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Baumgarten P, Prange G, Kamp MA, Monden D, Neef V, Schwarzer F, Dubinski D, Dinc N, Weber KJ, Czabanka M, Hattingen E, Ronellenfitsch MW, Steinbach JP, Senft C. Treatment of very elderly glioblastoma patients ≥ 75 years of age: whom to treat. J Neurooncol 2023; 165:509-515. [PMID: 38032426 PMCID: PMC10752837 DOI: 10.1007/s11060-023-04518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE The prognosis of patients ≥ 75 years suffering from glioblastoma is poor. Novel therapies are usually reserved for patients ≤ 70 years. In an aging population, treatment of very elderly patients remains a challenge. METHODS Between 2010 and 2018, a total of 977 glioblastoma patients were treated at our institution. Of these, 143 patients were ≥ 75 years at diagnosis. Primary procedure was surgical resection or biopsy followed by adjuvant treatment, whenever possible. We retrospectively investigated overall survival (OS) and potential prognostic factors influencing survival, including Karnofsky Performance Status (KPS), surgical therapy, adjuvant therapy as well as MGMT promotor status. RESULTS In very elderly patients, median age was 79 years (range: 75-110). Biopsy only was performed in 104 patients; resection was performed in 39 patients. Median OS for the entire cohort was 5.9 months. Univariate analysis showed that KPS at presentation (≥ 70 vs. ≤60), surgery vs. biopsy, adjuvant chemotherapy and adjuvant radiotherapy were significantly associated with OS (6 vs. 3, p < 0.0111; 12 vs. 4, p = 0.0011; 11 vs. 4, p = 0.0003 and 10 vs. 1.5 months, p < 0.0001, respectively). Multivariate analysis confirmed adjuvant radiotherapy (p < 0.0001) and chemotherapy (p = 0.0002) as independent factors influencing OS. CONCLUSION For very elderly patients, the natural course of disease without treatment is devastating. These patients benefit from multimodal treatment including adjuvant radiotherapy and chemotherapy. A beneficial effect of resection has not been demonstrated. Treatment options and outcomes should be thoughtfully discussed before treatment decisions are made.
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Affiliation(s)
- Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, D-07747, Jena, Germany.
| | - Georg Prange
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
- Centre for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Campus Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Daniel Monden
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Franziska Schwarzer
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Katharina J Weber
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt, Germany
- University Cancer Center (UCT), Goethe University Hospital, Frankfurt, Germany
| | - Markus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael W Ronellenfitsch
- Department of Neuro-Oncology, University Hospital Frankfurt - Goethe-University, Frankfurt, Germany
| | - Joachim P Steinbach
- Department of Neuro-Oncology, University Hospital Frankfurt - Goethe-University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, D-07747, Jena, Germany
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2
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Price G, Rossitto CP, Price H, Hadjipanayis C, Martini M. Trends in Immunotherapy Clinical Trials to Treat Glioblastoma: A Look at Progress and Challenges. World Neurosurg 2023; 178:e819-e827. [PMID: 37574192 DOI: 10.1016/j.wneu.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE We aimed to catalog past and present clinical trials on immunotherapy treatments for glioblastoma (GBM) and discover relevant trends in this field. METHODS Former and ongoing clinical trials involving the use of immunotherapy to treat GBM were queried in July 2022 within the clinicaltrials.gov registry (https://clinicaltrials.gov/). Pertinent trials were categorized by variables including immunotherapy classification, tumor type (newly diagnosed versus recurrent), country of origin, start date, clinical phase, study completion status, estimated subject enrollment, design, publication status, and funding source. RESULTS A list of 173 trials was identified in total. The number of immunotherapy clinical trials to treat GBM has increased over time. The largest proportion of trials were gene therapies (97 studies; 56.1%) and viral therapies (37 studies; 21.4%). Studies were designated as a biologic (45.1%), drug (43.9%), genetic (2.3%), or procedure (1.2%). Trials spanned 19 countries; China, the second largest contributor (5.8%) after the United States (70.0%), has increased clinical trial development in the past years. The average time to completion was 52.3 months. Trials were primarily funded by academic centers; however, one-fourth of the trials were funded by industry and 2 were funded by foundations. One-t of the trials were active and over one-third were linked to publications. CONCLUSIONS Our findings provide a comprehensive summary of the state of immunotherapy clinical trials for GBM, highlighting the evolving nature and growing scope of this field.
