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Wen PY, van den Bent M, Youssef G, Cloughesy TF, Ellingson BM, Weller M, Galanis E, Barboriak DP, de Groot J, Gilbert MR, Huang R, Lassman AB, Mehta M, Molinaro AM, Preusser M, Rahman R, Shankar LK, Stupp R, Villanueva-Meyer JE, Wick W, Macdonald DR, Reardon DA, Vogelbaum MA, Chang SM. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults. J Clin Oncol 2023; 41:5187-5199. [PMID: 37774317 PMCID: PMC10860967 DOI: 10.1200/jco.23.01059] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE The Response Assessment in Neuro-Oncology (RANO) criteria for high-grade gliomas (RANO-HGG) and low-grade gliomas (RANO-LGG) were developed to improve reliability of response assessment in glioma trials. Over time, some limitations of these criteria were identified, and challenges emerged regarding integrating features of the modified RANO (mRANO) or the immunotherapy RANO (iRANO) criteria. METHODS Informed by data from studies evaluating the different criteria, updates to the RANO criteria are proposed (RANO 2.0). RESULTS We recommend a standard set of criteria for both high- and low-grade gliomas, to be used for all trials regardless of the treatment modalities being evaluated. In the newly diagnosed setting, the postradiotherapy magnetic resonance imaging (MRI), rather than the postsurgical MRI, will be used as the baseline for comparison with subsequent scans. Since the incidence of pseudoprogression is high in the 12 weeks after radiotherapy, continuation of treatment and confirmation of progression during this period with a repeat MRI, or histopathologic evidence of unequivocal recurrent tumor, are required to define tumor progression. However, confirmation scans are not mandatory after this period nor for the evaluation of treatment for recurrent tumors. For treatments with a high likelihood of pseudoprogression, mandatory confirmation of progression with a repeat MRI is highly recommended. The primary measurement remains the maximum cross-sectional area of tumor (two-dimensional) but volumetric measurements are an option. For IDH wild-type glioblastoma, the nonenhancing disease will no longer be evaluated except when assessing response to antiangiogenic agents. In IDH-mutated tumors with a significant nonenhancing component, clinical trials may require evaluating both the enhancing and nonenhancing tumor components for response assessment. CONCLUSION The revised RANO 2.0 criteria refine response assessment in gliomas.
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Affiliation(s)
- Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Martin van den Bent
- Department Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Timothy F. Cloughesy
- UCLA Brain Tumor Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Benjamin M. Ellingson
- UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | | | - John de Groot
- Division of Neuro-Oncology, Department of Neurosurgery, University of California, San Francisco, CA
| | - Mark R. Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Raymond Huang
- Division of Neuro-radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Andrew B. Lassman
- Division of Neuro-Oncology, Department of Neurology, Herbert Irving Comprehensive Cancer Center and Irving Institute for Clinical and Translational Research, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY
| | | | - Annette M. Molinaro
- Division of Biomedical Statistics and Informatics, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Rifaquat Rahman
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lalitha K. Shankar
- Clinical Trials Branch, Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Roger Stupp
- Malnati Brain Tumor Institute, Lurie Comprehensive Cancer Center and Departments of Neurological Surgery, Neurology and Division of Hematology/Oncology, Northwestern University, Chicago, IL
| | | | - Wolfgang Wick
- Department of Neurology Heidelberg University Hospital & Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David R. Macdonald
- Departments of Clinical Neurological Sciences and Oncology (Emeritus), Western University, London, Ontario, Canada
| | - David A. Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Michael A. Vogelbaum
- Departments of Neuro-Oncology and Neurosurgery, Moffitt Cancer Center, Tampa, FL
| | - Susan M. Chang
- Division of Neuro-Oncology, Department of Neurosurgery, University of California, San Francisco, CA
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2
