1
|
Fougner V, Noeroexe A, Hasselbalch B, Urup T, Yde C, Belcaid L, Hoejgaard M, Spanggaard I, Rohrberg K, Skovgaard Poulsen H, Lassen U. 81P Implementing genomic profiling as standard-of-care for glioblastoma patients. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
|
2
|
Maarup S, Skadborg S, Draghi A, Borch A, Hasselbalch B, Yde C, Svane I, Hadrup S, Christensen I, Law I, Skjoeth-Rasmussen J, Scheie D, Skovgaard Poulsen H, Lassen U. PL02.3.A Survival and T-cell tumor reactivity in patients treated with nivolumab and bevacizumab for recurrent glioblastoma in the clinical trial CA209-9UP. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Glioblastoma (GBM) is an aggressive brain tumor with a median survival of 14.6 months. We have no standard treatment for relapse and current treatment options have limited effect. Novel treatments are necessary to improve survival and quality of life.
Material and Methods
We present data from; a phase II open label, two-armed clinical trial studying nivolumab and bevacizumab in treatment of recurrent GBM, with progression after Stupp’s regime. Patients were included in two arms depending on the possibility of salvage neurosurgical resection. All patients had biopsies for genome sequencing at primary tumor and recurrence. Both arms received nivolumab and bevacizumab administrated every second week and the surgical arm also received neoadjuvant nivolumab 7 days prior to surgery. Fresh tissue samples were collected for tumor digest, TILs (tumor infiltrating lymphocytes) for phenotype exploration and intracellular staining to test reactivity. Patients were treated until progression, death, or intolerable side effects. Toxicity screens were reported, and follow-up ended in Marts 2022.
Results
Forty-four patients were included from November 2018 to January 2022; 20 in each arm (four screen-failures). Treatment was overall well tolerated. Median (m) age at inclusion was 57,5 years (arm A) and 50,5 years (arm B), and the groups had an even distribution. The surgical and non-surgical arm had an mPFS of 5.95 and 3.83 months respectively, while the mOS was 13.96 months and 6.77 months, respectively. Multivariate analysis was performed by variables such us steroid, MGMT, gender, age at diagnosis, resection extent and arm. Steroid at inclusion was a significant negative predictor of outcome (p = 0.0378). Controls from our GBM registry (N=140), which were treated with neurosurgical resection and then bevazicumab and irinotecan in recurrent setting had an mOS of 8.64 months (log-rank p=0.0181).Furthermore, reactive tumor infiltrating lymphocytes (TIL) were detected in four of the patients who presented with a longer mOS and mPFS of 16.75 months and 9.18 months, while the 16 patients without TIL reactivity had mOS and mPFS of 12.63 months and 5.13 months, respectively (not significant).
Conclusion
We found an increased mOS in patients treated with nivolumab and bevacizumab at recurrence, compared to our controls: 13.96 months and 8.64 months, respectively. Four patients with T-cell reactivity towards tumor cells showed an even longer mPFS and mOS. Though not significant, these results warrant further research evaluation in larger patient cohorts. We are currently investigating proteomics and sequencing data to identify predictive biomarkers.
Collapse
Affiliation(s)
- S Maarup
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - S Skadborg
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - A Draghi
- National Center for Cancer Immune Therapy, Copenhagen University Hospital , Herlev , Denmark
| | - A Borch
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - B Hasselbalch
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - C Yde
- Center of Genomic Medicine, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - I Svane
- National Center for Cancer Immune Therapy, Copenhagen University Hospital , Herlev , Denmark
| | - S Hadrup
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - I Christensen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen , Copenhagen , Denmark
| | - I Law
- Department of Clinical Physiology, Nuclear Medicine and pet, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - J Skjoeth-Rasmussen
- Neurosurgery Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - D Scheie
- Pathology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - H Skovgaard Poulsen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - U Lassen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen , Copenhagen , Denmark
| |
Collapse
|
3
|
Urup T, Trip AK, Chiranth SB, Christensen IJ, Grunnet K, Møller S, Hasselbalch B, Muhic A, Lassen U, Poulsen HS. P11.32.A EGFR expression and non-methylated MGMT predict distant recurrence in glioblastoma patients treated with standard therapy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Infiltrative growth within the central nervous system is hallmark of glioblastoma (GBM) at time of diagnosis. Targeting infiltrative glioma cells by adding chemotherapy to local treatment (surgical resection and radiotherapy) has led to improved tumor control and survival. Still, infiltrative growth is a major factor in therapeutic failure and tumor recurrence is almost inevitable. Herein, we hypothesize that distant recurrence represents a more migratory phenotype and that biomarkers associated with distant recurrence can be used to personalize the treatment. The aim of this study was to identify clinical and molecular factors associated with distance recurrence in glioblastoma patients treated with standard therapy.
Material and Methods
A prospective cohort of consecutive, non-selected GBM patients administered standard therapy as primary treatment between 2005-2020 at Rigshospitalet, Copenhagen, Denmark. Distant recurrence was defined as a new contrast-enhancing tumor lesion outside the radiation field (> 2 cm from the gross tumor volume). Clinical and molecular factors were screened for association with time to distant recurrence (p < 0.30) using univariate analysis. The final model was generated employing multivariate Cox regression analysis to model the association with time to distant recurrence. It was chosen to maintain known prognostic factors in the model and subsequently add significantly associated factors (p < 0.05). Competing risk adjusted analysis were performed with death as a competing risk.
Results
A total of 897 patients were included and at a median follow-up time of 73 (range: 12-198) months, 733 patients were evaluable for recurrence pattern. Out of 733 patients, 146 patients (20%) had distant recurrence. Median time to tumor progression was 7.0 months for patients with a local recurrence and 8.0 months for those with a distant recurrence (p=0.31). The following prognostic factors were not associated with distant recurrence by multivariate analysis: Corticosteroid use (p=0.84), age (p=0.20), multifocal disease (p=0.81), ECOG performance status (p=0.99) and degree of tumor resection (p=0.20). In multivariate analysis, factors independently associated with a higher likelihood of distant recurrence were: Non-methylated promoter of the MGMT gene (HR=1.93; 95% CI: 1.27-2.95; p=0.002) and positive expression of Epidermal Growth Factor Receptor (EGFR) by immunohistochemistry (HR=3.70; 95% CI: 1.61-8.33; p=0.002).