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Affiliation(s)
- Gabrielle Price
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Christina P Rossitto
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Price
- Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York, USA
| | | | - Michael Martini
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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3
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Fogg D, Gersey ZC, Pease M, Mallela AN, Andrews E, Plute T, Pearce TM, Njoku-Austin C, Anthony A, Amankulor NM, Zinn P. Outcomes and Treatment Algorithm in Glioblastoma Patients 80 Years and Older. World Neurosurg 2023; 178:e540-e548. [PMID: 37516146 DOI: 10.1016/j.wneu.2023.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE The current standard of care for patients with glioblastoma (GBM) is maximal safe resection followed by adjuvant radiation therapy with concurrent temozolomide chemotherapy. Previous studies that identified this treatment regimen focused on younger patients with GBM. The proportion of patients with GBM over the age of 80 years is increasing. We investigate whether elderly patients benefit from the current standard of care with additional maximal safe resection. METHODS Clinical, operative, radiographic, demographic, genetic, and outcomes data were retrospectively collected for patients treated for histologically confirmed World Health Organization grade 4 GBM at University of Pittsburgh Medical Center from 2009 to 2020. Only patients 80 years and older were included (n = 123). Statistically significant values were set at P < 0.05. RESULTS A univariate Cox proportional hazards analysis of GBM patients aged >80 years identified the use of temozolomide, radiation, Karnofsky Performance Status (KPS) > 70, and methylguanine DNA methyltransferase methylation with increased overall survival (OS). Further multivariate Cox proportional hazards model analysis showed that the variables identified in the univariate analysis passed multicollinearity testing, and that use of temozolomide, KPS >70, and gross total resection were shown to significantly impact survival. Survival analysis showed that patients with biopsy alone had a shorter median OS compared with patients who received resection, temozolomide, and radiation (P < 0.0001, median OS 1.6 vs. 7.5 months). Additionally, patients who underwent biopsy and then received temozolomide and radiation had a shorter median OS when compared with patients who received resection, temozolomide, and radiation (P = 0.0047, median OS 3.6 vs. 7.5 months). CONCLUSIONS For elderly patients with KPS >70, GTR followed by radiation and temozolomide is associated with maximum OS.
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Affiliation(s)
- David Fogg
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Matthew Pease
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edward Andrews
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tritan Plute
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Thomas M Pearce
- Division of Neuropathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Austin Anthony
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nduka M Amankulor
- Department of Neurosurgery, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pascal Zinn
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Characteristics, Patterns of Care and Predictive Geriatric Factors in Elderly Patients Treated for High-Grade IDH-Mutant Gliomas: A French POLA Network Study. Cancers (Basel) 2022; 14:cancers14225509. [PMID: 36428602 PMCID: PMC9688655 DOI: 10.3390/cancers14225509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Describe the characteristics, patterns of care, and predictive geriatric factors of elderly patients with IDHm high-grade glioma (HGG) included in the French POLA network. Material and Methods: The characteristics of elderly (≥70 years) patients IDHm HGG were compared to those of younger patients IDHm HGG (<70 years) and of elderly patients IDHwt HGG. Geriatric features were collected. Results: Out of 1433 HGG patients included, 119 (8.3%) were ≥70 years. Among them, 39 presented with IDHm HGG. The main characteristics of elderly IDHm HGG were different from those of elderly IDHwt HGG but similar to those of younger IDHm HGG. In contrast, their therapeutic management was different from those of younger IDHm HGG with less frequent gross total resection and radiotherapy. The median progression-free survival (PFS) and overall survival (OS) were longer for elderly patients IDHm HGG (29.3 months and 62.1 months) than elderly patients IDHwt HGG (8.3 months and 13.3 months) but shorter than those of younger patients IDHm HGG (69.1 months and not reached). Geriatric factors associated with PFS and OS were mobility, neuropsychological disorders, body mass index, and autonomy. Geriatric factors associated with PFS and OS were mobility, neuropsychological disorders, and body mass index, and autonomy. Conclusion: the outcome of IDHm HGG in elderly patients is better than that of IDHwt HGG. Geriatric assessment may be particularly important to optimally manage these patients.
