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Ruotsalainen SE, Surakka I, Mars N, Karjalainen J, Kurki M, Kanai M, Krebs K, Graham S, Mishra PP, Mishra BH, Sinisalo J, Palta P, Lehtimäki T, Raitakari O, Milani L, Okada Y, Palotie A, Widen E, Daly MJ, Ripatti S. Inframe insertion and splice site variants in MFGE8 associate with protection against coronary atherosclerosis. Commun Biol 2022; 5:802. [PMID: 35978133 PMCID: PMC9385630 DOI: 10.1038/s42003-022-03552-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiovascular diseases are the leading cause of premature death and disability worldwide, with both genetic and environmental determinants. While genome-wide association studies have identified multiple genetic loci associated with cardiovascular diseases, exact genes driving these associations remain mostly uncovered. Due to Finland's population history, many deleterious and high-impact variants are enriched in the Finnish population giving a possibility to find genetic associations for protein-truncating variants that likely tie the association to a gene and that would not be detected elsewhere. In a large Finnish biobank study FinnGen, we identified an association between an inframe insertion rs534125149 in MFGE8 (encoding lactadherin) and protection against coronary atherosclerosis. This variant is highly enriched in Finland, and the protective association was replicated in meta-analysis of BioBank Japan and Estonian biobank. Additionally, we identified a protective association between splice acceptor variant rs201988637 in MFGE8 and coronary atherosclerosis, independent of the rs534125149, with no significant risk-increasing associations. This variant was also associated with lower pulse pressure, pointing towards a function of MFGE8 in arterial aging also in humans in addition to previous evidence in mice. In conclusion, our results suggest that inhibiting the production of lactadherin could lower the risk for coronary heart disease substantially.
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Affiliation(s)
- Sanni E Ruotsalainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Ida Surakka
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nina Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | | | - Mitja Kurki
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Masahiro Kanai
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Masfsachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Sarah Graham
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Pashupati P Mishra
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Binisha H Mishra
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Priit Palta
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Elisabeth Widen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Mark J Daly
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Masfsachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Brandes AA, Carpentier AF, Kesari S, Sepulveda-Sanchez JM, Wheeler HR, Chinot O, Cher L, Steinbach JP, Capper D, Specenier P, Rodon J, Cleverly A, Smith C, Gueorguieva I, Miles C, Guba SC, Desaiah D, Lahn MM, Wick W. A Phase II randomized study of galunisertib monotherapy or galunisertib plus lomustine compared with lomustine monotherapy in patients with recurrent glioblastoma. Neuro Oncol 2016; 18:1146-56. [PMID: 26902851 PMCID: PMC4933481 DOI: 10.1093/neuonc/now009] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/09/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The combination of galunisertib, a transforming growth factor (TGF)-β receptor (R)1 kinase inhibitor, and lomustine was found to have antitumor activity in murine models of glioblastoma. METHODS Galunisertib (300 mg/day) was given orally 14 days on/14 days off (intermittent dosing). Lomustine was given as approved. Patients were randomized in a 2:1:1 ratio to galunisertib + lomustine, galunisertib monotherapy, or placebo + lomustine. The primary objective was overall survival (OS); secondary objectives were safety, pharmacokinetics (PKs), and antitumor activity. RESULTS One hundred fifty-eight patients were randomized: galunisertib + lomustine (N = 79), galunisertib (N = 39), and placebo + lomustine (N = 40). Baseline characteristics were: male (64.6%), white (75.3%), median age 58 years, ECOG performance status (PS) 1 (63.3%), and primary glioblastoma (93.7%). The PKs of galunisertib were not altered with lomustine, and galunisertib had a median half-life of ∼8 hours. Median OS in months (95% credible interval [CrI]) for galunisertib + lomustine was 6.7 (range: 5.3-8.5), 8.0 (range: 5.7-11.7) for galunisertib alone, and 7.5 (range: 5.6-10.3) for placebo + lomustine. There was no difference in OS for patients treated with galunisertib + lomustine compared with placebo + lomustine [P (HR < 1) = 26%]. Median progression-free survival of ∼2 months was observed in all 3 arms. Among 8 patients with IDH1 mutation, 7 patients were treated with galunisertib (monotherapy or with lomustine); OS ranged from 4 to 17 months. Patients treated with galunisertib alone had fewer drug-related grade 3/4 adverse events (n = 34) compared with lomustine-treated patients (10% vs 26%). Baseline PS, post-discontinuation of bevacizumab, tumor size, and baseline levels of MDC/CCL22 were correlated with OS. CONCLUSIONS Galunisertib + lomustine failed to demonstrate improved OS relative to placebo + lomustine. Efficacy outcomes were similar in all 3 arms. CLINICAL TRIAL REGISTRATION NCT01582269, ClinicalTrials.gov.
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Affiliation(s)
- Alba A Brandes
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Antoine F Carpentier
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Santosh Kesari
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Juan M Sepulveda-Sanchez
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Helen R Wheeler
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Olivier Chinot
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Lawrence Cher
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Joachim P Steinbach
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - David Capper
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Pol Specenier
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Jordi Rodon
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Ann Cleverly
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Claire Smith
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Ivelina Gueorguieva
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Colin Miles
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Susan C Guba
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Durisala Desaiah
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Michael M Lahn
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
| | - Wolfgang Wick
- Medical Oncology Department, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B.); Hôpital Avicenne, Paris 13 University, Bobigny, France (A.F.C.); University of California San Diego Health System, La Jolla, California (S.K.); Hospital Universitario 12 de Octubre, Madrid, Spain (J.M.S.-S.); Department of Oncology, Royal North Shore Hospital, St Leonards, Australia (H.R.W.); CHU Hôspital De La Timone, Rue Saint Pierre, France (O.C.); Austin Hospital, Heidelberg, Australia (L.C.); Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt, Germany (J.P.S.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (D.C.); Antwerp University Hospital, Edegem, Belgium (P.S.); Medical Oncology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain (J.R.); Eli Lilly and Company, Erl Wood, England (A.C., C.S., I.G., C.M.); Eli Lilly and Company, Indianapolis, Indiana (S.C.G., D.D., M.M.L.); Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W.)
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