Conclusion
Non-methylated MGMT and positive expression of EGFR were independently associated with a higher likelihood of distant recurrence in GBM patients treated with standard-of-care. These factors, if validated, can be used for risk stratification and to enrich clinical treatment protocols aiming at improved local or distant tumor control.
Collapse
Affiliation(s)
- T Urup
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| | - A K Trip
- Danish Center for Particle Therapy , Aarhus , Denmark
| | - S B Chiranth
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| | - I J Christensen
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| | - K Grunnet
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| | - S Møller
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| | - B Hasselbalch
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| | - A Muhic
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| | - U Lassen
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| | - H S Poulsen
- DCCC The Brain Tumor Center, Rigshospitalet , Copenhagen , Denmark
| |
Collapse
|
4
|
Fougner VN, Urup TH, Hasselbalch B, Lassen U, Poulsen HS. P11.02.A Gliotarget: a Danish nationwide phase I/II platform trial focusing on individualized targeted treatment for newly diagnosed glioblastoma patients based on genomic profiling. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
The survival in glioblastoma has been unchanged since 2005. The introduction of targeted treatments, which have improved survival in several cancers has yet to influence the treatment of glioblastoma. In Gliotarget, we will individualize the targeted treatment, and give it in the primary setting alongside standard therapy with the intention to improve the likelihood of effect.
METHODS
Gliotarget is a biomarker enriched phase I/II platform trial with initially 4 predefined biomarker selected arms and one control arm. All patients receive standard therapy with concomitant radiochemotherapy and adjuvant temozolomide. The experimental treatment is given alongside the adjuvant temozolomide. Molecular analysis, including Whole Genome Sequencing, is performed on all patients, to identify actionable biomarkers. Gliotarget includes newly diagnosed IDH-wt glioblastoma patients. In addition, to exclude the patients where the inherent poor prognosis might conceal the drug efficacy, the patients must have a 50% probability of being alive 12 months after initial surgery, according to a prognostic model developed in our institution. The sample size is calculated with Simon’s two-stage design using treatment effect at 9-months progression free survival (PFS9). We anticipate 9 patients for stage one and 24 in total, for each arm. Treatment effect is defined as 65% of the patients in an experimental arm reaching PFS9. For the survival analysis, supplementing the control arm data with leveraged external controls taken from our prospectively registered database will decrease the probability of false positive results.
CONCLUSION
Gliotarget complements the field of ongoing platform trials with its distinctive trial design. The chosen biomarkers and treatments will be presented at the 2022 EANO meeting. Enrollment is set to open in Q4 2022.
Collapse
Affiliation(s)
- V N Fougner
- DCCC Brain Tumor Center , København , Denmark
| | - T H Urup
- DCCC Brain Tumor Center , København , Denmark
| | | | - U Lassen
- DCCC Brain Tumor Center , København , Denmark
| | - H S Poulsen
- DCCC Brain Tumor Center , København , Denmark
| |
Collapse
|
5
|
Jensen C, Maarup SB, Poulsen HS, Hasselbalch B, Karsdal MA, Svane IM, Lassen UN, Willumsen N. Indirect assessment of tumor-infiltrating lymphocyte activity in serum for predicting outcome in patients with glioblastoma treated with immunotherapy in the recurrent setting. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2059 Background: Glioblastoma (GBM) is an aggressive brain tumor and despite efforts in developing new effective therapies, patient survival remains low. There is increasing interest in using immune checkpoint inhibitors (ICIs) for GBM, however the immunosuppressive (cold tumor) characteristics of GBM limit the efficacy of ICIs. Consequently, there is a need to identify patients with active tumor-infiltrating lymphocytes (hot tumor). Several studies have shown that brain extracellular matrix such as type IV collagen has a dynamic composition with protease-induced alterations. In this study, we evaluated the clinical utility of a non-invasive biomarker of granzyme B degraded type IV collagen (C4G) reflecting tumor-infiltrating lymphocyte activity and of matrix metalloproteinase (MMP) degraded type IV collagen (C4M) in GBM patients treated with nivolumab (anti-PD-1) and bevacizumab (anti-VEGF) in the recurrent setting. Methods: C4G and C4M were measured in serum from 22 controls and 39 GBM patients previously treated with surgery, radiotherapy and chemotherapy in the primary setting. After GBM recurrence, 18 patients underwent salvage resection (arm A) however 21 patients had no possibility for resection (arm B). All patients were treated with nivolumab and bevacizumab (NCT03890952 phase II study). Baseline GBM samples were taken before the second-line treatment. The association between C4G levels and outcome was evaluated by Cox regression analysis for overall survival (OS) and odds ratio (OR) calculations for complete response (CR) rate after dichotomizing patients into low vs high levels of C4G (median cutpoint). Results: C4G (p = 0.004), but not C4M (p = 0.166), was significantly elevated in serum from GBM patients compared to controls. Moreover, patients with high C4G levels had a significantly increased likelihood of experiencing CR (OR=6.68, p<0.0001). Furthermore, patients with high C4G experienced improved OS compared to low C4G (HR=0.39), and this remained significant after adjusting for other significant risk factors (treatment arm and MGMT methylation) by multivariate analysis (HR=0.44) (table). Conclusions: A non-invasive biomarker reflecting tumor-infiltrating lymphocyte activity (C4G) has the potential to identify GBM patients responding to nivolumab and bevacizumab in the recurrent setting. In the future, this may provide a non-invasive biomarker tool for stratifying patients with GBM for ICI trials. Clinical trial information: NCT03890952. [Table: see text]
Collapse
Affiliation(s)
| | - Simone Bendix Maarup
- The Brain Tumor Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- The Brain Tumor Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Benedikte Hasselbalch
- The Brain Tumor Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Inge Marie Svane
- National Center for Cancer Immune Therapy, CCIT-DK, Copenhagen University Hospital, Herlev, Denmark
| | - Ulrik Niels Lassen
- The Brain Tumor Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | |
Collapse
|
6
|
Fougner V, Hasselbalch B, Lassen U, Weischenfeldt J, Poulsen HS, Urup T. Implementing targeted therapies in the treatment of glioblastoma: Previous shortcomings, future promises, and a multimodal strategy recommendation. Neurooncol Adv 2022; 4:vdac157. [PMID: 36325372 PMCID: PMC9616055 DOI: 10.1093/noajnl/vdac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
The introduction of targeted therapies to the field of oncology has prolonged the survival of several tumor types. Despite extensive research and numerous trials, similar outcomes have unfortunately not been realized for glioblastoma. For more than 15 years, the standard treatment of glioblastoma has been unchanged. This review walks through the elements that have challenged the success of previous trials and highlight some future promises. Concurrently, this review describes how institutions, through a multimodal and comprehensive strategy with 4 essential components, may increase the probability of finding a meaningful role for targeted therapies in the treatment of glioblastoma. These components are (1) prudent trial designs, (2) considered drug and target selection, (3) harnessed real-world clinical and molecular evidence, and (4) incorporation of translational research.