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Moody TW, Lee L, Ramos-Alvarez I, Iordanskaia T, Mantey SA, Jensen RT. Bombesin Receptor Family Activation and CNS/Neural Tumors: Review of Evidence Supporting Possible Role for Novel Targeted Therapy. Front Endocrinol (Lausanne) 2021; 12:728088. [PMID: 34539578 PMCID: PMC8441013 DOI: 10.3389/fendo.2021.728088] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/02/2021] [Indexed: 12/13/2022] Open
Abstract
G-protein-coupled receptors (GPCRs) are increasingly being considered as possible therapeutic targets in cancers. Activation of GPCR on tumors can have prominent growth effects, and GPCRs are frequently over-/ectopically expressed on tumors and thus can be used for targeted therapy. CNS/neural tumors are receiving increasing attention using this approach. Gliomas are the most frequent primary malignant brain/CNS tumor with glioblastoma having a 10-year survival <1%; neuroblastomas are the most common extracranial solid tumor in children with long-term survival<40%, and medulloblastomas are less common, but one subgroup has a 5-year survival <60%. Thus, there is an increased need for more effective treatments of these tumors. The Bombesin-receptor family (BnRs) is one of the GPCRs that are most frequently over/ectopically expressed by common tumors and is receiving particular attention as a possible therapeutic target in several tumors, particularly in prostate, breast, and lung cancer. We review in this paper evidence suggesting why a similar approach in some CNS/neural tumors (gliomas, neuroblastomas, medulloblastomas) should also be considered.
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Affiliation(s)
- Terry W. Moody
- Department of Health and Human Services, National Cancer Institute, Center for Cancer Training, Office of the Director, Bethesda, MD, United States
| | - Lingaku Lee
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
- Department of Gastroenterology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Irene Ramos-Alvarez
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Tatiana Iordanskaia
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Samuel A. Mantey
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Robert T. Jensen
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Robert T. Jensen,
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Renovanz M, Hickmann AK, Nadji-Ohl M, Keric N, Weimann E, Wirtz CR, Singer S, Ringel F, Coburger J. Health-related quality of life and distress in elderly vs. younger patients with high-grade glioma-results of a multicenter study. Support Care Cancer 2020; 28:5165-5175. [PMID: 32060706 PMCID: PMC7546979 DOI: 10.1007/s00520-020-05354-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/06/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Half of all newly diagnosed patients with glioblastoma are > 65 years still with a poor prognosis. Preserving quality of life is of high importance. However, patient reported outcome (PRO) data in this patient group is rare. The aim was to compare health-related quality of life (HRQoL) and distress between elderly and younger patients with high-grade glioma (HGG). METHODS We used baseline data of a prospective study where HGG patients were enrolled from 4 hospitals. Distress was measured using the distress thermometer (DT), HRQoL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) plus brain module (BN20). We compared distress and HRQoL by age (≥ 65 vs. < 65 years), gender, performance score, and time since diagnosis using multivariate linear and logistic regressions. RESULTS A total of n = 93 (30%) out of n = 309 patients were ≥ 65 years (mean 70 years, range 65-86 years). Mean DT score of elderly patients (5.2, SD 2.6) was comparable with younger patients (4.9, SD 2.6). Elderly patients reported significantly lower global health (GHS, mean elderly vs. younger; 50.8 vs. 60.5, p = 0.003), worse physical (56.8 vs. 73.3, p < 0.001) and lower cognitive functioning (51.1 vs. 63.2, p = 0.002), worse fatigue (52.5 vs. 43.5, p = 0.042), and worse motor dysfunction (34.9 vs. 23.6, p = 0.030). KPS and not age was consistently associated with HRQoL. CONCLUSION Physical functioning was significantly reduced in the elderly compared with younger HGG patients, and at the same time, emotional functioning and DT scores were comparable. KPS shows a greater association with HRQoL than with calendric age in HGG patients reflecting the particular importance for adequate assessment of HRQoL and general condition in elderly patients.
