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Nabian N, Ghalehtaki R, Zeinalizadeh M, Balaña C, Jablonska PA. State of the neoadjuvant therapy for glioblastoma multiforme-Where do we stand? Neurooncol Adv 2024; 6:vdae028. [PMID: 38560349 PMCID: PMC10981465 DOI: 10.1093/noajnl/vdae028] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. Despite several investigations in this field, maximal safe resection followed by chemoradiotherapy and adjuvant temozolomide with or without tumor-treating fields remains the standard of care with poor survival outcomes. Many endeavors have failed to make a dramatic change in the outcomes of GBM patients. This study aimed to review the available strategies for newly diagnosed GBM in the neoadjuvant setting, which have been mainly neglected in contrast to other solid tumors.
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Affiliation(s)
- Naeim Nabian
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghalehtaki
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Zeinalizadeh
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Carmen Balaña
- B.ARGO (Badalona Applied Research Group of Oncology) Medical Oncology Department, Catalan Institute of Oncology Badalona, Badalona, Spain
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Álvarez-Torres MDM, Balaña C, Fuster-García E, Puig J, García-Gómez JM. Unlocking Bevacizumab's Potential: rCBV max as a Predictive Biomarker for Enhanced Survival in Glioblastoma IDH-Wildtype Patients. Cancers (Basel) 2023; 16:161. [PMID: 38201588 PMCID: PMC10778147 DOI: 10.3390/cancers16010161] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Aberrant vascular architecture and angiogenesis are hallmarks of glioblastoma IDH-wildtype, suggesting that these tumors are suitable for antiangiogenic therapy. Bevacizumab was FDA-approved in 2009 following promising results in two clinical trials. However, its use for recurrent glioblastomas remains a subject of debate, as it does not universally improve patient survival. PURPOSES In this study, we aimed to analyze the influence of tumor vascularity on the benefit provided by BVZ and propose preoperative rCBVmax at the high angiogenic tumor habitat as a predictive biomarker to select patients who can benefit the most. METHODS Clinical and MRI data from 106 patients with glioblastoma IDH-wildtype have been analyzed. Thirty-nine of them received BVZ, and the remaining sixty-seven did not receive a second-line treatment. The ONCOhabitats method was used to automatically calculate rCBV. RESULTS We found a median survival from progression of 305 days longer for patients with moderate vascular tumors who received BVZ than those who did not receive any second-line treatment. This contrasts with patients with high-vascular tumors who only presented a median survival of 173 days longer when receiving BVZ. Furthermore, better responses to BVZ were found for the moderate-vascular group with a higher proportion of patients alive at 6, 12, 18, and 24 months after progression. CONCLUSIONS We propose rCBVmax as a potential biomarker to select patients who can benefit more from BVZ after tumor progression. In addition, we propose a threshold of 7.5 to stratify patients into moderate- and high-vascular groups to select the optimal second-line treatment.
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Affiliation(s)
- María del Mar Álvarez-Torres
- Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de Valencia, 46022 Valencia, Spain; (E.F.-G.); (J.M.G.-G.)
| | - Carmen Balaña
- Applied Research Group in Oncology (B-ARGO Group), Institut Catala d’Oncologia (ICO), Institut Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain;
| | - Elies Fuster-García
- Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de Valencia, 46022 Valencia, Spain; (E.F.-G.); (J.M.G.-G.)
| | - Josep Puig
- Radiology Department CDI, Hospital Clinic of Barcelona, 08036 Barcelona, Spain;
| | - Juan Miguel García-Gómez
- Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de Valencia, 46022 Valencia, Spain; (E.F.-G.); (J.M.G.-G.)
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3
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Pati S, Baid U, Edwards B, Sheller M, Wang SH, Reina GA, Foley P, Gruzdev A, Karkada D, Davatzikos C, Sako C, Ghodasara S, Bilello M, Mohan S, Vollmuth P, Brugnara G, Preetha CJ, Sahm F, Maier-Hein K, Zenk M, Bendszus M, Wick W, Calabrese E, Rudie J, Villanueva-Meyer J, Cha S, Ingalhalikar M, Jadhav M, Pandey U, Saini J, Garrett J, Larson M, Jeraj R, Currie S, Frood R, Fatania K, Huang RY, Chang K, Balaña C, Capellades J, Puig J, Trenkler J, Pichler J, Necker G, Haunschmidt A, Meckel S, Shukla G, Liem S, Alexander GS, Lombardo J, Palmer JD, Flanders AE, Dicker AP, Sair HI, Jones CK, Venkataraman A, Jiang M, So TY, Chen C, Heng PA, Dou Q, Kozubek M, Lux F, Michálek J, Matula P, Keřkovský M, Kopřivová T, Dostál M, Vybíhal V, Vogelbaum MA, Mitchell JR, Farinhas J, Maldjian JA, Yogananda CGB, Pinho MC, Reddy D, Holcomb J, Wagner BC, Ellingson BM, Cloughesy TF, Raymond C, Oughourlian T, Hagiwara A, Wang C, To MS, Bhardwaj S, Chong C, Agzarian M, Falcão AX, Martins SB, Teixeira BCA, Sprenger F, Menotti D, Lucio DR, LaMontagne P, Marcus D, Wiestler B, Kofler F, Ezhov I, Metz M, Jain R, Lee M, Lui YW, McKinley R, Slotboom J, Radojewski P, Meier R, Wiest R, Murcia D, Fu E, Haas R, Thompson J, Ormond DR, Badve C, Sloan AE, Vadmal V, Waite K, Colen RR, Pei L, Ak M, Srinivasan A, Bapuraj JR, Rao A, Wang N, Yoshiaki O, Moritani T, Turk S, Lee J, Prabhudesai S, Morón F, Mandel J, Kamnitsas K, Glocker B, Dixon LVM, Williams M, Zampakis P, Panagiotopoulos V, Tsiganos P, Alexiou S, Haliassos I, Zacharaki EI, Moustakas K, Kalogeropoulou C, Kardamakis DM, Choi YS, Lee SK, Chang JH, Ahn SS, Luo B, Poisson L, Wen N, Tiwari P, Verma R, Bareja R, Yadav I, Chen J, Kumar N, Smits M, van der Voort SR, Alafandi A, Incekara F, Wijnenga MMJ, Kapsas G, Gahrmann R, Schouten JW, Dubbink HJ, Vincent AJPE, van den Bent MJ, French PJ, Klein S, Yuan Y, Sharma S, Tseng TC, Adabi S, Niclou SP, Keunen O, Hau AC, Vallières M, Fortin D, Lepage M, Landman B, Ramadass K, Xu K, Chotai S, Chambless LB, Mistry A, Thompson RC, Gusev Y, Bhuvaneshwar K, Sayah A, Bencheqroun C, Belouali A, Madhavan S, Booth TC, Chelliah A, Modat M, Shuaib H, Dragos C, Abayazeed A, Kolodziej K, Hill M, Abbassy A, Gamal S, Mekhaimar M, Qayati M, Reyes M, Park JE, Yun J, Kim HS, Mahajan A, Muzi M, Benson S, Beets-Tan RGH, Teuwen J, Herrera-Trujillo A, Trujillo M, Escobar W, Abello A, Bernal J, Gómez J, Choi J, Baek S, Kim Y, Ismael H, Allen B, Buatti JM, Kotrotsou A, Li H, Weiss T, Weller M, Bink A, Pouymayou B, Shaykh HF, Saltz J, Prasanna P, Shrestha S, Mani KM, Payne D, Kurc T, Pelaez E, Franco-Maldonado H, Loayza F, Quevedo S, Guevara P, Torche E, Mendoza C, Vera F, Ríos E, López E, Velastin SA, Ogbole G, Soneye M, Oyekunle D, Odafe-Oyibotha O, Osobu B, Shu'aibu M, Dorcas A, Dako F, Simpson AL, Hamghalam M, Peoples JJ, Hu R, Tran A, Cutler D, Moraes FY, Boss MA, Gimpel J, Veettil DK, Schmidt K, Bialecki B, Marella S, Price C, Cimino L, Apgar C, Shah P, Menze B, Barnholtz-Sloan JS, Martin J, Bakas S. Author Correction: Federated learning enables big data for rare cancer boundary detection. Nat Commun 2023; 14:436. [PMID: 36702828 PMCID: PMC9879935 DOI: 10.1038/s41467-023-36188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sarthak Pati
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
| | - Ujjwal Baid
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chiharu Sako
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Satyam Ghodasara
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michel Bilello
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Zenk
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey Rudie
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Javier Villanueva-Meyer
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Soonmee Cha
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Manali Jadhav
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Umang Pandey
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - John Garrett
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Matthew Larson
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert Jeraj
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Stuart Currie
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Russell Frood
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Kavi Fatania
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | | | | | - Josep Puig
- Department of Radiology (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - Johannes Trenkler
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Josef Pichler
- Department of Neurooncology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Georg Necker
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Andreas Haunschmidt
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Stephan Meckel
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
- Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Gaurav Shukla
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, Christiana Care Health System, Philadelphia, PA, USA
| | - Spencer Liem
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory S Alexander
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Joseph Lombardo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Adam E Flanders
- Department of Radiology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Craig K Jones
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Meirui Jiang
- The Chinese University of Hong Kong, Hong Kong, China
| | - Tiffany Y So
- The Chinese University of Hong Kong, Hong Kong, China
| | - Cheng Chen
- The Chinese University of Hong Kong, Hong Kong, China
| | | | - Qi Dou
- The Chinese University of Hong Kong, Hong Kong, China
| | - Michal Kozubek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Filip Lux
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Jan Michálek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Petr Matula
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Tereza Kopřivová
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Václav Vybíhal
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, and University Hospital and Czech Republic, Brno, Czech Republic
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Ross Mitchell
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Joaquim Farinhas
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Marco C Pinho
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Divya Reddy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Holcomb
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Talia Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sargam Bhardwaj
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Chee Chong
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marc Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Bernardo C A Teixeira
- Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Flávia Sprenger
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - David Menotti
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Diego R Lucio
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Pamela LaMontagne
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel Marcus
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
| | - Florian Kofler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Marie Metz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Yvonne W Lui
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Richard McKinley
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Slotboom
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Derrick Murcia
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Eric Fu
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Rourke Haas
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - John Thompson
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - David Ryan Ormond
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Chaitra Badve
- Department of Radiology, University Hospitals Cleveland, Cleveland, OH, USA
| | - Andrew E Sloan
- Department of Neurological Surgery, University Hospitals-Seidman Cancer Center, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vachan Vadmal
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristin Waite
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Rivka R Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linmin Pei
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Murat Ak
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashok Srinivasan
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - J Rajiv Bapuraj
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Wang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Ota Yoshiaki
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Toshio Moritani
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Sevcan Turk
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Joonsang Lee
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Snehal Prabhudesai
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Konstantinos Kamnitsas
- Department of Computing, Imperial College London, London, UK
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Luke V M Dixon
- Department of Radiology, Imperial College NHS Healthcare Trust, London, UK
| | - Matthew Williams
- Computational Oncology Group, Institute for Global Health Innovation, Imperial College London, London, UK
| | - Peter Zampakis
- Department of NeuroRadiology, University of Patras, Patras, Greece
| | | | - Panagiotis Tsiganos
- Clinical Radiology Laboratory, Department of Medicine, University of Patras, Patras, Greece
| | - Sotiris Alexiou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Ilias Haliassos
- Department of Neuro-Oncology, University of Patras, Patras, Greece
| | - Evangelia I Zacharaki