Collapse
Affiliation(s)
- Vincent Fougner
- Department for Cancer Treatment, DCCC—Brain Tumor Center, Rigshospitalet, Copenhagen, Capitol Region of Denmark, Denmark
| | - Benedikte Hasselbalch
- Department for Cancer Treatment, DCCC—Brain Tumor Center, Rigshospitalet, Copenhagen, Capitol Region of Denmark, Denmark
| | - Ulrik Lassen
- Department for Cancer Treatment, DCCC—Brain Tumor Center, Rigshospitalet, Copenhagen, Capitol Region of Denmark, Denmark
| | - Joachim Weischenfeldt
- BRIC - Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- Department for Cancer Treatment, DCCC—Brain Tumor Center, Rigshospitalet, Copenhagen, Capitol Region of Denmark, Denmark
| | - Thomas Urup
- Department for Cancer Treatment, DCCC—Brain Tumor Center, Rigshospitalet, Copenhagen, Capitol Region of Denmark, Denmark
| |
Collapse
|
7
|
Skadborg S, Maarup S, Draghi A, Borch A, Svane IM, Hasselbalch B, Poulsen H, Lassen U, Hadrup S. CTIM-23. EVIDENCE OF T CELL ACTIVATION AND INTRATUMORAL NIVOLUMAB-PRESENCE IN GLIOBLASTOMA PATIENTS TREATED WITH NIVOLUMAB AND BEVACIZUMAB. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Glioblastoma (GBM) is an aggressive brain tumor with a dismal prognosis. Salvage neurosurgical resection is performed if possible and GBM patients are hereafter treated with Stupp’s regime as standard treatment in the primary setting. However, after relapse, treatment in the recurrent setting shows very limited effect. We are monitoring the immune system of patients participating in a phase II clinical trial, where patients with recurrent GBM receive Nivolumab and Bevacizumab, treatments blocking PD1 and VEGF, respectively. The clinical trial consists of two arms. Arm A includes patients where surgical removal of the tumor is possible, and arm B includes patients who are only able to receive medical treatment. Arm A has received Nivolumab 7 days prior to surgery. Single cells suspension was produced from the resected tumors and blood samples was collected from patients through the course of treatment, wherefrom PBMCs (peripheral blood mononuclear cells) were purified. All samples were immunophenotyped using multi-color flow cytometry, to identify and follow the distribution of various immune cell types, and determine their expression of activating and inhibitory molecules over the course of treatment, in the periphery and in the tumor. An activated subset of T cells was characterized by CD103 (tissue residence), CD39 (antigen exposure) and CD69 (cytotoxicity). Such T cell populations were significantly enriched in the tumor. Importantly, we could demonstrate the presence of Nivolumab in the tumor, using an anti-IgG4 antibody to detect Nivolumab binding to T cells. We observed IgG4 positive T cell in the tumor digest, suggesting T cells binding Nivolumab are present in the tumor. Additional data analysis will be performed prior to the conference. With this we hope to gain further knowledge of the immune system’s role in tumor clearance in the brain and the impact of immunotherapy hereupon.
Collapse
Affiliation(s)
- Signe Skadborg
- DTU, Department of Health Technology, DK-2100 Copenhagen, USA
| | - Simone Maarup
- Rigshospitalet, DCCC-Brain Tumor Center, Copenhagen, Denmark
| | - Arianna Draghi
- Herlev Hospital, National Center for Cancer Immune Therapy, CCIT, DK-2100 Copenhagen, Denmark
| | - Annie Borch
- Department of Health Technology, DK-2100 Copenhagen, Denmark
| | - Inge Marie Svane
- Herlev Hospital, National Center for Cancer Immune Therapy, CCIT, DK-2100 Copenhagen, Denmark
| | | | - Hans Poulsen
- Rigshospitalet, DCCC-Brain Tumor Center, Copenhagen, Denmark
| | - Ulrik Lassen
- Rigshospitalet, Department of Oncology, Copenhagen, Denmark
| | - Sine Hadrup
- DTU, Health Technology, DK-2100 Copenhagen, Denmark
| |
Collapse
|
8
|
Maarup S, Skadborg S, Borch A, Draghi A, Hasselbalch B, Østrup O, Scheie D, Skjoeth-Rasmussen J, Law I, Svane IM, Poulsen H, Hadrup S, Lassen U. CTIM-22. NIVOLUMAB AND BEVACIZUMAB FOR RECURRENT GLIOBLASTOMA; T-CELL REACTIVITY AGAINST AUTOLOGOUS TUMOR CELLS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Glioblastoma is an aggressive brain tumor with a median survival of 14.6 months. We have no standard treatment for relapse and known options have limited effect. Novel treatments are necessary to improve survival and quality of life.
METHODS
We present our trial; phase II open label, two-armed translational study of Nivolumab and Bevacizumab for recurrent GBM, who have failed Stupp’s regimen. Patients are included in two arms depending on the possibility of salvage neurosurgical resection. Both arms receive Nivolumab and Bevacizumab administrated every second weekend, and the surgical arm also receive Nivolumab 7 days prior surgery. Forty-four patients were included by January 2021; 20 in each arm (four screen-failures). In the surgical arm, 20 fresh tumor samples as well as paired tissue from primary tumor were available. Tumor infiltrating lymphocytes (TILs) and tumor digest were produced in vitro from recurrent settings. Young TILs were expanded from fresh tumor fragments after minimal-culture, whereas rapidly expanded TILs (REP TILs) were obtained after massive expansion. By intracellular cytokine staining, we investigated the TIL reactivity after exposure to autologous tumor digest in order to evaluate whether the TILs were tumor-reactive, non-reactive or bystanders. RNA and whole exome sequencing were available before and after treatment.
