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Clavreul A, Autier L, Lemée JM, Augereau P, Soulard G, Bauchet L, Figarella-Branger D, Menei P, Network FGB. Management of Recurrent Glioblastomas: What Can We Learn from the French Glioblastoma Biobank? Cancers (Basel) 2022; 14:cancers14225510. [PMID: 36428604 PMCID: PMC9688811 DOI: 10.3390/cancers14225510] [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: 10/04/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022] Open
Abstract
Safe maximal resection followed by radiotherapy plus concomitant and adjuvant temozolomide (TMZ) is universally accepted as the first-line treatment for glioblastoma (GB), but no standard of care has yet been defined for managing recurrent GB (rGB). We used the French GB biobank (FGB) to evaluate the second-line options currently used, with a view to defining the optimal approach and future directions in GB research. We retrospectively analyzed data for 338 patients with de novo isocitrate dehydrogenase (IDH)-wildtype GB recurring after TMZ chemoradiotherapy. Cox proportional hazards models and Kaplan-Meier analyses were used to investigate survival outcomes. Median overall survival after first surgery (OS1) was 19.8 months (95% CI: 18.5-22.0) and median OS after first progression (OS2) was 9.9 months (95% CI: 8.8-10.8). Two second-line options were noted for rGB patients in the FGB: supportive care and treatments, with systemic treatment being the treatment most frequently used. The supportive care option was independently associated with a shorter OS2 (p < 0.001). None of the systemic treatment regimens was unequivocally better than the others for rGB patients. An analysis of survival outcomes based on time to first recurrence (TFR) after chemoradiotherapy indicated that survival was best for patients with a long TFR (≥18 months; median OS1: 44.3 months (95% CI: 41.7-56.4) and median OS2: 13.0 months (95% CI: 11.2-17.7), but that such patients constituted only a small proportion of the total patient population (13.0%). This better survival appeared to be more strongly associated with response to first-line treatment than with response to second-line treatment, indicating that the recurring tumors were more aggressive and/or resistant than the initial tumors in these patients. In the face of high rates of treatment failure for GB, the establishment of well-designed large cohorts of primary and rGB samples, with the help of biobanks, such as the FGB, taking into account the TFR and survival outcomes of GB patients, is urgently required for solid comparative biological analyses to drive the discovery of novel prognostic and/or therapeutic clinical markers for GB.
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Affiliation(s)
- Anne Clavreul
- Département de Neurochirurgie, CHU, 49933 Angers, France
- Université d’Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCINA, F-49000 Angers, France
- Correspondence: ; Tel.: +33-241-354822; Fax: +33-241-354508
| | - Lila Autier
- Département de Neurologie, CHU, 49933 Angers, France
- Département d’Oncologie Médicale, Institut de Cancérologie de l’Ouest, Site Paul Papin, 49055 Angers, France
| | - Jean-Michel Lemée
- Département de Neurochirurgie, CHU, 49933 Angers, France
- Université d’Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCINA, F-49000 Angers, France
| | - Paule Augereau
- Département d’Oncologie Médicale, Institut de Cancérologie de l’Ouest, Site Paul Papin, 49055 Angers, France
| | | | - Luc Bauchet
- Département de Neurochirurgie, Hôpital Gui de Chauliac, CHU Montpellier, Université de Montpellier, 34295 Montpellier, France
- Institut de Génomique Fonctionnelle, CNRS, INSERM, 34295 Montpellier, France
| | - Dominique Figarella-Branger
- APHM, CHU Timone, Service d’Anatomie Pathologique et de Neuropathologie, 13385 Marseille, France
- Aix-Marseille University, CNRS, INP, Inst. Neurophysiopathol, 13005 Marseille, France
| | - Philippe Menei
- Département de Neurochirurgie, CHU, 49933 Angers, France
- Université d’Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCINA, F-49000 Angers, France
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2
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Saraf A, Trippa L, Rahman R. Novel Clinical Trial Designs in Neuro-Oncology. Neurotherapeutics 2022; 19:1844-1854. [PMID: 35969361 PMCID: PMC9723049 DOI: 10.1007/s13311-022-01284-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 12/13/2022] Open
Abstract
Scientific and technologic advances have led to a boon of candidate therapeutics for patients with malignancies of the central nervous system. The path from drug development to clinical use has generally followed a regimented order of sequential clinical trial phases. The recent increase in novel therapies, however, has strained the regulatory process and unearthed limitations of the current system, including significant cost, prolonged development time, and difficulties in testing therapies for rarer tumors. Novel clinical trial designs have emerged to increase efficiencies in clinical trial conduct to better evaluate and bring impactful drugs to patients in a timely manner. In order to better capture meaningful benefits for brain tumor patients, new endpoints to complement or replace traditional endpoints are also an increasingly important consideration. This review will explore the current challenges in the current clinical trial landscape and discuss novel clinical trial concepts, including consideration of limitations and risks of novel trial designs, within the context of neuro-oncology.
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Affiliation(s)
- Anurag Saraf
- Harvard Radiation Oncology Program, Boston, MA, USA
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Lorenzo Trippa
- Department of Data Sciences, Dana-Farber Cancer Institute, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
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3
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Al Feghali KA, Randall JW, Liu DD, Wefel JS, Brown PD, Grosshans DR, McAvoy SA, Farhat MA, Li J, McGovern SL, McAleer MF, Ghia AJ, Paulino AC, Sulman EP, Penas-Prado M, Wang J, de Groot J, Heimberger AB, Armstrong TS, Gilbert MR, Mahajan A, Guha-Thakurta N, Chung C. Phase II trial of proton therapy versus photon IMRT for GBM: secondary analysis comparison of progression-free survival between RANO versus clinical assessment. Neurooncol Adv 2021; 3:vdab073. [PMID: 34337411 PMCID: PMC8320688 DOI: 10.1093/noajnl/vdab073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background This secondary image analysis of a randomized trial of proton radiotherapy (PT) versus photon intensity-modulated radiotherapy (IMRT) compares tumor progression based on clinical radiological assessment versus Response Assessment in Neuro-Oncology (RANO). Methods Eligible patients were enrolled in the randomized trial and had MR imaging at baseline and follow-up beyond 12 weeks from completion of radiotherapy. “Clinical progression” was based on a clinical radiology report of progression and/or change in treatment for progression. Results Of 90 enrolled patients, 66 were evaluable. Median clinical progression-free survival (PFS) was 10.8 (range: 9.4–14.7) months; 10.8 months IMRT versus 11.2 months PT (P = .14). Median RANO-PFS was 8.2 (range: 6.9, 12): 8.9 months IMRT versus 6.6 months PT (P = .24). RANO-PFS was significantly shorter than clinical PFS overall (P = .001) and for both the IMRT (P = .01) and PT (P = .04) groups. There were 31 (46.3%) discrepant cases of which 17 had RANO progression more than a month prior to clinical progression, and 14 had progression by RANO but not clinical criteria. Conclusions Based on this secondary analysis of a trial of PT versus IMRT for glioblastoma, while no difference in PFS was noted relative to treatment technique, RANO criteria identified progression more often and earlier than clinical assessment. This highlights the disconnect between measures of tumor response in clinical trials versus clinical practice. With growing efforts to utilize real-world data and personalized treatment with timely adaptation, there is a growing need to improve the consistency of determining tumor progression within clinical trials and clinical practice.
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Affiliation(s)
- Karine A Al Feghali
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - James W Randall
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA.,Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Grosshans
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah A McAvoy
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Maguy A Farhat
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary F McAleer
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Langone, New York, New York, USA
| | - Marta Penas-Prado
- Department of Neuro-Oncology, National Institutes of Health, Bethesda, Maryland, USA
| | - Jihong Wang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - John de Groot
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy B Heimberger
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Terri S Armstrong
- Department of Neuro-Oncology, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Department of Neuro-Oncology, National Institutes of Health, Bethesda, Maryland, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
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Jo SW, Choi SH, Lee EJ, Yoo RE, Kang KM, Yun TJ, Kim JH, Sohn CH. Prognostic Prediction Based on Dynamic Contrast-Enhanced MRI and Dynamic Susceptibility Contrast-Enhanced MRI Parameters from Non-Enhancing, T2-High-Signal-Intensity Lesions in Patients with Glioblastoma. Korean J Radiol 2021; 22:1369-1378. [PMID: 33987994 PMCID: PMC8316772 DOI: 10.3348/kjr.2020.1272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/15/2020] [Accepted: 01/08/2021] [Indexed: 01/14/2023] Open
Abstract
Objective Few attempts have been made to investigate the prognostic value of dynamic contrast-enhanced (DCE) MRI or dynamic susceptibility contrast (DSC) MRI of non-enhancing, T2-high-signal-intensity (T2-HSI) lesions of glioblastoma multiforme (GBM) in newly diagnosed patients. This study aimed to investigate the prognostic values of DCE MRI and DSC MRI parameters from non-enhancing, T2-HSI lesions of GBM. Materials and Methods A total of 76 patients with GBM who underwent preoperative DCE MRI and DSC MRI and standard treatment were retrospectively included. Six months after surgery, the patients were categorized into early progression (n = 15) and non-early progression (n = 61) groups. We extracted and analyzed the permeability and perfusion parameters of both modalities for the non-enhancing, T2-HSI lesions of the tumors. The optimal percentiles of the respective parameters obtained from cumulative histograms were determined using receiver operating characteristic (ROC) curve and univariable Cox regression analyses. The results were compared using multivariable Cox proportional hazards regression analysis of progression-free survival. Results The 95th percentile value (PV) of Ktrans, mean Ktrans, and median Ve were significant predictors of early progression as identified by the ROC curve analysis (area under the ROC curve [AUC] = 0.704, p = 0.005; AUC = 0.684, p = 0.021; and AUC = 0.670, p = 0.0325, respectively). Univariable Cox regression analysis of the above three parametric values showed that the 95th PV of Ktrans and the mean Ktrans were significant predictors of early progression (hazard ratio [HR] = 1.06, p = 0.009; HR = 1.25, p = 0.017, respectively). Multivariable Cox regression analysis, which also incorporated clinical parameters, revealed that the 95th PV of Ktrans was the sole significant independent predictor of early progression (HR = 1.062, p < 0.009). Conclusion The 95th PV of Ktrans from the non-enhancing, T2-HSI lesions of GBM is a potential prognostic marker for disease progression.
