes the same effects in vivo in xenograft tumors. As the levels of Lyn protein or its activity are elevated in several cancers these findings may be of broad relevance to cancer biology.
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Affiliation(s)
- Wei Michael Liu
- Department of Cancer Biology, The Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Ping Huang
- Department of Cancer Biology, The Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Niladri Kar
- Department of Cancer Biology, The Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Monica Burgett
- Department of Cancer Biology, The Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- School of Biomedical Sciences, Kent State University, Kent, Ohio, United States of America
| | - Gaelle Muller-Greven
- Department of Cancer Biology, The Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- School of Biomedical Sciences, Kent State University, Kent, Ohio, United States of America
| | - Amy S. Nowacki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Clark W. Distelhorst
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Justin D. Lathia
- Department of Stem Cell Biology and Regenerative Medicine, The Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Jeremy N. Rich
- Department of Stem Cell Biology and Regenerative Medicine, The Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - John C. Kappes
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Candece L. Gladson
- Department of Cancer Biology, The Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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Chamberlain MC. Role for cytotoxic chemotherapy in patients with recurrent glioblastoma progressing on bevacizumab: a retrospective case series. Expert Rev Neurother 2013; 12:929-36. [PMID: 23002937 DOI: 10.1586/ern.12.84] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
One hundred patients, aged 36-84 years (median 62 years) with recurrent glioblastoma (GBM), were treated previously with surgery, concurrent radiotherapy and temozolomide and postradiotherapy temozolomide followed by single-agent bevacizumab (BEV) at either first (60 patients) or second recurrence (40 patients). Patients were then treated following progression on BEV only with BEV and carboplatin (75 patients), cyclophosphamide (15 patients) or BCNU (ten patients; BEV+). Three hundred and sixteen treatment cycles (median: 2; range: 1-9) were administered of BEV+. There were 74 grade 3 adverse events in 29 patients (29%) and 20 grade 4 adverse events in ten patients (10%). Following 2 months of BEV+, 60 patients (60%) demonstrated progressive disease and discontinued therapy. Forty patients (40%) had neuroradiographic stable disease. Survival ranged from 1 to 12 months (median: 4 months). Median and 6-month progression free survival was 2.5 months and 5%, respectively. BEV plus a cytotoxic chemotherapy demonstrated limited efficacy in BEV-refractory GBM and emphasizes an unmet need in neuro-oncology in adults with BEV-refractory GBM.
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Affiliation(s)
- Marc C Chamberlain
- Department of Neurology and Neurological Surgery, Fred Hutchinson Cancer Research Center, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA.
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Omuro A, Chan TA, Abrey LE, Khasraw M, Reiner AS, Kaley TJ, Deangelis LM, Lassman AB, Nolan CP, Gavrilovic IT, Hormigo A, Salvant C, Heguy A, Kaufman A, Huse JT, Panageas KS, Hottinger AF, Mellinghoff I. Phase II trial of continuous low-dose temozolomide for patients with recurrent malignant glioma. Neuro Oncol 2012; 15:242-50. [PMID: 23243055 DOI: 10.1093/neuonc/nos295] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In this phase II trial, we investigated the efficacy of a metronomic temozolomide schedule in the treatment of recurrent malignant gliomas (MGs). METHODS Eligible patients received daily temozolomide (50 mg/m2) continuously until progression. The primary endpoint was progression-free survival rate at 6 months in the glioblastoma cohort (N = 37). In an exploratory analysis, 10 additional recurrent grade III MG patients were enrolled. Correlative studies included evaluation of 76 frequent mutations in glioblastoma (iPLEX assay, Sequenom) aiming at establishing the frequency of potentially "drugable" mutations in patients entering recurrent MG clinical trials. RESULTS Among glioblastoma patients, median age was 56 y; median Karnofsky performance score (KPS) was 80; 62% of patients had been treated for ≥2 recurrences, including 49% of patients having failed bevacizumab. Treatment was well tolerated; clinical benefit (complete response + partial response + stable disease) was seen in 10 (36%) patients. Progression-free survival rate at 6 months was 19% and median overall survival was 7 months. Patients with previous bevacizumab exposure survived significantly less than bevacizumab-naive patients (median overall survival: 4.3 mo vs 13 mo; hazard ratio = 3.2; P = .001), but those patients had lower KPS (P = .04) and higher number of recurrences (P < .0001). Mutations were found in 13 of the 38 MGs tested, including mutations of EGFR (N = 10), IDH1 (N = 5), and ERBB2 (N = 1). CONCLUSIONS In spite of a heavily pretreated population, including nearly half of patients having failed bevacizumab, the primary endpoint was met, suggesting that this regimen deserves further investigation. Results in bevacizumab-naive patients seemed particularly favorable, while results in bevacizumab-failing patients highlight the need to develop further treatment strategies for advanced MG. Clinical trials.gov identifier NCT00498927 (available at http://clinicaltrials.gov/ct2/show/NCT00498927).