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Sung Soo Ahn
- Yonsei University College of Medicine, Seoul, Korea
| | - Bing Luo
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Laila Poisson
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
- SJTU-Ruijin-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | | | - Ruchika Verma
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
- Case Western Reserve University, Cleveland, OH, USA
| | - Rohan Bareja
- Case Western Reserve University, Cleveland, OH, USA
| | - Ipsa Yadav
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Neeraj Kumar
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Ahmed Alafandi
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Fatih Incekara
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Maarten M J Wijnenga
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Georgios Kapsas
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Renske Gahrmann
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Joost W Schouten
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pim J French
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tzu-Chi Tseng
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saba Adabi
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simone P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Olivier Keunen
- Translation Radiomics, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Ann-Christin Hau
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
- Luxembourg Center of Neuropathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Martin Vallières
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - David Fortin
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Neurosurgery and Neuro-Oncology, Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martin Lepage
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Nuclear Medicine and Radiobiology, Sherbrooke Molecular Imaging Centre, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Bennett Landman
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Akshitkumar Mistry
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuriy Gusev
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Krithika Bhuvaneshwar
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anousheh Sayah
- Division of Neuroradiology & Neurointerventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Camelia Bencheqroun
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anas Belouali
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Subha Madhavan
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, Ruskin Wing, King's College Hospital NHS Foundation Trust, London, UK
| | - Alysha Chelliah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Haris Shuaib
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Carmen Dragos
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
| | | | | | | | | | - Shady Gamal
- University of Cairo School of Medicine, Giza, Egypt
| | | | | | | | - Ji Eun Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Jihye Yun
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust Pembroke Place, Liverpool, UK
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sean Benson
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht, Netherlands
| | - Jonas Teuwen
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - William Escobar
- Clínica Imbanaco Grupo Quirón Salud, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | | | - Jose Bernal
- Universidad del Valle, Cali, Colombia
- The University of Edinburgh, Edinburgh, UK
| | | | - Joseph Choi
- Department of Industrial and Systems Engineering, University of Iowa, Iowa, USA
| | - Stephen Baek
- Department of Industrial and Systems Engineering, Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Yusung Kim
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Heba Ismael
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Bryan Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | | | - Hongwei Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andrea Bink
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Prateek Prasanna
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Sampurna Shrestha
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Kartik M Mani
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA
| | - David Payne
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Tahsin Kurc
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Scientific Data Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Enrique Pelaez
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | - Francis Loayza
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | | | | | | | - Franco Vera
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Elvis Ríos
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Eduardo López
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Sergio A Velastin
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Godwin Ogbole
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mayowa Soneye
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Dotun Oyekunle
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | | | - Babatunde Osobu
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mustapha Shu'aibu
- Department of Radiology, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Adeleye Dorcas
- Department of Radiology, Obafemi Awolowo University Ile-Ife, Ile-Ife, Osun, Nigeria
| | - Farouk Dako
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Simpson
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Mohammad Hamghalam
- School of Computing, Queen's University, Kingston, ON, Canada
- Department of Electrical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Jacob J Peoples
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Ricky Hu
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Anh Tran
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Danielle Cutler
- The Faculty of Arts & Sciences, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Michael A Boss
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - James Gimpel
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Deepak Kattil Veettil
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Kendall Schmidt
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Brian Bialecki
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Sailaja Marella
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Cynthia Price
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Lisa Cimino
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | | | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Jill S Barnholtz-Sloan
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), National Institute of Health, Bethesda, MD, USA
| | | | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Pineda E, Domenech M, Hernández A, Comas S, Balaña C. Recurrent Glioblastoma: Ongoing Clinical Challenges and Future Prospects. Onco Targets Ther 2023; 16:71-86. [PMID: 36721854 PMCID: PMC9884437 DOI: 10.2147/ott.s366371] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/27/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Virtually all glioblastomas treated in the first-line setting will recur in a short period of time, and the search for alternative effective treatments has so far been unsuccessful. Various obstacles remain unresolved, and no effective salvage therapy for recurrent glioblastoma can be envisaged in the short term. One of the main impediments to progress is the low incidence of the disease itself in comparison with other pathologies, which will be made even lower by the recent WHO classification of gliomas, which includes molecular alterations. This new classification helps refine patient prognosis but does not clarify the most appropriate treatment. Other impediments are related to clinical trials: glioblastoma patients are often excluded from trials due to their advanced age and limiting neurological symptoms; there is also the question of how best to measure treatment efficacy, which conditions the design of trials and can affect the acceptance of results by oncologists and medicine agencies. Other obstacles are related to the drugs themselves: most treatments cannot cross the blood-brain-barrier or the brain-to-tumor barrier to reach therapeutic drug levels in the tumor without producing toxicity; the drugs under study may have adverse metabolic interactions with those required for symptom control; identifying the target of the drug can be a complex issue. Additionally, the optimal method of treatment - local vs systemic therapy, the choice of chemotherapy, irradiation, targeted therapy, immunotherapy, or a combination thereof - is not yet clear in glioblastoma in comparison with other cancers. Finally, in addition to curing or stabilizing the disease, glioblastoma therapy should aim at maintaining the neurological status of the patients to enable them to return to their previous lifestyle. Here we review currently available treatments, obstacles in the search for new treatments, and novel lines of research that show promise for the future.
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Affiliation(s)
- Estela Pineda
- Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Domenech
- Medical Oncology, Institut Catala d’Oncologia (ICO) Badalona, Barcelona, Spain
| | - Ainhoa Hernández
- Medical Oncology, Institut Catala d’Oncologia (ICO) Badalona, Barcelona, Spain
| | - Silvia Comas
- Radiation Oncology, Institut Catala d’Oncologia (ICO) Badalona, Badalona, Spain
| | - Carmen Balaña
- Medical Oncology, Institut Catala d’Oncologia (ICO) Badalona, Barcelona, Spain,Correspondence: Carmen Balaña, Institut Catala d’Oncologia (ICO) Badalona, Carretera Canyet s/n, Badalona, 08916, Spain, Tel +34 497 89 25, Fax +34 497 89 50, Email
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5
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Pati S, Baid U, Edwards B, Sheller M, Wang SH, Reina GA, Foley P, Gruzdev A, Karkada D, Davatzikos C, Sako C, Ghodasara S, Bilello M, Mohan S, Vollmuth P, Brugnara G, Preetha CJ, Sahm F, Maier-Hein K, Zenk M, Bendszus M, Wick W, Calabrese E, Rudie J, Villanueva-Meyer J, Cha S, Ingalhalikar M, Jadhav M, Pandey U, Saini J, Garrett J, Larson M, Jeraj R, Currie S, Frood R, Fatania K, Huang RY, Chang K, Balaña C, Capellades J, Puig J, Trenkler J, Pichler J, Necker G, Haunschmidt A, Meckel S, Shukla G, Liem S, Alexander GS, Lombardo J, Palmer JD, Flanders AE, Dicker AP, Sair HI, Jones CK, Venkataraman A, Jiang M, So TY, Chen C, Heng PA, Dou Q, Kozubek M, Lux F, Michálek J, Matula P, Keřkovský M, Kopřivová T, Dostál M, Vybíhal V, Vogelbaum MA, Mitchell JR, Farinhas J, Maldjian JA, Yogananda CGB, Pinho MC, Reddy D, Holcomb J, Wagner BC, Ellingson BM, Cloughesy TF, Raymond C, Oughourlian T, Hagiwara A, Wang C, To MS, Bhardwaj S, Chong C, Agzarian M, Falcão AX, Martins SB, Teixeira BCA, Sprenger F, Menotti D, Lucio DR, LaMontagne P, Marcus D, Wiestler B, Kofler F, Ezhov I, Metz M, Jain R, Lee M, Lui YW, McKinley R, Slotboom J, Radojewski P, Meier R, Wiest R, Murcia D, Fu E, Haas R, Thompson J, Ormond DR, Badve C, Sloan AE, Vadmal V, Waite K, Colen RR, Pei L, Ak M, Srinivasan A, Bapuraj JR, Rao A, Wang N, Yoshiaki O, Moritani T, Turk S, Lee J, Prabhudesai S, Morón F, Mandel J, Kamnitsas K, Glocker B, Dixon LVM, Williams M, Zampakis P, Panagiotopoulos V, Tsiganos P, Alexiou S, Haliassos I, Zacharaki EI, Moustakas K, Kalogeropoulou C, Kardamakis DM, Choi YS, Lee SK, Chang JH, Ahn SS, Luo B, Poisson L, Wen N, Tiwari P, Verma R, Bareja R, Yadav I, Chen J, Kumar N, Smits M, van der Voort SR, Alafandi A, Incekara F, Wijnenga MMJ, Kapsas G, Gahrmann R, Schouten JW, Dubbink HJ, Vincent AJPE, van den Bent MJ, French PJ, Klein S, Yuan Y, Sharma S, Tseng TC, Adabi S, Niclou SP, Keunen O, Hau AC, Vallières M, Fortin D, Lepage M, Landman B, Ramadass K, Xu K, Chotai S, Chambless LB, Mistry A, Thompson RC, Gusev Y, Bhuvaneshwar K, Sayah A, Bencheqroun C, Belouali A, Madhavan S, Booth TC, Chelliah A, Modat M, Shuaib H, Dragos C, Abayazeed A, Kolodziej K, Hill M, Abbassy A, Gamal S, Mekhaimar M, Qayati M, Reyes M, Park JE, Yun J, Kim HS, Mahajan A, Muzi M, Benson S, Beets-Tan RGH, Teuwen J, Herrera-Trujillo A, Trujillo M, Escobar W, Abello A, Bernal J, Gómez J, Choi J, Baek S, Kim Y, Ismael H, Allen B, Buatti JM, Kotrotsou A, Li H, Weiss T, Weller M, Bink A, Pouymayou B, Shaykh HF, Saltz J, Prasanna P, Shrestha S, Mani KM, Payne D, Kurc T, Pelaez E, Franco-Maldonado H, Loayza F, Quevedo S, Guevara P, Torche E, Mendoza C, Vera F, Ríos E, López E, Velastin SA, Ogbole G, Soneye M, Oyekunle D, Odafe-Oyibotha O, Osobu B, Shu'aibu M, Dorcas A, Dako F, Simpson AL, Hamghalam M, Peoples JJ, Hu R, Tran A, Cutler D, Moraes FY, Boss MA, Gimpel J, Veettil DK, Schmidt K, Bialecki B, Marella S, Price C, Cimino L, Apgar C, Shah P, Menze B, Barnholtz-Sloan JS, Martin J, Bakas S. Federated learning enables big data for rare cancer boundary detection. Nat Commun 2022; 13:7346. [PMID: 36470898 PMCID: PMC9722782 DOI: 10.1038/s41467-022-33407-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022] Open
Abstract
Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by only sharing numerical model updates. Here we present the largest FL study to-date, involving data from 71 sites across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, reporting the largest such dataset in the literature (n = 6, 314). We demonstrate a 33% delineation improvement for the surgically targetable tumor, and 23% for the complete tumor extent, over a publicly trained model. We anticipate our study to: 1) enable more healthcare studies informed by large diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further analyses for glioblastoma by releasing our consensus model, and 3) demonstrate the FL effectiveness at such scale and task-complexity as a paradigm shift for multi-site collaborations, alleviating the need for data-sharing.