RESULTS
Material from 19 patients was analyzed (one out of the 20 collected biopsies was limited in size, therefore no tumor digest could be produced). Four out of 19 TIL samples showed tumor reactivity after exposure to the autologous tumor digest. Tumor reactivity was ranged between 1,2 to 13,6 tox% in CD8+ TILs and between 2,8 to 10,9 tox% in CD4+ TILs. By flowcytometry we found, IgG4+ CD3+ TILS from tumor biopsies, meaning that Nivolumab were found in the brain. Currently controls are included to evaluate these results.
CONCLUSIONS
Updated results will be presented at SNO.
Collapse
Affiliation(s)
- Simone Maarup
- Rigshospitalet, DCCC-Brain Tumor Center, Copenhagen, Denmark
| | - Signe Skadborg
- DTU, Department of Health Technology, DK-2100 Copenhagen, USA
| | - Annie Borch
- Department of Health Technology, DK-2100 Copenhagen, Denmark
| | - Arianna Draghi
- Herlev Hospital, National Center for Cancer Immune Therapy, CCIT, DK-2100 Copenhagen, Denmark
| | | | - Olga Østrup
- Genomic department, DK-2100 Copenhagen, Denmark
| | - David Scheie
- Neuropathology Department, DK-2100 Copenhagen, Denmark
| | | | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, DK-2100 Copenhagen, Denmark
| | - Inge Marie Svane
- Herlev Hospital, National Center for Cancer Immune Therapy, CCIT, DK-2100 Copenhagen, Denmark
| | - Hans Poulsen
- Rigshospitalet, DCCC-Brain Tumor Center, Copenhagen, Denmark
| | - Sine Hadrup
- DTU, Health Technology, DK-2100 Copenhagen, Denmark
| | - Ulrik Lassen
- Rigshospitalet, Department of Oncology, Copenhagen, Denmark
| |
Collapse
|
9
|
Fougner V, Hasselbalch B, Urup T, Lassen U, Poulsen H. RTID-04. GLIOTARGET: A DANISH NATIONWIDE PHASE I/II PLATFORM TRIAL FOCUSING ON INDIVIDUALIZED TARGETED TREATMENT FOR NEWLY DIAGNOSED GLIOBLASTOMA PATIENTS BASED ON GENOMIC PROFILING. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION
The survival in glioblastoma has been unchanged since 2005. The introduction of targeted treatments, which have improved survival in several cancers has yet to influence the treatment of glioblastoma. In Gliotarget, we will individualize the targeted treatment, and give it in the primary setting alongside standard therapy with the intention to improve the likelihood of effect.
METHODS
Gliotarget is a biomarker enriched phase I/II platform trial with initially 4 predefined biomarker selected arms, one miscellaneous biomarker arm and one control arm. All patients receive standard therapy with concomitant radiochemotherapy and adjuvant Temozolomide. The experimental treatment is given alongside the adjuvant Temozolomide. Molecular analysis, including Whole Genome Sequencing, is performed on all patients, to identify actionable biomarkers. The miscellaneous arm gathers patients with not previously defined biomarkers upon which the weekly molecular tumor board decides to treat. Gliotarget includes newly diagnosed IDH-wt glioblastoma patients. In addition, to exclude the patients where the inherent poor prognosis might conceal the drug efficacy, the patients must have a 50% probability of being alive 12 months after initial surgery, according to a prognostic model developed in our institution.
The sample size is calculated with Simon’s two-stage design using treatment effect at 9-months progression free survival (PFS9). We anticipate 9 patients for stage one and 24 in total, for each arm. Treatment effect is defined as 65% of the patients in an experimental arm reaching PFS9. For the survival analysis, supplementing the control arm data with leveraged external controls taken from our prospectively registered database will decrease the probability of false positive results.
CONCLUSION
Gliotarget complements the field of ongoing platform trials with its distinctive trial design. The chosen biomarkers and treatments will be presented at the annual meeting. Enrollment is set to open in Q4 2021.
Collapse
Affiliation(s)
- Vincent Fougner
- DCCC-Brain Tumor Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Thomas Urup
- DCCC-Brain Tumor Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulrik Lassen
- Rigshospitalet, Department of Oncology, Copenhagen, Denmark
| | - Hans Poulsen
- Rigshospitalet, DCCC-Brain Tumor Center, Copenhagen, Denmark
| |
Collapse
|
10
|
Abedi AA, Grunnet K, Christensen IJ, Michaelsen SR, Muhic A, Møller S, Hasselbalch B, Poulsen HS, Urup T. A Prognostic Model for Glioblastoma Patients Treated With Standard Therapy Based on a Prospective Cohort of Consecutive Non-Selected Patients From a Single Institution. Front Oncol 2021; 11:597587. [PMID: 33718145 PMCID: PMC7946965 DOI: 10.3389/fonc.2021.597587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Glioblastoma patients administered standard therapies, comprising maximal surgical resection, radiation therapy with concomitant and adjuvant temozolomide, have a variable prognosis with a median overall survival of 15–16 months and a 2-year overall survival of 30%. The aim of this study was to develop a prognostic nomogram for overall survival for glioblastoma patients treated with standard therapy outside clinical trials. Methods The study included 680 consecutive, non-selected glioblastoma patients administered standard therapy as primary treatment between the years 2005 and 2016 at Rigshospitalet, Copenhagen, Denmark. The prognostic model was generated employing multivariate Cox regression analysis modeling overall survival. Results The following poor prognostic factors were included in the final prognostic model for overall survival: Age (10-year increase: HR = 1.18, 95% CI: 1.08–1.28, p < 0.001), ECOG performance status (PS) 1 vs. 0 (HR = 1.30, 95% CI: 1.07–1.57, p = 0.007), PS 2 vs. 0 (HR = 2.99, 95% CI: 1.99–4.50, p < 0.001), corticosteroid use (HR = 1.42, 95% CI: 1.18–1.70, p < 0.001), multifocal disease (HR = 1.63, 95% CI: 1.25–2.13, p < 0.001), biopsy vs. resection (HR = 1.35, 95% CI: 1.04–1.72, p = 0.02), un-methylated promoter of the MGMT (O6-methylguanine-DNA methyltransferase) gene (HR = 1.71, 95% CI: 1.42–2.04, p < 0.001). The model was validated internally and had a concordance index of 0.65. Conclusion A nomogram for overall survival was established. This model can be used for risk stratification and treatment planning, as well as improve enrollment criteria for clinical trials.
