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Phillips C, Pinkham MB, Moore A, Sia J, Jeffree RL, Khasraw M, Kam A, Bressel M, Haworth A. Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02). Breast 2024; 74:103675. [PMID: 38340685 PMCID: PMC10869940 DOI: 10.1016/j.breast.2024.103675] [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: 10/16/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Introduction, A decade ago, stereotactic radiosurgery (SRS) without whole brain radiotherapy (WBRT) was emerging as preferred treatment for oligometastatic brain metastases. Studies of cavity SRS after neurosurgery were underway. Data specific to metastatic HER2 breast cancer (MHBC), describing intracranial, systemic and survival outcomes without WBRT, were lacking. A Phase II study was designed to address this gap. Method, Adults with MHBC, performance status 0-2, ≤ five BrM, receiving/planned to receive HER2-targeted therapy were eligible. Exclusions included leptomeningeal disease and prior WBRT. Neurosurgery allowed ≤6 weeks before registration and required for BrM >4 cm. Primary endpoint was 12-month requirement for WBRT. Secondary endpoints; freedom from (FF-) local failure (LF), distant brain failure (DBF), extracranial disease failure (ECDF), overall survival (OS), cause of death, mini-mental state examination (MMSE), adverse events (AE). Results, Twenty-five patients accrued Decembers 2016-2020. The study closed early after slow accrual. Thirty-seven BrM and four cavities received SRS. Four cavities and five BrM were observed. At 12 months: one patient required WBRT (FF-WBRT 95 %, 95 % CI 72-99), FFLF 91 % (95 % CI 69-98), FFDBF 57 % (95 % CI 34-74), FFECDF 64 % (95 % CI 45-84), OS 96 % (95 % CI 74-99). Two grade 3 AE occurred. MMSE was abnormal for 3/24 patients at baseline and 1/17 at 12 months. Conclusion, At 12 months, SRS and/or neurosurgery provided good control with low toxicity. WBRT was not required in 95 % of cases. This small study supports the practice change from WBRT to local therapies for MHBC BrM.
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Affiliation(s)
- Claire Phillips
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Australia.
| | - Mark B Pinkham
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Alisha Moore
- Trans-Tasman Radiation Oncology Group, Newcastle, Australia
| | - Joseph Sia
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Australia
| | - Rosalind L Jeffree
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Anthony Kam
- The Alfred, Prahran, Australia; Monash University, Clayton, Australia
| | - Mathias Bressel
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Australia
| | - Annette Haworth
- Department of Physics, University of Sydney, Sydney, Australia
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Jennings EM, Camidge DR, Gadgeel S, Barker S. Trial Design and Optimal Determination of CNS Activity of Small Molecule Targeted Therapy in NSCLC. Clin Lung Cancer 2024; 25:91-99. [PMID: 38135566 DOI: 10.1016/j.cllc.2023.11.014] [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: 05/13/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
Central nervous system (CNS) metastases are frequently diagnosed in patients with non-small cell lung cancer (NSCLC). Only recently, clinical trials are broadening eligibility to include patients with brain metastases, offering the potential for some assessment of CNS efficacy to be made. In this work we aim to review the available information on the activity of small molecule targeted drugs for advanced NSCLC with respect to CNS metastases. We analyze a framework for evaluation assessment regarding trials of systemic agents being conducted in patients with, or at risk from, CNS metastases, and provide examples of NSCLC targeted therapies evaluated in the CNS.
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Affiliation(s)
| | - D Ross Camidge
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Shirish Gadgeel
- Division of Hematology and Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/ Henry Ford Health, Detroit, MI
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Ortiz de Mendivil A, Martín-Medina P, García-Cañamaque L, Jiménez-Munarriz B, Ciérvide R, Diamantopoulos J. Challenges in radiological evaluation of brain metastases, beyond progression. RADIOLOGIA 2024; 66:166-180. [PMID: 38614532 DOI: 10.1016/j.rxeng.2024.03.003] [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: 11/15/2022] [Accepted: 04/02/2023] [Indexed: 04/15/2024]
Abstract
MRI is the cornerstone in the evaluation of brain metastases. The clinical challenges lie in discriminating metastases from mimickers such as infections or primary tumors and in evaluating the response to treatment. The latter sometimes leads to growth, which must be framed as pseudo-progression or radionecrosis, both inflammatory phenomena attributable to treatment, or be considered as recurrence. To meet these needs, imaging techniques are the subject of constant research. However, an exponential growth after radiotherapy must be interpreted with caution, even in the presence of results suspicious of tumor progression by advanced techniques, because it may be due to inflammatory changes. The aim of this paper is to familiarize the reader with inflammatory phenomena of brain metastases treated with radiotherapy and to describe two related radiological signs: "the inflammatory cloud" and "incomplete ring enhancement", in order to adopt a conservative management with close follow-up.
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Affiliation(s)
- A Ortiz de Mendivil
- Servicio de Radiodiagnóstico, Sección de Neurorradiología, Hospital Universitario HM Sanchinarro, Madrid, Spain.
| | - P Martín-Medina
- Servicio de Radiodiagnóstico, Sección de Neurorradiología, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | | | - B Jiménez-Munarriz
- Servicio de Oncología Médica, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - R Ciérvide
- Servicio de Oncología Radioterápica, Hospital Universitario HM Sanchinarro, Madrid, Spain
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Wang X, Bai H, Zhang J, Wang Z, Duan J, Cai H, Cao Z, Lin Q, Ding X, Sun Y, Zhang W, Xu X, Chen H, Zhang D, Feng X, Wan J, Zhang J, He J, Wang J. Genetic Intratumor Heterogeneity Remodels the Immune Microenvironment and Induces Immune Evasion in Brain Metastasis of Lung Cancer. J Thorac Oncol 2024; 19:252-272. [PMID: 37717855 DOI: 10.1016/j.jtho.2023.09.276] [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: 06/06/2023] [Revised: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Brain metastasis, with the highest incidence in patients with lung cancer, significantly worsens prognosis and poses challenges to clinical management. To date, how brain metastasis evades immune elimination remains unknown. METHODS Whole-exome sequencing and RNA sequencing were performed on 30 matched brain metastasis, primary lung adenocarcinoma, and normal tissues. Data from The Cancer Genome Atlas primary lung adenocarcinoma cohort, including multiplex immunofluorescence, were used to support the findings of bioinformatics analysis. RESULTS Our study highlights the key role of intratumor heterogeneity of genomic alterations in the metastasis process, mainly caused by homologous recombination deficiency or other somatic copy number alteration-associated mutation mechanisms, leading to increased genomic instability and genomic complexity. We further proposed a selection model of brain metastatic evolution in which intratumor heterogeneity drives immune remodeling, leading to immune escape through different mechanisms under local immune pressure. CONCLUSIONS Our findings provide novel insights into the metastatic process and immune escape mechanisms of brain metastasis and pave the way for precise immunotherapeutic strategies for patients with lung cancer with brain metastasis.
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Affiliation(s)
- Xin Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hua Bai
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiyang Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchun Duan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongqing Cai
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Cao
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingtang Lin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaosheng Ding
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yiting Sun
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhang
- Department of Translational Medicine, 3D Medicines Inc., Shanghai, China
| | - Xiaoya Xu
- Department of Translational Medicine, 3D Medicines Inc., Shanghai, China
| | - Hao Chen
- Department of Translational Medicine, 3D Medicines Inc., Shanghai, China
| | - Dadong Zhang
- Department of Translational Medicine, 3D Medicines Inc., Shanghai, China
| | - Xiaoli Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinghai Wan
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianjun Zhang
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Pan K, Concannon K, Li J, Zhang J, Heymach JV, Le X. Emerging therapeutics and evolving assessment criteria for intracranial metastases in patients with oncogene-driven non-small-cell lung cancer. Nat Rev Clin Oncol 2023; 20:716-732. [PMID: 37592034 PMCID: PMC10851171 DOI: 10.1038/s41571-023-00808-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
The improved survival outcomes of patients with non-small-cell lung cancer (NSCLC), largely owing to the improved control of systemic disease provided by immune-checkpoint inhibitors and novel targeted therapies, have highlighted the challenges posed by central nervous system (CNS) metastases as a devastating yet common complication, with up to 50% of patients developing such lesions during the course of the disease. Early-generation tyrosine-kinase inhibitors (TKIs) often provide robust systemic disease control in patients with oncogene-driven NSCLCs, although these agents are usually unable to accumulate to therapeutically relevant concentrations in the CNS owing to an inability to cross the blood-brain barrier. However, the past few years have seen a paradigm shift with the emergence of several novel or later-generation TKIs with improved CNS penetrance. Such agents have promising levels of activity against brain metastases, as demonstrated by data from preclinical and clinical studies. In this Review, we describe current preclinical and clinical evidence of the intracranial activity of TKIs targeting various oncogenic drivers in patients with NSCLC, with a focus on newer agents with enhanced CNS penetration, leptomeningeal disease and the need for intrathecal treatment options. We also discuss evolving assessment criteria and regulatory considerations for future clinical investigations.
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Affiliation(s)
- Kelsey Pan
- Department of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle Concannon
- Department of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Verhaak E, Schimmel WCM, Sitskoorn MM, Hanssens PEJ, Butterbrod E, Gehring K. The long-term course and relationship with survival of multidimensional fatigue in patients with brain metastases after Gamma Knife radiosurgery. J Cancer Res Clin Oncol 2023; 149:9891-9901. [PMID: 37249646 PMCID: PMC10423137 DOI: 10.1007/s00432-023-04857-1] [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: 02/10/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE The aims of this study were to evaluate long-term multidimensional fatigue in patients with brain metastases (BM) up to 21 months after Gamma Knife radiosurgery (GKRS) and (change in) fatigue as predictor of survival. METHODS Patients with 1 to 10 BM, expected survival > 3 months, and Karnofsky Performance Status ≥ 70, and Dutch non-cancer controls were included. Fatigue was measured with the Multidimensional Fatigue Inventory. Levels of fatigue between patients and controls were compared using independent-samples t-tests. Linear mixed models were used to evaluate fatigue within the patient group up to 21 months after GKRS. Pre-GKRS fatigue and minimal clinically important (MCI) changes in fatigue in the first three months (defined as a 2-point difference) after GKRS were evaluated as predictors of survival time. RESULTS Prior to GKRS, patients with BM (n = 92) experienced significantly higher fatigue on all subscales than controls (n = 104). Over 21 months, physical fatigue increased, and mental fatigue decreased significantly. More specifically, general, and physical fatigue increased significantly between pre-GKRS and 3 months, followed by stable scores between 3 (n = 67) and 6 (n = 53), 6 and 12 (n = 34) and 12 and 21 (n = 21) months. An MCI increase in general or physical fatigue over the first 3 months after GKRS was a significant predictor of shorter survival time. CONCLUSION Except for mental fatigue, all aspects of fatigue remained elevated or further increased up to 21 months after treatment. Furthermore, an increase in general or physical fatigue within three months after GKRS may be a prognostic indicator for poorer survival. CLINICALTRIALS GOV IDENTIFIER NCT02953756, November 3, 2016.
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Affiliation(s)
- Eline Verhaak
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands.
| | - Wietske C M Schimmel
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Margriet M Sitskoorn
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Patrick E J Hanssens
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Elke Butterbrod
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karin Gehring
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
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Mair MJ, Bartsch R, Le Rhun E, Berghoff AS, Brastianos PK, Cortes J, Gan HK, Lin NU, Lassman AB, Wen PY, Weller M, van den Bent M, Preusser M. Understanding the activity of antibody-drug conjugates in primary and secondary brain tumours. Nat Rev Clin Oncol 2023; 20:372-389. [PMID: 37085569 DOI: 10.1038/s41571-023-00756-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/23/2023]
Abstract
Antibody-drug conjugates (ADCs), a class of targeted cancer therapeutics combining monoclonal antibodies with a cytotoxic payload via a chemical linker, have already been approved for the treatment of several cancer types, with extensive clinical development of novel constructs ongoing. Primary and secondary brain tumours are associated with high mortality and morbidity, necessitating novel treatment approaches. Pharmacotherapy of brain tumours can be limited by restricted drug delivery across the blood-brain or blood-tumour barrier, although data from phase II studies of the HER2-targeted ADC trastuzumab deruxtecan indicate clinically relevant intracranial activity in patients with brain metastases from HER2+ breast cancer. However, depatuxizumab mafodotin, an ADC targeting wild-type EGFR and EGFR variant III, did not provide a definitive overall survival benefit in patients with newly diagnosed or recurrent EGFR-amplified glioblastoma in phase II and III trials, despite objective radiological responses in some patients. In this Review, we summarize the available data on the central nervous system activity of ADCs from trials involving patients with primary and secondary brain tumours and discuss their clinical implications. Furthermore, we explore pharmacological determinants of intracranial activity and discuss the optimal design of clinical trials to facilitate development of ADCs for the treatment of gliomas and brain metastases.
