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Scheepens JCC, Taphoorn MJB, Koekkoek JAF. Patient-reported outcomes in neuro-oncology. Curr Opin Oncol 2024:00001622-990000000-00193. [PMID: 38984633 DOI: 10.1097/cco.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE OF REVIEW To provide up-to-date evidence on patient-reported outcomes (PROs) in neuro-oncology, with a focus on the core constructs of health-related quality of life (HRQoL) and the use of PROs in clinical trials and clinical practice.[Supplemental Digital Content: Video Abstract PROs in Neuro-Oncology.mov]. RECENT FINDINGS PROs are gaining importance in brain tumor research and medical care. For patients with a brain tumor, core PRO constructs are pain, difficulty communicating, perceived cognition, seizures, symptomatic adverse events, physical functioning and role and social functioning, which are assessed through patient-reported outcome measures (PROMs). Initiatives have been taken to improve the reliability and robustness of PRO data, including standardization of items included in clinical trial protocols (the SPIRIT-PRO extension) and formulation of PRO priority objectives for use in clinical trials (the SISAQOL-Innovative Medicines Initiative). In brain tumor patients with cognitive impairment, caregiver-reported outcomes may complement or replace PROs to increase accuracy. The next key challenge will be to widely implement PROs and apply PRO data in clinical practice to benefit patients with brain tumors. SUMMARY PROs are clinically relevant endpoints providing information only known by the patient. Standardization of the use of PROs in clinical trials and wide implementation in clinical practice is needed to improve HRQoL of brain tumor patients.
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Affiliation(s)
- Josien C C Scheepens
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Pöhlmann J, Weller M, Marcellusi A, Grabe-Heyne K, Krott-Coi L, Rabar S, Pollock RF. High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma. Front Oncol 2024; 14:1368606. [PMID: 38571509 PMCID: PMC10987841 DOI: 10.3389/fonc.2024.1368606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
Gliomas are a group of heterogeneous tumors that account for substantial morbidity, mortality, and costs to patients and healthcare systems globally. Survival varies considerably by grade, histology, biomarkers, and genetic alterations such as IDH mutations and MGMT promoter methylation, and treatment, but is poor for some grades and histologies, with many patients with glioblastoma surviving less than a year from diagnosis. The present review provides an introduction to glioma, including its classification, epidemiology, economic and humanistic burden, as well as treatment options. Another focus is on treatment recommendations for IDH-mutant astrocytoma, IDH-mutant oligodendroglioma, and glioblastoma, which were synthesized from recent guidelines. While recommendations are nuanced and reflect the complexity of the disease, maximum safe resection is typically the first step in treatment, followed by radiotherapy and/or chemotherapy using temozolomide or procarbazine, lomustine, and vincristine. Immunotherapies and targeted therapies currently have only a limited role due to disappointing clinical trial results, including in recurrent glioblastoma, for which the nitrosourea lomustine remains the de facto standard of care. The lack of treatment options is compounded by frequently suboptimal clinical practice, in which patients do not receive adequate therapy after resection, including delayed, shortened, or discontinued radiotherapy and chemotherapy courses due to treatment side effects. These unmet needs will require significant efforts to address, including a continued search for novel treatment options, increased awareness of clinical guidelines, improved toxicity management for chemotherapy, and the generation of additional and more robust clinical and health economic evidence.
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Affiliation(s)
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA)-Centre for Economic and International Studies (CEIS), Faculty of Economics, University of Rome “Tor Vergata”, Rome, Italy
| | | | | | - Silvia Rabar
- Covalence Research Ltd, Harpenden, United Kingdom
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Hojan K, Adamska K, Lewandowska A, Procyk D, Leporowska E, Osztynowicz K, Michalak S. Neural and Onconeural Autoantibodies and Blood-Brain Barrier Disruption Markers in Patients Undergoing Radiotherapy for High-Grade Primary Brain Tumour. Diagnostics (Basel) 2024; 14:307. [PMID: 38337823 PMCID: PMC10855664 DOI: 10.3390/diagnostics14030307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Radiotherapy (RT) plays a key role in brain tumours but can negatively impact functional outcomes and quality of life. The aim of this study was to analyse anti-neural and onconeural autoantibodies and markers of blood-brain barrier (BBB) disruption in patients with primary brain cancer undergoing RT. MATERIALS AND METHODS A prospective study was conducted on 45 patients with a brain tumour scheduled for intensity-modulated radiotherapy. Assessments were performed at baseline, post-RT, and at three months. We measured serum levels of BBB disruption biomarkers and anti-neural, onconeural, and organ-specific antibodies. RESULTS Antibodies against nucleosome antigens and neuronal surface antigens were detected in 85% and 3% of cases, respectively; anti-neural and onconeural antibodies were observed in 47% and 5.8%. In 44% patients, ≥2 antibody types were detected. No significant changes in BBB biomarkers were observed. CONCLUSION The findings of this study show that a humoral immune response is common in patients undergoing RT for brain cancer. This response appears to be non-organ specific but rather directed against nucleosome antigens, but onconeural antibodies were uncommon, suggesting a low risk of a neurological paraneoplastic syndrome. Our data suggested that radiotherapy may not affect BBB integrity, but larger studies are needed to better characterise the pathophysiological effects of RT.