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Affiliation(s)
- Sarthak Pati
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
| | - Ujjwal Baid
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chiharu Sako
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Satyam Ghodasara
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michel Bilello
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Zenk
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey Rudie
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Javier Villanueva-Meyer
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Soonmee Cha
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Manali Jadhav
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Umang Pandey
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - John Garrett
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Matthew Larson
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert Jeraj
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Stuart Currie
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Russell Frood
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Kavi Fatania
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | | | | | - Josep Puig
- Department of Radiology (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - Johannes Trenkler
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Josef Pichler
- Department of Neurooncology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Georg Necker
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Andreas Haunschmidt
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Stephan Meckel
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
- Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Gaurav Shukla
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, Christiana Care Health System, Philadelphia, PA, USA
| | - Spencer Liem
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory S Alexander
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Joseph Lombardo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Adam E Flanders
- Department of Radiology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Craig K Jones
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Meirui Jiang
- The Chinese University of Hong Kong, Hong Kong, China
| | - Tiffany Y So
- The Chinese University of Hong Kong, Hong Kong, China
| | - Cheng Chen
- The Chinese University of Hong Kong, Hong Kong, China
| | | | - Qi Dou
- The Chinese University of Hong Kong, Hong Kong, China
| | - Michal Kozubek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Filip Lux
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Jan Michálek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Petr Matula
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Tereza Kopřivová
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Václav Vybíhal
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, and University Hospital and Czech Republic, Brno, Czech Republic
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Ross Mitchell
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Joaquim Farinhas
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Marco C Pinho
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Divya Reddy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Holcomb
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Talia Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sargam Bhardwaj
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Chee Chong
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marc Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Bernardo C A Teixeira
- Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Flávia Sprenger
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - David Menotti
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Diego R Lucio
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Pamela LaMontagne
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel Marcus
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
| | - Florian Kofler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Marie Metz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Yvonne W Lui
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Richard McKinley
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Slotboom
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Derrick Murcia
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Eric Fu
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Rourke Haas
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - John Thompson
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - David Ryan Ormond
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Chaitra Badve
- Department of Radiology, University Hospitals Cleveland, Cleveland, OH, USA
| | - Andrew E Sloan
- Department of Neurological Surgery, University Hospitals-Seidman Cancer Center, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vachan Vadmal
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristin Waite
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Rivka R Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linmin Pei
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Murat Ak
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashok Srinivasan
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - J Rajiv Bapuraj
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Wang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Ota Yoshiaki
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Toshio Moritani
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Sevcan Turk
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Joonsang Lee
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Snehal Prabhudesai
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Konstantinos Kamnitsas
- Department of Computing, Imperial College London, London, UK
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Luke V M Dixon
- Department of Radiology, Imperial College NHS Healthcare Trust, London, UK
| | - Matthew Williams
- Computational Oncology Group, Institute for Global Health Innovation, Imperial College London, London, UK
| | - Peter Zampakis
- Department of NeuroRadiology, University of Patras, Patras, Greece
| | | | - Panagiotis Tsiganos
- Clinical Radiology Laboratory, Department of Medicine, University of Patras, Patras, Greece
| | - Sotiris Alexiou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Ilias Haliassos
- Department of Neuro-Oncology, University of Patras, Patras, Greece
| | - Evangelia I Zacharaki
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Sung Soo Ahn
- Yonsei University College of Medicine, Seoul, Korea
| | - Bing Luo
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Laila Poisson
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
- SJTU-Ruijin-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | | | - Ruchika Verma
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
- Case Western Reserve University, Cleveland, OH, USA
| | - Rohan Bareja
- Case Western Reserve University, Cleveland, OH, USA
| | - Ipsa Yadav
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Neeraj Kumar
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Ahmed Alafandi
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Fatih Incekara
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Maarten M J Wijnenga
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Georgios Kapsas
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Renske Gahrmann
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Joost W Schouten
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pim J French
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tzu-Chi Tseng
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saba Adabi
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simone P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Olivier Keunen
- Translation Radiomics, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Ann-Christin Hau
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
- Luxembourg Center of Neuropathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Martin Vallières
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - David Fortin
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Neurosurgery and Neuro-Oncology, Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martin Lepage
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Nuclear Medicine and Radiobiology, Sherbrooke Molecular Imaging Centre, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Bennett Landman
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Akshitkumar Mistry
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuriy Gusev
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Krithika Bhuvaneshwar
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anousheh Sayah
- Division of Neuroradiology & Neurointerventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Camelia Bencheqroun
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anas Belouali
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Subha Madhavan
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, Ruskin Wing, King's College Hospital NHS Foundation Trust, London, UK
| | - Alysha Chelliah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Haris Shuaib
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Carmen Dragos
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
| | | | | | | | | | - Shady Gamal
- University of Cairo School of Medicine, Giza, Egypt
| | | | | | | | - Ji Eun Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Jihye Yun
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust Pembroke Place, Liverpool, UK
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sean Benson
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht, Netherlands
| | - Jonas Teuwen
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - William Escobar
- Clínica Imbanaco Grupo Quirón Salud, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | | | - Jose Bernal
- Universidad del Valle, Cali, Colombia
- The University of Edinburgh, Edinburgh, UK
| | | | - Joseph Choi
- Department of Industrial and Systems Engineering, University of Iowa, Iowa, USA
| | - Stephen Baek
- Department of Industrial and Systems Engineering, Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Yusung Kim
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Heba Ismael
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Bryan Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | | | - Hongwei Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andrea Bink
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Prateek Prasanna
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Sampurna Shrestha
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Kartik M Mani
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA
| | - David Payne
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Tahsin Kurc
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Scientific Data Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Enrique Pelaez
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | - Francis Loayza
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | | | | | | | - Franco Vera
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Elvis Ríos
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Eduardo López
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Sergio A Velastin
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Godwin Ogbole
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mayowa Soneye
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Dotun Oyekunle
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | | | - Babatunde Osobu
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mustapha Shu'aibu
- Department of Radiology, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Adeleye Dorcas
- Department of Radiology, Obafemi Awolowo University Ile-Ife, Ile-Ife, Osun, Nigeria
| | - Farouk Dako
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Simpson
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Mohammad Hamghalam
- School of Computing, Queen's University, Kingston, ON, Canada
- Department of Electrical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Jacob J Peoples
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Ricky Hu
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Anh Tran
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Danielle Cutler
- The Faculty of Arts & Sciences, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Michael A Boss
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - James Gimpel
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Deepak Kattil Veettil
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Kendall Schmidt
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Brian Bialecki
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Sailaja Marella
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Cynthia Price
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Lisa Cimino
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | | | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Jill S Barnholtz-Sloan
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), National Institute of Health, Bethesda, MD, USA
| | | | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Álvarez-Torres MDM, Fuster-García E, Balaña C, Puig J, García-Gómez JM. Lack of Benefit of Extending Temozolomide Treatment in Patients with High Vascular Glioblastoma with Methylated MGMT. Cancers (Basel) 2021; 13:5420. [PMID: 34771583 PMCID: PMC8582449 DOI: 10.3390/cancers13215420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
In this study, we evaluated the benefit on survival of the combination of methylation of O6-methylguanine-DNA methyltransferase (MGMT) promotor gene and moderate vascularity in glioblastoma using a retrospective dataset of 123 patients from a multicenter cohort. MRI processing and calculation of relative cerebral blood volume (rCBV), used to define moderate- and high-vascular groups, were performed with the automatic ONCOhabitats method. We assessed the previously proposed rCBV threshold (10.7) and the new calculated ones (9.1 and 9.8) to analyze the association with survival for different populations according to vascularity and MGMT methylation status. We found that patients included in the moderate-vascular group had longer survival when MGMT is methylated (significant median survival difference of 174 days, p = 0.0129*). However, we did not find significant differences depending on the MGMT methylation status for the high-vascular group (p = 0.9119). In addition, we investigated the combined correlation of MGMT methylation status and rCBV with the prognostic effect of the number of temozolomide cycles, and only significant results were found for the moderate-vascular group. In conclusion, there is a lack of benefit of extending temozolomide treatment for patients with high vascular glioblastomas, even presenting MGMT methylation. Preliminary results suggest that patients with moderate vascularity and methylated MGMT glioblastomas would benefit more from prolonged adjuvant chemotherapy.
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Affiliation(s)
- María del Mar Álvarez-Torres
- Biomedical Data Science Laboratory, Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, 46022 Valencia, Spain; (E.F.-G.); (J.M.G.-G.)
| | - Elies Fuster-García
- Biomedical Data Science Laboratory, Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, 46022 Valencia, Spain; (E.F.-G.); (J.M.G.-G.)
- Department of Diagnostic Physics, Oslo University Hospital, 0450 Oslo, Norway
| | - Carmen Balaña
- Institut Catala d’Oncologia (ICO), Applied Research Group in Oncology (B-ARGO Group), Institut Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain;
| | - Josep Puig
- Institut de Diagnostic per la Image (IDI), Hospital Dr. Josep Trueta, 17007 Girona, Spain;
| | - Juan M. García-Gómez
- Biomedical Data Science Laboratory, Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, 46022 Valencia, Spain; (E.F.-G.); (J.M.G.-G.)
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Balaña C, del Barco Berrón S, Stradella A, Villanueva Vazquez R, Cuesta A, Torres J, Roma J, Taylor R, Escriba P, Llobet E, McNicholl A. 346MO Safety of idroxioleic acid in combination with standard of care (temozolomide and/or radiation therapy) in newly diagnosed glioblastoma patients: A phase Ib trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.010] [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
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Notario Rincon L, Hierro C, Esteve A, Fontanals S, González A, Loureiro E, Sun C, Margelí M, Moran T, Font A, Manzano J, Balaña C, Quiroga V, Quer N, Ibañez C, Martínez-Benavides J, Brunet J, Clopes A, Mesia R. 1508MO Rationalizing the use of off-label drugs (OLD) within a special medication (ME) program for cancer patients (pt): The Catalan Institute of Oncology (ICO) prognostic score (ICO MEscore). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.837] [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: 10/20/2022] Open
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del Mar Álvarez-Torres M, Fuster-García E, Juan-Albarracín J, Puig J, Balaña C, Capellades J, Emblem KE, García-Gómez JM. Abstract 2654: Differential effect of MGMT methylation between moderate or high vascular profile in IDH wild-type glioblastoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2654] [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: 11/16/2022]
Abstract
Abstract
A significant association between MGMT methylation and prolonged overall survival (OS) was observed for patients with glioblastoma (GB) that present moderately relative cerebral blood volume (rCBV) 1. However, that study should be updated to the current glioma WHO classification. In the current study we assess the combined effect of rCBV and MGMT methylation combined on OS in patients with IDH wild-type GB.
An independent cohort of 95 IDH wild-type GB patients with OS>30 days and with tumor resection was included for this study. The rCBV values of the highest angiogenic tumor regions were automatically calculated using ONCOhabitats analysis services2. Finally, the whole cohort was divided into moderately and highly vascularized GB by the median of the previously calculated rCBVs (rCBVmedian=9.56).
We observed a significant association between MGMT methylation and prolonged OS for the whole cohort (p = 0.003, HR = 0.49), as well as for patients with moderate rCBV (p = 0.002, AUC = 0.30). The difference in OS between patients with MGMT methylated and patients with MGMT unmethylated was 4 times higher in the group with moderate rCBV than for the group with high rCBV (205 vs. 42 days). Finally, no association was found between MGMT methylation and OS in patients with high rCBV (p > 0.05) (Table below).
Our results highlight the combined prognostic effect of MGMT methylation and moderate vascularity in IDH wild-type GB patients. As demonstrated, non-invasive MRI perfusion markers may identify those patients who will mostly benefit in terms of prolonged OS owing to their MGMT methylation status.
1: doi.org/10.1007/s00330-020-07297-4
2: doi.org/10.1016/j.ijmedinf.2019.05.002
Number of patientsMedian OS (days)ResultsStatistical resultsTotalMeth MGMTUnmethMGMTMeth MGMTUnmethMGMTΔOSHR [95% CI]pAUCAll9551445894501390.49 [0.30-0.78]0.0028*0.61Moderate rCBV4221216534482050.30 [0.14-0.64]0.0020*0.72High rCBV533023493451420.68 [0.37-1.26]0.21800.52
Citation Format: Maria del Mar Álvarez-Torres, Elies Fuster-García, Javier Juan-Albarracín, Josep Puig, Carmen Balaña, Jaume Capellades, Kyrre Eeg Emblem, Juan Miguel García-Gómez. Differential effect of MGMT methylation between moderate or high vascular profile in IDH wild-type glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2654.
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Affiliation(s)
| | | | | | - Josep Puig
- 3Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Girona, Spain
| | - Carmen Balaña
- 4Institut Catala Oncologia, Badalona, Barcelona, Spain
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10
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Panciroli C, Esteve A, Muñoz-Ferrer A, Abad J, Hernandez JM, Balaña C, Lucente G, Comas S, Villà S. Prospective pilot study to explore the melatonin level in brain tumor patients undergoing radiotherapy. Sleep Breath 2021; 26:469-475. [PMID: 33825098 DOI: 10.1007/s11325-021-02365-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/07/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Our aim was to assess if the radiotherapy dose decreased the melatonin levels as well as the quality of life and sleep in brain tumor patients. METHODS We performed a follow-up study on melatonin levels in saliva and its urinary metabolite sulfatoxi-melatonine (STM) samples in patients with brain tumors treated with radiotherapy close to the pineal gland's area. We analyzed the cortisol, cortisone, and excrection of STM normalized by urinary creatinine. In some cases, a polysomnography (PSG) was performed. Quality of life questionnaires, distress scale, and sleepiness inventories were also administered. RESULTS We included twelve patients (experimental arm) and eight healthy controls (control group). No differences were observed between experimental arm and control group at baseline. No differences were detected in the experimental arm before and after delivering the radiotherapy. No clinically significant differences were found according to the radiotherapy dose delivered. CONCLUSION Melatonin levels and PSG outcomes do not change after receiving radiotherapy. The findings of this study do not show a statistically significant association between the treatment and the quality of life and sleep.