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Affiliation(s)
- Antonio Omuro
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Bevacizumab continuation beyond initial bevacizumab progression among recurrent glioblastoma patients. Br J Cancer 2012; 107:1481-7. [PMID: 23037712 PMCID: PMC3493761 DOI: 10.1038/bjc.2012.415] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Bevacizumab improves outcome for most recurrent glioblastoma patients, but the duration of benefit is limited and survival after initial bevacizumab progression is poor. We evaluated bevacizumab continuation beyond initial progression among recurrent glioblastoma patients as it is a common, yet unsupported practice in some countries. METHODS We analysed outcome among all patients (n=99) who received subsequent therapy after progression on one of five consecutive, single-arm, phase II clinical trials evaluating bevacizumab regimens for recurrent glioblastoma. Of note, the five trials contained similar eligibility, treatment and assessment criteria, and achieved comparable outcome. RESULTS The median overall survival (OS) and OS at 6 months for patients who continued bevacizumab therapy (n=55) were 5.9 months (95% confidence interval (CI): 4.4, 7.6) and 49.2% (95% CI: 35.2, 61.8), compared with 4.0 months (95% CI: 2.1, 5.4) and 29.5% (95% CI: 17.0, 43.2) for patients treated with a non-bevacizumab regimen (n=44; P=0.014). Bevacizumab continuation was an independent predictor of improved OS (hazard ratio=0.64; P=0.04). CONCLUSION The results of our retrospective pooled analysis suggest that bevacizumab continuation beyond initial progression modestly improves survival compared with available non-bevacizumab therapy for recurrent glioblastoma patients require evaluation in an appropriately randomised, prospective trial.
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McNamara MG, Mason WP. Antiangiogenic therapies in glioblastoma multiforme. Expert Rev Anticancer Ther 2012; 12:643-54. [PMID: 22594899 DOI: 10.1586/era.12.35] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Glioblastoma multiforme (GBM) is the most common and lethal of adult gliomas. The prognosis for the great majority of patients with GBM is poor as almost all tumors recur following optimal surgical resection, radiation and standard chemotherapy, resulting in rapid disease-related death. The standard of care for recurrent GBM has not been clearly established. GBMs are highly vascularized brain tumors and growth has been shown to be angiogenesis dependent, thus stimulating interest in developing antiangiogenic therapeutic strategies. Antiangiogenic agents are the most promising novel agents in development for GBM but to date have not substantially changed overall survival. Future antiangiogenic strategies designed to overcome limitations of current antiangiogenic agents will likely involve the use of agent combinations that target pathways mediating resistance to antiangiogenic agents and tumor invasion.
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Affiliation(s)
- Mairéad G McNamara
- Pencer Brain Tumor Centre, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, Canada
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Abstract
The diffuse nature of gliomas has long confounded attempts at achieving a definitive cure. The advent of computed tomography and magnetic resonance imaging made it increasingly apparent that gliomas could have a multifocal or multicentric appearance. Treating these tumors is the summit of an already daunting challenge, because the obstacles that must be surmounted to treat gliomas in general, namely, their heterogeneity, diffuse nature, and ability to insidiously invade normal brain, are more conspicuous in this subset of tumors.