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Lassman AB, Hoang-Xuan K, Polley MYC, Brandes AA, Cairncross JG, Kros JM, Ashby LS, Taphoorn MJ, Souhami L, Dinjens WN, Laack NN, Kouwenhoven MC, Fink KL, French PJ, Macdonald DR, Lacombe D, Won M, Gorlia T, Mehta MP, van den Bent MJ. Joint Final Report of EORTC 26951 and RTOG 9402: Phase III Trials With Procarbazine, Lomustine, and Vincristine Chemotherapy for Anaplastic Oligodendroglial Tumors. J Clin Oncol 2022; 40:2539-2545. [PMID: 35731991 PMCID: PMC9362869 DOI: 10.1200/jco.21.02543] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/24/2022] [Accepted: 05/11/2022] [Indexed: 11/20/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the basis of the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Anaplastic oligodendroglial tumors (AOTs) are chemotherapy-sensitive brain tumors. We report the final very long-term survival results from European Organization for the Research and Treatment of Cancer 26951 and Radiation Therapy Oncology Group 9402 phase III trials initiated in 1990s, which both studied radiotherapy with/without neo/adjuvant procarbazine, lomustine, and vincristine (PCV) for newly diagnosed anaplastic oligodendroglial tumors. The median follow-up duration in both was 18-19 years. For European Organization for the Research and Treatment of Cancer 26951, median, 14-year, and probable 20-year overall survival rates without versus with PCV were 2.6 years, 13.4%, and 10.1% versus 3.5 years, 25.1%, and 16.8% (N = 368 overall; hazard ratio [HR] 0.78; 95% CI, 0.63 to 0.98; P = .033), with 1p19q codeletion 9.3 years, 26.2%, and 13.6% versus 14.2 years, 51.0%, and 37.1% (n = 80; HR 0.60; 95% CI, 0.35 to 1.03; P = .063), respectively. For Radiation Therapy Oncology Group 9402, analogous results were 4.8 years, 16.5%, and 11.2% versus 4.8 years, 29.1%, and 24.6% (N = 289 overall; HR 0.79; 95% CI, 0.61 to 1.03; P = .08), with codeletion 7.3 years, 25.0%, and 14.9% versus 13.2 years, 46.1%, and 37% (n = 125; HR 0.61; 95% CI, 0.40 to 0.94; P = .02), respectively. With that, the studies show similar long-term survival even without tumor recurrence in a significant proportion of patients after first-line treatment with radiotherapy/PCV.
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Affiliation(s)
- Andrew B. Lassman
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Herbert Irving Comprehensive Cancer Center, New York, NY
- NewYork-Presbyterian Hospital, New York, NY
| | - Khê Hoang-Xuan
- AP-HP, Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2, Paris, France
| | - Mei-Yin C. Polley
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Alba A. Brandes
- Department of Medical Oncology, AUSL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Johan M. Kros
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | | | - Martin J.B. Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, the Hague, the Netherlands
| | - Luis Souhami
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Winand N.M. Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Nadia N. Laack
- Mayo Clinic Accruals for Rochester Methodist Hospital, Rochester, MN
| | - Mathilde C.M. Kouwenhoven
- Department of Neurology, Amsterdam Universities Medical Centers, location VUmc, Amsterdam, the Netherlands
| | | | - Pim J. French
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
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3
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Fleming JL, Pugh SL, Fisher BJ, Lesser GJ, Macdonald DR, Bell EH, McElroy JP, Becker AP, Timmers CD, Aldape KD, Rogers CL, Doyle TJ, Werner-Wasik M, Bahary JP, Yu HHM, D'Souza DP, Laack NN, Sneed PK, Kwok Y, Won M, Mehta MP, Chakravarti A. Long-Term Report of a Comprehensive Molecular and Genomic Analysis in NRG Oncology/RTOG 0424: A Phase II Study of Radiation and Temozolomide in High-Risk Grade II Glioma. JCO Precis Oncol 2021; 5:PO.21.00112. [PMID: 34589661 PMCID: PMC8462570 DOI: 10.1200/po.21.00112] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/18/2021] [Accepted: 07/27/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE This study sought to determine the prognostic significance of the WHO-defined glioma molecular subgroups along with additional alterations, including MGMT promoter methylation and mutations in ATRX, CIC, FUBP1, TERT, and TP53, in NRG/RTOG 0424 using long-term follow-up data. METHODS Mutations were determined using an Ion Torrent sequencing panel. 1p/19q co-deletion and MGMT promoter methylation were determined by Affymetrix OncoScan and Illumina 450K arrays. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and tested using the log-rank test. Hazard ratios were calculated using the Cox proportional hazard model. Multivariable analyses (MVAs) included patient pretreatment characteristics. RESULTS We obtained complete molecular data to categorize 80/129 eligible patients within the WHO subgroups. Of these, 26 (32.5%) were IDHmutant/co-deleted, 28 (35%) were IDHmutant/non-co-deleted, and 26 (32.5%) were IDHwild-type. Upon single-marker MVA, both IDHmutant subgroups were associated with significantly better OS and PFS (P values < .001), compared with the IDHwild-type subgroup. MGMT promoter methylation was obtained on 76 patients, where 58 (76%) were methylated and 18 (24%) were unmethylated. Single-marker MVAs demonstrated that MGMT promoter methylation was statistically significant for OS (P value < .001) and PFS (P value = .003). In a multimarker MVA, one WHO subgroup comparison (IDHmutant/co-deleted v IDHwild-type) was significant for OS (P value = .045), whereas MGMT methylation did not retain significance. CONCLUSION This study reports the long-term prognostic effect of the WHO molecular subgroups, MGMT promoter methylation, and other mutations in NRG/RTOG 0424. These results demonstrate that the WHO molecular classification and MGMT both serve as strong prognostic indicators, but that MGMT does not appear to add statistically significant prognostic value to the WHO subgrouping, above and beyond IDH and 1p/19q status.