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Affiliation(s)
- Sang Won Jo
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Korea.
| | - Eun Jung Lee
- Department of Radiology, Human Medical Imaging & Intervention Center, Seoul, Korea
| | - Roh Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Chul Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Miller JJ, Loebel F, Juratli TA, Tummala SS, Williams EA, Batchelor TT, Arrillaga-Romany I, Cahill DP. Accelerated progression of IDH mutant glioma after first recurrence. Neuro Oncol 2020; 21:669-677. [PMID: 30668823 DOI: 10.1093/neuonc/noz016] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Isocitrate dehydrogenase (IDH) mutant gliomas are a distinct subtype, reflected in the World Health Organization (WHO) 2016 revised diagnostic criteria. To inform IDH-targeting trial design, we sought to characterize outcomes exclusively within IDH mutant gliomas. METHODS We retrospectively analyzed 275 IDH mutant glioma patients treated at our institution. Progression was determined using low-grade glioma criteria from Response Assessment in Neuro-Oncology. We calculated survival statistics with the Kaplan-Meier method, and survival proportions were correlated with molecular, histologic, and clinical factors. RESULTS During a median follow-up of 6.4 years, 44 deaths (7.6%) and 149 first progression (PFS1) events (54.1%) were observed. Median PFS1 was 5.7 years (95% CI: 4.7-6.4) and OS was 18.7 years (95% CI: 12.2 y-not reached). Consistent with prior studies, we observed an association of grade, molecular diagnosis, and treatment with PFS1. Following the first progressive episode, 79 second progression events occurred during a median follow-up period of 4.1 years. Median PFS following an initial progressive event (PFS2) was accelerated at 3.1 years (95% CI: 2.1-4.1). PFS2 was a surrogate prognostic marker, identifying patients with poorer overall survival. CONCLUSION We report outcomes in a large cohort of IDH mutant glioma, providing a well-characterized historical control population for future clinical trial design. Notably, the interval between first and second recurrence (PFS2, 3.0 y) is shorter than time from diagnosis to first recurrence (PFS1, 5.7 y), evidence that these tumors clinically degenerate from an indolent course to an accelerated malignant phase. Thus, PFS2 represents a relevant outcome for trials investigating drug efficacy at recurrence.
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Affiliation(s)
- Julie J Miller
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Franziska Loebel
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
| | - Tareq A Juratli
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Shilpa S Tummala
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Erik A Williams
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tracy T Batchelor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,Division of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isabel Arrillaga-Romany
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel P Cahill
- Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
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Krauze AV, Megan M, Theresa CZ, Peter M, Shih JH, Tofilon PJ, Rowe L, Gilbert M, Camphausen K. The addition of Valproic acid to concurrent radiation therapy and temozolomide improves patient outcome: a Correlative analysis of RTOG 0525, SEER and a Phase II NCI trial. CANCER STUDIES AND THERAPEUTICS 2020; 5:10.31038/cst.2020511. [PMID: 34621499 PMCID: PMC8494241 DOI: 10.31038/cst.2020511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE/OBJECTIVES Valproic Acid (VPA) is an antiepileptic agent with HDACi (histone deacetylase inhibitor) activity shown to radiosensitize glioblastoma (GBM) cells. We evaluated the addition of VPA to standard radiation therapy (RT) and temozolomide (TMZ) in an open-label, phase II study (NCI-06-C-0112). The intent of the current study was to compare our patient outcomes with modern era standard of care data (RTOG 0525) and general population data (SEER 2006-2013). MATERIALS/METHODS 37 patients with newly diagnosed GBM were treated in a phase II NCI trial with daily VPA (25 mg/kg) in addition to concurrent RT and TMZ (2006 - 2013) and 411 patients with newly diagnosed GBM were treated in the standard TMZ dose arm of RTOG 0525 (2006 - 2008). Using the SEER database, adult patients (age > 15) with diagnostic codes 9440-9443 (third edition (IDC-O-3) diagnosed between 2006 - 2013 were identified and 6083 were included in the analysis. Kaplan-Meier method was used to estimate OS and PFS. The effect of patient characteristics and clinical factors on OS and PFS was analyzed using univariate analysis and a Cox regression model. A landmark analysis was performed to correlate recurrence to OS and conditional probabilities of surviving an additional 12 months at diagnosis, 6, 12, 18, 24 and 30 months were calculated for both the trial data and the SEER data. RESULTS Updated median OS in the NCI cohort was 30.9m (22.2- 65.6m), compared to RTOG 0525 18.9m (16.8-20.3m) (p= 0.007) and the SEER cohort of 11m. Median PFS in the NCI cohort was 11.1m (6.6 - 49.6m) compared to RTOG 0525 with a median PFS of 7.5m (6.9-8.2m) (p = 0.004). Younger age, class V RPA and MGMT status were significant for PFS in both the NCI cohort and the RTOG 0525 cohort, in addition KPS was also significant for OS. In comparison to RTOG 0525, the population in the NCI cohort had a more favorable KPS and RPA, and a higher proportion of patients receiving bevacizumab after protocol therapy however with the exception of RPA (V) (8% vs 18%) (0.026), the effects of these factors on PFS and OS were not significantly different between the two cohorts. CONCLUSION Previously reported improvements in PFS and OS with the addition of VPA to concurrent RT and TMZ in the NCI phase II study were confirmed by comparison to both a trial population receiving standard of care (RTOG 0525) and a contemporary SEER cohort. These results provide further justification of a phase III trial of VPA/RT/TMZ.
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Affiliation(s)
- A V Krauze
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Mackey Megan
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Cooley-Zgela Theresa
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - Mathen Peter
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - J H Shih
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - P J Tofilon
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - L Rowe
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - M Gilbert
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
| | - K Camphausen
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 9000 Rockville Pike, Building 10, CRC, Bethesda, MD 20892, USA
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7
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Yu KH, Ricigliano M, McCarthy B, Chou JF, Capanu M, Cooper B, Bartlett A, Covington C, Lowery MA, O'Reilly EM. Circulating Tumor and Invasive Cell Gene Expression Profile Predicts Treatment Response and Survival in Pancreatic Adenocarcinoma. Cancers (Basel) 2018; 10:cancers10120467. [PMID: 30477242 PMCID: PMC6315371 DOI: 10.3390/cancers10120467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/17/2018] [Accepted: 11/16/2018] [Indexed: 12/24/2022] Open
Abstract
Previous studies have shown that pharmacogenomic modeling of circulating tumor and invasive cells (CTICs) can predict response of pancreatic ductal adenocarcinoma (PDAC) to combination chemotherapy, predominantly 5-fluorouracil-based. We hypothesized that a similar approach could be developed to predict treatment response to standard frontline gemcitabine with nab-paclitaxel (G/nab-P) chemotherapy. Gene expression profiles for responsiveness to G/nab-P were determined in cell lines and a test set of patient samples. A prospective clinical trial was conducted, enrolling 37 patients with advanced PDAC who received G/nab-P. Peripheral blood was collected prior to treatment, after two months of treatment, and at progression. The CTICs were isolated based on a phenotype of collagen invasion. The RNA was isolated, cDNA synthesized, and qPCR gene expression analyzed. Patients were most closely matched to one of three chemotherapy response templates. Circulating tumor and invasive cells' SMAD4 expression was measured serially. The CTICs were reliably isolated and profiled from peripheral blood prior to and during chemotherapy treatment. Individual patients could be matched to distinct response templates predicting differential responses to G/nab-P treatment. Progression free survival was significantly correlated to response prediction and ΔSMAD4 was significantly associated with disease progression. These findings support phenotypic profiling and ΔSMAD4 of CTICs as promising clinical tools for choosing effective therapy in advanced PDAC, and for anticipating disease progression.
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Affiliation(s)
- Kenneth H Yu
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
- Weill Cornell Medical College, New York, NY 10065, USA.
| | | | | | - Joanne F Chou
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
- Weill Cornell Medical College, New York, NY 10065, USA.
| | - Marinela Capanu
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
- Weill Cornell Medical College, New York, NY 10065, USA.
| | | | | | | | - Maeve A Lowery
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Eileen M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
- Weill Cornell Medical College, New York, NY 10065, USA.