Collapse
Affiliation(s)
- Armita Armina Abedi
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Grunnet
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Signe Regner Michaelsen
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark.,Biotech, Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Aida Muhic
- Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Søren Møller
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Benedikte Hasselbalch
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Urup
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
11
|
Eibye S, Hasselbalch B, Marie Svane I, Reker Hadrup S, Rønn Olsen L, Skjoeth-Rasmussen J, Scheie D, Østrup O, Skovgaard Poulsen H, Lassen U. ATIM-01. NIVOLUMAB AND BEVACIZUMAB FOR RECURRENT GLIOBLASTOMA; A TRANSLATIONAL TRIAL IN PROGRESS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Glioblastoma multiforme (GBM) is an aggressive brain tumor with a poor prognosis. Standard of care at diagnosis is surgical resection, followed by radiation and temozolomide. Receiving this therapy, the median survival is 14.6 months [1]. We have no standard treatment for relapse and known options have limited effect. There is an urgent need for novel treatment interventions to improve clinical outcomes and quality of life. Recently, improved overall survival has been achieved with immune therapeutics in melanoma and renal cell carcinoma. Accordingly, it has been posited that immunotherapy may offer promise in other difficult cancers such as GBM [2]. We present our translational study; a phase II open label, two-armed translational study of Nivolumab and Bevacizumab for recurrent GBM, who have failed Stupp’s regime [1]. Patients are included in two arms depending on possibly salvage neurosurgical resection. Both arms receive Nivolumab and Bevacizumab administrated every second weekend, but the surgical arm also receive Nivolumab 7 days prior surgery. We expect 40 patients; 20 in each arm. Enrollment period is expected to 20 months, started October 2018. Our primary objective is to make preliminary assessment of immune related biomarkers, including PD-L1; therefore, we perform full genome sequencing on tumor biopsies from the surgical arm and on blood samples from both arms. We evaluate changes in the transcriptomic landscape caused by the check-point inhibition and relation to response as compared with baseline sequencing data, as well as the impact of tumor mutation burden and neoepitope load. We investigate the tumor microenvironment by harvesting tumor infiltrating lymphocytes and study the composition by flow-cytometry. The patients are evaluated by blood samples, FET-PET as wells as clinical examinations to evaluate PFS and OS. Overall the study will provide us with a unique possibility to investigate and thereof predict which patients will profit from the treatment.
Collapse
Affiliation(s)
- Simone Eibye
- Department of Radiation Biology and Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | - Inge Marie Svane
- National Center for Cancer Immune Therapy, CCIT, Herlev Hospital, Herlev, Denmark
| | | | | | - Jane Skjoeth-Rasmussen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Scheie
- Pathology Department, Rigshospitalet, Copenhagen, Denmark
| | - Olga Østrup
- Center of Genomic Medicine, Kennedy Center, Rigshospitalet, Glostrup, Denmark
| | - Hans Skovgaard Poulsen
- Department of Radiation Biology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrik Lassen
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
12
|
Lassen U, Sorensen M, Gaziel TB, Hasselbalch B, Poulsen HS. Phase II study of bevacizumab and temsirolimus combination therapy for recurrent glioblastoma multiforme. Anticancer Res 2013; 33:1657-1660. [PMID: 23564811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Bevacizumab combined with chemotherapy has recently shown promising efficacy in recurrent high-grade glioma. Phosphatase and tensin homolog (PTEN) mutation in glioblastoma multiforme (GBM) patients causes abnormally high activity of the pathways of Phosphatidylinositide 3-kinases (PI3K), Protein Kinase B (AKT), and the mammalian target of rapamycin (mTOR) and is associated with unfavorable prognosis. Temsirolimus, an mTOR inhibitor, has been well-tolerated in monotherapy, but with limited effects. The combination of temsirolimus and antibodies to vascular endothelial factor (VEGF) has not yet been investigated, but with the hypothesis that temsirolimus might provide complimentary therapeutic benefit in combination with bevacizumab, we included patients with progressive GBM after bevacizumab in an open phase II study. PATIENTS AND METHODS Adult patients with GBM recurrence after standard temozolomide chemoradiotherapy and bevacizumab-containing second-line therapy, received temsirolimus (25 mg i.v.) on days 1 and 8 and bevacizumab (10 mg/kg) on day 8, every two weeks. Assessments were performed every eight weeks. Blood samples for biomarkers were collected weekly for the first eight weeks and at progression. The primary end-point was median progression-free survival (PFS) and secondary end-points were radiographic response, overall survival (OS), and safety of the bevacizumab-temsirolimus combination. RESULTS Thirteen patients were included, whereof three went off-study during the first four weeks and were replaced. The trial was terminated at 13 patients, according to the planned two-stage design, because 0/10 patients obtained partial remission (PR). Two out of 10 patients obtained radiological stable disease (SD). The median PFS survival was eight weeks, and OS was 15 weeks. One patient had an serious adverse event (SAE) with a hypersensitive reaction to temsirolimus; overall, side-effects were mild, and the most common grade III side-effect was hypercholesterolaemia (4/10). Other grade III side-effects included hypertriglyceridaemia (1/10), thrombocytopenia (1/10), infection (1/10), hypertension (1/10), and hyperglycemia (1/10). CONCLUSION Temsirolimus can be safely administered in combination with bevacizumab. This study failed to detect activity of such a combination in patients with progressive GBM beyond bevacizumab therapy.
Collapse
Affiliation(s)
- Ulrik Lassen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
13
|
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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
14
|
Hasselbalch B, Lassen U, Poulsen HS, Stockhausen MT. Cetuximab insufficiently inhibits glioma cell growth due to persistent EGFR downstream signaling. Cancer Invest 2010; 28:775-87. [PMID: 20504227 DOI: 10.3109/07357907.2010.483506] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Overexpression and/or amplification of the epidermal growth factor receptor (EGFR) is present in 35-45% of primary glioblastoma multiforme tumors and has been correlated with a poor prognosis. In this study, we investigated the effect of cetuximab and intracellular signaling pathways downstream of EGFR, important for cell survival and proliferation. We show insufficient EGFR downregulation and competition with endogenous EGFR ligands upon cetuximab treatment. Dose-response experiments showed inhibition of EGFR phosphorylation without affecting two of the prominent downstream signaling pathways. Our results indicate that amplification and/or overexpression of EGFR is an unsatisfactory predictor for response to cetuximab.