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Affiliation(s)
- Maximilian J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Emilie Le Rhun
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Priscilla K Brastianos
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Javier Cortes
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quirónsalud Group, Madrid and Barcelona, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Medical Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | - Hui K Gan
- Cancer Therapies and Biology Group, Centre of Research Excellence in Brain Tumours, Olivia Newton-John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, VIC, Australia
- La Trobe University School of Cancer Medicine, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Heidelberg, VIC, Australia
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew B Lassman
- Division of Neuro-Oncology, Department of Neurology, Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY, USA
| | - Patrick Y Wen
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Martin van den Bent
- The Brain Tumour Center, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
- Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria.
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Multimodal Treatments for Brain Metastases from Renal Cell Carcinoma: Results of a Multicentric Retrospective Study. Cancers (Basel) 2023; 15:cancers15051393. [PMID: 36900186 PMCID: PMC10000216 DOI: 10.3390/cancers15051393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The aim of this study was to evaluate the clinical outcomes of a large series of brain metastatic renal cell carcinoma (BMRCC) patients treated in three Italian centers. METHODS A total of 120 BMRCC patients with a total of 176 lesions treated were evaluated. Patients received surgery plus postoperative HSRS, single-fraction SRS, or hypofractionated SRS (HSRS). Local control (LC), brain distant failure (BDF), overall survival (OS), toxicities, and prognostic factors were assessed. RESULTS The median follow-up time was 77 months (range 16-235 months). Surgery plus HSRS was performed in 23 (19.2%) cases, along with SRS in 82 (68.3%) and HSRS in 15 (12.5%). Seventy-seven (64.2%) patients received systemic therapy. The main total dose and fractionation used were 20-24 Gy in single fraction or 32-30 Gy in 4-5 daily fractions. Median LC time and 6 month and 1, 2 and 3 year LC rates were nr, 100%, 95.7% ± 1.8%, 93.4% ± 2.4%, and 93.4% ± 2.4%. Median BDF time and 6 month and 1, 2 and 3 year BDF rates were n.r., 11.9% ± 3.1%, 25.1% ± 4.5%, 38.7% ± 5.5%, and 44.4% ± 6.3%, respectively. Median OS time and 6 month and 1, 2 and 3 year OS rates were 16 months (95% CI: 12-22), 80% ± 3.6%, 58.3% ± 4.5%, 30.9% ± 4.3%, and 16.9% ± 3.6, respectively. No severe neurological toxicities occurred. Patients with a favorable/intermediate IMDC score, a higher RCC-GPA score, an early occurrence of BMs from primary diagnosis, absence of EC metastases, and a combined local treatment (surgery plus adjuvant HSRS) had a better outcome. CONCLUSIONS SRS/HSRS is proven to be an effective local treatment for BMRCC. A careful evaluation of prognostic factors is a valid step to manage the optimal therapeutic strategy for BMRCC patients.
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Scorsetti M, Navarria P, Cozzi L, Clerici E, Bellu L, Franceschini D, Marzo AM, Franzese C, Torri V, Reggiori G, Lobefalo F, Raspagliesi L, Attuati L, Pessina F, Franzini A, Picozzi P, Tomatis S. Radiosurgery of limited brain metastases from primary solid tumor: results of the randomized phase III trial (NCT02355613) comparing treatments executed with a specialized or a C-arm linac-based platform. Radiat Oncol 2023; 18:28. [PMID: 36750848 PMCID: PMC9906937 DOI: 10.1186/s13014-023-02216-5] [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: 11/16/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Comparative prospective data regarding different radiosurgery (SRS) modalities for treating brain metastases (BMs) from solid tumors are not available. To investigate with a single institute phase III randomized trial whether SRS executed with linac (Arm-B) is superior to a dedicated multi-source gamma-ray stereotactic platform (Arm-A). METHODS Adults patients with 1-4 BMs from solid tumors up to 30 mm in maximum diameter were randomly assigned to arms A and B. The primary endpoint was cumulative incidence of symptomatic (grade 2-3) radionecrosis (CIRN). Secondary endpoints were local progression cumulative incidence (CILP), distant brain failure, disease-free survival (DFS), and overall survival (OS). RESULTS A total of 251 patients were randomly assigned to Arm-A (121) or Arm-B (130). The 1-year RN cumulative incidence was 6.7% in whole cohort, 3.8% (95% CI 1.9-7.4%) in Arm-B, and 9.3% (95% CI 6.2-13.8%) in the Arm-A (p = 0.43). CIRN was influenced by target volume irradiated only for the Arm-A (p << 0.001; HR 1.36 [95% CI 1.25-1.48]). Symptomatic RN occurred in 56 cases at a median time of 10.3 months (range 1.15-54.8 months), 27 in the Arm-B at a median time of 15.9 months (range 4.9-54.8 months), and 29 in the Arm-A at a median time of 6.9 months (1.2-32.3 months), without statistically significant differences between the two arms. No statistically significant differences were recorded between the two arms in CILP, BDF, DFS or OS. The mean beam-on time to deliver SRS was 49.0 ± 36.2 min in Arm-A, and 3.1 ± 1.6 min in Arm-B. CONCLUSIONS Given the technical differences between the treatment platforms investigated in this single-institution study, linac-based SRS (Arm-B) did not lead to significantly lower grade 2-3 RN rates versus the multi-source gamma-ray system (Arm-A) in a population of patients with limited brain metastases of small volume. No significant difference in local control was observed between both arms. For Arm-B, the treatment delivery time was significantly lower than for Arm-A. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02355613.
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Affiliation(s)
- Marta Scorsetti
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Luca Cozzi
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Italy
| | - Elena Clerici
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Luisa Bellu
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Davide Franceschini
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Antonio Marco Marzo
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Ciro Franzese
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Italy
| | - Valter Torri
- grid.4527.40000000106678902Oncology Department, IRCCS Istituto Mario Negri, Milan, Italy
| | - Giacomo Reggiori
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Francesca Lobefalo
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Luca Raspagliesi
- grid.417728.f0000 0004 1756 8807Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Luca Attuati
- grid.417728.f0000 0004 1756 8807Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Federico Pessina
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Italy
| | - Andrea Franzini
- grid.417728.f0000 0004 1756 8807Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Piero Picozzi
- grid.417728.f0000 0004 1756 8807Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Stefano Tomatis
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
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10
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Krämer AS, Adeberg S, Kronsteiner D, König L, Schunn F, Bozorgmehr F, Christopoulos P, Eichkorn T, Schiele A, Hahnemann L, Rieken S, Debus J, Shafie RAE. Upfront and Repeated Stereotactic Radiosurgery in Patients With Brain Metastases From NSCLC. Clin Lung Cancer 2023; 24:269-277. [PMID: 36803615 DOI: 10.1016/j.cllc.2023.01.002] [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: 09/27/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Approximately 40% of non-small-cell lung cancer (NSCLC) patients develop brain metastases (BM). Stereotactic radiosurgery (SRS) instead of whole-brain radiotherapy (WBRT) is increasingly administered as an upfront treatment to patients with a limited number of BM. We present outcomes and validation of prognostic scores for these patients treated with upfront SRS. METHODS We retrospectively analyzed 199 patients with a total of 268 SRS courses for 539 brain metastases. Median patient age was 63 years. For larger BM, dose reduction to 18 Gy or hypofractionated SRS in 6 fractions was applied. We analyzed the BMV-, the RPA-, the GPA- and the lung-mol GPA score. Cox proportional hazards models with univariate and multivariate analyses were fitted for overall survival (OS) and intracranial progression-free survival (icPFS). RESULTS Sixty-four patients died, 7 of them of neurological causes. Thirty eight patients (19,3%) required a salvage WBRT. Median OS was 38, 8 months (IQR: 6-NA). In univariate analysis as well as multivariate analysis, the Karnofsky performance scale index (KPI) ≥90% (P = 0, 012 and P = 0, 041) remained as independent prognostic factor for longer OS. All 4 prognostic scoring indices could be validated for OS assessment (BMV P = 0, 007; RPA P = 0, 026; GPA P = 0, 003; lung-mol GPA P = 0, 05). CONCLUSION In this large cohort of NSCLC patients with BM treated with upfront and repeated SRS, OS was markedly favourable, in comparison to literature. Upfront SRS is an effective treatment approach in those patients and can decidedly reduce the impact of BM on overall prognosis. Furthermore, the analysed scores are useful prognostic tools for OS prediction.
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Affiliation(s)
- Anna S Krämer
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany.
| | - Sebastian Adeberg
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Dorothea Kronsteiner
- Institut für Medizinische Biometrie (IMB), Universitätsklinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Laila König
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Fabian Schunn
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | | | | | - Tanja Eichkorn
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Annabella Schiele
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Laura Hahnemann
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Stefan Rieken
- Universitätsmedizin Göttingen, Klinik für Strahlentherapie und Radioonkologie, Göttingen, Lower Saxony, Germany
| | - Jürgen Debus
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Rami A El Shafie
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany; Universitätsmedizin Göttingen, Klinik für Strahlentherapie und Radioonkologie, Göttingen, Lower Saxony, Germany
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11
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Aizer AA, Lamba N, Ahluwalia MS, Aldape K, Boire A, Brastianos PK, Brown PD, Camidge DR, Chiang VL, Davies MA, Hu LS, Huang RY, Kaufmann T, Kumthekar P, Lam K, Lee EQ, Lin NU, Mehta M, Parsons M, Reardon DA, Sheehan J, Soffietti R, Tawbi H, Weller M, Wen PY. Brain metastases: A Society for Neuro-Oncology (SNO) consensus review on current management and future directions. Neuro Oncol 2022; 24:1613-1646. [PMID: 35762249 PMCID: PMC9527527 DOI: 10.1093/neuonc/noac118] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Brain metastases occur commonly in patients with advanced solid malignancies. Yet, less is known about brain metastases than cancer-related entities of similar incidence. Advances in oncologic care have heightened the importance of intracranial management. Here, in this consensus review supported by the Society for Neuro-Oncology (SNO), we review the landscape of brain metastases with particular attention to management approaches and ongoing efforts with potential to shape future paradigms of care. Each coauthor carried an area of expertise within the field of brain metastases and initially composed, edited, or reviewed their specific subsection of interest. After each subsection was accordingly written, multiple drafts of the manuscript were circulated to the entire list of authors for group discussion and feedback. The hope is that the these consensus guidelines will accelerate progress in the understanding and management of patients with brain metastases, and highlight key areas in need of further exploration that will lead to dedicated trials and other research investigations designed to advance the field.
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Affiliation(s)
- Ayal A Aizer
- Corresponding Author: Dr. Ayal A. Aizer, MD/MHS, Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA ()
| | | | | | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Adrienne Boire
- Department of Neurology, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Priscilla K Brastianos
- Departments of Neuro-Oncology and Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - D Ross Camidge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Veronica L Chiang
- Departments of Neurosurgery and Radiation Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael A Davies
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Leland S Hu
- Department of Radiology, Neuroradiology Division, Mayo Clinic, Phoenix, Arizona, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Priya Kumthekar
- Department of Neurology at The Feinberg School of Medicine at Northwestern University and The Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Keng Lam
- Department of Neurology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Eudocia Q Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Minesh Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - Michael Parsons
- Departments of Oncology and Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David A Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Hussein Tawbi
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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12
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Lee EQ, Camidge DR, Mehta G. Extending Our Reach: Expanding Enrollment in Brain Metastases and Primary Brain Tumor Clinical Trials. Am Soc Clin Oncol Educ Book 2022; 42:1-9. [PMID: 35427188 DOI: 10.1200/edbk_349155] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Despite the unmet need, clinical trial opportunities for primary and metastatic central nervous system cancers are limited and clinical trial enrollment is poor. Multiple stakeholders have launched efforts to improve the clinical trial landscape for patients with primary and metastatic central nervous system tumors, including work that promotes the inclusion of patients with brain tumors into clinical trials, re-examination of eligibility criteria, and careful consideration of trial design aspects that may uniquely impact the patients with this disease. Herein, we consider regulatory perspectives from the U.S. Food and Drug Administration and clinician-trialist perspectives from a neuro-oncologist and a medical oncologist.