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8
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Tanguturi SK, Trippa L, Ramkissoon SH, Pelton K, Knoff D, Sandak D, Lindeman NI, Ligon AH, Beroukhim R, Parmigiani G, Wen PY, Ligon KL, Alexander BM. Leveraging molecular datasets for biomarker-based clinical trial design in glioblastoma. Neuro Oncol 2018; 19:908-917. [PMID: 28339723 DOI: 10.1093/neuonc/now312] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Biomarkers can improve clinical trial efficiency, but designing and interpreting biomarker-driven trials require knowledge of relationships among biomarkers, clinical covariates, and endpoints. We investigated these relationships across genomic subgroups of glioblastoma (GBM) within our institution (DF/BWCC), validated results in The Cancer Genome Atlas (TCGA), and demonstrated potential impacts on clinical trial design and interpretation. Methods We identified genotyped patients at DF/BWCC, and clinical associations across 4 common GBM genomic biomarker groups were compared along with overall survival (OS), progression-free survival (PFS), and survival post-progression (SPP). Significant associations were validated in TCGA. Biomarker-based clinical trials were simulated using various assumptions. Results Epidermal growth factor receptor (EGFR)(+) and p53(-) subgroups were more likely isocitrate dehydrogenase (IDH) wild-type. Phosphatidylinositol-3 kinase (PI3K)(+) patients were older, and patients with O6-DNA methylguanine-methyltransferase (MGMT)-promoter methylation were more often female. OS, PFS, and SPP were all longer for IDH mutant and MGMT methylated patients, but there was no independent prognostic value for other genomic subgroups. PI3K(+) patients had shorter PFS among IDH wild-type tumors, however, and no DF/BWCC long-term survivors were either EGFR(+) (0% vs 7%, P = .014) or p53(-) (0% vs 10%, P = .005). The degree of biomarker overlap impacted the efficiency of Bayesian-adaptive clinical trials, while PFS and OS distribution variation had less impact. Biomarker frequency was proportionally associated with sample size in all designs. Conclusions We identified several associations between GBM genomic subgroups and clinical or molecular prognostic covariates and validated known prognostic factors in all survival periods. These results are important for biomarker-based trial design and interpretation of biomarker-only and nonrandomized trials.
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Affiliation(s)
- Shyam K Tanguturi
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Lorenzo Trippa
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Shakti H Ramkissoon
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Kristine Pelton
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - David Knoff
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - David Sandak
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Neal I Lindeman
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Azra H Ligon
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Rameen Beroukhim
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Giovanni Parmigiani
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Patrick Y Wen
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Keith L Ligon
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
| | - Brian M Alexander
- Department of Radiation Oncology, Department of Pathology, Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center (DF/BWCC), Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Accelerate Brain Cancer Cure (ABC2), Washington, DC; Harvard Program in Therapeutic Science, Harvard Medical School, Boston, Massachusetts
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9
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Gravina GL, Mancini A, Mattei C, Vitale F, Marampon F, Colapietro A, Rossi G, Ventura L, Vetuschi A, Di Cesare E, Fox JA, Festuccia C. Enhancement of radiosensitivity by the novel anticancer quinolone derivative vosaroxin in preclinical glioblastoma models. Oncotarget 2018; 8:29865-29886. [PMID: 28415741 PMCID: PMC5444710 DOI: 10.18632/oncotarget.16168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/03/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose Glioblastoma multiforme (GBM) is the most aggressive brain tumor. The activity of vosaroxin, a first-in-class anticancer quinolone derivative that intercalates DNA and inhibits topoisomerase II, was investigated in GBM preclinical models as a single agent and combined with radiotherapy (RT). Results Vosaroxin showed antitumor activity in clonogenic survival assays, with IC50 of 10−100 nM, and demonstrated radiosensitization. Combined treatments exhibited significantly higher γH2Ax levels compared with controls. In xenograft models, vosaroxin reduced tumor growth and showed enhanced activity with RT; vosaroxin/RT combined was more effective than temozolomide/RT. Vosaroxin/RT triggered rapid and massive cell death with characteristics of necrosis. A minor proportion of treated cells underwent caspase-dependent apoptosis, in agreement with in vitro results. Vosaroxin/RT inhibited RT-induced autophagy, increasing necrosis. This was associated with increased recruitment of granulocytes, monocytes, and undifferentiated bone marrow–derived lymphoid cells. Pharmacokinetic analyses revealed adequate blood-brain penetration of vosaroxin. Vosaroxin/RT increased disease-free survival (DFS) and overall survival (OS) significantly compared with RT, vosaroxin alone, temozolomide, and temozolomide/RT in the U251-luciferase orthotopic model. Materials and Methods Cellular, molecular, and antiproliferative effects of vosaroxin alone or combined with RT were evaluated in 13 GBM cell lines. Tumor growth delay was determined in U87MG, U251, and T98G xenograft mouse models. (DFS) and (OS) were assessed in orthotopic intrabrain models using luciferase-transfected U251 cells by bioluminescence and magnetic resonance imaging. Conclusions Vosaroxin demonstrated significant activity in vitro and in vivo in GBM models, and showed additive/synergistic activity when combined with RT in O6-methylguanine methyltransferase-negative and -positive cell lines.
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Affiliation(s)
- Giovanni Luca Gravina
- Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
| | - Andrea Mancini
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
| | - Claudia Mattei
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Neurosciences, University of L'Aquila, L'Aquila, Italy
| | - Flora Vitale
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Neurosciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Marampon
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Colapietro
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
| | - Giulia Rossi
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
| | - Luca Ventura
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Neurosciences, University of L'Aquila, L'Aquila, Italy
| | - Antonella Vetuschi
- Department of Biotechnological and Applied Clinical Sciences, Chair of Human Anatomy, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, University of L'Aquila, L'Aquila, Italy
| | - Judith A Fox
- Sunesis Pharmaceuticals Inc., South San Francisco, CA, USA
| | - Claudio Festuccia
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
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10
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Taylor JW, Molinaro AM, Butowski N, Prados M. Clinical trial endpoints for patients with gliomas. Neurooncol Pract 2017; 4:201-208. [PMID: 31385993 PMCID: PMC6655446 DOI: 10.1093/nop/npw034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Malignant glioma represents a diverse set of molecularly heterogeneous diseases. Few therapeutic agents have been approved despite decades of clinical trials research and pre-clinical investigation. Attempts to refine neuroimaging criteria and recent discovery of the genomic profiles linking tumor subsets to survival outcomes have spurred discussion on a variety of new approaches in clinical trial design and relevant endpoints. Here we focus on those endpoints in clinical trial design for patients with primary glioma and related issues still to be resolved.
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Affiliation(s)
- Jennie W Taylor
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California (J.W.T., A.M.M., N.B., M.P.)
- Department of Neurology, University of California San Francisco, San Francisco, California (J.W.T.)
| | - Annette M Molinaro
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California (J.W.T., A.M.M., N.B., M.P.)
- Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California (A.M.M.)
| | - Nicholas Butowski
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California (J.W.T., A.M.M., N.B., M.P.)
| | - Michael Prados
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California (J.W.T., A.M.M., N.B., M.P.)
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11
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Booth TC, Larkin TJ, Yuan Y, Kettunen MI, Dawson SN, Scoffings D, Canuto HC, Vowler SL, Kirschenlohr H, Hobson MP, Markowetz F, Jefferies S, Brindle KM. Analysis of heterogeneity in T2-weighted MR images can differentiate pseudoprogression from progression in glioblastoma. PLoS One 2017; 12:e0176528. [PMID: 28520730 PMCID: PMC5435159 DOI: 10.1371/journal.pone.0176528] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/12/2017] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To develop an image analysis technique that distinguishes pseudoprogression from true progression by analyzing tumour heterogeneity in T2-weighted images using topological descriptors of image heterogeneity called Minkowski functionals (MFs). METHODS Using a retrospective patient cohort (n = 50), and blinded to treatment response outcome, unsupervised feature estimation was performed to investigate MFs for the presence of outliers, potential confounders, and sensitivity to treatment response. The progression and pseudoprogression groups were then unblinded and supervised feature selection was performed using MFs, size and signal intensity features. A support vector machine model was obtained and evaluated using a prospective test cohort. RESULTS The model gave a classification accuracy, using a combination of MFs and size features, of more than 85% in both retrospective and prospective datasets. A different feature selection method (Random Forest) and classifier (Lasso) gave the same results. Although not apparent to the reporting radiologist, the T2-weighted hyperintensity phenotype of those patients with progression was heterogeneous, large and frond-like when compared to those with pseudoprogression. CONCLUSION Analysis of heterogeneity, in T2-weighted MR images, which are acquired routinely in the clinic, has the potential to detect an earlier treatment response allowing an early change in treatment strategy. Prospective validation of this technique in larger datasets is required.
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Affiliation(s)
- Thomas C. Booth
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Timothy J. Larkin
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Yinyin Yuan
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Mikko I. Kettunen
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Sarah N. Dawson
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Scoffings
- Department of Radiology, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Holly C. Canuto
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Sarah L. Vowler
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Heide Kirschenlohr
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Michael P. Hobson
- Battock Centre for Experimental Astrophysics, Cavendish Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Florian Markowetz
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Sarah Jefferies
- Department of Oncology, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Kevin M. Brindle
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
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12
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Validation of surrogate endpoints in advanced solid tumors: systematic review of statistical methods, results, and implications for policy makers. Int J Technol Assess Health Care 2016; 30:312-24. [PMID: 25308694 DOI: 10.1017/s0266462314000300] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Licensing of, and coverage decisions on, new therapies should rely on evidence from patient-relevant endpoints such as overall survival (OS). Nevertheless, evidence from surrogate endpoints may also be useful, as it may not only expedite the regulatory approval of new therapies but also inform coverage decisions. It is, therefore, essential that candidate surrogate endpoints be properly validated. However, there is no consensus on statistical methods for such validation and on how the evidence thus derived should be applied by policy makers. METHODS We review current statistical approaches to surrogate-endpoint validation based on meta-analysis in various advanced-tumor settings. We assessed the suitability of two surrogates (progression-free survival [PFS] and time-to-progression [TTP]) using three current validation frameworks: Elston and Taylor's framework, the German Institute of Quality and Efficiency in Health Care's (IQWiG) framework and the Biomarker-Surrogacy Evaluation Schema (BSES3). RESULTS A wide variety of statistical methods have been used to assess surrogacy. The strength of the association between the two surrogates and OS was generally low. The level of evidence (observation-level versus treatment-level) available varied considerably by cancer type, by evaluation tools and was not always consistent even within one specific cancer type. CONCLUSIONS Not in all solid tumors the treatment-level association between PFS or TTP and OS has been investigated. According to IQWiG's framework, only PFS achieved acceptable evidence of surrogacy in metastatic colorectal and ovarian cancer treated with cytotoxic agents. Our study emphasizes the challenges of surrogate-endpoint validation and the importance of building consensus on the development of evaluation frameworks.