Collapse
Affiliation(s)
- Benedikte Hasselbalch
- Department of Radiation Biology, The Finsen Center, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | |
Collapse
|
15
|
Barker CA, Chang M, Lassman AB, Beal K, Chan TA, Hunter K, Grisdale K, Ritterhouse M, Moustakas A, Iwamoto FM, Kreisl TN, Sul J, Kim L, Butman J, Albert P, Fine HA, Chamberlain MC, Alexandru D, Glantz MJ, Kim L, Chamberlain MC, Bota DA, Takahashi K, Ikeda N, Kajimoto Y, Miyatake S, Kuroiwa T, Iwamoto F, Lamborn K, Kuhn J, Wen P, Yung WKA, Gilbert M, Chang S, Lieberman F, Prados M, Fine H, Lu-Emerson C, Norden AD, Drappatz J, Quant EC, Ciampa AS, Doherty LM, LaFrankie DC, Wen PY, Sherman JH, Moldovan K, Yeoh HK, Starke BM, Pouratian N, Shaffrey ME, Schiff D, O'Connor PC, Kroon HA, Recht L, Montano N, Cenci T, Martini M, D'Alessandris QG, Banna GL, Maira G, De Maria R, Larocca LM, Pallini R, Kim CH, Yang MS, Cheong JH, Kim JM, Shonka N, Gilbert M, Alfred Yung WK, Piao Y, Liu J, Bekele N, Wen P, Chen A, Heymach J, de Groot J, Gilbert MR, Wang M, Aldape K, Sorensen AG, Mikkelsen T, Bokstein F, Woo SY, Chmura SJ, Choucair AK, Mehta M, Perez Segura P, Gil M, Balana C, Chacon I, Munoz J, Martin M, Flowers A, Salner A, Gaziel TB, Soerensen M, Hasselbalch B, Poulsen HS, Lassen U, Peyre M, Cartalat-Carel S, Meyronet D, Sunyach MP, Jouanneau E, Guyotat J, Jouvet A, Frappaz D, Honnorat J, Ducray F, Wagle N, Nghiemphu PL, Lai A, Cloughesy TF, Kairouz VF, Elias EF, Chahine GY, Comair YG, Dimassi H, Kamar FG, Parchman AJ, Nock CJ, Bartolomeo J, Norden AD, Drappatz J, Ciampa AS, Doherty LM, LaFrankie DC, Ruland S, Quant EC, Beroukhim R, Wen PY, Graber JJ, Lassman AB, Kaley T, Johnson DR, Kimmel DW, Burch PA, Cascino TL, Giannini C, Wu W, Buckner JC, Dirier A, Abacioglu U, Okkan S, Pak Y, Guney YY, Aksu G, Soyuer S, Oksuzoglu B, Meydan D, Zincircioglu B, Yumuk PF, Alco G, Keven E, Ucer AR, Tsung AJ, Prabhu SS, Shonka NA, Alistar AT, van den Bent M, Taal W, Sleijfer S, van Heuvel I, Smitt PAS, Bromberg JE, Vernhout I, Porter AB, Dueck AC, Karlin NJ, Hiramatsu R, Kawabata S, Miyatake SI, Kuroiwa T, Easson MW, Vicente MGH, Sahebjam S, Garoufalis E, Guiot MC, Muanza T, Del Maestro R, Kavan P, Smolin AV, Konev A, Nikolaeva S, Shamanskaya Y, Malysheva A, Strelnikov V, Vranic A, Prestor B, Pizem J, Popovic M, Khatua S, Finlay J, Nelson M, Gonzalez I, Bruggers C, Dhall G, Fu BD, Linskey M, Bota D, Walbert T, Puduvalli V, Ozawa T, Brennan CW, Wang L, Squatrito M, Sasayama T, Nakada M, Huse JT, Pedraza A, Utsuki S, Tandon A, Fomchenko EI, Oka H, Levine RL, Fujii K, Ladanyi M, Holland EC, Raizer J, Avram MJ, Kaklamani V, Cianfrocca M, Gradishar W, Helenowski I, McCarthy K, Mulcahy M, Rademaker A, Grimm S, Landolfi JC, Chen S, Peeraully T, Anthony P, Linendoll NM, Zhu JJ, Yao K, Mignano J, Pfannl R, Pan E, Vera-Bolanos E, Armstrong TS, Bekele BN, Gilbert MR, Alexandru D, Glantz MJ, Kim L, Chamberlain MC, Bota DA, Albrecht V, Juerchott K, Selbig J, Tonn JC, Schichor C, Sawale KB, Wolff J, Vats T, Ketonen L, Khasraw M, Kaley T, Panageas K, Reiner A, Goldlust S, Tabar V, Green RM, Woyshner EA, Cloughesy TF, Abe T, Morishige M, Shiqi K, Momii Y, Sugita K, Fukuyoshi Y, Kamida T, Fujiki M, Kobayashi H, Lavon I, Refael M, Zrihan D, Siegal T, Elias EF, Kairouz VF, Chahine GY, Comair YG, Dimassi H, Kamar FG, Tham CK, See SJ, Toh CK, Kang SH, Park KJ, Kim CY, Yu MO, Park CK, Park SH, Chung YG, Park KJ, Yu MO, Kang SH, Cho TH, Chung YG, Sasaki H, Sano K, Nariai T, Uchino Y, Kitamura Y, Ohira T, Yoshida K, Kirson ED, Wasserman Y, Izhaki A, Mordechovich D, Gurvich Z, Dbaly V, Vymazal J, Tovarys F, Salzberg M, Rochlitz C, Goldsher D, Palti Y, Ram Z, Gutin PH, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Torcuator RG, Ibaoc K, Rafael A, Mariano M, Reardon DA, Peters K, Desjardins A, Sampson J, Vredenburgh JJ, Gururangan S, Friedman HS, Le Rhun E, Kotecki N, Zairi F, Baranzelli MC, Faivre-Pierret M, Dubois F, Bonneterre J, Arenson EB, Arenson JD, Arenson PK, Pierick M, Jensen W, Smith DB, Wong ET, Gautam S, Malchow C, Lun M, Pan E, Brem S, Raizer J, Grimm S, Chandler J, Muro K, Rice L, McCarthy K, Mrugala M, Johnston SK, Chamberlain M, Marosi C, Handisurya A, Kautzky-Willer A, Preusser M, Elandt K, Widhalm