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Affiliation(s)
- Chirag G Patil
- Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Reardon DA, Vredenburgh JJ, Desjardins A, Peters KB, Sathornsumetee S, Threatt S, Sampson JH, Herndon JE, Coan A, McSherry F, Rich JN, McLendon RE, Zhang S, Friedman HS. Phase 1 trial of dasatinib plus erlotinib in adults with recurrent malignant glioma. J Neurooncol 2012; 108:499-506. [PMID: 22407177 PMCID: PMC3690584 DOI: 10.1007/s11060-012-0848-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/26/2012] [Indexed: 12/20/2022]
Abstract
To determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of dasatinib, an inhibitor of the Src family kinase proteins, with erlotinib, an epidermal growth factor receptor tyrosine kinase inhibitor, among recurrent malignant glioma patients. Once daily dasatinib was escalated in successive cohorts while erlotinib was administered daily at established doses based on concurrent CYP3A-inducing anticonvulsant (EIAEDS) use. Dasatinib pharmacokinetic analyzes were performed. Forty-seven patients enrolled including 37 (79 %) with grade IV and 10 (21 %) with grade III malignant glioma. Thirty patients (64 %) were at ≥second recurrence, while 27 (57 %) had received prior bevacizumab. The dasatinib MTD was 180 mg when combined with either 150 mg of erlotinib for patients not on EIAEDs, or 450 mg of erlotinib for patients on EIAEDs. The most common DLTs were diarrhea and fatigue, while most adverse events were grade 2. Pharmacokinetic data suggests that dasatinib exposure increased with increased dasatinib dose and concurrent erlotinib administration, while concurrent EIAED use diminished dasatinib exposure. No radiographic responses were observed, and only one patient (2 %) remained progression-free at 6 months. We demonstrate that dasatinib plus erlotinib can be safely co-administered on a continuous, daily dosing schedule with erlotinib, and established the recommended dose level of this combination.
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Affiliation(s)
- David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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Abstract
Brain tumors--particularly glioblastoma multiforme--pose an important public health problem in the United States. Despite surgical and medical advances, the prognosis for patients with malignant gliomas remains grim: current therapy is insufficient with nearly universal recurrence. A major reason for this failure is the difficulty of delivering therapeutic agents to the brain: better delivery approaches are needed to improve treatment. In this article, we summarize recent progress in drug delivery to the brain, with an emphasis on convection-enhanced delivery of nanocarriers. We examine the potential of new delivery methods to permit novel drug- and gene-based therapies that target brain cancer stem cells and discuss the use of nanomaterials for imaging of tumors and drug delivery.
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Ohka F, Natsume A, Wakabayashi T. Current trends in targeted therapies for glioblastoma multiforme. Neurol Res Int 2012; 2012:878425. [PMID: 22530127 PMCID: PMC3317017 DOI: 10.1155/2012/878425] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/21/2011] [Accepted: 12/07/2011] [Indexed: 12/21/2022] Open
Abstract
Glioblastoma multiforme (GBM) is one of the most frequently occurring tumors in the central nervous system and the most malignant tumor among gliomas. Despite aggressive treatment including surgery, adjuvant TMZ-based chemotherapy, and radiotherapy, GBM still has a dismal prognosis: the median survival is 14.6 months from diagnosis. To date, many studies report several determinants of resistance to this aggressive therapy: (1) O(6)-methylguanine-DNA methyltransferase (MGMT), (2) the complexity of several altered signaling pathways in GBM, (3) the existence of glioma stem-like cells (GSCs), and (4) the blood-brain barrier. Many studies aim to overcome these determinants of resistance to conventional therapy by using various approaches to improve the dismal prognosis of GBM such as modifying TMZ administration and combining TMZ with other agents, developing novel molecular-targeting agents, and novel strategies targeting GSCs. In this paper, we review up-to-date clinical trials of GBM treatments in order to overcome these 4 hurdles and to aim at more therapeutical effect than conventional therapies that are ongoing or are about to launch in clinical settings and discuss future perspectives.