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Affiliation(s)
| | - Stephanie L. Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | | | | | - Erica H. Bell
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Aline P. Becker
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - C. Leland Rogers
- Barrow Neurological Institute, Phoenix, AZ (accruals under Arizona Oncology Services Foundation)
| | | | | | - Jean-Paul Bahary
- Centre Hospitalier de l`université De Montréal, Montreal, QC, Canada
| | | | | | | | | | - Young Kwok
- University of Maryland/Greenebaum Cancer Center, Baltimore, MA
| | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
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Climans SA, Macdonald DR, Sutherland DE, Mason WP. Prolonged response to vismodegib in a patient with systemic medulloblastoma metastases. BMJ Case Rep 2020; 13:13/10/e236406. [PMID: 33122230 DOI: 10.1136/bcr-2020-236406] [Citation(s) in RCA: 3] [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] [Indexed: 11/04/2022] Open
Abstract
Some patients with metastatic medulloblastoma can be successfully treated with targeted therapy. We report the case of a 42-year-old woman who was diagnosed with sonic hedgehog (SHH)-subgroup medulloblastoma. She was treated with surgery, radiation and chemotherapy. She then developed bone pain. A positron emission tomography (PET) scan confirmed widespread bone metastases from her medulloblastoma. She was started on vismodegib, an oral smoothened inhibitor that targets her tumour type. Her bone pain resolved. A repeat PET scan showed resolution of almost all metastases. Fourteen months after starting vismodegib, her disease recurred and she was transitioned to temozolomide chemotherapy. We document an important case of prolonged response to vismodegib in a patient with systemic SHH-subgroup medulloblastoma metastases.
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Affiliation(s)
- Seth A Climans
- Department of Medicine, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David R Macdonald
- Department of Medical Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Duncan Ek Sutherland
- Department of Medical Imaging, London Health Sciences Centre, London, Ontario, Canada
| | - Warren P Mason
- Department of Medicine, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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5
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Bell EH, Pugh SL, Fisher BJ, Lesser GJ, Macdonald DR, Fleming JL, McElroy JP, Becker AP, Rogers CL, Doyle TJ, Werner-Wasik M, Bahary JP, Yu M, D'Souza D, Laack NN, Sneed PP, Kwok Y, Howard SP, Mehta MP, Chakravarti A. Long-term analysis of the WHO-defined molecular subgroups of high-risk grade II gliomas treated with radiation and temozolomide on NRG Oncology/RTOG 0424. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2518] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2518 Background: This study sought to evaluate the prognostic significance of the three WHO-defined molecular glioma subgroups ( IDHwt, IDHmt/non-codel, and IDHmt/codel) in NRG Oncology/RTOG 0424, a phase II trial of high-risk low-grade gliomas treated with radiation (RT) and concurrent and adjuvant temozolomide (TMZ) after biopsy/surgical resection. Notably, this is the first clinical study to evaluate the prognostic value of the WHO subgroups in RT + TMZ-treated high-risk grade II (G2) gliomas using prospectively-collected long-term survival data. Methods: IDH1/2 mutation status was determined by next-generation sequencing. 