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Affiliation(s)
- Claudia Panciroli
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain.
| | - Anna Esteve
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain
| | - Aida Muñoz-Ferrer
- Sleep Disturbance Unit, Pulmonary Department, Germans Trias i Pujol University Hospital, Badalona (Barcelona), Catalonia, Spain
| | - Jorge Abad
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES); Pulmonary Department, Germans Trias i Pujol University Hospital, Badalona (Barcelona), Catalonia, Spain
| | - Jose Maria Hernandez
- Proteomic and Metabolomics Unit, Germans Trias i Pujol Institute (IGTP), Badalona (Barcelona), Catalonia, Spain
| | - Carmen Balaña
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain
| | - Giuseppe Lucente
- Neurology Service, Neuroscience Department, Germans Trias i Pujol University Hospital, Badalona (Barcelona), Catalonia, Spain
| | - Silvia Comas
- Radiation Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain
| | - Salvador Villà
- Radiation Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain
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Comas S, Luguera E, Molero J, Balaña C, Estival A, Castañer S, Carrato C, Hostalot C, Teixidor P, Villà S. Influence of glioblastoma contact with the subventricular zone on survival and recurrence patterns. Clin Transl Oncol 2020; 23:554-564. [PMID: 32728970 DOI: 10.1007/s12094-020-02448-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/02/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is growing evidence that the subventricular zone (SVZ) may be involved in both the initiation and progression of glioblastoma (GB). We aimed to assess tumor proximity to the SVZ as a potential prognostic factor in GB. METHOD Retrospective study of 133 patients diagnosed with primary GB who underwent surgery followed by temozolomide-based chemoradiation between 2010 and 2016. All lesions were classified according to their anatomic relation with the SVZ. We determined the effect of tumor contact with the SVZ on progression-free survival (PFS), overall survival (OS), type, and patterns of recurrence. RESULTS At a median follow-up of 18.6 months (95% CI 15.9-21.2), PFS and OS were 7.5 (95% CI 6.7-8.3) and 13.9 (95% CI 10.9-16.9) months, respectively. On the univariate analyses, initial contact with the SVZ was a factor for poor prognosis for both PFS (6.1 vs. 8.7 months; p = 0.006) and OS (10.6 vs. 17.9 months; p = 0.037). On the multivariate analysis, tumor contact with the SVZ remained statistically significant for PFS, but not OS. Patients with SVZ-contacting tumors presented a higher rate of aggressive clinical progression (30.9% vs. 11.3%; p = 0.007) and contralateral relapse patterns (23.4% vs. 9.1%; p = 0.048). CONCLUSIONS Our results suggest that glioblastoma contact with the SVZ appears to be an independent prognostic factor for poor PFS. The presence of an SVZ-contacting tumor was associated with more aggressive recurrences and a higher rate of contralateral relapses. These findings suggest that this variable may be a new prognostic factor in glioblastoma.
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Affiliation(s)
- S Comas
- Radiation Oncology, Institut Català D'Oncologia, c/ del Canyet SN, 08916, Badalona, Catalonia, Spain
| | - E Luguera
- Physics, Institut Català D'Oncologia, Badalona, Catalonia, Spain
| | - J Molero
- Physics, Institut Català D'Oncologia, Badalona, Catalonia, Spain
| | - C Balaña
- Medical Oncology, Institut Català D'Oncologia, Badalona, Catalonia, Spain
| | - A Estival
- Medical Oncology, Institut Català D'Oncologia, Badalona, Catalonia, Spain
| | - S Castañer
- Neuroradiology, Institut de Diagnòstic Per La Imatge, Badalona, Catalonia, Spain
| | - C Carrato
- Pathology. Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - C Hostalot
- Neurosurgery. Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - P Teixidor
- Neurosurgery. Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - S Villà
- Radiation Oncology, Institut Català D'Oncologia, c/ del Canyet SN, 08916, Badalona, Catalonia, Spain.
- Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain.
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Cardona AF, Ruiz-Patiño A, Zatarain-Barrón ZL, Hakim F, Jiménez E, Mejía JA, Ramón JF, Useche N, Bermúdez S, Pineda D, Cifuentes H, Rojas L, Ricaurte L, Pino LE, Balaña C, Arrieta O. Systemic management of malignant meningiomas: A comparative survival and molecular marker analysis between Octreotide in combination with Everolimus and Sunitinib. PLoS One 2019; 14:e0217340. [PMID: 31220093 PMCID: PMC6586269 DOI: 10.1371/journal.pone.0217340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/10/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare the effectiveness of octreotide/everolimus vs. sunitinib for the systemic treatment of recurrent aggressive meningiomas. Methods 31 patients with recurrent or refractory WHO II or WHO III meningiomas were examined in two reference centers in Colombia. Patients who had systemic treatment (sunitinib, everolimus/octreotide) and a complete follow-up were included. Overall survival (OS), progression-free survival (PFS) and toxicities were evaluated. Additionally, tissue samples were examined for PDGFRβ and VEGFR2, their expression was correlated with outcomes. Results Twenty-two patients (72%) were female with a median age of 55 years (SD±15.3). The most prevalent histology was anaplastic meningioma in 20 patients (65%) with 48% of patients suffering from three previous relapses before the start of systemic treatment. A total of 14 patients received combination therapy with octreotide/everolimus, 11 received sunitinib and the remaining 6 received other second-line agents. Median OS was 37.3 months (95%CI 28.5–42.1) and the PFS during the treatment with everolimus/octreotide (EO) and sunitinib (Su) was 12.1 months (95%CI 9.2–21.1) and 9.1 months (95%CI 6.8–16.8); p = 0.43), respectively. The OS of the group treated with the EO→Su→Bev sequence (1st/2nd/3rd line) was 6.5 months longer than the Su→EO→Bev sequence (36.0 vs. 29.5 months) (p = 0.0001). When analyzing molecular markers, the positive PDGFRβ and negative VEGFR2 expression were associated with longer survival both in OS and PFS. Conclusion Sunitinib and octreotide/everolimus have similar efficacy and safety in the systemic management of refractory meningioma. VEGFR2 and PDGFRβ expression are associated with better outcomes.
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Affiliation(s)
- Andrés F. Cardona
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Group (G-FOX), Universidad El Bosque, Bogotá, Colombia
- * E-mail: ,
| | | | | | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Enrique Jiménez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Juan Armando Mejía
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Juan Fernando Ramón
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Nicolás Useche
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
- Neuroradiology Section, Radiology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonia Bermúdez
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
- Neuroradiology Section, Radiology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Diego Pineda
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Neuroradiology Section, Clínica del Country, Bogotá, Colombia
| | | | - Leonardo Rojas
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
- Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
| | - Luis Eduardo Pino
- Clinical Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Carmen Balaña
- Neuro-Oncology Section, Oncology Department, Hospital Germans Trias I Pujol, Catalan Institute of Oncology–ICO, Barcelona, Spain
| | - Oscar Arrieta
- Laboratory of Experimental Oncology, Instituto Nacional de Cancerología (INCaN), México City, México
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Cardona AF, Rojas L, Wills B, Ruiz-Patiño A, Abril L, Hakim F, Jiménez E, Useche N, Bermúdez S, Mejía JA, Ramón JF, Carranza H, Vargas C, Otero J, Archila P, Rodríguez J, Rodríguez J, Behaine J, González D, Jacobo J, Cifuentes H, Feo O, Penagos P, Pineda D, Ricaurte L, Pino LE, Vargas C, Marquez JC, Mantilla MI, Ortiz LD, Balaña C, Rosell R, Zatarain-Barrón ZL, Arrieta O. A comprehensive analysis of factors related to carmustine/bevacizumab response in recurrent glioblastoma. Clin Transl Oncol 2019; 21:1364-1373. [DOI: 10.1007/s12094-019-02066-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/15/2019] [Indexed: 11/30/2022]
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Panciroli C, Lucente G, Cecilia O, Quiroga V, Carcereny E, Pardo J, Romeo M, Velarde J, Villa S, Balaña C. P05.81 Neurocognitive assessment in cancer patients without central nervous system disease treated with bevacizumab at week 34: an observational transversal multi-centric pilot study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Panciroli
- Clinical Investigation Unit - Institut Catala d’Oncologia, Badalona, Spain
| | - G Lucente
- Neurology Service/Neuroscience Department - Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - O Cecilia
- Medical Oncology Service - Hospital Clinic, Barcelona, Spain
| | - V Quiroga
- Medical Oncology Service - Institut Catala d’Oncologia, Badalona, Spain
| | - E Carcereny
- Medical Oncology Service - Institut Catala d’Oncologia, Badalona, Spain
| | - J Pardo
- Medical Oncology Service - Institut Catala d’Oncologia, Badalona, Spain
| | - M Romeo
- Medical Oncology Service - Institut Catala d’Oncologia, Badalona, Spain
| | - J Velarde
- Institut Catala d’Oncologia, Badalona, Spain
| | - S Villa
- Radiation Oncology Service - Institut Catala d’Oncologia, Badalona, Spain
| | - C Balaña
- Medical Oncology Service - Institut Catala d’Oncologia, Badalona, Spain
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Durà Mata M, Molleda Marzo M, Teixidor P, Caceres C, Enseñat A, Boldó M, Martínez S, Sanchez-Carrion R, Ruiz-Almazán I, Balaña C, Villà S. Randomized controlled trial on the impact of cognitive telerehabilitation on cognition and quality of life in glioma patients. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.631] [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]
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Balaña C, Estival A, Teruel I, Hardy-Werbin M, Sepulveda J, Pineda E, Martinez-García M, Gallego O, Luque R, Gil-Gil M, Mesia C, Del Barco S, Herrero A, Berrocal A, Perez-Segura P, De Las Penas R, Marruecos J, Fuentes R, Reynes G, Velarde JM, Cardona A, Verger E, Panciroli C, Villà S. Delay in starting radiotherapy due to neoadjuvant therapy does not worsen survival in unresected glioblastoma patients. Clin Transl Oncol 2018; 20:1529-1537. [PMID: 29737461 DOI: 10.1007/s12094-018-1883-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We retrospectively examined the potential effect on overall survival (OS) of delaying radiotherapy to administer neoadjuvant therapy in unresected glioblastoma patients. PATIENTS AND METHODS We compared OS in 119 patients receiving neoadjuvant therapy followed by standard treatment (NA group) and 96 patients receiving standard treatment without neoadjuvant therapy (NoNA group). The MaxStat package of R identified the optimal cut-off point for waiting time to radiotherapy. RESULTS OS was similar in the NA and NoNA groups. Median waiting time to radiotherapy after surgery was 13 weeks for the NA group and 4.2 weeks for the NoNA group. The longest OS was attained by patients who started radiotherapy after 12 weeks and the shortest by patients who started radiotherapy within 4 weeks (12.3 vs 6.6 months) (P = 0.05). OS was 6.6 months for patients who started radiotherapy before the optimal cutoff of 6.43 weeks and 19.1 months for those who started after this time (P = 0.005). Patients who completed radiotherapy had longer OS than those who did not, in all 215 patients and in the NA and NoNA groups (P = 0.000). In several multivariate analyses, completing radiotherapy was a universally favorable prognostic factor, while neoadjuvant therapy was never identified as a negative prognostic factor. CONCLUSION In our series of unresected patients receiving neoadjuvant treatment, in spite of the delay in starting radiotherapy, OS was not inferior to that of a similar group of patients with no delay in starting radiotherapy.