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13
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The Diagnostic Ability of Follow-Up Imaging Biomarkers after Treatment of Glioblastoma in the Temozolomide Era: Implications from Proton MR Spectroscopy and Apparent Diffusion Coefficient Mapping. BIOMED RESEARCH INTERNATIONAL 2015; 2015:641023. [PMID: 26448943 PMCID: PMC4584055 DOI: 10.1155/2015/641023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/25/2015] [Accepted: 04/27/2015] [Indexed: 12/02/2022]
Abstract
Objective. To prospectively determine institutional cut-off values of apparent diffusion coefficients (ADCs) and concentration of tissue metabolites measured by MR spectroscopy (MRS) for early differentiation between glioblastoma (GBM) relapse and treatment-related changes after standard treatment. Materials and Methods. Twenty-four GBM patients who received gross total resection and standard adjuvant therapy underwent MRI examination focusing on the enhancing region suspected of tumor recurrence. ADC maps, concentrations of N-acetylaspartate, choline, creatine, lipids, and lactate, and metabolite ratios were determined. Final diagnosis as determined by biopsy or follow-up imaging was correlated to the results of advanced MRI findings. Results. Eighteen (75%) and 6 (25%) patients developed tumor recurrence and pseudoprogression, respectively. Mean time to radiographic progression from the end of chemoradiotherapy was 5.8 ± 5.6 months. Significant differences in ADC and MRS data were observed between those with progression and pseudoprogression. Recurrence was characterized by N-acetylaspartate ≤ 1.5 mM, choline/N-acetylaspartate ≥ 1.4 (sensitivity 100%, specificity 91.7%), N-acetylaspartate/creatine ≤ 0.7, and ADC ≤ 1300 × 10−6 mm2/s (sensitivity 100%, specificity 100%). Conclusion. Institutional validation of cut-off values obtained from advanced MRI methods is warranted not only for diagnosis of GBM recurrence, but also as enrollment criteria in salvage clinical trials and for reporting of outcomes of initial treatment.
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14
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Lee ST, Park CK, Kim JW, Park MJ, Lee H, Lim JA, Choi SH, Kim TM, Lee SH, Park SH, Kim IH, Lee KM. Early cognitive function tests predict early progression in glioblastoma. Neurooncol Pract 2015; 2:137-143. [PMID: 31386094 DOI: 10.1093/nop/npv007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Indexed: 11/15/2022] Open
Abstract
Background Early progression of glioblastoma prevents patients from completing the standard chemoradiation protocol. Given that cognitive function is associated with prognosis in glioblastoma, we investigated the usefulness of preoperative cognitive function tests for predicting the early progression of glioblastoma. Methods Consecutive patients who underwent glioma surgery were preoperatively evaluated with cognitive function tests including the Mini Mental State Examination, digit span tests, the Controlled Oral Word Association Test, the Trail Making Tests (TMT, parts A, B, and C), and the Stroop test. Glioblastomas were treated with a standard protocol using radiation and temozolomide, and 6-month progression-free survival (PFS-6) was analyzed retrospectively. Results Among 126 patients who underwent glioma surgery, 55 patients were diagnosed with glioblastoma, and 50 patients were eligible for the PFS-6 analysis. Thirty-four patients (68%) achieved PFS-6. No significant differences were observed in demographics or tumor characteristics between patients without progression (PFS-6) or patients with progression (no-PFS-6). In the cognitive function tests, the PFS-6 patients exhibited better performance in TMT-A and TMT-B. In a multivariate logistic regression, TMT-B was the only independent predictor for PFS-6, whereas age, years of education, gross total or near total resection, concomitant chemoradiation, and TMT-A were not predictors. Patients with good TMT-B performance exhibited better early prognosis in the Kaplan-Meier survival analysis and had better recursive partitioning analysis classes. Conclusions Our results indicated that preoperative TMTs can be useful for rapid evaluation of early prognosis in patients with glioblastoma.
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Affiliation(s)
- Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Chul-Kee Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Jin Wook Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Min-Jung Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Hyon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Jung-Ah Lim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Seung Hong Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Tae Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Se-Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Sung-Hye Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Il Han Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Kyoung-Min Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
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15
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Surapaneni K, Kennedy BC, Yanagihara TK, DeLaPaz R, Bruce JN. Early Cerebral Blood Volume Changes Predict Progression After Convection-Enhanced Delivery of Topotecan for Recurrent Malignant Glioma. World Neurosurg 2015; 84:163-72. [PMID: 25772608 DOI: 10.1016/j.wneu.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess whether early changes in enhancing tumor volume (eTV) and relative cerebral blood volume (rCBV) 1 month after convection-enhanced delivery of topotecan in patients with recurrent malignant glioma correlated with 6-month disease progression status. METHODS Sixteen patients were enrolled in a Phase Ib trial of convection-enhanced delivery of topotecan for recurrent malignant glioma. Each patient was evaluated with serial follow-up magnetic resonance imaging at baseline and at 4- to 8-week intervals. Changes at 1 month compared with baseline in eTV and rCBV were evaluated as potential predictors of 6-month progression status, classified as either progressive disease or nonprogressive disease. Relationships between percent changes in eTV and rCBV at 1 month with the probability of progressive disease at 6 months were estimated by the use of logistic regression analysis. Receiver operating characteristic curves for varying percent change thresholds in eTV and rCBV were evaluated by the use of 6-month progressive disease as the reference. RESULTS There was a significant difference in the percent change in rCBV at 1 month in patients with progressive disease compared with those with nonprogressive disease at 6 months (+12% vs. -29%, P = 0.02). Logistic regression analysis demonstrated on average that a 10% increase in rCBV at 1 month after convection-enhanced delivery of topotecan was associated with 1.7 times the odds of developing progressive disease at 6 months (95% confidence interval [CI] 1.0-2.9 P = 0.05). Receiver operating characteristic analysis for determining progressive disease at 6 months showed a greater area under the curve with rCBV (0.867; 95% CI 0.66-1.00) than with change in enhancing tumor volume (0.767; 95% CI 0.51-1.00). CONCLUSION In this selected population of patients with recurrent malignant glioma treated with convection-enhanced delivery of topotecan, early changes in rCBV at 4 weeks after therapy may help predict progression status at 6 months.
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Affiliation(s)
- Krishna Surapaneni
- Department of Radiology, Columbia University Medical Center, New York, New York, USA.
| | - Benjamin C Kennedy
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Ted K Yanagihara
- Department of Neuroscience, Columbia University Medical Center, New York, New York, USA
| | - Robert DeLaPaz
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
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Besse B, Le Moulec S, Mazières J, Senellart H, Barlesi F, Chouaid C, Dansin E, Bérard H, Falchero L, Gervais R, Robinet G, Ruppert AM, Schott R, Léna H, Clément-Duchêne C, Quantin X, Souquet PJ, Trédaniel J, Moro-Sibilot D, Pérol M, Madroszyk AC, Soria JC. Bevacizumab in Patients with Nonsquamous Non–Small Cell Lung Cancer and Asymptomatic, Untreated Brain Metastases (BRAIN): A Nonrandomized, Phase II Study. Clin Cancer Res 2015; 21:1896-903. [DOI: 10.1158/1078-0432.ccr-14-2082] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
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Evaluation of RANO response criteria compared to clinician evaluation in WHO grade III anaplastic astrocytoma: implications for clinical trial reporting and patterns of failure. J Neurooncol 2015; 122:197-203. [PMID: 25577400 DOI: 10.1007/s11060-014-1703-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
Abstract
The utility of current response criteria has not been established in anaplastic astrocytoma (AA). We retrospectively reviewed MR images for 20 patients with AA and compared RANO-based approaches to clinician impression described as follow: (1) standard RANO-based criteria met by growth of or development of new enhancing lesion (RANO-C), (2) RANO criteria for progression based on significant FLAIR increase (RANO-F) and (3) clinical progression usually resulting in change of treatment (Clinical). Patterns of failure (POF) were analyzed utilizing all proposed progression MRIs fused with the patients' radiotherapy treatment plan. With an overall median survival of 24.3 months, development of new enhancing lesion was the most common determinant of progression (70 % of patients). Median time to RANO-C, RANO-F and Clinical progression was 9.2, 9.2 and 11.76 months respectively. RANO-C and RANO-F preceded Clinical in 70 and 55 % of patients, respectively. In six patients (30 %) Clinical was concurrent with RANO-F; four of six also met RANO-C. POF for FLAIR component differed based on time point used to determine progression. FLAIR POF was more often marginal or distant when progression was defined clinically compared to either RANO-C or RANO-F criteria. Central POF based on FLAIR at Clinical determination of progression was associated with significantly poorer OS (9.8 vs. 34.4 months). Clinical progression occurs later than progression determined by RANO-based criteria. Evaluation of POF based on FLAIR signal abnormality at the time of clinical progression suggests central recurrences are associated with worse survival.