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Affiliation(s)
- Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, 61-781 Poznan, Poland
- Department of Rehabilitation, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Krystyna Adamska
- Department of Radiotherapy, Greater Poland Cancer Centre, 61-866 Poznan, Poland; (K.A.); (A.L.)
- Department of Elektroradiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Agnieszka Lewandowska
- Department of Radiotherapy, Greater Poland Cancer Centre, 61-866 Poznan, Poland; (K.A.); (A.L.)
| | - Danuta Procyk
- Laboratory Ward, Greater Poland Cancer Centre, 61-866 Poznan, Poland; (D.P.); (E.L.)
| | - Ewa Leporowska
- Laboratory Ward, Greater Poland Cancer Centre, 61-866 Poznan, Poland; (D.P.); (E.L.)
| | - Krystyna Osztynowicz
- Department of Neurochemistry and Neuropathology, Neurology Department, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (K.O.); (S.M.)
| | - Slawomir Michalak
- Department of Neurochemistry and Neuropathology, Neurology Department, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (K.O.); (S.M.)
- Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
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Darlix A, Monnier M, Castan F, Coutant L, Fabbro M, Denis-Chammas È, Carrière M, Menjot-de-Champfleur N, Rigau V, Duffau H, Guerdoux E. Longitudinal assessment of quality of life, neurocognition, and psychopathology in patients with low-grade glioma on first-line temozolomide: A feasibility study. Neurooncol Adv 2024; 6:vdae084. [PMID: 38946878 PMCID: PMC11212068 DOI: 10.1093/noajnl/vdae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background The treatment timing and choice after neurosurgical resection in patients with newly diagnosed diffuse low-grade glioma (DLGG) remain controversial. Indeed, the effect of such treatments must be balanced with the possible side effects. This study evaluated the feasibility of longitudinal exhaustive quality of life (QoL) and neuropsychological assessments in patients with DLGG receiving first-line temozolomide. Methods QoL, neurocognition, and psychological disorders were assessed prospectively until disease progression, using testing, clinician-reported, and self-reported questionnaires. The primary endpoint was the participation and adherence to this complete assessment at Baseline (before temozolomide initiation), months 6 and 12 of treatment, and month 6 post-treatment. The QoL and neuropsychological changes over time also were described. Results Twenty-six of the twenty-nine eligible patients were enrolled (participation rate: 89.7%, 95% CI: 72.6-97.8). The adherence rate was 95.7% (95% CI: 78.1-99.9; n = 23 because 3 patients progressed in the first 12 months of treatment). Up to month 6 post-treatment, QoL and fatigue remained stable (EORTC QLQC30 and BN20, MFI-20); some specific symptoms were transitory. Both subjective (FACT-Cog) and objective (Z-scores of neurocognitive tests) neurocognitive outcomes remained stable or tended to improve. The percentage of patients with severe depression (BDI-II), anxiety (STAI-Y), or anger (STAXI-II) was stable over time. Conclusions This prospective study demonstrated the feasibility of an exhaustive and longitudinal evaluation of QoL, neurocognition, and psychological disorders, with high acceptability by patients with DLGG undergoing chemotherapy. First-line temozolomide seems to have limited short-term effects on QoL and neurocognition. These findings must be confirmed in the long term and in a larger cohort.
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Affiliation(s)
- Amélie Darlix
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Maëva Monnier
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Florence Castan
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Louise Coutant
- Department of Supportive Care, Psycho-Oncology Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Michel Fabbro
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Ève Denis-Chammas
- Department of Neuroradiology, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Mathilde Carrière
- Department of Neuroradiology, University of Montpellier, CHU Montpellier, Montpellier, France
| | | | - Valérie Rigau
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Pathology, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Hugues Duffau
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Neurosurgery, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Estelle Guerdoux
- Department of Supportive Care, Psycho-Oncology Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, Montpellier Cancer Institute (ICM), University of Montpellier, France
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Ng S, Duffau H. Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies. Cancers (Basel) 2023; 15:3698. [PMID: 37509359 PMCID: PMC10378506 DOI: 10.3390/cancers15143698] [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: 06/27/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The ability of neural circuits to compensate for damage to the central nervous system is called postlesional plasticity. In diffuse low-grade gliomas (LGGs), a crosstalk between the brain and the tumor activates modulations of plasticity, as well as tumor proliferation and migration, by means of paracrine and electrical intercommunications. Such adaptative mechanisms have a major impact on the benefits and risks of oncological treatments but are still disregarded by current neuro-oncological guidelines. In this review, the authors first aimed to highlight clinical, radiological, and oncological markers that robustly reflect the plasticity potentials and limitations in LGG patients, including the location of the tumor and the degree of critical white matter tract infiltration, the velocity of tumor expansion, and the reactional changes of neuropsychological performances over time. Second, the interactions between the potential/limitations of cerebral plasticity and the efficacy/tolerance of treatment options (i.e., surgery, chemotherapy, and radiotherapy) are reviewed. Finally, a longitudinal and multimodal treatment approach accounting for the evolutive profiles of brain plasticity is proposed. Such an approach integrates personalized predictive models of plasticity potentials with a step-by-step therapeutic decision making and supports onco-functional balanced strategies in patients with LGG, with the ultimate aim of optimizing overall survival and quality of life.
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Affiliation(s)
- Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de le Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale 1191, 34094 Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de le Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale 1191, 34094 Montpellier, France
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