G, Dieckmann K, Torcuator RG, Opinaldo P, Chua E, Barredo C, Cuanang J, Grimm S, Phuphanich S, Recht LD, Rosenfeld SS, Chamberlain MC, Zhu JJ, Fadul CE, Swabb EA, Pope C, Beelen AP, Raizer JJ, Kim IH, Park CK, Han JH, Lee SH, Kim CY, Kim TM, Kim DW, Kim JE, Paek SH, Kim IA, Kim YJ, Kim JH, Nam DH, Rhee CH, Lee SH, Park BJ, Kim DG, Heo DS, Jung HW, Desjardins A, Peters KB, Vredenburgh JJ, Friedman HS, Reardon DA, Becker K, Baehring J, Hammond SN, Norden AD, Fisher DC, Wong ET, Cote GM, Ciampa AS, Doherty LM, Ruland SF, LaFrankie DC, Wen PY, Drappatz J, Brandes AA, Franceschi E, Tosoni A, Poggi R, Agati R, Bartolini S, Spagnolli F, Pozzati E, Marucci G, Ermani M, Taillibert S, Guillevin R, Dehais C, Bellanger A, Delattre JY, Omuro A, Taillibert S, Hoang-Xuan K, Barrie M, Guiu S, Chauffert B, Cartalat-Carel S, Taillandier L, Fabbro M, Laigre M, Guillamo JS, Geffrelot J, Rouge TDLM, Bonnetain F, Chinot O, Gil MJ, de las Penas R, Reynes G, Balana C, Perez-Segura P, Garcia-Velasco A, Gallego O, Herrero A, de Lucas CFC, Benavides M, Perez-Martin X, Mesia C, Martinez-Garcia M, Muggeri AD, Cervio A, Rojas M, Arakaki N, Sevlever GE, Diez BD, Muggeri AD, Cerrato S, Martinetto H, Diez BD, Peereboom DM, Brewer CJ, Suh JH, Chao ST, Parsons MW, Elson PJ, Vogelbaum MA, Sade B, Barnett GH, Shonka NA, Yung WKA, Bekele N, Gilbert MR, Kobyakov G, Absalyamova O, Amanov R, Rauschkolb PK, Drappatz J, Batchelor TT, Meyer LP, Fadul CE, Lallana EC, Nghiemphu PL, Kohanteb P, Lai A, Green RM, Cloughesy TF, Mrugala MM, Lee LK, Graham CA, Fink JR, Spence AM, Portnow J, Badie B, Liu X, Frankel P, Chen M, Synold TW, Al Jishi AA, Golan J, Polley MYC, Lamborn KR, Chang SM, Butowski N, Clarke JL, Prados M, Grommes C, Oxnard GR, Kris MG, Miller VA, Pao W, Lassman AB, Renfrow J, DeTroye A, Chan M, Tatter S, Ellis T, McMullen K, Johnson A, Mott R, Lesser GJ, Cavaliere R, Abrey LE, Mason WP, Lassman AB, Perentesis J, Ivy P, Villalona M, Nayak L, Fleisher M, Gonzalez-Espinoza R, Reiner A, Panageas K, Lin O, Liu CM, Deangelis LM, Omuro A, Taylor LP, Ammirati M, Lamki T, Zarzour H, Grecula J, Dudley RW, Kavan P, Garoufalis E, Guiot MC, Del Maestro RF, Maurice C, Belanger K, Moumdjian R, Dufresne S, Fortin C, Fortin MA, Berthelet F, Renoult E, Belair M, Rouleau D, Gallego O, Benavides M, Segura PP, Balana C, Gil MJG, Berrocal A, Reynes G, Garcia JL, Mazarico J, Bague S. Medical and Neuro-Oncology. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Hasselbalch B, Eriksen JG, Broholm H, Christensen IJ, Grunnet K, Horsman MR, Poulsen HS, Stockhausen MT, Lassen U. Prospective evaluation of angiogenic, hypoxic and EGFR-related biomarkers in recurrent glioblastoma multiforme treated with cetuximab, bevacizumab and irinotecan. APMIS 2010; 118:585-94. [PMID: 20666740 DOI: 10.1111/j.1600-0463.2010.02631.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Several recent studies have demonstrated a beneficial effect of anti-angiogenic treatment with the vascular endothelial growth factor-neutralizing antibody bevacizumab in recurrent high-grade glioma. In the current study, immunohistochemical evaluation of biomarkers involved in angiogenesis, hypoxia and mediators of the epidermal growth factor receptor (EGFR) pathway were investigated. Tumor tissue was obtained from a previous phase II study, treating recurrent primary glioblastoma multiforme (GBM) patients with the EGFR inhibitor cetuximab in combination with bevacizumab and irinotecan. Of the 37 patients with available tumor tissue, 29 were evaluable for response. We concurrently performed immunohistochemical stainings on tumor tissue from 21 GBM patients treated with bevacizumab and irinotecan. We found a tendency of correlation between the hypoxia-related markers, indicating that they share the same regulatory mechanisms. None of the EGFR-related biomarkers showed any significant correlations with each other. None of the biomarkers tested alone or in combination could identify a patient population likely to benefit from bevacizumab and irinotecan, with or without the addition of cetuximab. There is still an urgent need for one or more reliable and reproducible biomarkers able to predict the efficacy of anti-angiogenic therapy.