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Affiliation(s)
- C Balaña
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona (Barcelona), Spain.
| | - A Estival
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona (Barcelona), Spain
| | - I Teruel
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona (Barcelona), Spain
| | - M Hardy-Werbin
- Cancer Research Programm, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J Sepulveda
- Medical Oncology Service, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - E Pineda
- Medical Oncology Service, Hospital Clinic Provincial, Barcelona, Spain
| | | | - O Gallego
- Medical Oncology Service, Hospital de Sant Pau, Barcelona, Spain
| | - R Luque
- Medical Oncology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M Gil-Gil
- Medical Oncology Service, Institut Català d'Oncologia-IDIBELL, Hospitalet de Llobregat, Spain
| | - C Mesia
- Medical Oncology Service, Institut Català d'Oncologia-IDIBELL, Hospitalet de Llobregat, Spain
| | - S Del Barco
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain
| | - A Herrero
- Medical Oncology Service, Hospital Miguel Servet, Saragossa, Spain
| | - A Berrocal
- Medical Oncology Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - P Perez-Segura
- Medical Oncology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - R De Las Penas
- Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
| | - J Marruecos
- Radiation Oncology Service, Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain
| | - R Fuentes
- Radiation Oncology Service, Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain
| | - G Reynes
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - J M Velarde
- Institut Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Badalona, Spain
| | - A Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia.,Biology Systems Department, Universidad el Bosque, Bogotá, Colombia
| | - E Verger
- Radiation Oncology Service, Hospital Clinic Provincial, Barcelona, Spain
| | - C Panciroli
- Institut Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Badalona, Spain
| | - S Villà
- Radiation Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Capellades J, Puig J, Domenech S, Pujol T, Oleaga L, Camins A, Majós C, Diaz R, de Quintana C, Teixidor P, Conesa G, Plans G, Gonzalez J, García-Balañà N, Velarde JM, Balaña C. Is a pretreatment radiological staging system feasible for suggesting the optimal extent of resection and predicting prognosis in glioblastoma? An observational study. J Neurooncol 2017; 137:367-377. [DOI: 10.1007/s11060-017-2726-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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Cardona AF, Rojas L, Wills B, Bernal L, Ruiz-Patiño A, Arrieta O, Hakim EJ, Hakim F, Mejía JA, Useche N, Bermúdez S, Carranza H, Vargas C, Otero J, Mayor LC, Ortíz LD, Franco S, Ortíz C, Gil-Gil M, Balaña C, Zatarain-Barrón ZL. Efficacy and safety of Levetiracetam vs. other antiepileptic drugs in Hispanic patients with glioblastoma. J Neurooncol 2017; 136:363-371. [PMID: 29177594 DOI: 10.1007/s11060-017-2660-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/29/2017] [Indexed: 01/05/2023]
Abstract
Epilepsy is a common symptom in patients with glioblastoma (GB). 213 patients with GB from RedLANO follow-up registry were included. All patients underwent surgery, if feasible, followed by chemoradiation based on temozolomide (Stupp platform). Information was recorded regarding demographics, seizure timing, anti-epileptic drugs (AEDs), dosage, time to next seizure, total seizures in 6 months, and main side effects of AEDs. The relationship between epilepsy treatment and overall survival (OS) was evaluated. Mean age was 53 years old and 56.8% were male. Seventy-eight patients (37%) were treated with levetiracetam (LEV), 27% were given another AED and 36% did not require any AED. Choice of AED was not associated with age (p = 0.67), performance status (p = 0.24) or anatomic tumor site (p = 0.34). Seizures and AED requirement were greater in those having primary GB (p = 0.04). After starting an AED, the mean time until next crisis was 9.9 days (SD ± 6.3), which was shorter in those receiving LEV (p = 0.03); mean number of seizures during the first 3 and 6 months were 2.9 and 4, respectively. Most patients treated with LEV (n = 46) required less than two medication adjustments compared to those treated with other AEDs (p = 0.02). Likewise, less patients exposed to LEV required a coadjuvant drug (p = 0.04). Additionally, patients receiving LEV had significantly less adverse effects compared to patients treated with another AED. OS was significantly higher in the group treated with LEV compared to other AEDs (25.5 vs. 17.9 months; p = 0.047). Patients treated with LEV had better seizure control and longer OS compared to other AEDs.
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Affiliation(s)
- Andrés F Cardona
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia. .,Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia. .,Latin American Neuro-Oncology Network (RedLANO), Bogotá, Colombia.
| | - Leonardo Rojas
- Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Beatriz Wills
- Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia
| | - Laura Bernal
- Internal Medicine Department, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Enrique Jiménez Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
| | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
| | - Juan Armando Mejía
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
| | - Nicolás Useche
- Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia.,Radiology Department, Neuro-radiology Section, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonia Bermúdez
- Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia.,Radiology Department, Neuro-radiology Section, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hernán Carranza
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia
| | - Carlos Vargas
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia
| | - Jorge Otero
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia
| | - Luis Carlos Mayor
- Neurology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - León Darío Ortíz
- Latin American Neuro-Oncology Network (RedLANO), Bogotá, Colombia.,Neuro-Oncology Unit, Clinical Oncology Department, Clínica de Las Américas, Medellín, Colombia
| | - Sandra Franco
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - Carlos Ortíz
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - Miguel Gil-Gil
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran I Reynals - IDIBELL, Hospitalet de Llobregat, Spain
| | - Carmen Balaña
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona, Spain
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
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Balaña C, Capellades J, Pineda E, Estival A, Puig J, Domenech S, Verger E, Pujol T, Martinez-García M, Oleaga L, Velarde J, Mesia C, Fuentes R, Marruecos J, Del Barco S, Villà S, Carrato C, Gallego O, Gil-Gil M, Craven-Bartle J, Alameda F. Pseudoprogression as an adverse event of glioblastoma therapy. Cancer Med 2017; 6:2858-2866. [PMID: 29105360 PMCID: PMC5727237 DOI: 10.1002/cam4.1242] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 07/25/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 01/01/2023] Open
Abstract
We explored predictive factors of pseudoprogression (PsP) and its impact on prognosis in a retrospective series of uniformly treated glioblastoma patients. Patients were classified as having PsP, early progression (eP) or neither (nP). We examined potential associations with clinical, molecular, and basal imaging characteristics and compared overall survival (OS), progression‐free survival (PFS), post‐progression survival (PPS) as well as the relationship between PFS and PPS in the three groups. Of the 256 patients studied, 56 (21.9%) were classified as PsP, 70 (27.3%) as eP, and 130 (50.8%) as nP. Only MGMT methylation status was associated to PsP. MGMT methylated patients had a 3.5‐fold greater possibility of having PsP than eP (OR: 3.48; 95% CI: 1.606–7.564; P = 0.002). OS was longer for PsP than eP patients (18.9 vs. 12.3 months; P = 0.0001) but was similar for PsP and nP patients (P = 0.91). OS was shorter–though not significantly so—for PsP than nP patients (OS: 19.5 vs. 27.9 months; P = 0.63) in methylated patients. PPS was similar for patients having PsP, eP or nP (PPS: 7.2 vs. 5.4 vs. 6.7; P = 0.43). Neurological deterioration occurred in 64.3% of cases at the time they were classified as PsP and in 72.8% of cases of eP (P = 0.14). PsP confounds the evaluation of disease and does not confer a survival advantage in glioblastoma.
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Affiliation(s)
- Carmen Balaña
- Medical Oncology, Institut Catala Oncologia (ICO), Badalona, Barcelona, Spain
| | | | | | - Anna Estival
- Medical Oncology, Institut Catala Oncologia (ICO), Badalona, Barcelona, Spain
| | - Josep Puig
- Imaging Research Unit, Institut de Diagnostic per la Imatge (IDI), Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Sira Domenech
- Radiology, Institut Diagnòstic per la Imatge (IDI), Badalona, Barcelona, Spain
| | | | | | | | | | - JoseMaria Velarde
- Statistics, Institut Catala Oncologia (ICO), Badalona, Barcelona, Spain
| | - Carlos Mesia
- Medical Oncology, IDIBELL, Institut Catala Oncologia (ICO), Hospitalet de LLobregat, Barcelona, Spain
| | - Rafael Fuentes
- Radiation Oncology, Institut Catala Oncologia (ICO), Girona, Spain
| | - Jordi Marruecos
- Radiation Oncology, Institut Catala Oncologia (ICO), Girona, Spain
| | - Sonia Del Barco
- Medical Oncology, Institut Catala Oncologia (ICO), Girona, Spain
| | - Salvador Villà
- Radiation Oncology, Statistics, Institut Catala Oncologia (ICO), Badalona, Barcelona, Spain
| | - Cristina Carrato
- Pathology, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Oscar Gallego
- Medical Oncology, Hospital de Sant Pau, Barcelona, Spain
| | - Miguel Gil-Gil
- Medical Oncology, IDIBELL, Institut Catala Oncologia (ICO), Hospitalet de LLobregat, Barcelona, Spain
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Balaña C, Estival A, Pineda E, Sepúlveda J, Mesía C, Del Barco S, Gil-Gil M, Hardy M, Indacoechea A, Cardona AF. Prolonged survival after bevacizumab rechallenge in glioblastoma patients with previous response to bevacizumab †. Neurooncol Pract 2016; 4:15-23. [PMID: 31385992 DOI: 10.1093/nop/npw004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 12/31/2022] Open
Abstract
Background The use of bevacizumab for recurrent glioblastoma is controversial. Here we show data on patients who responded to bevacizumab, then stopped bevacizumab for any reason other than progression and were rechallenged with bevacizumab at the time of subsequent progression. Methods This retrospective study included 28 patients, classified in 2 cohorts: those for whom the first exposure to bevacizumab (BEV-1) was first-line treatment for newly diagnosed glioblastoma (Bev-F; N = 12) and those for whom BEV-1 was second- or third-line treatment for recurrent disease after standard treatment (Bev-S; N = 16). Results All patients received standard radiotherapy plus temozolomide. Bev-F patients also received concomitant bevacizumab. All 28 patients received a total of 57 treatment lines with bevacizumab (12 first-line and 45 second- or further-line). Twenty-nine lines were rechallenges (BEV-2 [N = 26] or BEV-3 [N = 3]). Objective response to rechallenge was 58.6% and clinical benefit was 89.6%. Overall survival (OS) was 55 months for RPA class IV and 26.7 months for RPA class V patients (P = .01). OS was 26.7 months for Bev-F patients and 52.1 months for Bev-S patients (P = .004). Post-progression survival was 20 months for Bev-F patients and 39.6 months for Bev-S patients (HR = 0.26; P = .007). Conclusion This is the largest study to examine the impact of a bevacizumab rechallenge in glioblastoma patients who had responded to previous bevacizumab treatment but who stopped before progression. Our findings indicate that these patients can attain a second response or clinical benefit from re-introduction of bevacizumab. The potential benefit from intermittent versus continuous treatment warrants comparison in clinical trials.
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Affiliation(s)
- Carmen Balaña
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Anna Estival
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Estela Pineda
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Juan Sepúlveda
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Carles Mesía
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Sonia Del Barco
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Miguel Gil-Gil
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Max Hardy
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Alberto Indacoechea
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
| | - Andrés Felipe Cardona
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona 08916, Spain (C.B., A.E., M.H., A.I.); Medical Oncology Service, Hospital Clinic, Barcelona 08036, Spain (E.P.); Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid 28041, Spain (J.S.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals - IDIBELL, Hospitalet de Llobregat 08907, Spain (C.M., M.G.-G.); Medical Oncology Service, Catalan Institute of Oncology, Hospital Trueta, Girona 17007, Spain (S.d.B.); Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Bogotá c. 318, Colombia (A.F.C.)
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Cardona AF, Rojas L, Wills B, Behaine J, Jiménez E, Hakim F, Useche N, Bermúdez S, Arrieta O, Mejía JA, Ramón JF, Carranza H, Vargas C, Otero J, González D, Rodríguez J, Ortiz LD, Cifuentes H, Balaña C. Genotyping low-grade gliomas among Hispanics. Neurooncol Pract 2016; 3:164-172. [PMID: 31386063 DOI: 10.1093/nop/npv061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 11/12/2022] Open
Abstract
Background Low-grade gliomas (LGGs) are classified by the World Health Organization as astrocytoma (DA), oligodendroglioma (OD), and mixed oligoastrocytoma (OA). TP53 mutation and 1p19q codeletion are the most-commonly documented molecular abnormalities. Isocitrate dehydrogenase (IDH) 1/2 mutations are frequent in LGGs; however, IDH-negative gliomas can also occur. Recent research suggests that ATRX plays a significant role in gliomagenesis. Methods We investigated p53 and Olig2 protein expression, and MGMT promoter methylation, 1p19q codeletion, IDH, and ATRX status in 63 Colombian patients with LGG. The overall survival (OS) rate was estimated and compared according to genotype. Results The most common histology was DA, followed by OD and OA. IDH1/2 mutations were found in 57.1% and MGMT+ (positive status of MGMT promoter methylation methyl-guanyl-methyl-transferase gene) in 65.1% of patients, while overexpression of p53 and Olig2 was present in 30.2% and 44.4%, respectively, and 1p19q codeletion in 34.9% of the patients. Overexpression of ATRX was analyzed in 25 patients, 16% tested positive and were also mutations in isocitrate dehydrogenase and negative 1p19q-codelition. The median follow-up was 15.8 months (95% CI, 7.6-42.0) and OS was 39.2 months (95% CI, 1.3-114). OS was positively and significantly affected by MGMT+, 1p19q codeletion, surgical intervention extent, and number of lobes involved. Multivariate analysis confirmed that MGMT methylation status and 1p19q codeletion affected OS. Conclusions This is the first study evaluating the molecular profile of Hispanic LGG patients. Findings confirmed the prognostic relevance of MGMT methylation and 1p19q codeletion, but do not support IDH1/2 mutation as a relevant marker. The latter may be explained by sample size and selection bias. ATRX alterations were limited to patients with DA and were mutations in isocitrate dehydrogenase and negative 1p19q-codelition.