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Affiliation(s)
- Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Gautam Mehta
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD
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13
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Zhu L, Retana D, García‐Gómez P, Álvaro‐Espinosa L, Priego N, Masmudi‐Martín M, Yebra N, Miarka L, Hernández‐Encinas E, Blanco‐Aparicio C, Martínez S, Sobrino C, Ajenjo N, Artiga M, Ortega‐Paino E, Torres‐Ruiz R, Rodríguez‐Perales S, Soffietti R, Bertero L, Cassoni P, Weiss T, Muñoz J, Sepúlveda JM, González‐León P, Jiménez‐Roldán L, Moreno LM, Esteban O, Pérez‐Núñez Á, Hernández‐Laín A, Toldos O, Ruano Y, Alcázar L, Blasco G, Fernández‐Alén J, Caleiras E, Lafarga M, Megías D, Graña‐Castro O, Nör C, Taylor MD, Young LS, Varešlija D, Cosgrove N, Couch FJ, Cussó L, Desco M, Mouron S, Quintela‐Fandino M, Weller M, Pastor J, Valiente M. A clinically compatible drug-screening platform based on organotypic cultures identifies vulnerabilities to prevent and treat brain metastasis. EMBO Mol Med 2022; 14:e14552. [PMID: 35174975 PMCID: PMC8899920 DOI: 10.15252/emmm.202114552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 12/14/2022] Open
Abstract
We report a medium-throughput drug-screening platform (METPlatform) based on organotypic cultures that allows to evaluate inhibitors against metastases growing in situ. By applying this approach to the unmet clinical need of brain metastasis, we identified several vulnerabilities. Among them, a blood-brain barrier permeable HSP90 inhibitor showed high potency against mouse and human brain metastases at clinically relevant stages of the disease, including a novel model of local relapse after neurosurgery. Furthermore, in situ proteomic analysis applied to metastases treated with the chaperone inhibitor uncovered a novel molecular program in brain metastasis, which includes biomarkers of poor prognosis and actionable mechanisms of resistance. Our work validates METPlatform as a potent resource for metastasis research integrating drug-screening and unbiased omic approaches that is compatible with human samples. Thus, this clinically relevant strategy is aimed to personalize the management of metastatic disease in the brain and elsewhere.
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Affiliation(s)
- Lucía Zhu
- Brain Metastasis GroupCNIOMadridSpain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raúl Torres‐Ruiz
- Molecular Cytogenetics UnitCNIOMadridSpain,Division of Hematopoietic Innovative TherapiesCentro de Investigaciones EnergeticasMedioambientales y Tecnologicas (CIEMAT)MadridSpain
| | | | | | - Riccardo Soffietti
- Department of Neuro‐OncologyUniversity and City of Health and Science HospitalTurinItaly
| | - Luca Bertero
- Department of Medical SciencesUniversity of TurinTurinItaly
| | - Paola Cassoni
- Department of Medical SciencesUniversity of TurinTurinItaly
| | - Tobias Weiss
- Department of NeurologyClinical Neuroscience CenterUniversity Hospital Zurich and University of ZurichZurichSwitzerland
| | - Javier Muñoz
- Proteomics UnitProteoRedISCIIICNIOMadridSpain,Present address:
Cell Signaling and Clinical Proteomics GroupBiocruces Bizkaia Health Research InstituteBarakaldoSpain,Present address:
IkerbasqueBasque Foundation for ScienceBilbaoSpain
| | | | | | - Luis Jiménez‐Roldán
- Neurosurgery UnitHospital Universitario 12 de OctubreMadridSpain,Department of SurgeryUniversidad Complutense de MadridMadridSpain,Neuropathology UnitInstituto i+12, Hospital Universitario 12 de OctubreMadridSpain
| | | | - Olga Esteban
- Neurosurgery UnitHospital Universitario 12 de OctubreMadridSpain
| | - Ángel Pérez‐Núñez
- Neurosurgery UnitHospital Universitario 12 de OctubreMadridSpain,Department of SurgeryUniversidad Complutense de MadridMadridSpain,Neuro‐Oncology GroupResearch Institute Hospital 12 de Octubre (i+12)MadridSpain
| | | | - Oscar Toldos
- Neuropathology UnitInstituto i+12, Hospital Universitario 12 de OctubreMadridSpain
| | - Yolanda Ruano
- Pathology DepartmentInstituto i+12, Hospital Universitario 12 de OctubreMadridSpain,Universidad Francisco de VitoriaMadridSpain
| | - Lucía Alcázar
- Neurosurgery DepartmentHospital Universitario de La PrincesaMadridSpain
| | - Guillermo Blasco
- Neurosurgery DepartmentHospital Universitario de La PrincesaMadridSpain
| | | | | | - Miguel Lafarga
- Department of Anatomy and Cell Biology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)University of Cantabria‐IDIVALSantanderSpain
| | | | | | - Carolina Nör
- Developmental and Stem Cell Biology Program and The Arthur and Sonia Labatt Brain Tumour Research CentreThe Hospital for Sick ChildrenTorontoONCanada
| | - Michael D Taylor
- Developmental and Stem Cell Biology Program and The Arthur and Sonia Labatt Brain Tumour Research CentreThe Hospital for Sick ChildrenTorontoONCanada
| | - Leonie S Young
- Endocrine Oncology Research GroupDepartment of SurgeryRCSI University of Medicine and Health SciencesDublinIreland
| | - Damir Varešlija
- Endocrine Oncology Research GroupDepartment of SurgeryRCSI University of Medicine and Health SciencesDublinIreland
| | - Nicola Cosgrove
- Endocrine Oncology Research GroupDepartment of SurgeryRCSI University of Medicine and Health SciencesDublinIreland
| | - Fergus J Couch
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMNUSA
| | - Lorena Cussó
- Departamento de Bioingeniería e Ingeniería AeroespacialUniversidad Carlos III de MadridMadridSpain,Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain,Unidad de Imagen AvanzadaCentro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
| | - Manuel Desco
- Departamento de Bioingeniería e Ingeniería AeroespacialUniversidad Carlos III de MadridMadridSpain,Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain,Unidad de Imagen AvanzadaCentro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
| | | | | | - Michael Weller
- Department of NeurologyClinical Neuroscience CenterUniversity Hospital Zurich and University of ZurichZurichSwitzerland
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14
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Shahbazi-Gahrouei D, Banisharif S, Akhavan A, Rasouli N, Shahbazi-Gahrouei S. Determining the optimum tumor control probability model in radiotherapy of glioblastoma multiforme using magnetic resonance imaging data pre- and post- radiation therapy. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:10. [PMID: 35342443 PMCID: PMC8943575 DOI: 10.4103/jrms.jrms_1138_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 04/14/2021] [Accepted: 08/30/2021] [Indexed: 11/06/2022]
Abstract
Background: Glioblastoma multiforme (GBM) is the most common and malignant brain tumor. The current standard of care is surgery followed by radiation therapy (RT). Radiotherapy treatment plan evaluation relies on radiobiological models for accurate estimation of tumor control probability (TCP). This study aimed to assess the impact of obtained magnetic resonance imaging (MRI) data before and 12 weeks after RT to achieve the optimum TCP model to improve dose prescriptions in radiation therapy of GBM. Materials and Methods:: In this quasi-experimental study, MR images and its relevant data from 30 patients consisting of 9 females and 21 males (mean age of 46.3 ± 15.8 years) diagnosed with GBM, whose referred for radiotherapy were selected. The data of age, gender, tumor size, volume, and signal intensity using analysis of MRI data pre- and postradiotherapy were used for calculating TCP. TCP was calculated from three common radiobiological models including Poisson, linear quadratic, and equivalent uniform dose. The impact of some radiobiological parameters on final TCP in all patients planned with three-dimensional conformal radiation therapy was obtained. Results: A statistically significant difference was found among TCP in Poisson model compared to the other two models (P < 0.001). Changes in tumor volume and size after treatment were statistically significant (P < 0.05). Different combinations of radiobiological parameters (α/β and SF2 in all models) observed were meaningful (P < 0.05). Conclusion: The results showed that among TCP radiobiological models, the optimum is the Poisson. The results also identified the importance of TCP radiobiological models in order to improve radiotherapy dose prescriptions.
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15
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Abstract
Clinical trials play a critical role in discovering new treatments, but the path to regulatory approval can be cumbersome and time consuming. Efforts to increase the efficiency and interpretability of clinical trials within the neuro-oncology community have focused on standardization of response assessment, development of consensus guidelines for clinical trial conduct, decentralization of clinical trials, removal of barriers to clinical trial accrual, and re-examination of patient eligibility criteria.
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Affiliation(s)
- Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
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16
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Corbett K, Sharma A, Pond GR, Brastianos PK, Das S, Sahgal A, Jerzak KJ. Central Nervous System-Specific Outcomes of Phase 3 Randomized Clinical Trials in Patients With Advanced Breast Cancer, Lung Cancer, and Melanoma. JAMA Oncol 2021; 7:1062-1064. [PMID: 34014298 DOI: 10.1001/jamaoncol.2021.1359] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kathryn Corbett
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alisha Sharma
- Faculty of Medicine, McMaster University, Hamilton, Canada
| | - Gregory R Pond
- Department of Oncology, Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, Canada
| | - Priscilla K Brastianos
- Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston.,Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sunit Das
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Katarzyna J Jerzak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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17
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Kaufmann TJ, Smits M, Boxerman J, Huang R, Barboriak DP, Weller M, Chung C, Tsien C, Brown PD, Shankar L, Galanis E, Gerstner E, van den Bent MJ, Burns TC, Parney IF, Dunn G, Brastianos PK, Lin NU, Wen PY, Ellingson BM. Consensus recommendations for a standardized brain tumor imaging protocol for clinical trials in brain metastases. Neuro Oncol 2021; 22:757-772. [PMID: 32048719 PMCID: PMC7283031 DOI: 10.1093/neuonc/noaa030] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A recent meeting was held on March 22, 2019, among the FDA, clinical scientists, pharmaceutical and biotech companies, clinical trials cooperative groups, and patient advocacy groups to discuss challenges and potential solutions for increasing development of therapeutics for central nervous system metastases. A key issue identified at this meeting was the need for consistent tumor measurement for reliable tumor response assessment, including the first step of standardized image acquisition with an MRI protocol that could be implemented in multicenter studies aimed at testing new therapeutics. This document builds upon previous consensus recommendations for a standardized brain tumor imaging protocol (BTIP) in high-grade gliomas and defines a protocol for brain metastases (BTIP-BM) that addresses unique challenges associated with assessment of CNS metastases. The "minimum standard" recommended pulse sequences include: (i) parameter matched pre- and post-contrast inversion recovery (IR)-prepared, isotropic 3D T1-weighted gradient echo (IR-GRE); (ii) axial 2D T2-weighted turbo spin echo acquired after injection of gadolinium-based contrast agent and before post-contrast 3D T1-weighted images; (iii) axial 2D or 3D T2-weighted fluid attenuated inversion recovery; (iv) axial 2D, 3-directional diffusion-weighted images; and (v) post-contrast 2D T1-weighted spin echo images for increased lesion conspicuity. Recommended sequence parameters are provided for both 1.5T and 3T MR systems. An "ideal" protocol is also provided, which replaces IR-GRE with 3D TSE T1-weighted imaging pre- and post-gadolinium, and is best performed at 3T, for which dynamic susceptibility contrast perfusion is included. Recommended perfusion parameters are given.