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Trippa L, Wen PY, Parmigiani G, Berry DA, Alexander BM. Combining progression-free survival and overall survival as a novel composite endpoint for glioblastoma trials. Neuro Oncol 2015; 17:1106-13. [PMID: 25568226 DOI: 10.1093/neuonc/nou345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/23/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The use of auxiliary endpoints may provide efficiencies for clinical trial design, but such endpoints may not have intrinsic clinical relevance or clear linkage to more meaningful endpoints. The purpose of this study was to generate a novel endpoint that considers both overall survival (OS) and earlier events such as progression-free survival (PFS) and determine whether such an endpoint could increase efficiency in the design of glioblastoma clinical trials. METHODS Recognizing that the association between PFS and OS varies depending on therapy and tumor type, we developed a statistical model to predict OS based on PFS as the trial progresses. We then evaluated the efficiency of our model using simulations of adaptively randomized trials incorporating PFS and OS distributions from prior published trials in neuro-oncology. RESULTS When treatment effects on PFS and OS are concordant, our proposed approach results in efficiency gains compared with randomization based on OS alone while sacrificing minimal efficiency compared with using PFS as the primary endpoint. When treatment effects are limited to PFS, our approach provides randomization probabilities that are close to those based on OS alone. CONCLUSION Use of OS as the primary endpoint, combined with statistical modeling of the relationship between OS and PFS during the course of the trial, results in more robust and efficient trial designs than using either endpoint alone.
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Affiliation(s)
- Lorenzo Trippa
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (L.T., G.P.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (L.T., G.P.); Center for Neuro-Oncology Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, (P.Y.W., B.M.A.); Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.M.A.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (D.A.B.)
| | - Patrick Y Wen
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (L.T., G.P.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (L.T., G.P.); Center for Neuro-Oncology Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, (P.Y.W., B.M.A.); Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.M.A.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (D.A.B.)
| | - Giovanni Parmigiani
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (L.T., G.P.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (L.T., G.P.); Center for Neuro-Oncology Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, (P.Y.W., B.M.A.); Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.M.A.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (D.A.B.)
| | - Donald A Berry
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (L.T., G.P.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (L.T., G.P.); Center for Neuro-Oncology Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, (P.Y.W., B.M.A.); Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.M.A.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (D.A.B.)
| | - Brian M Alexander
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (L.T., G.P.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (L.T., G.P.); Center for Neuro-Oncology Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, (P.Y.W., B.M.A.); Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.M.A.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (D.A.B.)
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19
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Post progression survival in glioblastoma: where are we? J Neurooncol 2014; 121:399-404. [PMID: 25366365 DOI: 10.1007/s11060-014-1651-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 10/26/2014] [Indexed: 10/24/2022]
Abstract
The optimal end point for phase II studies for recurrent glioblastoma (GBM) is unclear and a matter of debate. Moreover, data about post-progression survival (PPS) after the first disease progression in GBM patients treated according to EORTC 26981/22981/NCIC CE.3 trial are limited. The aim of this study was to evaluate the PPS in GBM patients. The analysis was made with a database on 1,006 GBM patients followed prospectively between 06/2005 and 06/2010. Eligibility criteria for the study were: age ≥ 18 years; PS: 0-2; chemotherapy given at disease progression after RT/TMZ. 232 patients (mean age 52 years, range 18-77 years) were enrolled. The median PFS following second line chemotherapy (PFS2) was 2.5 months (95 % CI 2.1-2.9) and the rate of patients free of progression at 6 months (PFS2-6 mo), was 21.6 % (95 % CI 16.3-26.9 %). The median PPS was 8.6 months (95 % CI 7.4-9.8), PPS rates were: PPS-6: 66 % (95 % CI 60.3-72.9 %), PPS-9: 48.2 % (95 % CI 41.5-54.9 %) and PPS-12: 31.7 % (95 % CI 25.2-38.2 %). PPS in unselected patients treated with alkylating agents is about 8 months. PPS rates could be of interest as an end point in future studies in recurrent GBM.
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20
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Alexander BM, Galanis E, Yung WKA, Ballman KV, Boyett JM, Cloughesy TF, Degroot JF, Huse JT, Mann B, Mason W, Mellinghoff IK, Mikkelsen T, Mischel PS, O'Neill BP, Prados MD, Sarkaria JN, Tawab-Amiri A, Trippa L, Ye X, Ligon KL, Berry DA, Wen PY. Brain Malignancy Steering Committee clinical trials planning workshop: report from the Targeted Therapies Working Group. Neuro Oncol 2014; 17:180-8. [PMID: 25165194 DOI: 10.1093/neuonc/nou154] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Glioblastoma is the most common primary brain malignancy and is associated with poor prognosis despite aggressive local and systemic therapy, which is related to a paucity of viable treatment options in both the newly diagnosed and recurrent settings. Even so, the rapidly increasing number of targeted therapies being evaluated in oncology clinical trials offers hope for the future. Given the broad range of possibilities for future trials, the Brain Malignancy Steering Committee convened a clinical trials planning meeting that was held at the Udvar-Hazy Center in Chantilly, Virginia, on September 19 and 20, 2013. This manuscript reports the deliberations leading up to the event from the Targeted Therapies Working Group and the results of the meeting.
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Affiliation(s)
- Brian M Alexander
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Evanthia Galanis
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - W K Alfred Yung
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Karla V Ballman
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - James M Boyett
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Timothy F Cloughesy
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - John F Degroot
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Jason T Huse
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Bhupinder Mann
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Warren Mason
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Ingo K Mellinghoff
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Tom Mikkelsen
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Paul S Mischel
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Brian P O'Neill
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Michael D Prados
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Jann N Sarkaria
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Abdul Tawab-Amiri
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Lorenzo Trippa
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Xiaobu Ye
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Keith L Ligon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Donald A Berry
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
| | - Patrick Y Wen
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (B.M.A., L.T., K.L.L., P.Y.W.); Mayo Clinic, Rochester, Minnesota (E.G., K.V.B., B.P.O., J.N.S.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (W.K.A.Y., J.F.D., D.A.B.); St. Jude Children's Research Hospital, Memphis, Tennessee (J.M.B.); University of California, Los Angeles, California (T.F.C.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H., I.K.M.); National Cancer Institute, Bethesda, Maryland (B.M., A.T.-A.); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (W.M.); Henry Ford Hospital, Detroit, Michigan (T.M.); University of California, San Diego, La Jolla, California (P.S.M.); University of California, San Francisco, California (M.D.P.); Johns Hopkins University, Baltimore, Maryland (X.Y.)
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Kanaly CW, Mehta AI, Ding D, Hoang JK, Kranz PG, Herndon JE, Coan A, Crocker I, Waller AF, Friedman AH, Reardon DA, Sampson JH. A novel, reproducible, and objective method for volumetric magnetic resonance imaging assessment of enhancing glioblastoma. J Neurosurg 2014; 121:536-42. [PMID: 25036205 DOI: 10.3171/2014.4.jns121952] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Robust methodology that allows objective, automated, and observer-independent measurements of brain tumor volume, especially after resection, is lacking. Thus, determination of tumor response and progression in neurooncology is unreliable. The objective of this study was to determine if a semi-automated volumetric method for quantifying enhancing tissue would perform with high reproducibility and low interobserver variability. METHODS Fifty-seven MR images from 13 patients with glioblastoma were assessed using our method, by 2 neuroradiologists, 1 neurosurgeon, 1 neurosurgical resident, 1 nurse practitioner, and 1 medical student. The 2 neuroradiologists also performed traditional 1-dimensional (1D) and 2-dimensional (2D) measurements. Intraclass correlation coefficients (ICCs) assessed interobserver variability between measurements. Radiological response was determined using Response Evaluation Criteria In Solid Tumors (RECIST) guidelines and Macdonald criteria. Kappa statistics described interobserver variability of volumetric radiological response determinations. RESULTS There was strong agreement for 1D (RECIST) and 2D (Macdonald) measurements between neuroradiologists (ICC = 0.42 and 0.61, respectively), but the agreement using the authors' novel automated approach was significantly stronger (ICC = 0.97). The volumetric method had the strongest agreement with regard to radiological response (κ = 0.96) when compared with 2D (κ = 0.54) or 1D (κ = 0.46) methods. Despite diverse levels of experience of the users of the volumetric method, measurements using the volumetric program remained remarkably consistent in all users (0.94). CONCLUSIONS Interobserver variability using this new semi-automated method is less than the variability with traditional methods of tumor measurement. This new method is objective, quick, and highly reproducible among operators with varying levels of expertise. This approach should be further evaluated as a potential standard for response assessment based on contrast enhancement in brain tumors.