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Affiliation(s)
- Fumiharu Ohka
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Reardon DA, Herndon JE, Peters K, Desjardins A, Coan A, Lou E, Sumrall A, Turner S, Sathornsumetee S, Rich JN, Boulton S, Lipp ES, Friedman HS, Vredenburgh JJ. Outcome after bevacizumab clinical trial therapy among recurrent grade III malignant glioma patients. J Neurooncol 2011; 107:213-21. [PMID: 21997879 DOI: 10.1007/s11060-011-0740-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 10/03/2011] [Indexed: 12/23/2022]
Abstract
Although outcome following bevacizumab among recurrent grade IV malignant glioma patients is documented as poor by several analyses, outcome for recurrent grade III patients following bevacizumab therapy has not been specifically evaluated. We performed a pooled analysis of 96 recurrent grade III malignant glioma patients enrolled on three consecutive phase II bevacizumab salvage trials to evaluate overall outcome following bevacizumab trial discontinuation. Outcome on the three bevacizumab trials, which included similar eligibility, treatment and assessment criteria, was comparable. Forty-nine patients who progressed on bevacizumab trial therapy and remained alive for at least 30 days elected to receive additional therapy. These patients achieved a median PFS-6 and OS of 30.6% (95% CI: 18.4, 43.6) and 10.3 months (95% CI: 5.2, 11.7), respectively. Among patients who continued bevacizumab therapy (n = 23) after study progression, PFS-6 and median OS were 39.1% (95% CI: 19.9, 58.0) and 9.2 months (95% CI: 5.2, 13.6), respectively, compared to 23.1% (95% CI: 9.4, 40.3; P = 0.51) and 10.3 months (95% CI: 2.5, 14.4; P = 0.91) for patients who initiated non-bevacizumab containing therapy (n = 26). Outcome after discontinuation of bevacizumab therapy for recurrent grade III malignant glioma patients is associated with improved outcome compared to historical data for recurrent grade IV malignant glioma patients. Salvage therapies following bevacizumab failure have modest activity for grade III malignant glioma patients that is independent of further bevacizumab continuation.
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Affiliation(s)
- David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, SW-460F, Boston, MA 02215, USA.
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Antiangiogenic therapy for patients with recurrent and newly diagnosed malignant gliomas. JOURNAL OF ONCOLOGY 2011; 2012:193436. [PMID: 21804824 PMCID: PMC3139866 DOI: 10.1155/2012/193436] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 05/24/2011] [Indexed: 12/21/2022]
Abstract
Malignant gliomas have a poor prognosis despite advances in diagnosis and therapy. Although postoperative temozolomide and radiotherapy improve overall survival in glioblastoma patients, most patients experience a recurrence. The prognosis of recurrent malignant gliomas is dismal, and more effective therapeutic strategies are clearly needed. Antiangiogenesis is currently considered an attractive targeting therapy for malignant gliomas due to its important role in tumor growth. Clinical trials using bevacizumab have been performed for recurrent glioblastoma, and these studies have shown promising response rates along with progression-free survival. Based on the encouraging results, bevacizumab was approved by the FDA for the treatment of recurrent glioblastoma. In addition, bevacizumab has shown to be effective for recurrent anaplastic gliomas. Large phase III studies are currently ongoing to demonstrate the efficacy and safety of the addition of bevacizumab to temozolomide and radiotherapy for newly diagnosed glioblastoma. In contrast, several other antiangiogenic drugs have also been used in clinical trials. However, previous studies have not shown whether antiangiogenesis improves the overall survival of malignant gliomas. Specific severe side effects, difficult assessment of response, and lack of rational predictive markers are challenging problems. Further studies are warranted to establish the optimized antiangiogenesis therapy for malignant gliomas.
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Abstract
Despite advances in upfront therapy, the prognosis in the great majority of patients with glioblastoma (GBM) is poor as almost all recur and result in disease-related death. Glioblastoma are highly vascularized cancers with elevated expression levels of vascular endothelial growth factor (VEGF), the dominant mediator of angiogenesis. A compelling biologic rationale, a need for improved therapy, and positive results from studies of bevacizumab in other cancers led to the evaluation of bevacizumab in the treatment of recurrent GBM. Bevacizumab, a humanized monoclonal antibody that targets VEGF, has been shown to improve patient outcomes in combination with chemotherapy (most commonly irinotecan) in recurrent GBM, and on the basis of positive results in two prospective phase 2 studies, bevacizumab was granted accelerated approval by the US Food and Drug Administration (FDA) as a single agent in recurrent GBM. Bevacizumab therapy is associated with manageable, class-specific toxicity as severe treatment-related adverse events are observed in only a minority of patients. With the goal of addressing questions and controversies regarding the optimal use of bevacizumab, the objective of this review is to provide a summary of the clinical efficacy and safety data of bevacizumab in patients with recurrent GBM, the practical issues surrounding the administration of bevacizumab, and ongoing investigations of bevacizumab in managing GBM.
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Affiliation(s)
- Marc C. Chamberlain
- Departments of Neurology and Neurological Surgery, University of Washington, Seattle, WA, USA
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