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Affiliation(s)
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jerrold Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Raymond Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel P Barboriak
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina Tsien
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lalitha Shankar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA
| | - Evanthia Galanis
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Gerstner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Terry C Burns
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gavin Dunn
- Department of Neurological Surgery, Washington University, St Louis, Missouri, USA
| | - Priscilla K Brastianos
- Departments of Medicine and Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Departments of Radiological Sciences and Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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18
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Vázquez M, Altabas M, Moreno DC, Geng AA, Pérez-Hoyos S, Giralt J. 30-Day Mortality Following Palliative Radiotherapy. Front Oncol 2021; 11:668481. [PMID: 33968775 PMCID: PMC8103895 DOI: 10.3389/fonc.2021.668481] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/19/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose 30-day mortality (30-DM) is a parameter with widespread use as an indicator of avoidance of harm used in medicine. Our objective is to determine the 30-DM followed by palliative radiation therapy (RT) in our department and to identify potential prognosis factors. Material/Methods We conducted a retrospective cohort study including patients treated with palliative RT in our center during 2018 and 2019. Data related to clinical and treatment characteristics were collected. Results We treated 708 patients to whom 992 palliative irradiations were delivered. The most frequent primary tumor sites were lung (31%), breast (14.8%), and gastrointestinal (14.8%). Bone was the predominant location of the treatment (56%), and the use of single doses was the preferred treatment schedule (34.4%). The 30-DM was 17.5%. For those who died in the first month the median survival was 17 days. Factors with a significant impact on 30-DM were: male gender (p < 0.0001); Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 2–3 (p = 0.0001); visceral metastases (p = 0.0353); lung, gastrointestinal or urinary tract primary tumors (p = 0.016); and single dose RT (p = <0.0001). In the multivariate analysis, male gender, ECOG PS 2–3, gastrointestinal and lung cancer were found to be independent factors related to 30-DM. Conclusion Our 30-DM is similar to previous studies. We have found four clinical factors related to 30-DM of which ECOG was the most strongly associated. This data may help to identify terminally ill patients with poor prognosis in order to avoid unnecessary treatments.
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Affiliation(s)
- Miriam Vázquez
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Manuel Altabas
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Diana C Moreno
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Abraham A Geng
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Unit of Statistics and Bioinformatics, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jordi Giralt
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Prevention of brain metastases in human epidermal growth factor receptor 2-positive breast cancer. Curr Opin Oncol 2021; 32:555-560. [PMID: 32890023 DOI: 10.1097/cco.0000000000000682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW For patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer, treatments that could prevent or delay occurrence of brain metastases would improve outcome. RECENT FINDINGS Few studies were specifically designed to assess brain metastasis prevention. Most evidence derives from subgroup analyses of randomized trials. In the first-line metastatic setting, lapatinib, was not superior to trastuzumab to prevent CNS metastases as first site of relapse. Pertuzumab when added to trastuzumab and taxane significantly delay occurrence of brain metastases. In the second line setting, trastuzumab-emtansine has shown to improve overall survival of patients with brain metastases when compared with capecitabine-lapatinib, but there was no significant delay in brain metastases progression. Neratinib, has shown that it was able to delay brain metastases progression. Finally, tucatinib, has demonstrated benefit in progression-free survival and overall survival in combination with trastuzumab and capecitabine over trastuzumab and capecitabine for patients with or without brain metastases. SUMMARY There has been an impressive improvement of the outcome of patients with HER2-positive metastatic breast cancer, with improved control of systemic disease and delayed occurrence of CNS progression. Specific studies are needed to assess TKI for brain metastases prevention, particularly in the adjuvant setting.
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20
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Sheng S, Hu Y. [Ongoing Evaluation of Immune-related Response Assessment in Brain Metastases]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:124-130. [PMID: 33626854 PMCID: PMC7936082 DOI: 10.3779/j.issn.1009-3419.2021.101.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
脑转移瘤是成人恶性神经系统肿瘤最常见的病因。针对这一部分人群,治疗手段有限,预后不佳。近年来,以程序性死亡受体1(programmed cell death protein 1, PD-1)及程序性死亡受体配体1(programmed cell death protein ligand 1, PD-L1)抑制剂为主的免疫治疗,给恶性肿瘤的治疗模式带来了革新。免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)彻底改变了晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)的治疗模式。ICI在某些驱动基因阴性的NSCLC脑转移瘤治疗中,取得了令人鼓舞的结果。然而,针对脑转移瘤患者的临床研究,不仅相应的临床数据有限,其疗效的评价也缺乏统一标准。本文旨在阐述不同的疗效评价标准及其在临床研究中的应用,比较之间的异同,并对未来发展趋势进行展望。
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Affiliation(s)
- Shuyan Sheng
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor
Research Institute, Beijing 101149, China
| | - Ying Hu
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor
Research Institute, Beijing 101149, China
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21
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The use of multiparametric 18F-fluoro-L-3,4-dihydroxy-phenylalanine PET/MRI in post-therapy assessment of patients with gliomas. Nucl Med Commun 2021; 41:517-525. [PMID: 32282634 DOI: 10.1097/mnm.0000000000001184] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the utility of F-fluoro-L-3,4-dihydroxy-phenylalanine (F-DOPA) PET/MRI versus cross-sectional MRI alone in glioma response assessment and identify whether the two techniques demonstrate different tumour features. METHODS F-DOPA PET/MRI studies from 40 patients were analysed. Quantitative PET parameters and conventional MRI features were recorded. Tumour volume was assessed on both PET and MRI. Using dynamic susceptibility contrast perfusion-weighted imaging, maps of cerebral blood flow (CBF) and cerebral blood volume (CBV) were obtained. Within volume of tumours of tumour features and normal-appearing white matter (NAWM) drawn on MRI, standardised uptake value (SUV)max, CBF and CBV were recorded. Presence of residual active tumour was assessed by qualitative visual assessment. Receiver operating characteristic analysis was performed univariately and on parameter combination to analyse ability to determine presence/absence of disease. Reference standard for presence of viable tissue was biopsy or clinical follow-up. RESULTS Median SUVmax was 3.4 for low-grade glioma (LGG) and 3.3 for high-grade glioma (HGG). There was a significant correlation between PWI parameters and WHO grade (P < 0.001), but no correlation with SUVmax. Median F-DOPA volume was 8216.88 mm for HGG and 6284.94 mm for LGG; MRI volume was 6316.57 mm and 5931.55 mm, respectively. SUVmax analysis distinguished enhancing and nonenhancing components from necrosis and NAWM and demonstrated active disease in nonenhancing regions. Visually, the modalities were concordant in 37 patients. Combining the multiparametric PET/MRI approach with all available data-enhanced detection of the presence of tumour (area under the curve 0.99, P < 0.01). CONCLUSION MRI and F-DOPA are complementary modalities for assessment of tumour burden. Matching F-DOPA and MRI in assessing residual tumour volume may better delineate the radiotherapy target volume.
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22
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Belderbos JSA, De Ruysscher DKM, De Jaeger K, Koppe F, Lambrecht MLF, Lievens YN, Dieleman EMT, Jaspers JPM, Van Meerbeeck JP, Ubbels F, Kwint MH, Kuenen MA, Deprez S, De Ruiter MB, Boogerd W, Sikorska K, Van Tinteren H, Schagen SB. Phase 3 Randomized Trial of Prophylactic Cranial Irradiation With or Without Hippocampus Avoidance in SCLC (NCT01780675). J Thorac Oncol 2021; 16:840-849. [PMID: 33545387 DOI: 10.1016/j.jtho.2020.12.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To compare neurocognitive functioning in patients with SCLC who received prophylactic cranial irradiation (PCI) with or without hippocampus avoidance (HA). METHODS In a multicenter, randomized phase 3 trial (NCT01780675), patients with SCLC were randomized to standard PCI or HA-PCI of 25 Gy in 10 fractions. Neuropsychological tests were performed at baseline and 4, 8, 12, 18, and 24 months after PCI. The primary end point was total recall on the Hopkins Verbal Learning Test-Revised at 4 months; a decline of at least five points from baseline was considered a failure. Secondary end points included other cognitive outcomes, evaluation of the incidence, location of brain metastases, and overall survival. RESULTS From April 2013 to March 2018, a total of 168 patients were randomized. The median follow-up time was 26.6 months. In both treatment arms, 70% of the patients had limited disease and baseline characteristics were well balanced. Decline on the Hopkins Verbal Learning Test-Revised total recall score at 4 months was not significantly different between the arms: 29% of patients on PCI and 28% of patients on HA-PCI dropped greater than or equal to five points (p = 1.000). Performance on other cognitive tests measuring memory, executive function, attention, motor function, and processing speed did not change significantly different over time between the groups. The overall survival was not significantly different (p = 0.43). The cumulative incidence of brain metastases at 2 years was 20% (95% confidence interval: 12%-29%) for the PCI arm and 16% (95% confidence interval: 7%-24%) for the HA-PCI arm. CONCLUSIONS This randomized phase 3 trial did not find a lower probability of cognitive decline in patients with SCLC receiving HA-PCI compared with conventional PCI. No increase in brain metastases at 2 years was observed in the HA-PCI arm.
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Affiliation(s)
- José S A Belderbos
- Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Dirk K M De Ruysscher
- Radiation Oncology (MAASTRO), School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Friederike Koppe
- Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | | | - Yolande N Lievens
- Radiation Oncology, Ghent University Hospital and Ghent University, Gent, Belgium
| | - Edith M T Dieleman
- Radiation Oncology, Amsterdam UMC-Location AMC, Amsterdam, The Netherlands
| | - Jaap P M Jaspers
- Radiation Oncology, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan P Van Meerbeeck
- Pulmonology & Thoracic Oncology, Antwerp University and Antwerp University Hospital, Edegem, Belgium
| | - Fred Ubbels
- Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Margriet H Kwint
- Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marianne A Kuenen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sabine Deprez
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium; Leuven Cancer Institute (LKI), Leuven, Belgium
| | - Michiel B De Ruiter
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Willem Boogerd
- Neurology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harm Van Tinteren
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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23
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Cali Daylan AE, Leone JP. Targeted Therapies for Breast Cancer Brain Metastases. Clin Breast Cancer 2021; 21:263-270. [PMID: 33384227 DOI: 10.1016/j.clbc.2020.11.014] [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: 07/02/2020] [Revised: 10/17/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
The management of breast cancer, the most common cancer in the female population, has changed dramatically over years with the introduction of newer therapies. An increased incidence of brain metastases in recent years has created a challenge for oncologists because this population continues to have a poorer prognosis compared to metastatic breast cancer without central nervous system involvement. Historically, the exclusion of breast cancer patients with brain metastases from clinical trials has made treatment options even more limited. Nonetheless, more recently, this unmet need has been recognized by basic and clinical researchers and has led to the development of targeted therapies with better blood-brain barrier penetration and intracranial efficacy. Here we review targeted therapies directed at human epidermal growth factor receptor type 2 (HER2), vascular endothelial growth factor (VEGF), mammalian target of rapamycin (mTOR), epidermal growth factor receptor (EGFR), cyclin-dependent kinase 4 and 6 (CDK4/6) and poly(ADP-ribose) polymerase (PARP) for breast cancer patients with brain metastases. These therapies aim to be more efficacious and less toxic to represent a paradigm shift in the management of breast cancer brain metastases.
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Affiliation(s)
- Ayse Ece Cali Daylan
- Department of Medicine, St Elizabeth's Medical Center, Boston, MA; Department of Medicine, Tufts University School of Medicine, Boston, MA.
| | - José Pablo Leone
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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24
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Abstract
Brain metastases (BM) are the most common intracranial neoplasm and represent a major clinical challenge across many medical disciplines. The incidence of BM is increasing, largely due to improvements in primary disease therapeutics conferring greater systemic control, and advancements in neuroimaging techniques and availability leading to earlier diagnosis. In recent years, the landscape of BM treatment has changed significantly with the advent of personalized targeted chemotherapies and immunotherapy, the adoption of focal radiotherapy (RT) for higher intracranial disease burden, and the implementation of new surgical strategies. The increasing permutations of options available for the treatment of patients diagnosed with BM necessitate coordinated care by a multidisciplinary team. This review discusses the current treatment regimens for BM as well as examines the salient features of a modern multidisciplinary approach.