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McNamara MG, Lwin Z, Jiang H, Templeton AJ, Zadeh G, Bernstein M, Chung C, Millar BA, Laperriere N, Mason WP. Factors impacting survival following second surgery in patients with glioblastoma in the temozolomide treatment era, incorporating neutrophil/lymphocyte ratio and time to first progression. J Neurooncol 2014; 117:147-52. [PMID: 24469854 DOI: 10.1007/s11060-014-1366-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/09/2014] [Indexed: 12/28/2022]
Abstract
Patients with progressive glioblastoma (GBM) have a poor prognosis. Neutrophil/lymphocyte ratio (NLR), a host inflammatory marker, is prognostic in several solid tumors. The prognostic impact of either NLR, or time from first surgery for GBM to first progression (TTP), in patients undergoing second surgery, has not been assessed. Patients undergoing second surgery for GBM were retrospectively reviewed. Primary outcome was overall survival (OS) and Cox proportional hazard models were used to assess the prognostic value of baseline characteristics including TTP and NLR. Univariable and multivariable analysis (MVA) of OS from second surgery were performed using accelerated failure time Weibull model. Of 584 patients with GBM, 107 (18 %) underwent second surgery between 01/04 and 12/11. Patients who underwent second surgery had longer OS versus those having primary surgery alone; 20.9 versus 9.9 months (P < 0.001). Median OS from second surgery in patients with NLR ≤ 4 versus NLR > 4 was 9.7 versus 5.9 months (log rank P = 0.02). The NLR retained its prognostic significance for survival on MVA (time ratio [TR] 1.65, 95 % confidence interval [CI] 1.15-2.35, P < 0.01). No chemotherapy post second surgery (TR 0.23, 95 % CI 0.16-0.33, P < 0.001) portended worse survival. In patients undergoing second surgery, when TTP was ≤ 12 months, 12-24 months, or >24 months, median OS from second surgery was 7.2, 7.0 and 6.3 months, respectively (P = 0.6). A NLR > 4 prior to second surgery is a poor prognostic factor in GBM and later progression is associated with longer survival in patients but not in longer survival after second surgery.
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Affiliation(s)
- Mairéad G McNamara
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Suite 18-717, Toronto, ON, M5G 2M9, Canada
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23
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Six-month progression-free survival as the primary endpoint to evaluate the activity of new agents as second-line therapy for advanced urothelial carcinoma. Clin Genitourin Cancer 2013; 12:130-7. [PMID: 24220220 DOI: 10.1016/j.clgc.2013.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/04/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Second-line systemic therapy for advanced urothelial carcinoma (UC) has substantial unmet needs, and current agents show dismal activity. Second-line trials of metastatic UC have used response rate (RR) and median progression-free survival (PFS) as primary endpoints, which may not reflect durable benefits. A more robust endpoint to identify signals of durable benefits when investigating new agents in second-line trials may expedite drug development. PFS at 6 months (PFS6) is a candidate endpoint, which may correlate with overall survival (OS) at 12 months (OS12) and may be applicable across cytostatic and cytotoxic agents. METHODS Ten second-line phase II trials with individual patient outcomes data evaluating chemotherapy or biologics were combined for discovery, followed by external validation in a phase III trial. The relationship between PFS6/RR and OS12 was assessed at the trial level using Pearson correlation and weighted linear regression, and at the individual level using Pearson chi-square test with Yates continuity correction. RESULTS In the discovery dataset, a significant correlation was observed between PFS6 and OS12 at the trial (R(2) = 0.55, Pearson correlation = 0.66) and individual levels (82%, Қ = 0.45). Response correlated with OS12 at the individual level less robustly (78%, Қ = 0.36), and the trial level association was not statistically significant (R(2) = 0.16, Pearson correlation = 0.37). The correlation of PFS6 (81%, Қ = 0.44) appeared stronger than the correlation of response (76%, Қ = 0.17) with OS12 in the external validation dataset. CONCLUSIONS PFS6 is strongly associated with OS12 and appears more optimal than RR to identify active second-line agents for advanced UC.
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Chinot OL, Macdonald DR, Abrey LE, Zahlmann G, Kerloëguen Y, Cloughesy TF. Response assessment criteria for glioblastoma: practical adaptation and implementation in clinical trials of antiangiogenic therapy. Curr Neurol Neurosci Rep 2013; 13:347. [PMID: 23529375 PMCID: PMC3631110 DOI: 10.1007/s11910-013-0347-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since 1990, the primary criteria used for assessing response to therapy in high-grade gliomas were those developed by Macdonald and colleagues, which incorporated 2-dimensional area measurements of contrast-enhancing tumor regions, corticosteroid dosing, and clinical assessment to arrive at a designation of response, stable disease, or progression. Recent advances in imaging technology and targeted therapeutics, however, have exposed limitations of the Macdonald criteria and have highlighted the need for reevaluation of response assessment criteria. In 2010, the Response Assessment in Neuro-Oncology (RANO) Working Group published updated criteria to address this need and to standardize response assessment for high-grade gliomas. In 2009, prior to the publication of the RANO criteria, the randomized, placebo-controlled, multicenter, phase 3 AVAglio trial was designed and initiated to investigate the effectiveness of radiotherapy and temozolomide with or without bevacizumab in newly diagnosed glioblastoma. The AVAglio protocol enacted specific measures to adapt the Macdonald criteria to the frontline treatment setting and to antiangiogenic agent evaluation, including the incorporation of a T2/fluid-attenuated inversion recovery component, qualitative assessment of irregularly shaped contrast-enhancing lesions, and a decision tree for confirming or ruling out pseudoprogression. Moreover, the protocol outlines practical means by which these adapted response criteria can be implemented in the clinic. This article describes the evolution of radiographic response criteria for high-grade gliomas and highlights the similarities and differences between those implemented in the AVAglio study and those subsequently published by RANO.
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Affiliation(s)
- Olivier L Chinot
- Aix-Marseille University, AP-HM, Service de Neuro-Oncologie, CHU Timone, 264 Rue Saint Pierre, 13005, Marseille, France.
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Alexander BM, Wen PY, Trippa L, Reardon DA, Yung WKA, Parmigiani G, Berry DA. Biomarker-based adaptive trials for patients with glioblastoma--lessons from I-SPY 2. Neuro Oncol 2013; 15:972-8. [PMID: 23857706 DOI: 10.1093/neuonc/not088] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The traditional clinical trials infrastructure may not be ideally suited to evaluate the numerous therapeutic hypotheses that result from the increasing number of available targeted agents combined with the various methodologies to molecularly subclassify patients with glioblastoma. Additionally, results from smaller screening studies are rarely translated to successful larger confirmatory studies, potentially related to a lack of efficient control arms or the use of unvalidated surrogate endpoints. Streamlining clinical trials and providing a flexible infrastructure for biomarker development is clearly needed for patients with glioblastoma. The experience developing and implementing the I-SPY studies in breast cancer may serve as a guide to developing such trials in neuro-oncology.
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Affiliation(s)
- Brian M Alexander
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA.
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Galsky MD, Krege S, Lin CC, Hahn N, Ecke T, Moshier E, Sonpavde G, Godbold J, Oh WK, Bamias A. Relationship between 6- and 9-month progression-free survival and overall survival in patients with metastatic urothelial cancer treated with first-line cisplatin-based chemotherapy. Cancer 2013; 119:3020-6. [DOI: 10.1002/cncr.28145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/17/2013] [Accepted: 02/28/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew D. Galsky
- The Tisch Cancer Institute, Mount Sinai School of Medicine; New York New York
| | - Susan Krege
- Urology Clinic, Alexianer Krefeld GmbH; Krefeld Germany
| | - Chia-Chi Lin
- National Taiwan University Hospital; Taipei Taiwan
| | - Noah Hahn
- Indiana University Melvin and Bren Simon Cancer Center; Indianapolis Indiana
| | | | - Erin Moshier
- The Tisch Cancer Institute, Mount Sinai School of Medicine; New York New York
| | - Guru Sonpavde
- US Oncology Research; LLC, McKesson Specialty Health, The Woodlands, Texas, and Texas Oncology; Webster Texas
| | - James Godbold
- The Tisch Cancer Institute, Mount Sinai School of Medicine; New York New York
| | - William K. Oh
- The Tisch Cancer Institute, Mount Sinai School of Medicine; New York New York
| | - Aristotle Bamias
- University of Athens and Hellenic Cooperative Oncology Group; Athens Greece
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Chaudhry NS, Shah AH, Ferraro N, Snelling BM, Bregy A, Madhavan K, Komotar RJ. Predictors of long-term survival in patients with glioblastoma multiforme: advancements from the last quarter century. Cancer Invest 2013; 31:287-308. [PMID: 23614654 DOI: 10.3109/07357907.2013.789899] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over the last quarter century there has been significant progress toward identifying certain characteristics and patterns in GBM patients to predict survival times and outcomes. We sought to identify clinical predictors of survival in GBM patients from the past 24 years. We examined patient survival related to tumor locations, surgical treatment, postoperative course, radiotherapy, chemotherapy, patient age, GBM recurrence, imaging characteristics, serum, and molecular markers. We present predictors that may increase, decrease, or play no significant role in determining a GBM patient's long-term survival or affect the quality of life.
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Affiliation(s)
- Nauman S Chaudhry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Li Y, Lupo JM, Parvataneni R, Lamborn KR, Cha S, Chang SM, Nelson SJ. Survival analysis in patients with newly diagnosed glioblastoma using pre- and postradiotherapy MR spectroscopic imaging. Neuro Oncol 2013; 15:607-17. [PMID: 23393206 DOI: 10.1093/neuonc/nos334] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this study was to examine the predictive value of parameters of 3D (1)H magnetic resonance spectroscopic imaging (MRSI) prior to treatment with radiation/chemotherapy (baseline) and at a postradiation 2-month follow-up (F2mo) in relationship to 6-month progression-free survival (PFS6) and overall survival (OS). METHODS Sixty-four patients with newly diagnosed glioblastoma multiforme (GBM) being treated with radiation and concurrent chemotherapy were involved in this study. Evaluated were metabolite indices and metabolite ratios. Logistic linear regression and Cox proportional hazards models were utilized to evaluate PFS6 and OS, respectively. These analyses were adjusted by age and MR scanner field strength (1.5 T or 3 T). Stepwise regression was performed to determine a subset of the most relevant variables. RESULTS Associated with shorter PFS6 were a decrease in the ratio of N-acetyl aspartate to choline-containing compounds (NAA/Cho) in the region with a Cho-to-NAA index (CNI) >3 at baseline and an increase of the CNI within elevated CNI regions (>2) at F2mo. Patients with higher normalized lipid and lactate at either time point had significantly worse OS. Patients who had larger volumes with abnormal CNI at F2mo had worse PFS6 and OS. CONCLUSIONS Our study found more 3D MRSI parameters that predicted PFS6 and OS for patients with GBM than did anatomic, diffusion, or perfusion imaging, which were previously evaluated in the same population of patients.