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Affiliation(s)
- Mirjam Renovanz
- Department of Neurosurgery, University Medical Center, Mainz, Germany.
- Division of Neuro-Oncology, University Medical Center Tubingen, Tübingen, Germany.
| | | | - Minou Nadji-Ohl
- Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Center, Mainz, Germany
| | - Elke Weimann
- Department of Neurology, RKH Kliniken Ludwigsburg, Ludwigsburg, Germany
| | | | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center, Mainz, Germany
| | - Jan Coburger
- Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany
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Chen X, Fan X, Zhao C, Zhao Z, Hu L, Wang D, Wang R, Fang Z. Molecular subtyping of glioblastoma based on immune-related genes for prognosis. Sci Rep 2020; 10:15495. [PMID: 32968155 PMCID: PMC7511296 DOI: 10.1038/s41598-020-72488-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 09/02/2020] [Indexed: 01/01/2023] Open
Abstract
Glioblastoma (GBM) is associated with an increasing mortality and morbidity and is considered as an aggressive brain tumor. Recently, extensive studies have been carried out to examine the molecular biology of GBM, and the progression of GBM has been suggested to be correlated with the tumor immunophenotype in a variety of studies. Samples in the current study were extracted from the ImmPort and TCGA databases to identify immune-related genes affecting GBM prognosis. A total of 92 immune-related genes displaying a significant correlation with prognosis were mined, and a shrinkage estimate was conducted on them. Among them, the 14 most representative genes showed a marked correlation with patient prognosis, and LASSO and stepwise regression analysis was carried out to further identify the genes for the construction of a predictive GBM prognosis model. Then, samples in training and test cohorts were incorporated into the model and divided to evaluate the efficiency, stability, and accuracy of the model to predict and classify the prognosis of patients and to identify the relevant immune features according to the median value of RiskScore (namely, Risk-H and Risk-L). In addition, the constructed model was able to instruct clinicians in diagnosis and prognosis prediction for various immunophenotypes.
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Affiliation(s)
- Xueran Chen
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, No. 350, Shushan Hu Road, Hefei, 230031, Anhui, China. .,Department of Molecular Pathology, Hefei Cancer Hospital, Chinese Academy of Sciences, No. 350, Shushan Hu Road, Hefei, 230031, Anhui, China.
| | - Xiaoqing Fan
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), No. 17, Lujiang Road, Hefei, 230001, Anhui, China.,Department of Anesthesiology, Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, Anhui, China
| | - Chenggang Zhao
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, No. 350, Shushan Hu Road, Hefei, 230031, Anhui, China.,University of Science and Technology of China, No. 96, Jin Zhai Road, Hefei, 230026, Anhui, China
| | - Zhiyang Zhao
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, No. 350, Shushan Hu Road, Hefei, 230031, Anhui, China.,University of Science and Technology of China, No. 96, Jin Zhai Road, Hefei, 230026, Anhui, China
| | - Lizhu Hu
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, No. 350, Shushan Hu Road, Hefei, 230031, Anhui, China.,University of Science and Technology of China, No. 96, Jin Zhai Road, Hefei, 230026, Anhui, China
| | - Delong Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), No. 17, Lujiang Road, Hefei, 230001, Anhui, China.,Department of Anesthesiology, Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, Anhui, China
| | - Ruiting Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), No. 17, Lujiang Road, Hefei, 230001, Anhui, China.,Department of Anesthesiology, Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, Anhui, China
| | - Zhiyou Fang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, No. 350, Shushan Hu Road, Hefei, 230031, Anhui, China.,Department of Molecular Pathology, Hefei Cancer Hospital, Chinese Academy of Sciences, No. 350, Shushan Hu Road, Hefei, 230031, Anhui, China
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8