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25
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Seligmann JF, Wright-Hughes A, Pottinger A, Velikova G, Oughton JB, Murden G, Rizwanullah M, Price C, Passant H, Heudtlass P, Marshall H, Johnston S, Dodwell D. Lapatinib plus Capecitabine versus Trastuzumab plus Capecitabine in the Treatment of Human Epidermal Growth Factor Receptor 2-positive Metastatic Breast Cancer with Central Nervous System Metastases for Patients Currently or Previously Treated with Trastuzumab (LANTERN): a Phase II Randomised Trial. Clin Oncol (R Coll Radiol) 2020; 32:656-664. [PMID: 32600919 DOI: 10.1016/j.clon.2020.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/14/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022]
Abstract
AIMS Brain (central nervous system; CNS) metastases occur in 30-50% of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). A substantive evidence base for treatment is lacking, but activity with lapatinib plus capecitabine (lap-cap) has been reported. We compared lap-cap with trastuzumab plus capecitabine (tras-cap) in patients with HER2-positive MBC with CNS metastases previously treated with trastuzumab. MATERIALS AND METHODS This open-label randomised phase II screening trial aimed to randomise 130 participants over 2 years to receive lap-cap or tras-cap. Eligible patients had HER2-positive MBC with newly diagnosed or recently progressed CNS metastases; previous, or current, treatment included: trastuzumab, a taxane or anthracycline and recent completion of local cranial therapy. The primary end point was time to progression of CNS metastases within the 24-week trial period. Secondary objectives included CNS response rate, progression-free survival, steroid use for CNS symptoms and feasibility of recruitment to a large phase III trial. RESULTS Between September 2011 and October 2013, 30 participants were randomised, 16 to lap-cap and 14 to tras-cap. Recruitment to a large phase III trial was determined not to be feasible. At 24 weeks, CNS disease progression was 41.8% (95% confidence interval 16.1-67.5%) in lap-cap and 41.2% (95% confidence interval 12.8-69.6%) in tras-cap arms; progression-free survival was 44.4% (95% confidence interval 18.1-70.8%) in lap-cap and 50.0% (95% confidence interval 20.9-79.1%) in tras-cap arms. CONCLUSION Poor recruitment confirmed that a larger phase III trial would not be feasible and prohibited a preliminary evaluation of the superiority of lap-cap over tras-cap. Descriptive statistics are presented to inform the limited evidence base and future study design.
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Affiliation(s)
- J F Seligmann
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - A Wright-Hughes
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - A Pottinger
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Velikova
- St James's Institute of Oncology, St James University Hospital, Leeds, UK
| | - J B Oughton
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Murden
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - M Rizwanullah
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Price
- Department of Medical Oncology, University Hospitals, Bristol, UK
| | - H Passant
- Department of Medical Oncology, Velindre Hospital, Cardiff, UK
| | - P Heudtlass
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - S Johnston
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Dodwell
- St James's Institute of Oncology, St James University Hospital, Leeds, UK; Nuffield Department of Population Health, Oxford University, Oxford, UK.
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26
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Abstract
Brain metastases are a very common manifestation of cancer that have historically been approached as a single disease entity given the uniform association with poor clinical outcomes. Fortunately, our understanding of the biology and molecular underpinnings of brain metastases has greatly improved, resulting in more sophisticated prognostic models and multiple patient-related and disease-specific treatment paradigms. In addition, the therapeutic armamentarium has expanded from whole-brain radiotherapy and surgery to include stereotactic radiosurgery, targeted therapies and immunotherapies, which are often used sequentially or in combination. Advances in neuroimaging have provided additional opportunities to accurately screen for intracranial disease at initial cancer diagnosis, target intracranial lesions with precision during treatment and help differentiate the effects of treatment from disease progression by incorporating functional imaging. Given the numerous available treatment options for patients with brain metastases, a multidisciplinary approach is strongly recommended to personalize the treatment of each patient in an effort to improve the therapeutic ratio. Given the ongoing controversies regarding the optimal sequencing of the available and expanding treatment options for patients with brain metastases, enrolment in clinical trials is essential to advance our understanding of this complex and common disease. In this Review, we describe the key features of diagnosis, risk stratification and modern paradigms in the treatment and management of patients with brain metastases and provide speculation on future research directions.
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27
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Moravan MJ, Fecci PE, Anders CK, Clarke JM, Salama AKS, Adamson JD, Floyd SR, Torok JA, Salama JK, Sampson JH, Sperduto PW, Kirkpatrick JP. Current multidisciplinary management of brain metastases. Cancer 2020; 126:1390-1406. [PMID: 31971613 DOI: 10.1002/cncr.32714] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/08/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022]
Abstract
Brain metastasis (BM), the most common adult brain tumor, develops in 20% to 40% of patients with late-stage cancer and traditionally are associated with a poor prognosis. The management of patients with BM has become increasingly complex because of new and emerging systemic therapies and advancements in radiation oncology and neurosurgery. Current therapies include stereotactic radiosurgery, whole-brain radiation therapy, surgical resection, laser-interstitial thermal therapy, systemic cytotoxic chemotherapy, targeted agents, and immune-checkpoint inhibitors. Determining the optimal treatment for a specific patient has become increasingly individualized, emphasizing the need for multidisciplinary discussions of patients with BM. Recognizing and addressing the sequelae of BMs and their treatment while maintaining quality of life and neurocognition is especially important because survival for patients with BMs has improved. The authors present current and emerging treatment options for patients with BM and suggest approaches for managing sequelae and disease recurrence.
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Affiliation(s)
- Michael J Moravan
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.,Department of Radiation Oncology, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina
| | - Carey K Anders
- Department of Internal Medicine, Division of Medical Oncology, Duke University Hospital, Durham, North Carolina
| | - Jeffrey M Clarke
- Department of Internal Medicine, Division of Medical Oncology, Duke University Hospital, Durham, North Carolina
| | - April K S Salama
- Department of Internal Medicine, Division of Medical Oncology, Duke University Hospital, Durham, North Carolina
| | - Justus D Adamson
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Scott R Floyd
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jordan A Torok
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.,Department of Radiation Oncology, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - John H Sampson
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.,Department of Neurosurgery, Duke University Hospital, Durham, North Carolina
| | - Paul W Sperduto
- Minneapolis Radiation Oncology, Minneapolis, Minnesota.,University of Minnesota Gamma Knife Center, Minneapolis, Minnesota
| | - John P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.,Department of Neurosurgery, Duke University Hospital, Durham, North Carolina
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28
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Brain metastasis as exclusion criteria in clinical trials involving extensive-stage small cell lung cancer. J Cancer Res Clin Oncol 2019; 145:3099-3104. [PMID: 31549227 DOI: 10.1007/s00432-019-03034-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The American Society of Clinical Oncology and Friends of Cancer Research submitted recommendations to the FDA to reduce barriers in clinical trial participation. They proposed the removal of several specific exclusion criteria, including brain metastasis. Clinical trials involving small cell lung cancer (SCLC) have varying exclusion criteria regarding brain metastasis. METHODS We completed an online search of clinicaltrials.gov for the query "SCLC, extensive stage." The trials were classified into a group of strict exclusion, allowed only if treated, allowed without treatment, or undefined. Relationships between status of brain metastasis in exclusion criteria and study characteristics (trial status, trial design, sponsor, location, and treatment groups) were investigated by Chi-squared test. The trends of exclusion status were investigated by a comparison against the variable time. RESULTS Of the 204 eligible trials, 32 strictly excluded any form or history of CNS metastases, 129 allowed patients that are undergoing or have undergone CNS-specific therapy, 9 allowed patients without any CNS-specific therapy, and 34 did not mention any criteria involving CNS metastases. Studies conducted outside the United States and with single systemic therapy were associated with strict exclusion of brain metastasis (p = 0.026 and 0.039, respectively). The proportion of clinical trials with strict exclusion has remained around 15% for the past few decades. CONCLUSION Non-US and single systemic therapy studies are more commonly associated with strict exclusion of brain metastasis in ES-SCLC trials. The strict exclusion of brain metastases in clinical trials has remained relatively constant for the past few decades.
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29
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Chukwueke UN, Wen PY. Use of the Response Assessment in Neuro-Oncology (RANO) criteria in clinical trials and clinical practice. CNS Oncol 2019; 8:CNS28. [PMID: 30806082 PMCID: PMC6499019 DOI: 10.2217/cns-2018-0007] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/15/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ugonma N Chukwueke
- Department of Medical Oncology, Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Neurology, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Patrick Y Wen
- Department of Medical Oncology, Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Neurology, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
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30
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Camidge DR, Lee EQ, Lin NU, Margolin K, Ahluwalia MS, Bendszus M, Chang SM, Dancey J, de Vries EGE, Harris GJ, Hodi FS, Lassman AB, Macdonald DR, Peereboom DM, Schiff D, Soffietti R, van den Bent MJ, Wefel JS, Wen PY. Clinical trial design for systemic agents in patients with brain metastases from solid tumours: a guideline by the Response Assessment in Neuro-Oncology Brain Metastases working group. Lancet Oncol 2018; 19:e20-e32. [PMID: 29304358 DOI: 10.1016/s1470-2045(17)30693-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/24/2017] [Accepted: 08/22/2017] [Indexed: 12/30/2022]
Abstract
Patients with active CNS disease are often excluded from clinical trials, and data regarding the CNS efficacy of systemic agents are usually obtained late in the drug development process or not at all. In this guideline from the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) working group, we provide detailed recommendations on when patients with brain metastases from solid tumours should be included or excluded in clinical trials of systemic agents. We also discuss the limitations of retrospective studies in determining the CNS efficacy of systemic drugs. Inclusion of patients with brain metastases early on in the clinical development of a drug or a regimen is needed to generate appropriate CNS efficacy or non-efficacy signals. We consider how to optimally incorporate or exclude such patients in systemic therapy trials depending on the likelihood of CNS activity of the agent by considering three scenarios: drugs that are considered very unlikely to have CNS antitumour activity or efficacy; drugs that are considered very likely to have CNS activity or efficacy; and drugs with minimal baseline information on CNS activity or efficacy. We also address trial design issues unique to patients with brain metastases, including the selection of appropriate CNS endpoints in systemic therapy trials.
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Affiliation(s)
- D Ross Camidge
- Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kim Margolin
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Manmeet S Ahluwalia
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Susan M Chang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Janet Dancey
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Netherlands
| | - Gordon J Harris
- Department of Radiology, 3D Imaging Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew B Lassman
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Columbia University, NY, USA
| | - David R Macdonald
- Department of Oncology and Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - David M Peereboom
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - David Schiff
- Division of Neuro-Oncology, University of Virginia, Charlottesville, VA, USA
| | - Ricardo Soffietti
- Department of Neurology/Neuro-Oncology, University of Turin, Turin, Italy
| | | | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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31
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Kotecki N, Lefranc F, Devriendt D, Awada A. Therapy of breast cancer brain metastases: challenges, emerging treatments and perspectives. Ther Adv Med Oncol 2018; 10:1758835918780312. [PMID: 29977353 PMCID: PMC6024336 DOI: 10.1177/1758835918780312] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023] Open
Abstract
Brain metastases are the most common central nervous system tumors in adults, and incidence of brain metastases is increasing due to both improved diagnostic techniques (e.g. magnetic resonance imaging) and increased cancer patient survival through advanced systemic treatments. Outcomes of patients remain disappointing and treatment options are limited, usually involving multimodality approaches. Brain metastases represent an unmet medical need in solid tumor care, especially in breast cancer, where brain metastases are frequent and result in impaired quality of life and death. Challenges in the management of brain metastases have been highlighted in this review. Innovative research and treatment strategies, including prevention approaches and emerging systemic treatment options for brain metastases of breast cancer, are further discussed.