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Affiliation(s)
- Yan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
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Alam R, Schultz CR, Golembieski WA, Poisson LM, Rempel SA. PTEN suppresses SPARC-induced pMAPKAPK2 and inhibits SPARC-induced Ser78 HSP27 phosphorylation in glioma. Neuro Oncol 2013; 15:451-61. [PMID: 23382286 DOI: 10.1093/neuonc/nos326] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Secreted protein acidic and rich in cysteine (SPARC) is overexpressed in astrocytomas (World Health Organization grades II-IV). We previously demonstrated that SPARC promotes glioma migration and invasion-in part, by activating the P38 mitogen-activated protein kinase (MAPK)-heat shock protein (HSP)27 signaling pathway. The commonly lost tumor suppressor phosphatase and tensin homolog (PTEN) suppresses SPARC-induced migration, which is accompanied by suppression of Shc-Ras-Raf-MEK-ERK1/2 and Akt signaling. As PTEN completely suppresses SPARC-induced migration, we proposed that PTEN must also interfere with SPARC-induced HSP27 signaling. Therefore, this study determined the effects of PTEN expression on SPARC-induced expression and phosphorylation of HSP27. METHODS Control and SPARC-expressing clones transfected with control- or PTEN-expression plasmids were plated on fibronectin-coated tissue culture plates for 3, 6, 24, and 48 h and then lysed. Equal amounts of protein were subjected to Western blot and densitometric analyses. RESULTS The results show that SPARC enhances phosphorylated (p)P38 MAPK, phosphorylated MAPK-activated protein kinase 2 (pMAPKAPK2), and serine (Ser)78 HSP27 phosphorylation relative to total HSP27. PTEN suppresses pAkt and pMAPKAPK2, suggesting that PTEN effects are downstream of pP38 MAPK. PTEN suppressed SPARC-induced sustained phosphorylation at Ser78 HSP27. As the level of total HSP27 differed based on the presence of SPARC or PTEN, the ratios of phosphorylation-specific to total HSP27 were examined. The data demonstrate that SPARC-induced phosphorylation at Ser78 remains elevated despite increasing levels of total HSP27. In contrast, PTEN inhibits SPARC-induced increases in Ser78 HSP27 phosphorylation relative to total HSP27. CONCLUSION These data describe a novel mechanism whereby PTEN inhibits SPARC-induced migration through suppression and differential regulation of pAkt and the P38 MAPK-MAPKAPK2-HSP27 signaling pathway.
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Affiliation(s)
- Ridwan Alam
- Barbara Jane Levy Laboratory of Molecular Neuro-Oncology, Hermelin Brain Tumor Center, Department of Neurosurgery, Education and Research Bldg., Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA
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Measuring Clinical Benefit: Use of Patient-Reported Outcomes (PRO) in Primary Brain Tumor Clinical Trials. Curr Oncol Rep 2012; 15:27-32. [DOI: 10.1007/s11912-012-0276-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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DeWire MD, Beltran C, Boop FA, Helton KJ, Ellison DW, McKinnon PJ, Gajjar A, Pai Panandiker AS. Radiation therapy and adjuvant chemotherapy in a patient with a malignant glioneuronal tumor and underlying ataxia telangiectasia: a case report and review of the literature. J Clin Oncol 2012; 31:e12-4. [PMID: 22689803 DOI: 10.1200/jco.2011.40.1430] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mariko D DeWire
- St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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Hu LS, Eschbacher JM, Heiserman JE, Dueck AC, Shapiro WR, Liu S, Karis JP, Smith KA, Coons SW, Nakaji P, Spetzler RF, Feuerstein BG, Debbins J, Baxter LC. Reevaluating the imaging definition of tumor progression: perfusion MRI quantifies recurrent glioblastoma tumor fraction, pseudoprogression, and radiation necrosis to predict survival. Neuro Oncol 2012; 14:919-30. [PMID: 22561797 PMCID: PMC3379799 DOI: 10.1093/neuonc/nos112] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION: Contrast-enhanced MRI (CE-MRI) represents the current mainstay for monitoring treatment response in glioblastoma multiforme (GBM), based on the premise that enlarging lesions reflect increasing tumor burden, treatment failure, and poor prognosis. Unfortunately, irradiating such tumors can induce changes in CE-MRI that mimic tumor recurrence, so called post treatment radiation effect (PTRE), and in fact, both PTRE and tumor re-growth can occur together. Because PTRE represents treatment success, the relative histologic fraction of tumor growth versus PTRE affects survival. Studies suggest that Perfusion MRI (pMRI)–based measures of relative cerebral blood volume (rCBV) can noninvasively estimate histologic tumor fraction to predict clinical outcome. There are several proposed pMRI-based analytic methods, although none have been correlated with overall survival (OS). This study compares how well histologic tumor fraction and OS correlate with several pMRI-based metrics. METHODS: We recruited previously treated patients with GBM undergoing surgical re-resection for suspected tumor recurrence and calculated preoperative pMRI-based metrics within CE-MRI enhancing lesions: rCBV mean, mode, maximum, width, and a new thresholding metric called pMRI–fractional tumor burden (pMRI-FTB). We correlated all pMRI-based metrics with histologic tumor fraction and OS. RESULTS: Among 25 recurrent patients with GBM, histologic tumor fraction correlated most strongly with pMRI-FTB (r = 0.82; P < .0001), which was the only imaging metric that correlated with OS (P<.02). CONCLUSION: The pMRI-FTB metric reliably estimates histologic tumor fraction (i.e., tumor burden) and correlates with OS in the context of recurrent GBM. This technique may offer a promising biomarker of tumor progression and clinical outcome for future clinical trials.
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Affiliation(s)
- Leland S Hu
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ 85054, USA.
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Schultz CR, Golembieski WA, King DA, Brown SL, Brodie C, Rempel SA. Inhibition of HSP27 alone or in combination with pAKT inhibition as therapeutic approaches to target SPARC-induced glioma cell survival. Mol Cancer 2012; 11:20. [PMID: 22480225 PMCID: PMC3349587 DOI: 10.1186/1476-4598-11-20] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 04/05/2012] [Indexed: 12/18/2022] Open
Abstract
Background The current treatment regimen for glioma patients is surgery, followed by radiation therapy plus temozolomide (TMZ), followed by 6 months of adjuvant TMZ. Despite this aggressive treatment regimen, the overall survival of all surgically treated GBM patients remains dismal, and additional or different therapies are required. Depending on the cancer type, SPARC has been proposed both as a therapeutic target and as a therapeutic agent. In glioma, SPARC promotes invasion via upregulation of the p38 MAPK/MAPKAPK2/HSP27 signaling pathway, and promotes tumor cell survival by upregulating pAKT. As HSP27 and AKT interact to regulate the activity of each other, we determined whether inhibition of HSP27 was better than targeting SPARC as a therapeutic approach to inhibit both SPARC-induced glioma cell invasion and survival. Results Our studies found the following. 1) SPARC increases the expression of tumor cell pro-survival and pro-death protein signaling in balance, and, as a net result, tumor cell survival remains unchanged. 2) Suppressing SPARC increases tumor cell survival, indicating it is not a good therapeutic target. 3) Suppressing HSP27 decreases tumor cell survival in all gliomas, but is more effective in SPARC-expressing tumor cells due to the removal of HSP27 inhibition of SPARC-induced pro-apoptotic signaling. 4) Suppressing total AKT1/2 paradoxically enhanced tumor cell survival, indicating that AKT1 or 2 are poor therapeutic targets. 5) However, inhibiting pAKT suppresses tumor cell survival. 6) Inhibiting both HSP27 and pAKT synergistically decreases tumor cell survival. 7) There appears to be a complex feedback system between SPARC, HSP27, and AKT. 8) This interaction is likely influenced by PTEN status. With respect to chemosensitization, we found the following. 1) SPARC enhances pro-apoptotic signaling in cells exposed to TMZ. 2) Despite this enhanced signaling, SPARC protects cells against TMZ. 3) This protection can be reduced by inhibiting pAKT. 4) Combined inhibition of HSP27 and pAKT is more effective than TMZ treatment alone. Conclusions We conclude that inhibition of HSP27 alone, or in combination with pAKT inhibitor IV, may be an effective therapeutic approach to inhibit SPARC-induced glioma cell invasion and survival in SPARC-positive/PTEN-wildtype and SPARC-positive/PTEN-null tumors, respectively.