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Affiliation(s)
- Andrés Felipe Cardona
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Leonardo Rojas
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Beatriz Wills
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - José Behaine
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Enrique Jiménez
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Fernando Hakim
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Nicolás Useche
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Sonia Bermúdez
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Oscar Arrieta
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Juan Armando Mejía
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Juan Fernando Ramón
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Hernán Carranza
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Carlos Vargas
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Jorge Otero
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Diego González
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - July Rodríguez
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - León Darío Ortiz
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Hernando Cifuentes
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
| | - Carmen Balaña
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia (A.F.C., H.C., C.V., J.O.); Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia (A.F.C., B.W., H.C., C.V., J.O., J.R.); Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia (A.F.C., J.B., E.J., F.H., N.U., S.B., D.G.); Internal Medicicine Depatment, Universidad del Bosque-Fundación Santa Fe de Bogotá, Bogotá, Colombia (B.W.); Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia (L.R.); Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia (F.H., J.A.M., J.F.R., E.J.); Radiology Department, Division of Neuro-radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (N.U., S.B.); Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), México City, México (O.A.); Clinical Oncology Department, Division of Neuro-Oncology, Clínica de Las Américas, Medellín, Colombia (L.D.O.); Neurosurgery Department, Clínica del Country, Bogotá, Colombia (H.C.); Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (C.B.)
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Molina D, Pérez-Beteta J, Martínez-González A, Sepúlveda JM, Peralta S, Gil-Gil MJ, Reynes G, Herrero A, De Las Peñas R, Luque R, Capellades J, Balaña C, Pérez-García VM. Geometrical Measures Obtained from Pretreatment Postcontrast T1 Weighted MRIs Predict Survival Benefits from Bevacizumab in Glioblastoma Patients. PLoS One 2016; 11:e0161484. [PMID: 27557121 PMCID: PMC4996463 DOI: 10.1371/journal.pone.0161484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background Antiangiogenic therapies for glioblastoma (GBM) such as bevacizumab (BVZ), have been unable to extend survival in large patient cohorts. However, a subset of patients having angiogenesis-dependent tumors might benefit from these therapies. Currently, there are no biomarkers allowing to discriminate responders from non-responders before the start of the therapy. Methods 40 patients from the randomized GENOM009 study complied the inclusion criteria (quality of images, clinical data available). Of those, 23 patients received first line temozolomide (TMZ) for eight weeks and then concomitant radiotherapy and TMZ. 17 patients received BVZ+TMZ for seven weeks and then added radiotherapy to the treatment. Clinical variables were collected, tumors segmented and several geometrical measures computed including: Contrast enhancing (CE), necrotic, and total volumes; equivalent spherical CE width; several geometric measures of the CE ‘rim’ geometry and a set of image texture measures. The significance of the results was studied using Kaplan-Meier and Cox proportional hazards analysis. Correlations were assessed using Spearman correlation coefficients. Results Kaplan-Meier and Cox proportional hazards analysis showed that total, CE and inner volume (p = 0.019, HR = 4.258) and geometric heterogeneity of the CE areas (p = 0.011, HR = 3.931) were significant parameters identifying response to BVZ. The group of patients with either regular CE areas (small geometric heterogeneity, median difference survival 15.88 months, p = 0.011) or those with small necrotic volume (median survival difference 14.50 months, p = 0.047) benefited substantially from BVZ. Conclusion Imaging biomarkers related to the irregularity of contrast enhancing areas and the necrotic volume were able to discriminate GBM patients with a substantial survival benefit from BVZ. A prospective study is needed to validate our results.
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Affiliation(s)
- David Molina
- Laboratory of Mathematical Oncology (MôLAB), Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Edificio Politécnico, Avda. Camilo José Cela 3, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain
- * E-mail:
| | - Julián Pérez-Beteta
- Laboratory of Mathematical Oncology (MôLAB), Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Edificio Politécnico, Avda. Camilo José Cela 3, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain
| | - Alicia Martínez-González
- Laboratory of Mathematical Oncology (MôLAB), Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Edificio Politécnico, Avda. Camilo José Cela 3, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain
| | - Juan M. Sepúlveda
- Medical Oncology Service, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Sergi Peralta
- Medical Oncology Service, Hospital Sant Joan de Reus, Reus, Spain
| | - Miguel J. Gil-Gil
- Medical Oncology Service, Institut Catalá d’Oncologia IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Gaspar Reynes
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - Ana Herrero
- Medical Oncology Service, Hospital Miguel Servet, Zaragoza, Spain
| | - Ramón De Las Peñas
- Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
| | - Raquel Luque
- Medical Oncology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Jaume Capellades
- Neuroradiology Section. Radiology Service. Hospital del Mar, Barcelona, Spain
| | - Carmen Balaña
- Medical Oncology Service, Institut Català d’Oncologia, IGTP, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Víctor M. Pérez-García
- Laboratory of Mathematical Oncology (MôLAB), Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Edificio Politécnico, Avda. Camilo José Cela 3, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain
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Martin-Broto J, Pousa AL, de Las Peñas R, García Del Muro X, Gutierrez A, Martinez-Trufero J, Cruz J, Alvarez R, Cubedo R, Redondo A, Maurel J, Carrasco JA, López-Martin JA, Sala Á, Meana JA, Ramos R, Martinez-Serra J, Lopez-Guerrero JA, Sevilla I, Balaña C, Vaz Á, De Juan A, Alemany R, Poveda A. Randomized Phase II Study of Trabectedin and Doxorubicin Compared With Doxorubicin Alone as First-Line Treatment in Patients With Advanced Soft Tissue Sarcomas: A Spanish Group for Research on Sarcoma Study. J Clin Oncol 2016; 34:2294-302. [PMID: 27185843 DOI: 10.1200/jco.2015.65.3329] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Doxorubicin and trabectedin are considered active drugs in soft tissue sarcoma (STS). The combination of both drugs was hypothesized to be advantageous and safe on the basis of preclinical evidence and a previous phase I trial, respectively. The aim of this study was to compare the clinical outcome of trabectedin plus doxorubicin with doxorubicin as first-line treatment of advanced STS patients. PATIENTS AND METHODS In this open-label randomized phase II trial, the main end point was progression-free survival (PFS). Trabectedin 1.1 mg/m(2) in a 3-hour infusion plus doxorubicin 60 mg/m(2) as the experimental arm and doxorubicin 75 mg/m(2) as the control arm were administered for up to six cycles. Translational research was planned to correlate the expression of apoptotic and DNA repair genes with clinical outcome. RESULTS In 115 randomly assigned patients, the median PFS was 5.5 months in the control arm and 5.7 months in the experimental arm (hazard ratio, 1.16; 95% CI, 0.79 to 1.71; P = .45) in the intent-to-treat analysis. The trial was stopped for futility after the interim analysis, because the results in the experimental arm showed the risk reduction for the main end point to be < 9.64%. The proportion of patients with grade 3 or 4 thrombocytopenia, asthenia, and liver toxicity was significantly higher in the experimental arm. FAS and p53 were shown to be prognostic factors for PFS (7.0 months if FAS+ and p53-; 3.4 months if FAS+/p53+ or FAS-/p53-; and 0.7 months if FAS- and p53+; P < .001) and for overall survival. CONCLUSION Trabectedin plus doxorubicin did not show superiority over doxorubicin alone as first-line treatment of advanced STS. The prognostic role of apoptotic key genes, FAS and p53, was shown to be robust enough to continue this research line.
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Affiliation(s)
- Javier Martin-Broto
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain.
| | - Antonio López Pousa
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ramón de Las Peñas
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Xavier García Del Muro
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Antonio Gutierrez
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Javier Martinez-Trufero
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Josefina Cruz
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Rosa Alvarez
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ricardo Cubedo
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Andrés Redondo
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Joan Maurel
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Juan A Carrasco
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - José A López-Martin
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ángeles Sala
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - José Andrés Meana
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Rafael Ramos
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Jordi Martinez-Serra
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - José A Lopez-Guerrero
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Isabel Sevilla
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Carmen Balaña
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ángeles Vaz
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ana De Juan
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Regina Alemany
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Andrés Poveda
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
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Gallego O, Cuatrecasas M, Benavides M, Segura PP, Berrocal A, Erill N, Colomer A, Quintana MJ, Balaña C, Gil M, Gallardo A, Murata P, Barnadas A. Efficacy of erlotinib in patients with relapsed gliobastoma multiforme who expressed EGFRVIII and PTEN determined by immunohistochemistry. J Neurooncol 2013; 116:413-9. [PMID: 24352766 PMCID: PMC3890043 DOI: 10.1007/s11060-013-1316-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 11/17/2013] [Indexed: 11/26/2022]
Abstract
Epidermal growth factor receptor gene (EGFR) alteration is a common feature in most of glioblastoma multiforme (GBM). Robust response of anti-EGFR treatments has been mostly associated with the EGFR deletion mutant variant III (EGFRvIII) and expression of PTEN. We have performed a prospective trial in order to confirm the efficacy of erlotinib treatment in patients with relapsed GBM who expressed EGFRvIII and PTEN. All patients included in the trial were required to be PTEN (+++), EGFR (+++) and EGFRvIII (+++) positives by immunohistochemistry. This new phase II trial enrolled 40 patients and was design to be stopped in case of fewer than two responses in the first 13 patients. Patient eligibility included histopathology criteria, radiological progression, more than 18 years old, Karnofsky performed status, KPS > 50, and adequate bone marrow and organ function. There was no limit to the number of prior treatments for relapses. No enzyme-inducing antiepileptic drugs were allowed. The primary endpoints were response and progression-free survival at 6 months (PFS6). Thirteen patients (6 men, 7 women) with recurrent GBM received erlotinib 150 mg/day. Median age was 53 years, median KPS was 80, and median prior treatments for relapses were 2. There was one partial response and three stable diseases (one at 18 months). PFS at 6 months was 20 %. Dose reduction for toxicity was not needed in any patient. Dermatitis was the main treatment-related toxicity, grade 1 in 8 patients and grade 2 in 5 patients. No grade 3 toxicity was observed. Median survival was 7 months (95 % IC 1.41–4.7). As conclusion, monotherapy with erlotinib in GBM relapses patients with high protein expression for PTEN (+++), EGFR (+++), and EGFRvlII (+++) showed low toxicity but minimal efficacy and the trial stopped.
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Affiliation(s)
- Oscar Gallego
- Medical Oncology Service, Santa Creu i Sant Pau Hospital, Sant Antoni Mº Claret nº 167, 08025, Barcelona, Spain,
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25
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Abstract
High-grade gliomas are an infrequent disease diagnosed usually in the fifth or sixth decade. Careful histopathological diagnosis is essential because tumour grade and type condition the treatment. Magnetic resonance with gadolinium is considered the standard radiologic exploration and should be followed by tissue sampling. Treatment of these patients should be decided in a multidisciplinary committee. Surgery, radiotherapy and chemotherapy are the basis of patients' treatment, with the best results obtained when the three of them can be used.
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Affiliation(s)
- Alfonso Berrocal
- Medical Oncology Service, Hospital General Universitario, Valencia, Spain.