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Affiliation(s)
- Nuria Kotecki
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Florence Lefranc
- Department of Neurosurgery, Hopital Erasme, Université Libre de Bruxelles, Belgium
| | - Daniel Devriendt
- Department of Radiotherapy, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Ahmad Awada
- Medical Oncology Clinic, Institut Jules Bordet, 1 rue Heger Bordet, Université Libre de Bruxelles, Brussels, Belgium
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32
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Liu Y, Liu X, Xu L, Liu L, Sun Y, Li M, Zeng H, Yuan S, Yu J. Magnetic resonance imaging evaluation of treatment efficacy and prognosis for brain metastases in lung cancer patients after radiotherapy: A preliminary study. Thorac Cancer 2018; 9:865-873. [PMID: 29774659 PMCID: PMC6026610 DOI: 10.1111/1759-7714.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/08/2018] [Accepted: 04/08/2018] [Indexed: 01/10/2023] Open
Abstract
Background This study used magnetic resonance imaging (MRI) to monitor changes to brain metastases and investigate the imaging signs used to evaluate treatment efficacy and determine prognosis following radiotherapy for brain metastases from lung cancer. Methods A total of 60 non‐small cell lung cancer patients with brain oligometastases were selected. MRI scans were conducted before and 3, 6, 9, 12, 18, 24, and 30 months after radiotherapy. The tumor and peritumoral edema diameters, Cho/Cr values, elevation of the Lip peak value, and whether the island (yu‐yuan) sign or high‐signal ring were present on T2 fluid‐attenuated inversion recovery (FLAIR) imaging were recorded for each metastasis. Results The mortality risk was higher the earlier the maximum value of peritumoral edema diameter was reached, when there were fewer island signs, and when brain metastases did not present as tumor progression on imaging. There were significant differences in the average peritumoral edema diameter, apparent diffusion coefficient value, the number of elevated Lip peak values, and the number of T2 FLAIR imaging high‐signal rings in a year after radiotherapy in 14 patients with a survival period < 1 year compared to patients with a survival period > 2 years. Conclusion After radiotherapy for brain metastases, patients with the island sign had longer survival periods, high‐signal rings in T2 FLAIR, elevated Lip peaks, and reduced apparent diffusion coefficient values, indicating tumor necrosis. Increased diameter of metastases and Cho/Cr > 2 cannot serve as reliable indicators of brain metastasis progression.
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Affiliation(s)
- Yuhui Liu
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Xibin Liu
- Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Liang Xu
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Liheng Liu
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yuhong Sun
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Haiyan Zeng
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
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Digernes I, Grøvik E, Nilsen LB, Saxhaug C, Geier O, Reitan E, Sætre DO, Breivik B, Reese T, Jacobsen KD, Helland Å, Emblem KE. Brain metastases with poor vascular function are susceptible to pseudoprogression after stereotactic radiation surgery. Adv Radiat Oncol 2018; 3:559-567. [PMID: 30370356 PMCID: PMC6200880 DOI: 10.1016/j.adro.2018.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 12/27/2022] Open
Abstract
Purpose This study aimed to investigate the hemodynamic status of cerebral metastases prior to and after stereotactic radiation surgery (SRS) and to identify the vascular characteristics that are associated with the development of pseudoprogression from radiation-induced damage with and without a radionecrotic component. Methods and materials Twenty-four patients with 29 metastases from non-small cell lung cancer or malignant melanoma received SRS with dose of 15 Gy to 25 Gy. Magnetic resonance imaging (MRI) scans were acquired prior to SRS, every 3 months during the first year after SRS, and every 6 months thereafter. On the basis of the follow-up MRI scans or histology after SRS, metastases were classified as having response, tumor progression, or pseudoprogression. Advanced perfusion MRI enabled the estimation of vascular status in tumor regions including fractions of abnormal vessel architecture, underperfused tissue, and vessel pruning. Results Prior to SRS, metastases that later developed pseudoprogression had a distinct poor vascular function in the peritumoral zone compared with responding metastases (P < .05; number of metastases = 15). In addition, differences were found between the peritumoral zone of pseudoprogressing metastases and normal-appearing brain tissue (P < .05). In contrast, for responding metastases, no differences in vascular status between peritumoral and normal-appearing brain tissue were observed. The dysfunctional peritumoral vasculature persisted in pseudoprogressing metastases after SRS. Conclusions Our results suggest that the vascular status of peritumoral tissue prior to SRS plays a defining role in the development of pseudoprogression and that advanced perfusion MRI may provide new insights into patients' susceptibility to radiation-induced effects.
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Affiliation(s)
- Ingrid Digernes
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Endre Grøvik
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Line B Nilsen
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Cathrine Saxhaug
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Oliver Geier
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Edmund Reitan
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Dag Ottar Sætre
- Department of Radiology, Østfold Hospital Trust, Kalnes, Norway
| | - Birger Breivik
- Department of Radiology, Hospital of Southern Norway, Kristiansand, Norway
| | - Timothy Reese
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Åslaug Helland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Kyrre Eeg Emblem
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
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34
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Renier C, Do J, Reyna-Neyra A, Foster D, De A, Vogel H, Jeffrey SS, Tse V, Carrasco N, Wapnir I. Regression of experimental NIS-expressing breast cancer brain metastases in response to radioiodide/gemcitabine dual therapy. Oncotarget 2018; 7:54811-54824. [PMID: 27363025 PMCID: PMC5342383 DOI: 10.18632/oncotarget.10238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/19/2016] [Indexed: 11/25/2022] Open
Abstract
Treating breast cancer brain metastases (BCBMs) is challenging. Na+/I− symporter (NIS) expression in BCBMs would permit their selective targeting with radioiodide (131I−). We show impressive enhancement of tumor response by combining131I− with gemcitabine (GEM), a cytotoxic radiosensitizer. Nude mice mammary fat-pad (MFP) tumors and BCBMs were generated with braintropic MDA-MB-231Br cells transduced with bicistronically-linked NIS and firefly luciferase cDNAs. Response was monitored in vivo via bioluminescent imaging and NIS tumor expression.131I−/GEM therapy inhibited MFP tumor growth more effectively than either agent alone. BCBMs were treated with: high or low-dose GEM (58 or 14.5 mg/Kg×4); 131I− (1mCi or 2×0.5 mCi 7 days apart); and 131I−/GEM therapy. By post-injection day (PID) 25, 82-86% of controls and 78-83% of 131I−-treated BCBM grew, whereas 17% low-dose and 36% high-dose GEM regressed. The latter tumors were smaller than the controls with comparable NIS expression (~20% of cells). High and low-dose 131I−/GEM combinations caused 89% and 57% tumor regression, respectively. High-dose GEM/131I− delayed tumor growth: tumors increased 5-fold in size by PID45 (controls by PID18). Although fewer than 25% of cells expressed NIS, GEM/131I− caused dramatic tumor regression in NIS-transduced BCBMs. This effect was synergistic, and supports the hypothesis that GEM radiosensitizes cells to 131I−.
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Affiliation(s)
- Corinne Renier
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - John Do
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea Reyna-Neyra
- Department of Cellular and Molecular Physiology, Yale University, New Haven, CT, USA
| | - Deshka Foster
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Abhijit De
- Department of Radiology and Molecular Imaging Program at Stanford, Stanford, CA, USA.,Molecular Functional Imaging Laboratory, ACTREC Tata Memorial Centre, Navi Mumbai, India
| | - Hannes Vogel
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Stefanie S Jeffrey
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Victor Tse
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Nancy Carrasco
- Department of Cellular and Molecular Physiology, Yale University, New Haven, CT, USA
| | - Irene Wapnir
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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35
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Boost Irradiation Integrated to Whole Brain Radiotherapy in the Management of Brain Metastases. Pathol Oncol Res 2018; 26:149-157. [DOI: 10.1007/s12253-018-0383-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 01/10/2018] [Indexed: 12/30/2022]
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36
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Clinical trial design for local therapies for brain metastases: a guideline by the Response Assessment in Neuro-Oncology Brain Metastases working group. Lancet Oncol 2018; 19:e33-e42. [DOI: 10.1016/s1470-2045(17)30692-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 11/23/2022]
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37
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Soliman H, Das S, Larson DA, Sahgal A. Stereotactic radiosurgery (SRS) in the modern management of patients with brain metastases. Oncotarget 2017; 7:12318-30. [PMID: 26848525 PMCID: PMC4914287 DOI: 10.18632/oncotarget.7131] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/13/2016] [Indexed: 12/01/2022] Open
Abstract
Stereotactic radiosurgery (SRS) is an established non-invasive ablative therapy for brain metastases. Early clinical trials with SRS proved that tumor control rates are superior to whole brain radiotherapy (WBRT) alone. As a result, WBRT plus SRS was widely adopted for patients with a limited number of brain metastases (“limited number” customarily means 1-4). Subsequent trials focused on answering whether WBRT upfront was necessary at all. Based on current randomized controlled trials (RCTs) and meta-analyses comparing SRS alone to SRS plus WBRT, adjuvant WBRT results in better intracranial control; however, at the expense of neurocognitive functioning and quality of life. These adverse effects of WBRT may also negatively impact on survival in younger patients. Based on the results of these studies, treatment has shifted to SRS alone in patients with a limited number of metastases. Additionally, RCTs are evaluating the role of SRS alone in patients with >4 brain metastases. New developments in SRS include fractionated SRS for large tumors and the integration of SRS with targeted systemic therapies that cross the blood brain barrier and/or stimulate an immune response. We present in this review the current high level evidence and rationale supporting SRS as the standard of care for patients with limited brain metastases, and emerging applications of SRS.
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Affiliation(s)
- Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michaels Hospital, University of Toronto, Toronto, ON, Canada
| | - David A Larson
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, St. Michaels Hospital, University of Toronto, Toronto, ON, Canada
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38
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Martínez-Aranda A, Hernández V, Moreno F, Baixeras N, Cuadras D, Urruticoechea A, Gil-Gil M, Vidal N, Andreu X, Seguí MA, Ballester R, Castella E, Sierra A. Predictive and Prognostic Brain Metastases Assessment in Luminal Breast Cancer Patients: FN14 and GRP94 from Diagnosis to Prophylaxis. Front Oncol 2017; 7:283. [PMID: 29250484 PMCID: PMC5716976 DOI: 10.3389/fonc.2017.00283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/09/2017] [Indexed: 11/13/2022] Open
Abstract
FN14 has been implicated in many intracellular signaling pathways, and GRP94 is a well-known endoplasmic reticulum protein regulated by glucose. Recently, both have been associated with metastasis progression in breast cancer patients. We studied the usefulness of FN14 and GRP94 expression to stratify breast cancer patients according their risk of brain metastasis (BrM) progression. We analyzed FN14 and GRP94 by immunohistochemistry in a retrospective multicenter study using tissue microarrays from 208 patients with breast carcinomas, of whom 52 had developed BrM. Clinical and pathological characteristics and biomarkers expression in Luminal and non-Luminal patients were analyzed using a multivariate logistic regression model adjusted for covariates, and brain metastasis-free survival (BrMFS) was estimated using the Kaplan-Meier method and the Cox proportional hazards model. FN14 expression was associated with BrM progression mainly in Luminal breast cancer patients with a sensitivity (53.85%) and specificity (89.60%) similar to Her2 expression (46.15 and 89.84%, respectively). Moreover, the likelihood to develop BrM in FN14-positive Luminal carcinomas increased 36.70-fold (3.65-368.25, p = 0.002). Furthermore, the worst prognostic factor for BrMFS in patients with Luminal carcinomas was FN14 overexpression (HR = 8.25; 95% CI: 2.77-24.61; p = 0.00015). In these patients, GRP94 overexpression also increased the risk of BrM (HR = 3.58; 95% CI: 0.98-13.11; p = 0.054-Wald test). Therefore, FN14 expression in Luminal breast carcinomas is a predictive/prognostic biomarker of BrM, which combined with GRP94 predicts BrM progression in non-Luminal tumors 4.04-fold (1.19-8.22, p = 0.025), suggesting that both biomarkers are useful to stratify BrM risk at early diagnosis. We propose a new follow-up protocol for the early prevention of clinical BrM of breast cancer patients with BrM risk.