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Berger K, Turowski B, Felsberg J, Malzkorn B, Reifenberger G, Steiger HJ, Budach W, Haussmann J, Knipps J, Rapp M, Hänggi D, Sabel M, Mijderwijk HJ, Kamp MA. Age-stratified clinical performance and survival of patients with IDH-wildtype glioblastoma homogeneously treated by radiotherapy with concomitant and maintenance temozolomide. J Cancer Res Clin Oncol 2020; 147:253-262. [PMID: 32748120 PMCID: PMC7810639 DOI: 10.1007/s00432-020-03334-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/22/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Isocitrate dehydrogenase (IDH)-wildtype glioblastomas are the most malignant glial tumours. Median survival is only 14-16 months after diagnosis, with patients aged ≥ 65 years reportedly showing worse outcome. This study aimed to further evaluate the prognostic role of age in a homogenously treated patient cohort. METHODS The study includes 132 IDH-wildtype glioblastoma patients treated between 2013 and 2017 with open resection followed by radiotherapy with concomitant and maintenance temozolomide. Patients were dichotomized into a non-elderly (< 65 years) and an elderly (≥ 65 years) group. Extent of resection and the O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status were determined for each tumour. Clinical and radiological follow-up data were obtained at 6 weeks after the end of radiation therapy and thereafter in 3-month intervals. Progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate cox regression analyses. RESULTS The elderly group consisted of 58 patients (median age: 70.5 years) and the non-elderly group of 74 patients (median age: 55 years). Median pre- and postoperative operative Karnofsky Performance Scale (KPS), Eastern Cooperative Oncology Group (ECOG) score and National Institutes of Stroke Scale (NIHSS) were not significantly different between the groups, but KPS and ECOG scores became significantly worse in the elderly group at 6 weeks after termination of radiation therapy. Neither PFS nor OS differed significantly between the age groups. Patients with MGMT promoter-methylated tumours survived longer. CONCLUSION Elderly patients in good pre- and postoperative clinical conditions may show similar outcome as younger patients when treated according to standard of care. However, elderly patients may suffer more frequently from clinical deterioration following chemoradiotherapy. In both age groups, MGMT promoter methylation was linked to longer PFS and OS.
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Affiliation(s)
- Kerstin Berger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Bernd Turowski
- Institute for Diagnostic and Interventional Radiology, Frankfurt, Germany
| | | | | | | | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Johannes Knipps
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Hendrik-Jan Mijderwijk
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Lütgendorf-Caucig C, Freyschlag C, Masel EK, Marosi C. Guiding Treatment Choices for Elderly Patients with Glioblastoma by a Comprehensive Geriatric Assessment. Curr Oncol Rep 2020; 22:93. [PMID: 32651730 PMCID: PMC7351817 DOI: 10.1007/s11912-020-00951-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The incidence of glioblastoma multiforme (GBM) increases with age; more than half of newly diagnosed patients are older than 65 years. Due to age-dependent decreasing organ functions, comorbidities, functional decline, and increasing risk of social isolation, not all patients are able to tolerate standard therapy of GBM with 6 weeks of radiochemotherapy. RECENT FINDINGS A set of alleviated therapies, e.g., chemotherapy or radiotherapy alone, hypofractionated radiotherapies with different total doses and variable fractionation regimens as well as hypofractionated radiotherapy with concomitant and adjuvant chemotherapy, have been evaluated during the last years. However, clinicians are still unsure which therapy would fit best to a given patient. Recently, the predictive value of comprehensive geriatric assessment regarding tolerance of chemotherapy and prediction of early mortality has been validated for older GBM patients in a retrospective trial. Thus, it appears that neuro-oncology is now ready for the prospective implementation of geriatric assessment to guide treatment planning for elderly GBM patients.