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Berrocal A, Perez Segura P, Gil M, Balaña C, Garcia Lopez J, Yaya R, Rodríguez J, Reynes G, Gallego O, Iglesias L. Extended-schedule dose-dense temozolomide in refractory gliomas. J Neurooncol 2010; 96:417-22. [PMID: 19669096 PMCID: PMC2808507 DOI: 10.1007/s11060-009-9980-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 07/20/2009] [Indexed: 11/26/2022]
Abstract
This multicenter phase II study conducted by the Spanish Neuro-Oncology Group evaluated the activity of an extended, dose-dense temozolomide regimen in patients with temozolomide-refractory malignant glioma. Adult patients (at least 18 years of age) with WHO grade III or IV glioma and a Karnofsky Performance Status of 60 or higher were treated with temozolomide (85 mg/m(2)/day) for 21 consecutive days every 28-day cycle until disease progression or unacceptable toxicity. All patients had developed progressive disease either during or less than 3 months after completing previous temozolomide treatment. Forty-seven patients were treated with a median of 2 (range, 1-13) cycles of temozolomide. Before study entry, patients had received a median of 6 cycles of temozolomide: 39 (83%) as part of initial therapy and 23 (49%) as second-line therapy. Three patients (6.4%) had a partial response with durations of 8.0, 3.5, and 3.2 months; 15 patients (31.9%) had stable disease with a median duration of 2.1 months, including 2 patients with stable disease (SD) for greater than 6 months (14 and 16 months). Median time to progression was 2 months, and median overall survival from study entry was 5.1 months. The 6-month progression-free survival rate was 16.7%. The most common hematologic toxicities were lymphopenia, thrombocytopenia, and leukopenia. Lymphopenia occurred in 83% of patients and was grade 3 in 28%, but no opportunistic infections occurred. In conclusion, this extended dose-dense schedule of temozolomide appears to have modest activity in patients refractory to previous treatment with temozolomide and is associated with manageable toxicity.
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Affiliation(s)
- A Berrocal
- Servicio de Oncologia Medica, Consorcio Hospital General Universitario de Valencia, Avda Tres Cruces S/N, 46006, Valencia, Spain.
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Balaña C, Capellades J, Teixidor P, Roussos I, Ballester R, Cuello M, Arellano A, Florensa R, Rosell R. Clinical course of high-grade glioma patients with a "biopsy-only" surgical approach: a need for individualised treatment. Clin Transl Oncol 2008; 9:797-803. [PMID: 18158984 DOI: 10.1007/s12094-007-0142-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION 'Biopsy-only' high-grade glioma (HGG) patients get limited benefit from post-operative treatments, and as a group, negatively impact median survival outcomes. MATERIAL AND METHODS We retrospectively evaluated clinical characteristics, treatment and overall survival of HGG patients with a 'biopsy- only' surgical approach diagnosed between 1997 and 2005 at a University Hospital in Spain. RESULTS In 31% of 294 suspected gliomas, only a diagnostic biopsy was undertaken. Reasons for 'biopsy-only' for all patients were either location in eloquent areas: (motor area 18.7%, language area 25,3%, basal ganglia 7.7%, visual area 4.4%) or extension of the disease (corpus callosum invasion 14.3% and multicentricity/multifocality 28.6%). Seventy-four patients (80.4%) were HGG: 26% of all grade IV and 49% of all grade III tumours. For these patients, post-operative Karnofsky Performance Status of over 70%, median age and median survival were, respectively: 64 and 70%, 60.7 and 57 years old, and 23.1 and 42.7 weeks (p=0.0006). Patients lived longer if post-operative treatment was given, in all grades (p<0.0001). Nineteen patients (25.6%) died within 42 days after surgery. Only 60% of them initiated radiotherapy and 10% of them did not complete it. However, tumour grade, radiotherapy and temozolomide- based chemotherapy were independently associated with longer survival in multivariate analysis (p<0.05). CONCLUSION Almost one third of HGG patients can undergo only a biopsy and not debulking surgery. Although radiotherapy improves survival, only 50% of them complete the treatment. An individualised approach to these patients is needed to facilitate a correct analysis of therapy results. New therapies must be investigated in these patients.
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Affiliation(s)
- C Balaña
- Medical Oncology Service, Institut Català d'Oncologia, Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Abstract
Medulloblastoma is a rare entity in adult patients. All data about treatment are from children, where this disease is the most common cerebral tumour. Reports of medulloblastoma in adults are scarce but in all of them the prognosis seems similar to the prognosis of children. We present our experience in five cases of medulloblastoma in young adults, treated at the University Hospital "Germans Trias i Pujol" from June 1994 to October 2003. This has not been a good experience as more than 50% of the patients had a recurrence in spite of the standard treatment. We have reviewed the literature, concluding that we have to adapt the findings in children to our adult patients, offering them adjuvant chemotherapy after surgery.
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Affiliation(s)
- I Roussos
- Department of Neurosurgery. Hospital Universitari Germans Trias i Pujol, Institut Català d'Oncologia, Carretera Canyet s/n, 08916 Badalona, Spain.
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Berrocal A, Perez-Segura P, Gil M, Balaña C, Yaya-Tur R, Yaya-Tur R, Rodriguez J, Reynes G, Garcia-Lopez J, Gallego O. Phase II study of extended schedule temozolomide in refractory gliomas. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.1516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
1516 Background: Temozolomide resistance is mainly mediated by the enzyme AGT that repair DNA damage in a suicide way. Inhibition of this enzyme is greater when temozolomide is administered in a extended schedule that also obtains higher exposure to the drug. Methods: Primary objective is to assess is extended schedule temozolomide can revert resistance. Patients with bidimensionally measurable high grade glioma refractory to temozolomide defined as either progression during treatment or in the following tree months of drug withdrawal were included. Temozolomide was administered at a dose of 85 mg/m2 daily for 21 consecutive days every 28 days until unacceptable toxicity or progression. Results: Up to now we have included 41 patients, 29 of them available for the first analysis. Mean age is 51.3 (23–77), male 22 (76%), ECOG 0/1/2 7 (24%)/13 (45%)/9 (31%), histology is glioblastoma 18 (61%), anaplastic astrocytoma 9 (31%), anaplastic oligodendroglioma 1 (3.4%) other high grade glioma 1. Fourteen patients received more than one line of chemotherapy before study entrance. 65% were on anticonvulsant therapy mainly with phenytoin 56% or valproic acid 42%. Response to treatment was partial in 2 (6.7%), stable in 9 (31%) progression in 13% (45%) and not assessed in 5. Response only in assessable patients was PR/SD/P 2 (8.3%)/9 (37.5%)/13 (54%). Responses were seen in oligodendroglioma and anaplastic astrocytoma. Median survival has been 5.9 months and time to progression 2 months. 80 courses have been administered with a mean per patient of 2 (1–7). Toxicity has been very mild mainly haematological and grade I and II. 7% of the patients experienced platelet toxicity grade III and 3.5% neutropenia grade III. Non haematological toxicity was mainly transaminase elevation grade I to II in 24% of patients and nausea and vomiting grade I to II in 31%. Conclusions: Extended schedule temozolomide is an active regimen in resistant patients with moderate toxicity. Resistance to temozolomide may be reverted by extended schedule of administration [Table: see text]
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Affiliation(s)
- A. Berrocal
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - P. Perez-Segura
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - M. Gil
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - C. Balaña
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - R. Yaya-Tur
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - R. Yaya-Tur
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - J. Rodriguez
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - G. Reynes
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - J. Garcia-Lopez
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
| | - O. Gallego
- Genom Cooperative Group; Hospital General Universitario de Valencia, Valencia, Spain; Hospital Clinico San Carlos, Madrid, Spain; Instituto Catalan de Oncologia Duran i Reynals, Barcelona, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Instituto Valenciano de Oncologia, Valencia, Spain; Hospital de Sondureta, Palma de Mallorca, Spain; Hospital La Fe, Valencia, Spain; Hospital Ramon y Cajal, Madrid, Spain; Hospital Santa Creu i San Pau, Barcelona, Spain
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Salvatierra A, Tarrats A, Gomez C, Sastre JM, Balaña C. A case of c-kit positive high-grade stromal endometrial sarcoma responding to Imatinib Mesylate. Gynecol Oncol 2006; 101:545-7. [PMID: 16487996 DOI: 10.1016/j.ygyno.2006.01.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 12/16/2005] [Accepted: 01/03/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND High-grade endometrial stromal sarcoma (HGES) is an aggressive disease with dismal prognosis. Surgery is the standard treatment, and radiotherapy seems to reduce local relapse. No other treatment has proved to be useful in the case of non-resectable diseases. CASE A 41-year-old woman suffering HGES, with positive staining for CD117 (c-kit) and large abdominal and retroperitoneal mass progressing after chemotherapy, was treated with Imatinib Mesylate. After 3 months, objective response was documented and radical surgery performed. Two years after surgical intervention, she is currently free of the disease. CONCLUSION The response seen with Imatinib should be further investigated in a larger number of cases.
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Affiliation(s)
- Alejandro Salvatierra
- Medical Oncology Service, Institut Català d'Oncologia, Germans Trias i Pujol, Carretera Canyet s/n, 08916 Badalona, Barcelona, Spain
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31
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Paz MF, Yaya-Tur R, Rojas-Marcos I, Reynes G, Pollan M, Aguirre-Cruz L, García-Lopez JL, Piquer J, Safont MJ, Balaña C, Sanchez-Cespedes M, García-Villanueva M, Arribas L, Esteller M. CpG island hypermethylation of the DNA repair enzyme methyltransferase predicts response to temozolomide in primary gliomas. Clin Cancer Res 2005; 10:4933-8. [PMID: 15297393 DOI: 10.1158/1078-0432.ccr-04-0392] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The DNA repair enzyme O(6)-methylguanine DNA methyltransferase (MGMT) inhibits the killing of tumor cells by alkylating agents, and its loss in cancer cells is associated with hypermethylation of the MGMT CpG island. Thus, methylation of MGMT has been correlated with the clinical response to 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) in primary gliomas. Here, we investigate whether the presence of MGMT methylation in gliomas is also a good predictor of response to another emergent alkylating agent, temozolomide. EXPERIMENTAL DESIGN Using a methylation-specific PCR approach, we assessed the methylation status of the CpG island of MGMT in 92 glioma patients who received temozolomide as first-line chemotherapy or as treatment for relapses. RESULTS Methylation of the MGMT promoter positively correlated with the clinical response in the glioma patients receiving temozolomide as first-line chemotherapy (n = 40). Eight of 12 patients with MGMT-methylated tumors (66.7%) had a partial or complete response, compared with 7 of 28 patients with unmethylated tumors (25.0%; P = 0.030). We also found a positive association between MGMT methylation and clinical response in those patients receiving BCNU (n = 35, P = 0.041) or procarbazine/1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (n = 17, P = 0.043) as first-line chemotherapy. Overall, if we analyze the clinical response of all of the first-line chemotherapy treatments with temozolomide, BCNU, and procarbazine/1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea as a group in relation to the MGMT methylation status, MGMT hypermethylation was strongly associated with the presence of partial or complete clinical response (P < 0.001). Finally, the MGMT methylation status determined in the initial glioma tumor did not correlate with the clinical response to temozolomide when this drug was administered as treatment for relapses (P = 0.729). CONCLUSIONS MGMT methylation predicts the clinical response of primary gliomas to first-line chemotherapy with the alkylating agent temozolomide. These results may open up possibilities for more customized treatments of human brain tumors.