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Affiliation(s)
- Antonio Martínez-Aranda
- Biological Clues of the Invasive and Metastatic Phenotype Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Departament de Medicina, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vanessa Hernández
- Biological Clues of the Invasive and Metastatic Phenotype Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Moreno
- Servei d'Oncologia Radioteràpica, Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Baixeras
- Servei d'Anatomia Patològica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Cuadras
- Statistical Service, Sant Joan de Déu Research Foundation, Barcelona, Spain
| | - Ander Urruticoechea
- Breast Cancer Unit, Institut Català d'Oncologia - IDIBELL, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Gil-Gil
- Neuroncology Unit, Institut Català d'Oncologia - IDIBELL, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Noemí Vidal
- Servei d'Anatomia Patològica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Andreu
- Servei d'Anatomia Patològica, Consorci Hospitalari Parc Taulí, Barcelona, Spain
| | - Miquel A Seguí
- Servei d'Oncología Mèdica, Consorci Hospitalari Parc Taulí, Barcelona, Spain
| | - Rosa Ballester
- Servei d'Oncología Radioteràpica, Institut Català d'Oncologia (ICO), Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Eva Castella
- Servei d'Anatomia Patològica de Can Ruti, Institut Català d'Oncologia (ICO), Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Angels Sierra
- Laboratory of Molecular and Translational Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer-IDIBAPS, Centre de Recerca Biomèdica CELLEX, Barcelona, Spain.,Faculty of Medicine, Universitat de VIC-Universitat Central de Catalunya, Barcelona, Spain
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Lin NU, Prowell T, Tan AR, Kozak M, Rosen O, Amiri-Kordestani L, White J, Sul J, Perkins L, Beal K, Gaynor R, Kim ES. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology-Friends of Cancer Research Brain Metastases Working Group. J Clin Oncol 2017; 35:3760-3773. [PMID: 28968165 DOI: 10.1200/jco.2017.74.0761] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose Broadening trial eligibility to improve accrual and access and to better reflect intended-to-treat populations has been recognized as a priority. Historically, patients with brain metastases have been understudied, because of restrictive eligibility across all phases of clinical trials. Methods In 2016, after a literature search and series of teleconferences, a multistakeholder workshop was convened. Our working group focused on developing consensus recommendations regarding the inclusion of patients with brain metastases in clinical trials, as part of a broader effort that encompassed minimum age, HIV status, and organ dysfunction. The working group attempted to balance the needs of protecting patient safety, facilitating access to investigational therapies, and ensuring trial integrity. On the basis of input at the workshop, guidelines were further refined and finalized. Results The working group identified three key populations: those with treated/stable brain metastases, defined as patients who have received prior therapy for their brain metastases and whose CNS disease is radiographically stable at study entry; those with active brain metastases, defined as new and/or progressive brain metastases at the time of study entry; and those with leptomeningeal disease. In most circumstances, the working group encourages the inclusion of patients with treated/stable brain metastases in clinical trials. A framework of key considerations for patients with active brain metastases was developed. For patients with leptomeningeal disease, inclusion of a separate cohort in both early-phase and later-phase trials is recommended, if CNS activity is anticipated and when relevant to the specific disease type. Conclusion Expanding eligibility to be more inclusive of patients with brain metastasis is justified in many cases and may speed the development of effective therapies in this area of high clinical need.
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Affiliation(s)
- Nancy U Lin
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Tatiana Prowell
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Antoinette R Tan
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Marina Kozak
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Oliver Rosen
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Laleh Amiri-Kordestani
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Julia White
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Joohee Sul
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Louise Perkins
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Katherine Beal
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Richard Gaynor
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
| | - Edward S Kim
- Nancy U. Lin, Dana-Farber Cancer Institute, Boston; Oliver Rosen, Deciphera Pharmaceuticals, Waltham, MA; Tatiana Prowell, Laleh Amiri-Kordestani, and Joohee Sul, US Food and Drug Administration, Silver Spring; Tatiana Prowell, Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Antoinette R. Tan and Edward S. Kim, Carolinas HealthCare System, Charlotte, NC; Marina Kozak, Friends of Cancer Research; Louise Perkins, Melanoma Research Alliance, Washington, DC; Julia White, The Ohio State University, Columbus, OH; Katherine Beal, Memorial Sloan Kettering Cancer Center, New York, NY; and Richard Gaynor, Eli Lilly, Indianapolis, IN
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Soffietti R, Chiavazza C, Rudà R. Imaging and clinical end points in brain metastases trials. CNS Oncol 2017; 6:243-246. [PMID: 28984137 DOI: 10.2217/cns-2017-0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Riccardo Soffietti
- Department of Neuro-Oncology, University & City of Health & Science Hospital, 10126 Turin, Italy
| | - Carlotta Chiavazza
- Department of Neuro-Oncology, University & City of Health & Science Hospital, 10126 Turin, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University & City of Health & Science Hospital, 10126 Turin, Italy
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Wen PY, Chang SM, Van den Bent MJ, Vogelbaum MA, Macdonald DR, Lee EQ. Response Assessment in Neuro-Oncology Clinical Trials. J Clin Oncol 2017; 35:2439-2449. [PMID: 28640707 PMCID: PMC5516482 DOI: 10.1200/jco.2017.72.7511] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Development of novel therapies for CNS tumors requires reliable assessment of response and progression. This requirement has been particularly challenging in neuro-oncology for which contrast enhancement serves as an imperfect surrogate for tumor volume and is influenced by agents that affect vascular permeability, such as antiangiogenic therapies. In addition, most tumors have a nonenhancing component that can be difficult to accurately quantify. To improve the response assessment in neuro-oncology and to standardize the criteria that are used for different CNS tumors, the Response Assessment in Neuro-Oncology (RANO) working group was established. This multidisciplinary international working group consists of neuro-oncologists, medical oncologists, neuroradiologists, neurosurgeons, radiation oncologists, neuropsychologists, and experts in clinical outcomes assessments, working in collaboration with government and industry to enhance the interpretation of clinical trials. The RANO working group was originally created to update response criteria for high- and low-grade gliomas and to address such issues as pseudoresponse and nonenhancing tumor progression from antiangiogenic therapies, and pseudoprogression from radiochemotherapy. RANO has expanded to include working groups that are focused on other tumors, including brain metastases, leptomeningeal metastases, spine tumors, pediatric brain tumors, and meningiomas, as well as other clinical trial end points, such as clinical outcomes assessments, seizures, corticosteroid use, and positron emission tomography imaging. In an effort to standardize the measurement of neurologic function for clinical assessment, the Neurologic Assessment in Neuro-Oncology scale was drafted. Born out of a workshop conducted by the Jumpstarting Brain Tumor Drug Development Coalition and the US Food and Drug Administration, a standardized brain tumor imaging protocol now exists to reduce variability and improve reliability. Efforts by RANO have been widely accepted and are increasingly being used in neuro-oncology trials, although additional refinements will be needed.
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Affiliation(s)
- Patrick Y. Wen
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Susan M. Chang
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Martin J. Van den Bent
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Michael A. Vogelbaum
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - David R. Macdonald
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Eudocia Q. Lee
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
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Tian J, Luo Y, Xiang J, Tang J. Combined treatment for non-small cell lung cancer and breast cancer patients with brain metastases with whole brain radiotherapy and temozolomide: a systematic review and meta-analysis. J Neurooncol 2017; 135:217-227. [PMID: 28726172 DOI: 10.1007/s11060-017-2572-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/13/2017] [Indexed: 12/25/2022]
Abstract
Brain metastasis is the leading cause of death among advanced non-small cell lung cancer (NSCLC) and breast cancer patients. The standard treatment for brain metastases is radiotherapy. The combination of radiotherapy and chemotherapy has been tested. However, the management of brain metastases has yet to be successful. Here, we aimed to determine the efficacy and safety of whole brain radiotherapy (WBRT) alone or in combination with temozolomide (TMZ) in NSCLC and breast cancer patients with brain metastases. A systematic review of PubMed, CNKI (China National Knowledge Infrastructure) and WANFANG (WANGFANG data) involving 870 patients were conducted. Fourteen randomized controlled trials (RCTs) were independently identified by two reviewers. The primary outcome measures were objective response rate (ORR), overall survival (OS), progression-free survival (PFS) and toxicity. The ORR was better with combination therapy of WBRT and TMZ than with WBRT alone (RR = 1.34, p < 0.00001) and subgroup analysis showed a significantly superior ORR in NSCLC patients (RR = 1.38, p < 0.00001), but not in breast cancer patients (RR = 1.03, p = 0.86). OS and PFS did not significantly differ between combination therapy and WBRT alone. A higher rate of toxicity was observed in combination therapy than in WBRT alone (RR = 1.83, p = 0.0006). No advantages of concurrent WBRT and TMZ were observed in breast cancer patients with brain metastases. Combination therapy was associated with improved ORR in NSCLC patients, especially in Chinese patients. As a "surrogate endpoint" for OS, ORR may allow a conclusion to be made about the management of NSCLC with brain metastases with the combination of WBRT and TMZ. However, it needs to be validated to show that improved ORR predicts the treatment effects on the clinical benefit. The ORR may be valid for a particular indication such as status of MGMT promoter methylation.
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Affiliation(s)
- Jingru Tian
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410013, China.,Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Cancer Research Institute, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Key Laboratory of Carcinogenesis of Ministry of Health, Central South University, Changsha, 410078, Hunan, China
| | - Yien Luo
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410013, China.,Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.,Cancer Research Institute, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Key Laboratory of Carcinogenesis of Ministry of Health, Central South University, Changsha, 410078, Hunan, China
| | - Juanjuan Xiang
- Cancer Research Institute, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Key Laboratory of Carcinogenesis of Ministry of Health, Central South University, Changsha, 410078, Hunan, China
| | - Jingqun Tang
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410013, China.
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Feenstra HEM, Murre JMJ, Vermeulen IE, Kieffer JM, Schagen SB. Reliability and validity of a self-administered tool for online neuropsychological testing: The Amsterdam Cognition Scan. J Clin Exp Neuropsychol 2017; 40:253-273. [PMID: 28671504 DOI: 10.1080/13803395.2017.1339017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To facilitate large-scale assessment of a variety of cognitive abilities in clinical studies, we developed a self-administered online neuropsychological test battery: the Amsterdam Cognition Scan (ACS). The current studies evaluate in a group of adult cancer patients: test-retest reliability of the ACS and the influence of test setting (home or hospital), and the relationship between our online and a traditional test battery (concurrent validity). METHOD Test-retest reliability was studied in 96 cancer patients (57 female; Mage = 51.8 years) who completed the ACS twice. Intraclass correlation coefficients (ICCs) were used to assess consistency over time. The test setting was counterbalanced between home and hospital; influence on test performance was assessed by repeated measures analyses of variance. Concurrent validity was studied in 201 cancer patients (112 female; Mage = 53.5 years) who completed both the online and an equivalent traditional neuropsychological test battery. Spearman or Pearson correlations were used to assess consistency between online and traditional tests. RESULTS ICCs of the online tests ranged from .29 to .76, with an ICC of .78 for the ACS total score. These correlations are generally comparable with the test-retest correlations of the traditional tests as reported in the literature. Correlating online and traditional test scores, we observed medium to large concurrent validity (r/ρ = .42 to .70; total score r = .78), except for a visuospatial memory test (ρ = .36). Correlations were affected-as expected-by design differences between online tests and their offline counterparts. CONCLUSIONS Although development and optimization of the ACS is an ongoing process, and reliability can be optimized for several tests, our results indicate that it is a highly usable tool to obtain (online) measures of various cognitive abilities. The ACS is expected to facilitate efficient gathering of data on cognitive functioning in the near future.