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Affiliation(s)
- Chad R Schultz
- The Barbara Jane Levy Laboratory of Molecular Neuro-Oncology, Henry Ford Hospital, Detroit, MI 48202, USA
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Sampson JH, Hoang JK. Resection and survival. J Neurosurg 2012; 116:1169-70; discussion 1170-1. [PMID: 22424561 DOI: 10.3171/2011.10.jns111437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Christians A, Hartmann C, Benner A, Meyer J, von Deimling A, Weller M, Wick W, Weiler M. Prognostic value of three different methods of MGMT promoter methylation analysis in a prospective trial on newly diagnosed glioblastoma. PLoS One 2012; 7:e33449. [PMID: 22428052 PMCID: PMC3302822 DOI: 10.1371/journal.pone.0033449] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 02/13/2012] [Indexed: 12/02/2022] Open
Abstract
Hypermethylation in the promoter region of the MGMT gene encoding the DNA repair protein O6-methylguanine-DNA methyltransferase is among the most important prognostic factors for patients with glioblastoma and predicts response to treatment with alkylating agents like temozolomide. Hence, the MGMT status is widely determined in most clinical trials and frequently requested in routine diagnostics of glioblastoma. Since various different techniques are available for MGMT promoter methylation analysis, a generally accepted consensus as to the most suitable diagnostic method remains an unmet need. Here, we assessed methylation-specific polymerase chain reaction (MSP) as a qualitative and semi-quantitative method, pyrosequencing (PSQ) as a quantitative method, and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) as a semi-quantitative method in a series of 35 formalin-fixed, paraffin-embedded glioblastoma tissues derived from patients treated in a prospective clinical phase II trial that tested up-front chemoradiotherapy with dose-intensified temozolomide (UKT-05). Our goal was to determine which of these three diagnostic methods provides the most accurate prediction of progression-free survival (PFS). The MGMT promoter methylation status was assessable by each method in almost all cases (n = 33/35 for MSP; n = 35/35 for PSQ; n = 34/35 for MS-MLPA). We were able to calculate significant cut-points for the continuous methylation signals at each CpG site analysed by PSQ (range, 11.5 to 44.9%) and at one CpG site assessed by MS-MLPA (3.6%) indicating that a dichotomisation of continuous methylation data as a prerequisite for comparative survival analyses is feasible. Our results show that, unlike MS-MLPA, MSP and PSQ provide a significant improvement of predicting PFS compared with established clinical prognostic factors alone (likelihood ratio tests: p<0.001). Conclusively, taking into consideration prognostic value, cost effectiveness and ease of use, we recommend pyrosequencing for analyses of MGMT promoter methylation in high-throughput settings and MSP for clinical routine diagnostics with low sample numbers.
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Affiliation(s)
- Arne Christians
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
- * E-mail:
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen Meyer
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurooncology at the National Center for Tumour Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Markus Weiler
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurooncology at the National Center for Tumour Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Jakobsen JN, Hasselbalch B, Stockhausen MT, Lassen U, Poulsen HS. Irinotecan and bevacizumab in recurrent glioblastoma multiforme. Expert Opin Pharmacother 2011; 12:825-33. [DOI: 10.1517/14656566.2011.566558] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Reardon DA, Galanis E, DeGroot JF, Cloughesy TF, Wefel JS, Lamborn KR, Lassman AB, Gilbert MR, Sampson JH, Wick W, Chamberlain MC, Macdonald DR, Mehta MP, Vogelbaum MA, Chang SM, Van den Bent MJ, Wen PY. Clinical trial end points for high-grade glioma: the evolving landscape. Neuro Oncol 2011; 13:353-61. [PMID: 21310734 PMCID: PMC3064608 DOI: 10.1093/neuonc/noq203] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/26/2010] [Indexed: 01/13/2023] Open
Abstract
To review the strengths and weaknesses of primary and auxiliary end points for clinical trials among patients with high-grade glioma (HGG). Recent advances in outcome for patients with newly diagnosed and recurrent HGG, coupled with the development of multiple promising therapeutics with myriad antitumor actions, have led to significant growth in the number of clinical trials for patients with HGG. Appropriate clinical trial design and the incorporation of optimal end points are imperative to efficiently and effectively evaluate such agents and continue to advance outcome. Growing recognition of limitations weakening the reliability of traditional clinical trial primary end points has generated increasing uncertainty of how best to evaluate promising therapeutics for patients with HGG. The phenomena of pseudoprogression and pseudoresponse have made imaging-based end points, including overall radiographic response and progression-free survival, problematic. Although overall survival is considered the "gold-standard" end point, recently identified active salvage therapies such as bevacizumab may diminish the association between presalvage therapy and overall survival. Finally, advances in imaging as well as the assessment of patient function and well being have strengthened interest in auxiliary end points assessing these aspects of patient care and outcome. Better appreciation of the strengths and limitations of primary end points will lead to more effective clinical trial strategies. Technical advances in imaging as well as improved survival for patients with HGG support the further development of auxiliary end points evaluating novel imaging approaches as well as measures of patient function and well being.
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Affiliation(s)
- David A Reardon
- The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Box 3624, Durham, NC 27710, USA.
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Shah N, Lin B, Sibenaller Z, Ryken T, Lee H, Yoon JG, Rostad S, Foltz G. Comprehensive analysis of MGMT promoter methylation: correlation with MGMT expression and clinical response in GBM. PLoS One 2011; 6:e16146. [PMID: 21249131 PMCID: PMC3017549 DOI: 10.1371/journal.pone.0016146] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 12/08/2010] [Indexed: 11/29/2022] Open
Abstract
O6-methylguanine DNA-methyltransferase (MGMT) promoter methylation has been identified as a potential prognostic marker for glioblastoma patients. The relationship between the exact site of promoter methylation and its effect on gene silencing, and the patient's subsequent response to therapy, is still being defined. The aim of this study was to comprehensively characterize cytosine-guanine (CpG) dinucleotide methylation across the entire MGMT promoter and to correlate individual CpG site methylation patterns to mRNA expression, protein expression, and progression-free survival. To best identify the specific MGMT promoter region most predictive of gene silencing and response to therapy, we determined the methylation status of all 97 CpG sites in the MGMT promoter in tumor samples from 70 GBM patients using quantitative bisulfite sequencing. We next identified the CpG site specific and regional methylation patterns most predictive of gene silencing and improved progression-free survival. Using this data, we propose a new classification scheme utilizing methylation data from across the entire promoter and show that an analysis based on this approach, which we call 3R classification, is predictive of progression-free survival (HR = 5.23, 95% CI [2.089–13.097], p<0.0001). To adapt this approach to the clinical setting, we used a methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) test based on the 3R classification and show that this test is both feasible in the clinical setting and predictive of progression free survival (HR = 3.076, 95% CI [1.301–7.27], p = 0.007). We discuss the potential advantages of a test based on this promoter-wide analysis and compare it to the commonly used methylation-specific PCR test. Further prospective validation of these two methods in a large independent patient cohort will be needed to confirm the added value of promoter wide analysis of MGMT methylation in the clinical setting.
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Affiliation(s)
- Nameeta Shah
- The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute, Seattle, Washington, United States of America
| | - Biaoyang Lin
- The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute, Seattle, Washington, United States of America
| | - Zita Sibenaller
- Department of Radiation and Oncology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Timothy Ryken
- Iowa Spine and Brain Institute, Waterloo, Iowa, United States of America
| | - Hwahyung Lee
- The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute, Seattle, Washington, United States of America
| | - Jae-Geun Yoon
- The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute, Seattle, Washington, United States of America
| | - Steven Rostad
- Cellnetix Pathology and Laboratories, Seattle, Washington, United States of America
| | - Greg Foltz
- The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute, Seattle, Washington, United States of America
- * E-mail:
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Stupp R, Hegi ME, Neyns B, Goldbrunner R, Schlegel U, Clement PM, Grabenbauer GG, Ochsenbein AF, Simon M, Dietrich PY, Pietsch T, Hicking CB, Tonn JC, Diserens AC, Pica A, Hermisson M, Picard M, Weller M. Reply to M.C. Chamberlain. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.31.2843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Roger Stupp
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Monika E. Hegi
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Bart Neyns
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Uwe Schlegel
- Knappschaftskrankenhaus Bochum-Langendreer, Ruhr University, Bochum, Germany
| | | | | | | | | | | | | | | | | | - Annie-Claire Diserens
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Alessia Pica
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | | | - Michael Weller
- UniversitätsSpital Zürich, and University of Zurich, Zurich, Switzerland
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Chamberlain MC. What role should cilengitide have in the treatment of glioblastoma? J Clin Oncol 2010; 28:e695; author reply e696-7. [PMID: 20975074 DOI: 10.1200/jco.2010.31.2371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Khayal IS, Polley MYC, Jalbert L, Elkhaled A, Chang SM, Cha S, Butowski NA, Nelson SJ. Evaluation of diffusion parameters as early biomarkers of disease progression in glioblastoma multiforme. Neuro Oncol 2010; 12:908-16. [PMID: 20501631 DOI: 10.1093/neuonc/noq049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to evaluate diffusion parameters at pre-, mid-, and post-radiation therapy (RT) in contrast-enhancing and nonenhancing lesions of postsurgical glioblastoma multiforme patients treated with the standard of care RT concurrently with temozolomide (TMZ) followed by adjuvant TMZ and an antiangiogenic drug. The diffusion parameters explored include baseline and short-term changes in apparent diffusion coefficient, fractional anisotropy, and eigenvalues. These diffusion parameters were examined as early markers for disease progression by relating them to clinical outcome of 6-month progression-free survival. The results indicated that changes from mid- to post-RT were significantly different between patients who progressed within 6 months vs those who were free of progression for 6 months after initiation of therapy. The study also showed that the changes in diffusion parameters from the mid- to post-RT scan may be more significant than those from pre- to mid-RT and pre- to post-RT. This is important because the mid-RT scan is currently not performed as part of the standard clinical care.
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Affiliation(s)
- Inas S Khayal
- UCSF/UCB Joint Graduate Group in Bioengineering, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California 94158-2330, USA.
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