1p/19q co-deletion status was determined by Oncoscan and/or 450K methylation data. Overall survival (OS) and progression-free survival (PFS) by marker status were determined by the Cox proportional hazard model and tested using the log-rank test in a post-hoc analysis. Patient pre-treatment characteristics were included as covariates in multivariate analyses. Results: Of all the eligible patients (N=129), 80 (62%) had sufficient quality DNA for both IDH and 1p/19q analyses. Of these 80, 54 (67.5%) were IDHmt, and 26 (32.5%) were IDHwt. Of the 54 IDHmt patients, 26 (32.5% of total, 48% of IDHmt) were IDHmt/codel, and 28 (35% of total, 52% of IDHmt) were IDHmt/non-codel. Both IDHmt subgroups were significantly correlated with longer PFS ( IDHmt/co-del = 8.1yrs (5.2-not reached (NR)); IDHmt/non-codel = 7.5yrs (3.9-11.8); IDHwt = 1.0yr (0.6-1.7), p<0.001) and OS ( IDHmt/co-del = 9.4yrs (8.2-NR); IDHmt/non-codel = 8.8yrs (5.9-NR); IDHwt = 2.3yrs (1.4-3.4), p<0.001) relative to the IDHwt subgroup. Upon univariate and multivariate analyses, both molecular IDHmt subgroup comparisons relative to IDHwt remained significant (p<0.001) even after incorporation of known clinical variables. Conclusions: These analyses suggest that G2 glioma patients harboring IDH1/2 mutations, regardless of co-deletion status, demonstrated longer survival with RT + TMZ relative to IDHwt tumors, although sample size is limited and analyses were post-hoc. These results also support the notion that outcomes for IDHwt high-risk G2 gliomas remain dismal (median = 2.3yrs, similar to G3 anaplastic astrocytoma); these patients should be separated from IDHmt patients in future G2 glioma trials, and warrant novel treatment strategies. Funding: U10CA180868, U10CA180822, U24CA196067, CURE, PA Dept. of Health, and Merck. Also, R01CA108633, R01CA169368, RC2CA148190, U10CA180850, BTFC, OSUCCC (all to AC). Clinical trial information: NCT00114140 .
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Affiliation(s)
| | - Stephanie L. Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | - Jean-Paul Bahary
- Centre Hospitalier Universitaire de Montreal, Montreal, QC, Canada
| | - Michael Yu
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - David D'Souza
- Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | | | | | - Young Kwok
- University of Maryland Medical Center, Baltimore, MD
| | - Steven P. Howard
- Univ of Wisconsin School of Medcn and Public Health, Madison, WI
| | - Minesh P. Mehta
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
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6
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Fisher BJ, Pugh SL, Macdonald DR, Chakravatri A, Lesser GJ, Fox S, Rogers CL, Werner-Wasik M, Doyle T, Bahary JP, Fiveash JB, Bovi JA, Howard SP, Michael Yu HH, D'Souza D, Laack NN, Barani IJ, Kwok Y, Wahl DR, Strasser JF, Won M, Mehta MP. Phase 2 Study of a Temozolomide-Based Chemoradiation Therapy Regimen for High-Risk, Low-Grade Gliomas: Long-Term Results of Radiation Therapy Oncology Group 0424. Int J Radiat Oncol Biol Phys 2020; 107:720-725. [PMID: 32251755 DOI: 10.1016/j.ijrobp.2020.03.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To report the long-term outcomes of the RTOG 0424 study of a high-risk, low-grade glioma population treated with concurrent and adjuvant temozolomide (TMZ) and radiation therapy (RT). METHODS AND MATERIALS For this single-arm, phase 2 study, patients with low-grade gliomas with ≥3 risk factors (age ≥40 years, astrocytoma, bihemispheric tumor, size ≥6 cm, or preoperative neurologic function status >1) received RT (54 Gy in 30 fractions) with TMZ and up to 12 cycles of post-RT TMZ. The initial primary endpoint P was overall survival (OS) at 3 years after registration. Secondary endpoints included progression-free survival (PFS) and the association of survival outcomes with methylation status. The initial 3-year report of this study was published in 2015. RESULTS The study accrued 136 patients, of whom 129 were analyzable. The median follow-up for surviving patients was 9.0 years. The 3-year OS was 73.5% (95% confidence interval, 65.8%-81.1%), numerically superior to the 3-year OS historical control of 54% (P < .001). The median survival time was 8.2 years (95% confidence interval, 5.6-9.1). Five- and 10-year OS rates were 60.9% and 34.6%, respectively, and 5- and 10-year PFS rates were 46.8% and 25.5%, respectively. CONCLUSIONS The long-term results confirmed the findings from the initial report for efficacy, suggesting OS and PFS outcomes with the RT-TMZ regimen exceeded historical control groups treated with radiation alone. Toxicity was acceptable.
