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Rahman R, Hempfling K, Norden AD, Reardon DA, Nayak L, Rinne ML, Beroukhim R, Doherty L, Ruland S, Rai A, Rifenburg J, LaFrankie D, Alexander BM, Huang RY, Wen PY, Lee EQ. Retrospective study of carmustine or lomustine with bevacizumab in recurrent glioblastoma patients who have failed prior bevacizumab. Neuro Oncol 2014; 16:1523-9. [PMID: 24958095 DOI: 10.1093/neuonc/nou118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Currently, there are no known effective treatments for recurrent glioblastoma once patients have progressed on a bevacizumab-containing regimen. We examined the efficacy of adding nitrosoureas to bevacizumab in patients who progressed while on an initial bevacizumab-containing regimen. METHODS In this retrospective study, we identified adult patients with histologically confirmed glioblastoma (WHO grade IV) who were treated with lomustine or carmustine in combination with bevacizumab as a second or third regimen after failing an alternative initial bevacizumab-containing regimen. Response rate (RR), 6-month progression free survival (PFS6), and progression-free survival (PFS) were assessed for each treatment. RESULTS Forty-two patients were identified (28 males) with a median age of 49 years (range, 24-78 y). Of 42 patients, 28 received lomustine (n = 22) or carmustine (n = 6) with bevacizumab as their second bevacizumab-containing regimen, and 14 received lomustine (n = 11) or carmustine (n = 3) as their third bevacizumab-containing regimen. While the median PFS for the initial bevacizumab-containing regimen was 16.3 weeks, the median PFS for the nitrosourea-containing bevacizumab regimen was 6.3 weeks. Patients had an RR of 44% and a PFS6 rate of 26% during the initial bevacizumab regimen and an RR of 0% and a PFS6 rate of 3% during the nitrosourea-containing bevacizumab regimen. There was increased grade 3-4 toxicity (45% vs 19%, P = .010) during the nitrosourea-containing bevacizumab regimen relative to the initial bevacizumab regimen. Median overall survival was 18.7 weeks from initiation of the nitrosourea-containing bevacizumab regimen. CONCLUSION The addition of lomustine or carmustine to bevacizumab after a patient has already progressed on a bevacizumab-containing regimen does not appear to provide benefit for most patients and is associated with additional toxicity with the doses used in this cohort.
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Affiliation(s)
- Rifaquat Rahman
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Kelly Hempfling
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Andrew D Norden
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - David A Reardon
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Lakshmi Nayak
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Mikael L Rinne
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Rameen Beroukhim
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Lisa Doherty
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Sandra Ruland
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Arun Rai
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Jennifer Rifenburg
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Debra LaFrankie
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Brian M Alexander
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Raymond Y Huang
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Patrick Y Wen
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
| | - Eudocia Q Lee
- Harvard Medical School, Boston, Massachusetts (R.R., A.D.N., D.A.R., L.N., M.L.R., R.B., B.M.A., R.Y.H., P.Y.W., E.Q.L.); Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.H., A.D.N., D.A.R., L.N., M.L.R., R.B., L.D., S.R., J.R., D.L., P.Y.W., E.Q.L.); Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (A.D.N., D.A.R., L.N., M.L.R., R.B., P.Y.W., E.Q.L.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (B.M.A.); Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (R.Y.H.); Boston University School of Medicine, Boston, Massachusetts (A.R.)
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Piccioni DE, Selfridge J, Mody RR, Chowdhury R, Li S, Lalezari S, Wawrzynski J, Quan J, Zurayk M, Chou AP, Sanchez DE, Liau LM, Ellingson BM, Pope WB, Nghiemphu PL, Green RM, Wang HJ, Yong WH, Elashoff R, Cloughesy TF, Lai A. Deferred use of bevacizumab for recurrent glioblastoma is not associated with diminished efficacy. Neuro Oncol 2014; 16:815-22. [PMID: 24627236 DOI: 10.1093/neuonc/nou028] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The optimal timing to initiate bevacizumab (BV) therapy for recurrent glioblastoma (GBM) is currently unclear. To address this issue, we examined progression-free survival (PFS) and survival time (ST) in a large retrospective cohort of GBM patients treated with BV at different recurrences. METHODS We identified 468 primary GBM patients who underwent biopsy or surgery followed by radiation therapy and temozolomide (RT/TMZ), and then received BV. PFS and ST were compared between patients stratified by the recurrence that BV was initiated (upfront, first recurrence, second recurrence, or 3+ recurrences). We also examined the effect on PFS and ST of the addition of chemotherapy to BV. In a larger cohort of GBM patients, we determined overall treatment continuation rates at each recurrence and identified variables predictive of inability to continue treatment. RESULTS BV PFS was similar for all 3 recurrence groups (median, 4.1 months). There were no differences in BV ST (median, 9.8 months). The addition of chemotherapy to BV improved PFS but not ST. Analysis of treatment continuation rates indicated that the number of patients unable to undergo further treatments is modest, and that patients unable to tolerate BV delay can be identified by age ≥60 years and low extent of resection. CONCLUSIONS Deferred use of bevacizumab is not associated with diminished efficacy. Analysis of treatment continuation rates identified patients who may be unable to delay BV therapy. Our findings suggest that there is a fixed survival after BV initiation and that delayed BV treatment is preferable for most patients.
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Affiliation(s)
- David E Piccioni
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Julia Selfridge
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Reema R Mody
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Reshmi Chowdhury
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Sichen Li
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Shadi Lalezari
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - James Wawrzynski
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Jennifer Quan
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Mira Zurayk
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Arthur P Chou
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Desiree E Sanchez
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Linda M Liau
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Benjamin M Ellingson
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Whitney B Pope
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Phioanh L Nghiemphu
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Richard M Green
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - He-Jing Wang
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - William H Yong
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Robert Elashoff
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Timothy F Cloughesy
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
| | - Albert Lai
- Department of Neurosciences, University of California San Diego, San Diego, California (D.E.P.); Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (J.S., R.R.M., R.C., S.L., S.L., M.Z., P.L.N., T.F.C., A.L.); Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (A.P.C., L.M.L.); Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (D.E.S., W.H.Y.); Peterhouse, University of Cambridge, Cambridge, UK (J.W.); Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Kaiser Permanente Southern California, Los Angeles, California (J.Q., R.M.G.); Department of Biomathematics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California (H.W., R.E.)
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