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Affiliation(s)
- Maria F Paz
- Cancer Epigenetics Laboratory, Spanish National Cancer Centre, Madrid, Spain
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Balaña C, López-Pousa A, Berrocal A, Yaya-Tur R, Herrero A, García JL, Martín-Broto J, Benavides M, Cerdá-Nicolás M, Ballester R, Balart J, Capellades J. Phase II study of temozolomide and cisplatin as primary treatment prior to radiotherapy in newly diagnosed glioblastoma multiforme patients with measurable disease. A study of the Spanish Medical Neuro-Oncology Group (GENOM). J Neurooncol 2004; 70:359-69. [PMID: 15662978 DOI: 10.1007/s11060-004-9175-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED This phase II study evaluates the activity of temozolomide and cisplatin administered before radiation therapy in newly diagnosed glioblastoma multiforme patients, in terms of response, time to progression and survival. PATIENTS AND METHODS Forty patients with measurable disease after surgery, a Karnofsky status > 60, and Barthel Index > 10 were included. They were treated with three cycles of temozolomide 200 mg/m2/day for 5 days and cisplatin 100 mg/m2 on day 1. Conventional focal radiation therapy to 60 Gy was administered after response evaluation. RESULTS Three patients were not evaluable for central reviewed response but all 40 were evaluable for toxicity, time to progression and survival. Objective responses by Macdonald criteria on an intent to treat basis were 45% including complete response in three patients (7.5%), and partial response in 15 patients (37.5%). Responses were seen in biopsy-only patients (33.4%) as well as in partial surgery patients (52%). Median survival for all patients was 12.5 months. Biopsy-only patients had a median survival of 12.8 months. Grade 3 to 4 neutropenia was the most important toxicity, and occurred in 37.5% of patients. A delay in 18.2% and a dose reduction in 9.6% of cycles were necessary due to myelosuppression on day 28. Two patients had neutropenic fever resulting in one treatment-related death. Eighty-two percent of patients received radiotherapy. CONCLUSION This regimen has significant activity, as it induces objective responses even in biopsy-only patients, appearing to improve their median survival. A better combination schedule is needed to improve the toxicity profile.
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Affiliation(s)
- Carmen Balaña
- Medical Oncology Services, Institut Catala d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Rosell R, Felip E, Garcia-Campelo R, Balaña C. The biology of non-small-cell lung cancer: identifying new targets for rational therapy. Lung Cancer 2004; 46:135-48. [PMID: 15474661 DOI: 10.1016/j.lungcan.2004.04.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Revised: 04/13/2004] [Accepted: 04/29/2004] [Indexed: 01/21/2023]
Abstract
Lung cancer, and in particular non-small-cell lung cancer (NSCLC), remains the leading cause of cancer death throughout the world. Almost three decades ago, the major concern was to identify whether cisplatin or cisplatin-based chemotherapy enhanced survival in metastatic NSCLC, and whether any survival benefit compensated for cisplatin-related toxicity. Over the last 10 years, significant advances have been achieved in molecular biology, including the identification of critical genes related to the pathogenesis of NSCLC, which have formed the basis for new targeted therapeutic approaches. These new approaches include novel agents against established chemotherapeutic targets such as thymidylate synthetase as well as agents that inhibit novel targets such as growth factor receptors and proteins important in angiogenesis. With the advent of genomic technologies that can identify patterns of gene expression, the hope is that therapy will be tailored to the genetic pattern of the patients's tumor, and individualized treatments that minimize toxicity and maximize efficacy can be developed.
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Affiliation(s)
- R Rosell
- Medical Oncology Service, Hospital Germans Trias i Pujol, Ctra Canyet, s/n 08916 Barcelona, Spain.
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Lopez-Pousa A, Buesa J, Casado A, Garcia Del Muro J, Poveda A, Maurel J, Martin J, Balaña C, Martinez J. Doxorubicin (DXR) and prolonged infusion gemcitabine (GMC) as first-line treatment in advanced soft tissue sarcomas (STS). A phase II trial of the Spanish Group for Research in Sarcomas (GEIS). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Lopez-Pousa
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
| | - J. Buesa
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
| | - A. Casado
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
| | - J. Garcia Del Muro
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
| | - A. Poveda
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
| | - J. Maurel
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
| | - J. Martin
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
| | - C. Balaña
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
| | - J. Martinez
- Hospital Sant Pau, Barcelona, Spain; Hospital Central, Oviedo, Spain; Hospital San Carlos, Madrid, Spain; ICO, Hospitalet, Spain; IVO, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Hospital Son Dureta, Mallorca, Spain; Hospital Germans Trias, Badalona, Spain; Hospital Miguel Servet, Zaragoza, Spain
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Balaña C, Manzano JL, Moreno I, Cirauqui B, Abad A, Font A, Mate JL, Rosell R. A phase II study of cisplatin, etoposide and gemcitabine in an unfavourable group of patients with carcinoma of unknown primary site. Ann Oncol 2003; 14:1425-9. [PMID: 12954583 DOI: 10.1093/annonc/mdg361] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this phase II study was to determine toxicity, response rate, time to progression, and overall survival of cisplatin, etoposide and gemcitabine in patients with carcinoma of unknown primary tumour site. PATIENTS AND METHODS Thirty patients with no previous chemotherapy and not belonging to a treatable group were treated with cisplatin 70 mg/m(2) on day 1, etoposide 70 mg/m(2) on days 1 and 2, and gemcitabine 700 mg m(2) on days 1 and 8, administered every 3 weeks. Stable or responding patients received a maximum of eight cycles. Twenty patients (67%) had more than three affected sites, and 25 patients (84%) had adenocarcinomas. RESULTS Overall response rate was 36.6% (11 patients), including four complete responses (13.3%) and seven partial responses (23.3%), with a 95% confidence interval of 19.9-56. Median survival was 7.21 months and eight patients remained alive for >1 year. Myelosuppression was the most important toxicity, with grade 3-4 neutropenia in 18 patients (60%) in 32% of the cycles: eight patients had neutropenic fever and 10 patients had thrombopenia in 11% of cycles. No non-haematological grade 4 toxicity occurred. CONCLUSIONS Cisplatin, etoposide and gemcitabine is an active combination, inducing objective responses in a subset of heavily advanced disease patients with carcinoma of unknown primary site. The role of adding gemcitabine to cisplatin and etoposide remains to be resolved as to the best schedule to diminish toxicity for the three-drug combination.
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Affiliation(s)
- C Balaña
- Medical Oncology Service, Pathology Service, Hospital Germans Trias i Pujol, Barcelona, Spain.
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Ramirez JL, Taron M, Balaña C, Sarries C, Mendez P, de Aguirre I, Nuñez L, Roig B, Queralt C, Botia M, Rosell R. Serum DNA as a tool for cancer patient management. Rocz Akad Med Bialymst 2003; 48:34-41. [PMID: 14737938] [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] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE Genetic analysis has shown that cell-free circulating DNA in plasma or serum of cancer patients shares similar genetic alterations to those described in the corresponding tumor. One of the most important alterations involved in carcinogenesis is aberrant promoter methylation. The interest in this field has grown due to the implementation of the methylation-specific PCR (MSP) assay. The main objective of this study is to analyze the methylation status of different genes in tumor and serum DNA obtained at the time of surgery in two different tumor models (glioblastoma [GBM] and non-small-cell lung cancer [NSCLC]) and their relationship to clinico-pathological characteristics and response to chemotherapy. MATERIAL AND METHODS Using MSP assay, we assessed the methylation status of MGMT, RASSF1A, p16, DAPK, TMS-1 in tumor and serum DNA obtained at time of surgery or stereotactic biopsy from 28 GBM patients and from 51 NSCLC patients. RESULTS In GBM patients, the prevalence of MGMT, p16, DAPK, and RASSF1A promoter methylation was 38.1%, 66.7%, 52.4%, 57.1%, respectively, in glioma tissue, and 39.3%, 53.6%, 34.3%, 50%, respectively, in serum. A high correlation between methylation in tumor and serum (Spearman test p = 0.0001) was observed. In NSCLC patients, RASSF1A, DAPK and TMS-1 were methylated in 34%, 45% and 35% tumors, respectively, and in 34%, 40% and 34% serum, respectively. A good correlation was found between alterations found in tumor and serum (Spearman test p = 0.0001). CONCLUSIONS The study of serum or plasma DNA has opened new roads for translational research and new strategies for molecular diagnosis. Due to the similarities of alterations found in serum DNA and primary tumor, we can use this tool to calculate the risk of local or distant recurrence and its relationship with survival and its value in patient follow-up to evaluate response to therapy.
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Affiliation(s)
- J L Ramirez
- Medical Oncology Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916 Badalona, Barcelona, Spain
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Vallejos V, Balaña C, Fraile M, Roussos Y, Capellades J, Cuadras P, Ballester R, Ley A, Arellano A, Rosell R. Use of 201Tl SPECT imaging to assess the response to therapy in patients with high grade gliomas. J Neurooncol 2002; 59:81-90. [PMID: 12222842 DOI: 10.1023/a:1016389119399] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To assess the potential role of 201Tl single photon emission tomography (201-Thallium SPECT) when compared to other imaging modalities in the evaluation of the response to therapy in high grade gliomas. MATERIALS AND METHODS Twenty patients with histologically proved high grade glioma have been included: 15 with glioblastoma (GBM), 3 with anaplastic astrocytoma (AA) and 2 with anaplastic oligoastrocytoma (AOA). Patients were assessed by 201Tl SPECT, computed tomography (CT) and magnetic resonance imaging (MRI) at (a) either at the moment of maximum response to first line chemotherapy, or after the completion of radiotherapy and chemotherapy if post-surgical residual disease was present, and (b) after the completion of second line chemotherapy if disease persisted, or either a relapse or disease progression was confirmed. Final response was evaluated according to the McDonald criteria, and by comparing SPECT, CT and MRI results. RESULTS According to the McDonald criteria, clinical response after first line chemotherapy was 5 partial response, 7 stable disease and 8 progressive disease. Evaluation by 201Tl SPECT was in agreement with such criteria in nearly all patients (90%). MRI findings closely agreed with the clinical follow-up. CT findings clearly differed from those observed by SPECT and MRI. After second line therapy, 10 patients progressed, 3 had stable disease and 7 had partial response. 201Tl SPECT agreed with the clinical status in 89% cases, whereas MRI and, specially CT, fared significantly lower. CONCLUSION Compared to conventional neuroimaging, 201Tl SPECT added valuable information in the assessment of the response to therapy in our patient population; whenever findings were not conclusive and in the case of disagreement between CT and MRI findings.
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Affiliation(s)
- V Vallejos
- Department of Nuclear Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Balaña C, Margelí M, Manzano J, Moran T, Font A, Abad A, Rosell R. Phase II of cisplatin (CDDP), etoposide (VP16) and gemcitabine (G) in cancer of unknown primary (CUP). Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81386-1] [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: 10/26/2022]
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Font A, Taron M, Ramirez J, Margeli M, Areal J, Barnadas A, Balaña C, Saladié J, Abad A, Rosell R. Prognostic value of circulating extracellular DNA in bladder cancer patients. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81307-1] [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: 11/25/2022]
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Abstract
Ifosfamide has been used in combination with several drugs including cisplatin, giving rise to multiple doublets and triplets including the ifosfamide-cisplatin-mitomycin regimen (Cullen's MIC regimen) that has been commonly used in Europe. However, new combinations are challenging the activity of the old chemotherapy regimens, especially in terms of objective response rate and time to progressive disease, as has been shown in several phase III randomized trials. Among these new combinations, ifosfamide-vinorelbine and ifosfamide-gemcitabine-cisplatin are especially promising. In this paper, several ifosfamide doublets and triplets are reviewed.
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Affiliation(s)
- R Rosell
- Medical Oncology Service, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Balaña C, Massuti B, Minguell J, Talavera J, Sánchez B, Pico C. [Induction chemotherapy in the treatment of head and neck cancer in advanced stages]. Acta Otorrinolaringol Esp 1992; 43:61-6. [PMID: 1581100] [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: 12/27/2022]
Abstract
Fifty patients with inoperable head and neck carcinomas were treated with Cisplatin-5-fluorouracil induction chemotherapy. After 3 years follow-up, characteristics of patients have been studied, that is: age, sex, stage, primary site, histological type, histological grade and performance status. The analysis of chemotherapy treatment and results on primary tumor and lymphatic areas are presented. A total response rate of 83.3% with 22.9% of complete response rate have been observed. Local treatment after chemotherapy is studied. Radiotherapy increased response in 33.4% of cases. Response duration and survival is to have a complete response after systemic and local treatment. Literature is revised.
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Affiliation(s)
- C Balaña
- Oncología Médica, Hospital General de Alicante
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Villar A, Antón E, Jimeno J, Aranda E, Balaña C, Massuti B, Lizón J, Carrato A, Belón J, Candel MT, Del Moral F, González R, Guaraz R. Fractionated high doses (HD) of epirubicin (E) in adenocarcinoma of the lung (ADL). Lung Cancer 1991. [DOI: 10.1016/0169-5002(91)91804-k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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