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Affiliation(s)
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | - Glenn J Lesser
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina
| | - Sherry Fox
- Cullather Brain Tumor Quality of Life Center, Richmond, Virginia
| | | | | | | | - Jean-Paul Bahary
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - John B Fiveash
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Joseph A Bovi
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - David D'Souza
- London Regional Cancer Program, London, Ontario, Canada
| | | | - Igor J Barani
- UCSF Medical Center - Mount Zion, San Francisco, California
| | - Young Kwok
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Daniel R Wahl
- University of Michigan Medical Center, Ann Arbor, Michigan
| | - Jon F Strasser
- Christiana Care Health Services, Inc, Wilmington, Delaware
| | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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7
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Bell EH, Zhang P, Fisher BJ, Macdonald DR, McElroy JP, Lesser GJ, Fleming J, Chakraborty AR, Liu Z, Becker AP, Fabian D, Aldape KD, Ashby LS, Werner-Wasik M, Walker EM, Bahary JP, Kwok Y, Yu HM, Laack NN, Schultz CJ, Gray HJ, Robins HI, Mehta MP, Chakravarti A. Association of MGMT Promoter Methylation Status With Survival Outcomes in Patients With High-Risk Glioma Treated With Radiotherapy and Temozolomide: An Analysis From the NRG Oncology/RTOG 0424 Trial. JAMA Oncol 2019; 4:1405-1409. [PMID: 29955793 DOI: 10.1001/jamaoncol.2018.1977] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance The initial report of NRG Oncology/Radiation Therapy Oncology Group (RTOG) 0424 demonstrated a 3-year overall survival benefit with the addition of temozolomide to radiotherapy compared with a historical control. However, an important end point of the trial-evaluation of the association between O6-methylgaunine-DNA-methyltransferase (MGMT) promoter methylation and survival outcomes-was not previously reported. Objective To examine the proportion of patients in NRG Oncology/RTOG 0424 with MGMT promoter methylation and its association with survival outcomes. Design, Setting, and Participants Specimens collected were analyzed after trial completion to determine MGMT promoter methylation and IDH1/2 status and the association between MGMT status and survival outcomes. A model derived from logistic regression (MGMT-STP27) was used to calculate MGMT promoter methylation status. Univariate and multivariable analyses were performed using the Cox proportional hazards regression model to determine the association of MGMT status with survival outcomes. Patient pretreatment characteristics were included as covariates in multivariable analyses. Main Outcomes and Measures Progression-free survival (PFS) and overall survival (OS). Results Of all 129 eligible patients in NRG Oncology/RTOG 0424, 75 (58.1%) had MGMT status available (median age, 48 years; age range, 20-76 years; 42 [56.0%] male): 57 (76.0%) methylated and 18 (24.0%) unmethylated. A total of 13 unmethylated patients (72.2%) had astrocytoma as opposed to oligoastrocytoma or oligodendroglioma, whereas 23 methylated patients (40.4%) had astrocytoma. On univariate analyses, an unmethylated MGMT promoter was significantly associated with worse OS (hazard ratio [HR], 3.52; 95% CI, 1.64-7.56; P < .001) and PFS (HR, 3.06; 95% CI, 1.55-6.04; P < .001). The statistical significances were maintained in multimarker multivariable analyses, including IDH1/2 status for both OS (HR, 2.70; 95% CI, 1.02-7.14; P = .045) and PFS (HR, 2.74; 95% CI, 1.19-6.33; P = .02). Conclusions and Relevance In this study, MGMT promoter methylation was an independent prognostic biomarker of high-risk, low-grade glioma treated with temozolomide and radiotherapy. This is the first study, to our knowledge, to validate the prognostic importance of MGMT promoter methylation in patients with grade II glioma treated with combined radiotherapy and temozolomide and highlights its potential prognostic value beyond IDH1/2 mutation status. Trial Registration ClinicalTrials.gov Identifier: NCT00114140.