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Affiliation(s)
| | | | - Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christine Marosi
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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10
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Lisi L, Chiavari M, Ciotti GMP, Lacal PM, Navarra P, Graziani G. DNA inhibitors for the treatment of brain tumors. Expert Opin Drug Metab Toxicol 2020; 16:195-207. [PMID: 32067518 DOI: 10.1080/17425255.2020.1729352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: The worldwide incidence of central nervous system (CNS) primary tumors is increasing. Most of the chemotherapeutic agents used for treating these cancer types induce DNA damage, and their activity is affected by the functional status of repair systems involved in the detection or correction of DNA lesions. Unfortunately, treatment of malignant high-grade tumors is still an unmet medical need.Areas covered: We summarize the action mechanisms of the main DNA inhibitors used for the treatment of brain tumors. In addition, studies on new agents or drug combinations investigated for this indication are reviewed, focusing our attention on clinical trials that in the last 3 years have been completed, terminated or are still recruiting patients.Expert opinion: Much still needs to be done to render aggressive CNS tumors curable or at least to transform them from lethal to chronic diseases, as it is possible for other cancer types. Drugs with improved penetration in the CNS, toxicity profile, and activity against primary and recurrent tumors are eagerly needed. Targeted agents with innovative mechanisms of action and ability to harness the cells of the tumor microenvironment against cancer cells represent a promising approach for improving the clinical outcome of CNS tumors.
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Affiliation(s)
- Lucia Lisi
- Department of Safety and Bioethics, Catholic University Medical School, Rome, Italy
| | - Marta Chiavari
- Department of Safety and Bioethics, Catholic University Medical School, Rome, Italy
| | | | - Pedro M Lacal
- Laboratory of Molecular Oncology, IDI-IRCCS, Rome, Italy
| | - Pierluigi Navarra
- Department of Safety and Bioethics, Catholic University Medical School, Rome, Italy.,Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Grazia Graziani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Guo XX, Su J, He XF. A 4-gene panel predicting the survival of patients with glioblastoma. J Cell Biochem 2019; 120:16037-16043. [PMID: 31081973 DOI: 10.1002/jcb.28883] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND To identify independently prognostic gene panel in patients with glioblastoma (GBM). MATERIALS AND METHODS The Cancer Genome Atlas (TCGA)-GBM was used as a training set and a test set. GSE13041 was used as a validation set. Survival associated differentially expression genes (DEGs), derived between GBM and normal brain tissue, was obtained using univariate Cox proportional hazards regression model and then was included in a least absolute shrinkage and selection operator penalized Cox proportional hazards regression model. Thus, a 4-gene prognostic panel was developed based on the risk score for each patient in that model. The prognostic role of the 4-gene panel was validated using univariate and multivariable Cox proportional hazards regression model. RESULTS A total of 686 patients with GBM were included in our study; 724 DEGs was identified, 133 of which was significantly correlated with the overall survival (OS) of patients with GBM. A 4-gene panel including NMB, RTN1, GPC5, and epithelial membrane protein 3 (EMP3) was developed. Kaplan-Meier survival analysis suggested that patients in the 4-gene panel low risk group had significantly better OS than those in the 4-gene panel high risk group in the training set (hazard ratio [HR] = 0.3826; 95% confidence interval [CI]: 0.2751-0.532; P < 0.0001), test set (HR = 0.718; 95% CI: 0.5282-0.9759; P = 0.033) and the independent validation set (HR = 0.6898; 95% CI: 0.4872-0.9766; P = 0.035). Both univariate and multivariable Cox proportional hazards regression analysis suggested that the 4-gene panel was independent prognostic factor for GBM in the training set. CONCLUSION We developed and validated 4-gene panel that was independently correlated with the survival of patients with GBM.
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Affiliation(s)
- Xiao-Xia Guo
- Department of Neurosurgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Jiao Su
- Department of Biological Chemistry, Changzhi Medical College, Changzhi, Shanxi, China
| | - Xiao-Feng He
- Department of Science and Education, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
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