Collapse
Affiliation(s)
- Benedikte Hasselbalch
- Departments of Radiation Biology, The Finsen Center, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Hasselbalch B, Lassen U, Hansen S, Holmberg M, Sørensen M, Kosteljanetz M, Broholm H, Stockhausen MT, Poulsen HS. Cetuximab, bevacizumab, and irinotecan for patients with primary glioblastoma and progression after radiation therapy and temozolomide: a phase II trial. Neuro Oncol 2010; 12:508-16. [PMID: 20406901 PMCID: PMC2940618 DOI: 10.1093/neuonc/nop063] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 09/07/2009] [Indexed: 12/29/2022] Open
Abstract
The aim of this clinical trial was to investigate safety and efficacy when combining cetuximab with bevacizumab and irinotecan in patients with recurrent primary glioblastoma multiforme (GBM). Patients were included with recurrent primary GBM and progression within 6 months of ending standard treatment (radiotherapy and temozolomide). Bevacizumab and irinotecan were administered IV every 2 weeks. The first 10 patients received bevacizumab 5 mg/kg, but this was increased to 10 mg/kg after interim safety analysis. Irinotecan dose was based on whether patients were taking enzyme-inducing antiepileptic drugs or not: 340 and 125 mg/m(2), respectively. Cetuximab 400 mg/m(2) as loading dose followed by 250 mg/m(2) weekly was administered IV. Forty-three patients were enrolled in the trial, of which 32 were available for response. Radiographic responses were noted in 34%, of which 2 patients had complete responses and 9 patients had partial responses. The 6-month progression-free survival probability was 30% and median overall survival was 29 weeks (95% CI: 23-37 weeks). One patient had lacunar infarction, 1 patient had multiple pulmonary embolisms, and 3 patients had grade 3 skin toxicity, for which 1 patient needed plastic surgery. One patient was excluded due to suspicion of interstitial lung disease. Three patients had deep-vein thrombosis; all continued on study after adequate treatment. Cetuximab in combination with bevacizumab and irinotecan in recurrent GBM is well tolerated except for skin toxicity, with an encouraging response rate. However, the efficacy data do not seem to be superior compared with results with bevacizumab and irinotecan alone.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Hans Skovgaard Poulsen
- Departments of Radiation Biology (B.H., M.-T.S., H.S.P.) and Oncology (B.H., M.S., H.S.P.), The Finsen Center, Copenhagen University Hospital, Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark (U.L.); Department of Oncology, Odense University Hospital, Odense, Denmark (S.H.); Department of Oncology, Aalborg Sygehus, Aarhus University Hospital, Aalborg, Denmark (M.H.); Departments of Neurosurgery (M.K.) and Neuropathology (H.B.), Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
18
|
Poulsen HS, Grunnet K, Sorensen M, Olsen P, Hasselbalch B, Nelausen K, Kosteljanetz M, Lassen U. Bevacizumab plus irinotecan in the treatment patients with progressive recurrent malignant brain tumours. Acta Oncol 2009; 48:52-8. [PMID: 19031176 DOI: 10.1080/02841860802537924] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
MATERIAL AND METHODS We retrospectively determined the efficacy and safety of a combination of bevacizumab and irinotecan in a consecutive series of 52 heavily pre-treated patients with recurrent high-grade brain tumours. Patients received bevacizumab (10 mg/kg) and irinotecan [340 mg/m(2) for those receiving enzyme-inducing antiepileptic drugs (EIAEDs) and 125 mg/m(2) for those not receiving EIAEDs] every 2 weeks. Fifty-two patients were included and 47 were evaluable for response. RESULTS Complete or partial response was observed in 25% of all cases (30% response in grade IV glioma and 15% in grade III glioma). Estimated median progression-free survival (PFS) for both grade IV and grade III glioma was 22 weeks. The 6-month PFS was 32% for all patients, 40% for grade IV glioma and 33% for grade III glioma. Estimated median overall survival was 30 weeks for all patients, 28 weeks for grade IV glioma and 32 weeks for grade III glioma. Four patients discontinued treatment because of unmanageable toxicity: cerebral haemorrhage, cardiac arrhythmia, intestinal perforation and diarrhoea, the latter resulting in death. DISCUSSION We conclude that the combination of bevacizumab and irinotecan shows acceptable safety and is a clinically relevant choice of therapy in heavily pre-treated patients with recurrent high-grade brain tumours.
Collapse
|
19
|
Lassen U, Hasselbalch B, Sørensen M, Holmberg M, Hansen S, Kosteljanetz M, Laursen H, Poulsen HS. A phase II trial with cetuximab, bevacizumab, and irinotecan for patients with primary glioblastomas and progression after radiation therapy and temozolamide. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.2056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Hasselbalch B, Stockhausen M, Lassen U, Poulsen HS. 35 In vitro effect of cetuximab on EGFR and downstream mediators. With a focus on gliomas. APMIS 2008. [DOI: 10.1111/j.1600-0463.2008.00abs1165_44.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Hasselbalch B, Stockhausen M, Lassen U, Poulsen HS. 35
In vitroeffect of cetuximab on EGFR and downstream mediators. With a focus on gliomas. APMIS 2008. [DOI: 10.1111/j.1600-0463.2008.001165_44.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Lassen U, Grunnet K, Kosteljanetz M, Hasselbalch B, Laursen H, Poulsen HS. Bevacizumab, a monoclonal antibody to the vascular endothelial growth factor (VEGF), and irinotecan for treatment of recurrent primary malignant brain tumors in adults. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12503 Background: The prognosis of recurrent malignant brain tumors is poor, and no efficacious therapy exists in patients previously treated with radiotherapy and standard chemotherapy. Bevacizumab (B) binds to VEGF and inhibits tumor angiogenesis, and treatment with this drug might induce tumor regression and prolongation of life. Irinotecan (I) is a topoisomerase 1 inhibitor with modest effect on recurrent primary brain tumors. The combination of B and I in recurrent malignant gliomas was presented at ASCO 2006 and showed very encouraging responses. Methods: We report confirmatory results of the combination of B and I in a consecutive series of patients with primary malignant brain tumors recurring after standard primary and secondary treatment (surgery, radiotherapy and standard or secondline chemotherapy).With standard inclusion criteria, including PS 0–2, patients received B as 10mg/kg, and I 125 mg/m2 in patients not treated with enzyme inducing antiepileptic drugs (EIAED) or 340 mg/m2 in patients treated with EIAED every other week until progression or non-manageable toxicity. Response evaluation was performed by MacDonald criteria and MRI scans. Results: The results of 31 patients is presented, 15 with grade IV tumors (Glioblastoma multiforme), 7 with grade III anaplastic astrocytomas, 5 with anaplastic oligodendrogliomas, 1 with anaplastic ependymoma, 1 with hemangiopericytoma, 1 with prolactinoma, and 1 with medulloblastoma. Four patients had complete response, 3 grade IV tumors and 1 anaplastic oligodendroglioma. One patient had partial response (> 50% tumor reduction), 12 had stable disease (3 had tumor reduction between 31 - 45 %). 14 progressed. No grade 4 toxicity was observed and most patients experienced grade 1–2 toxicity. Two tromboembolic events and 1 intestinal perforation were observed. Conclusion: The combination of B and I is safe, induces tumor regression in a substantial number of patients, and can be used as treatment to patients recurring after standard treatment. No significant financial relationships to disclose.
Collapse
|
23
|
Bæksgaard L, Henriksen A, Hasselbalch B, Dandanell J, Perell K, Sørensen J. 2 Quality of life assessment in the elderly population (above 70 years of age) with locally advanced or metastatic non-small cell lung cancer (NSCLC) treated with a platinum-based combination-chemotherapy regimen. Crit Rev Oncol Hematol 2006. [DOI: 10.1016/s1040-8428(13)70073-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|