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Affiliation(s)
- Erica H Bell
- Department of Radiation Oncology, The Ohio State University, Columbus
| | - Peixin Zhang
- Statistics and Data Management Center, NRG Oncology, Philadelphia, Pennsylvania
| | - Barbara J Fisher
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - David R Macdonald
- Department of Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Joseph P McElroy
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Glenn J Lesser
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jessica Fleming
- Department of Radiation Oncology, The Ohio State University, Columbus
| | | | - Ziyan Liu
- Department of Radiation Oncology, The Ohio State University, Columbus
| | - Aline P Becker
- Department of Radiation Oncology, The Ohio State University, Columbus
| | - Denise Fabian
- Department of Radiation Oncology, The Ohio State University, Columbus
| | - Kenneth D Aldape
- Department of Pathology, Toronto General Hospital/Princess Margaret, Toronto, Ontario, Canada
| | - Lynn S Ashby
- Department of Neurology, St Joseph's Hospital and Medical Center-Accruals Arizona Oncology Services Foundation, Phoenix
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan
| | - Jean-Paul Bahary
- Department of Radiation Oncology, Centre Hospitalier de L`Université de Montréal-Notre Dame, Montreal, Quebec, Canada
| | - Young Kwok
- Department of Radiation Oncology, University of Maryland Medical Systems, Baltimore
| | - H Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Heidi J Gray
- Department of Obstetrics and Gynecology, University of Washington Medical Center-Accruals University of California San Francisco, Seattle
| | - H Ian Robins
- Departments of Medicine, Human Oncology and Neurology, University of Wisconsin Hospital, Madison
| | - Minesh P Mehta
- Department of Radiation Oncology, Baptist Hospital of Miami, Miami, Florida
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University, Columbus
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Megyesi JF, Macdonald DR. P14.111 Successful treatment of extensive metastatic disease with successive use of two different EGF receptor antagonists: case report and review of the literature. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.346] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
EGFR-targeted agents can be useful in the treatment of systemic metastatic cancer including that which has spread to the brain. We present the case of a patient with two different EGFR mutations that responded to receptor blockade.
CASE REPORT
A 38 year old right-handed female presented with a one week history of progressive left-sided weakness and focal seizures. Neuroimaging revealed multiple enhancing brain lesions and a lesion in the left maxillary antrum. Body imaging revealed a right lung mass, hilar and mediastinal nodes and multiple bony lesions. Biopsy of the maxillary antrum lesion showed metastatic poorly differentiated adenocarcinoma, TTF-1 positive, suggesting a lung primary. ALK was not mutated but there was an EGFR mutation (exon 19 deletion). The patient underwent treatment with dexamethasone, levetiracetam, whole brain radiation and afatinib, an oral EGFR-targeted agent. Most of the brain lesions responded completely with only two small residual lesions. Seizures were controlled. There was major partial response from the systemic lesions. Two years later the patient was clinically well but the lung lesion, mediastinal nodes and bony lesions were all enlarging. A new pituitary lesion was identified on brain MRI. A liquid biopsy (blood) revealed a T790M mutation and the patient underwent stereotactic body radiation and EGFR-targeted therapy with osimertinib. All lesions responded to treatment and four years after initial diagnosis the patient is clinically well with stable disease.
DISCUSSION
Successful treatment of widespread metastatic disease is possible with the use of multiple EGFR-targeted agents in certain patients.