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Affiliation(s)
- Heleen E M Feenstra
- a Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Jaap M J Murre
- b Department of Psychology , University of Amsterdam , Amsterdam , The Netherlands
| | - Ivar E Vermeulen
- c Department of Communication Science , VU University Amsterdam , Amsterdam , The Netherlands
| | - Jacobien M Kieffer
- a Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Sanne B Schagen
- a Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam , The Netherlands.,b Department of Psychology , University of Amsterdam , Amsterdam , The Netherlands
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Nayak L, DeAngelis LM, Brandes AA, Peereboom DM, Galanis E, Lin NU, Soffietti R, Macdonald DR, Chamberlain M, Perry J, Jaeckle K, Mehta M, Stupp R, Muzikansky A, Pentsova E, Cloughesy T, Iwamoto FM, Tonn JC, Vogelbaum MA, Wen PY, van den Bent MJ, Reardon DA. The Neurologic Assessment in Neuro-Oncology (NANO) scale: a tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria. Neuro Oncol 2017; 19:625-635. [PMID: 28453751 PMCID: PMC5464449 DOI: 10.1093/neuonc/nox029] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The Macdonald criteria and the Response Assessment in Neuro-Oncology (RANO) criteria define radiologic parameters to classify therapeutic outcome among patients with malignant glioma and specify that clinical status must be incorporated and prioritized for overall assessment. But neither provides specific parameters to do so. We hypothesized that a standardized metric to measure neurologic function will permit more effective overall response assessment in neuro-oncology. Methods An international group of physicians including neurologists, medical oncologists, radiation oncologists, and neurosurgeons with expertise in neuro-oncology drafted the Neurologic Assessment in Neuro-Oncology (NANO) scale as an objective and quantifiable metric of neurologic function evaluable during a routine office examination. The scale was subsequently tested in a multicenter study to determine its overall reliability, inter-observer variability, and feasibility. Results The NANO scale is a quantifiable evaluation of 9 relevant neurologic domains based on direct observation and testing conducted during routine office visits. The score defines overall response criteria. A prospective, multinational study noted a >90% inter-observer agreement rate with kappa statistic ranging from 0.35 to 0.83 (fair to almost perfect agreement), and a median assessment time of 4 minutes (interquartile range, 3-5). Conclusion The NANO scale provides an objective clinician-reported outcome of neurologic function with high inter-observer agreement. It is designed to combine with radiographic assessment to provide an overall assessment of outcome for neuro-oncology patients in clinical trials and in daily practice. Furthermore, it complements existing patient-reported outcomes and cognition testing to combine for a global clinical outcome assessment of well-being among brain tumor patients.
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Affiliation(s)
- Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL-IRCCS Institute of Neurological Science, Bologna, Italy
| | - David M Peereboom
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Riccardo Soffietti
- Department of Neurology and Neuro-Oncology, University of Turin, Turin, Italy
| | - David R Macdonald
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Marc Chamberlain
- Department of Neurology, Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, University of Washington School of Medicine, Seattle, Washington, USA
| | - James Perry
- Division of Neurology, Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada
| | - Kurt Jaeckle
- Department of Neurology and Hematology/Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Minesh Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - Roger Stupp
- Department of Oncology, University of Zurich, Zurich, Switzerland
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elena Pentsova
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Timothy Cloughesy
- Neuro-Oncology Program, Ronald Reagan UCLA Medical Center, University of CaliforniaLos Angeles, Los Angeles, California, USA
| | - Fabio M Iwamoto
- Division of Neuro-Oncology, Neurological Institute of New York College of Physicians and Surgeons, Columbia University, New York, USA
| | | | - Michael A Vogelbaum
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Martin J van den Bent
- Neuro-Oncology Unit, Erasmus MC Cancer Center, Erasmus MC, Rotterdam, The Netherlands
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Sindoni A, Minutoli F, Ascenti G, Pergolizzi S. Combination of immune checkpoint inhibitors and radiotherapy: Review of the literature. Crit Rev Oncol Hematol 2017; 113:63-70. [PMID: 28427523 DOI: 10.1016/j.critrevonc.2017.03.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 12/20/2022] Open
Abstract
Literature experiences in cancer treatment usually deal with either targeting the tumour cell or the immune system, which often fail to reach the curative purposes in many solid tumours. On the other hand, one mechanism of radiation-induced tumour control is the activation of the adaptive immune system by tumour antigen release following radiotherapy. So, combining radiation therapy with immune checkpoint blockade treatment at the same time may represent a way to stimulate the adaptive immune system, with further amplification of immune responses reached through systemic immune checkpoint blockade. Until now, only few studies deal with the association of immune checkpoint blockade treatment and radiotherapy. In this review, we evaluate this association, highlighting this possibility as a new strategy to improve outcome in cancer patients.
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Affiliation(s)
- Alessandro Sindoni
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Italy.
| | - Fabio Minutoli
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Stefano Pergolizzi
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
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Kuchcinski G, Le Rhun E, Cortot AB, Drumez E, Duhal R, Lalisse M, Dumont J, Lopes R, Pruvo JP, Leclerc X, Delmaire C. Dynamic contrast-enhanced MR imaging pharmacokinetic parameters as predictors of treatment response of brain metastases in patients with lung cancer. Eur Radiol 2017; 27:3733-3743. [PMID: 28210799 DOI: 10.1007/s00330-017-4756-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/04/2017] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of pharmacokinetic parameters measured by dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in predicting the response of brain metastases to antineoplastic therapy in patients with lung cancer. METHODS Forty-four consecutive patients with lung cancer, harbouring 123 newly diagnosed brain metastases prospectively underwent conventional 3-T MRI at baseline (within 1 month before treatment), during the early (7-10 weeks) and midterm (5-7 months) post-treatment period. An additional DCE MRI sequence was performed during baseline and early post-treatment MRI to evaluate baseline pharmacokinetic parameters (K trans, k ep, v e, v p) and their early variation (∆K trans, ∆k ep, ∆v e, ∆v p). The objective response was judged by the volume variation of each metastasis from baseline to midterm MRI. ROC curve analysis determined the best DCE MRI parameter to predict the objective response. RESULTS Baseline DCE MRI parameters were not associated with the objective response. Early ∆K trans, ∆v e and ∆v p were significantly associated with the objective response (p = 0.02, p = 0.001 and p = 0.02, respectively). The best predictor of objective response was ∆v e with an area under the curve of 0.93 [95% CI = 0.87, 0.99]. CONCLUSIONS DCE MRI and early ∆v e may be a useful tool to predict the objective response of brain metastases in patients with lung cancer. KEY POINTS • DCE MRI could predict the response of brain metastases from lung cancer • ∆v e was the best predictor of response • DCE MRI could be used to individualize patients' follow-up.
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Affiliation(s)
- Grégory Kuchcinski
- Department of Neuroradiology, University of Lille, CHU Lille, Rue Emile Laine, F-59000, Lille, France.
| | - Emilie Le Rhun
- Department of Neurosurgery, University of Lille, CHU Lille, F-59000, Lille, France.,Department of Medical Oncology, Oscar Lambret Center, F-59000, Lille, France.,Inserm U1192-PRISM-Laboratoire de Protéomique, Réponse Inflammatoire, Spectrométrie de Masse, F-59000, Lille, France
| | - Alexis B Cortot
- Department of Thoracic Oncology, University of Lille, CHU Lille, F-59000, Lille, France
| | - Elodie Drumez
- Department of Biostatistics, University of Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, F-59000, Lille, France
| | - Romain Duhal
- Department of Neuroradiology, University of Lille, CHU Lille, Rue Emile Laine, F-59000, Lille, France
| | - Maxime Lalisse
- Department of Neuroradiology, University of Lille, CHU Lille, Rue Emile Laine, F-59000, Lille, France
| | - Julien Dumont
- Department of Neuroradiology, University of Lille, CHU Lille, Rue Emile Laine, F-59000, Lille, France
| | - Renaud Lopes
- Department of Neuroradiology, University of Lille, CHU Lille, Rue Emile Laine, F-59000, Lille, France
| | - Jean-Pierre Pruvo
- Department of Neuroradiology, University of Lille, CHU Lille, Rue Emile Laine, F-59000, Lille, France
| | - Xavier Leclerc
- Department of Neuroradiology, University of Lille, CHU Lille, Rue Emile Laine, F-59000, Lille, France
| | - Christine Delmaire
- Department of Neuroradiology, University of Lille, CHU Lille, Rue Emile Laine, F-59000, Lille, France
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Munzone E, Casali C, Del Bene M, Di Meco F. Treatment of Central Nervous System Involvement. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Cohen JV, Tawbi H, Margolin KA, Amravadi R, Bosenberg M, Brastianos PK, Chiang VL, de Groot J, Glitza IC, Herlyn M, Holmen SL, Jilaveanu LB, Lassman A, Moschos S, Postow MA, Thomas R, Tsiouris JA, Wen P, White RM, Turnham T, Davies MA, Kluger HM. Melanoma central nervous system metastases: current approaches, challenges, and opportunities. Pigment Cell Melanoma Res 2016; 29:627-642. [PMID: 27615400 DOI: 10.1111/pcmr.12538] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/06/2016] [Indexed: 12/17/2022]
Abstract
Melanoma central nervous system metastases are increasing, and the challenges presented by this patient population remain complex. In December 2015, the Melanoma Research Foundation and the Wistar Institute hosted the First Summit on Melanoma Central Nervous System (CNS) Metastases in Philadelphia, Pennsylvania. Here, we provide a review of the current status of the field of melanoma brain metastasis research; identify key challenges and opportunities for improving the outcomes in patients with melanoma brain metastases; and set a framework to optimize future research in this critical area.
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Affiliation(s)
- Justine V Cohen
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Hussain Tawbi
- Department of Melanoma, Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kim A Margolin
- Department of Medical Oncology & Therapeutics Research, City of Hope Cancer Center, Duarte, CA, USA
| | - Ravi Amravadi
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - John de Groot
- Division of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Isabella C Glitza
- Department of Melanoma, Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Meenhard Herlyn
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - Sheri L Holmen
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | | | - Andrew Lassman
- Department of Neurology & Herbert Irving Comprehensive, Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Stergios Moschos
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A Postow
- Department of Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, USA
| | - Reena Thomas
- Division of Neuro-Oncology, Department of Neurology, Stanford University, Stanford, CA, USA
| | - John A Tsiouris
- Department of Radiology, New York-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA
| | - Patrick Wen
- Department of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Richard M White
- Department of Cancer Biology & Genetics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, USA
| | | | - Michael A Davies
- Department of Melanoma, Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Veliparib in combination with whole-brain radiation therapy for patients with brain metastases from non-small cell lung cancer: results of a randomized, global, placebo-controlled study. J Neurooncol 2016; 131:105-115. [PMID: 27655223 PMCID: PMC5258788 DOI: 10.1007/s11060-016-2275-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/01/2016] [Indexed: 10/26/2022]
Abstract
Veliparib is a potent, orally bioavailable, poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor that crosses the blood-brain barrier and has been shown to potentiate the effects of radiation in preclinical and early clinical studies. This phase 2, randomized, global study evaluated the efficacy and safety of veliparib in combination with whole-brain radiation therapy (WBRT) in patients with brain metastases from non-small cell lung cancer (NSCLC). Three-hundred and seven patients with brain metastases from NSCLC were randomized 1:1:1 to WBRT (30 Gy in 10 fractions) plus 50 mg veliparib twice daily (BID; n = 103), 200 mg veliparib BID (n = 102), or placebo BID (n = 102). Treatment began within 28 days of diagnosis. Tumor response and safety were assessed; the primary endpoint was overall survival (OS). Patients who received ≥1 dose of treatment were included in the safety analysis. All randomized patients were included in the efficacy endpoint analyses. Patient characteristics were well balanced between treatment arms. Median OS was 185 days for patients treated with WBRT plus placebo and 209 days for WBRT plus veliparib (50 or 200 mg). No statistically significant differences in OS, intracranial response rate, and time to clinical or radiographic progression between any of the treatment arms were noted. No differences were observed in adverse events (all grades) across treatment arms; nausea, fatigue, alopecia, and headache were the most commonly reported. No new safety signals were identified for veliparib. A significant unmet need for therapies that improve the outcomes of patients with brain metastases from NSCLC remains.
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Huang RY, Wen PY. Response Assessment in Neuro-Oncology Criteria and Clinical Endpoints. Magn Reson Imaging Clin N Am 2016; 24:705-718. [PMID: 27742111 DOI: 10.1016/j.mric.2016.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Response Assessment in Neuro-Oncology (RANO) Working Group is an international multidisciplinary group whose goal is to improve response criteria and define endpoints for neuro-oncology trials. The RANO criteria for high-grade gliomas attempt to address the issues of pseudoprogression, pseudoresponse, and nonenhancing tumor progression. Incorporation of advanced MR imaging may eventually help improve the ability of these criteria to define enhancing and nonenhancing disease better. The RANO group has also developed criteria for neurologic response and evaluation of patients receiving immunologic therapies. RANO criteria have been developed for brain metastases and are in progress for meningiomas, leptomeningeal disease, spinal tumors, and pediatric tumors.
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Affiliation(s)
- Raymond Y Huang
- Division of Neuroradiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Patrick Y Wen
- Division of Neuro-Oncology, Department of Neurology, Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
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