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Affiliation(s)
- J F Megyesi
- University of Western Ontario, London, ON, Canada
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9
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Camidge DR, Lee EQ, Lin NU, Margolin K, Ahluwalia MS, Bendszus M, Chang SM, Dancey J, de Vries EGE, Harris GJ, Hodi FS, Lassman AB, Macdonald DR, Peereboom DM, Schiff D, Soffietti R, van den Bent MJ, Wefel JS, Wen PY. Clinical trial design for systemic agents in patients with brain metastases from solid tumours: a guideline by the Response Assessment in Neuro-Oncology Brain Metastases working group. Lancet Oncol 2018; 19:e20-e32. [PMID: 29304358 DOI: 10.1016/s1470-2045(17)30693-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/24/2017] [Accepted: 08/22/2017] [Indexed: 12/30/2022]
Abstract
Patients with active CNS disease are often excluded from clinical trials, and data regarding the CNS efficacy of systemic agents are usually obtained late in the drug development process or not at all. In this guideline from the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) working group, we provide detailed recommendations on when patients with brain metastases from solid tumours should be included or excluded in clinical trials of systemic agents. We also discuss the limitations of retrospective studies in determining the CNS efficacy of systemic drugs. Inclusion of patients with brain metastases early on in the clinical development of a drug or a regimen is needed to generate appropriate CNS efficacy or non-efficacy signals. We consider how to optimally incorporate or exclude such patients in systemic therapy trials depending on the likelihood of CNS activity of the agent by considering three scenarios: drugs that are considered very unlikely to have CNS antitumour activity or efficacy; drugs that are considered very likely to have CNS activity or efficacy; and drugs with minimal baseline information on CNS activity or efficacy. We also address trial design issues unique to patients with brain metastases, including the selection of appropriate CNS endpoints in systemic therapy trials.
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Affiliation(s)
- D Ross Camidge
- Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kim Margolin
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Manmeet S Ahluwalia
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Susan M Chang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Janet Dancey
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Netherlands
| | - Gordon J Harris
- Department of Radiology, 3D Imaging Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew B Lassman
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Columbia University, NY, USA
| | - David R Macdonald
- Department of Oncology and Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - David M Peereboom
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - David Schiff
- Division of Neuro-Oncology, University of Virginia, Charlottesville, VA, USA
| | - Ricardo Soffietti
- Department of Neurology/Neuro-Oncology, University of Turin, Turin, Italy
| | | | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Arvold ND, Armstrong TS, Warren KE, Chang SM, DeAngelis LM, Blakeley J, Chamberlain MC, Dunbar E, Loong HH, Macdonald DR, Reardon DA, Vogelbaum MA, Yuan Y, Weller M, van den Bent M, Wen PY. Corticosteroid use endpoints in neuro-oncology: Response Assessment in Neuro-Oncology Working Group. Neuro Oncol 2018; 20:897-906. [PMID: 29788429 PMCID: PMC6007454 DOI: 10.1093/neuonc/noy056] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Corticosteroids are the mainstay of treatment for peritumor edema but are often associated with significant side effects. Therapies that can reduce corticosteroid use would potentially be of significant benefit to patients. However, currently there are no standardized endpoints evaluating corticosteroid use in neuro-oncology clinical trials. Methods The Response Assessment in Neuro-Oncology (RANO) Working Group has developed consensus recommendations for endpoints evaluating corticosteroid use in clinical trials in both adults and children with brain tumors. Results Responders are defined as patients with a 50% reduction in total daily corticosteroid dose compared with baseline or reduction of the total daily dose to ≤2 mg of dexamethasone (or equivalent dose of other corticosteroid); baseline dose must be at least 4 mg of dexamethasone daily (or equivalent dose of other corticosteroids) for at least one week. Patients must have stable or improved Neurologic Assessment in Neuro-Oncology (NANO) score or Karnofsky performance status score or Eastern Cooperative Oncology Group (ECOG) (Lansky score for children age <16 y), and an improved score on a relevant clinical outcome assessment tool. These criteria must be sustained for at least 4 weeks after baseline assessment to be considered a response, and are confirmed 4 weeks after that (ie, 8 wk after baseline assessment) to be considered a sustained response. Conclusions This RANO proposal for corticosteroid use endpoints in neuro-oncology clinical trials may need to be refined and will require prospective validation in clinical studies.
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Affiliation(s)
- Nils D Arvold
- St Luke’s Radiation Oncology Associates, St Luke’s Cancer Center, University of Minnesota, Duluth, Minnesota, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Katherine E Warren
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Susan M Chang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Lisa M DeAngelis
- Department of Neuro-Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaishri Blakeley
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Erin Dunbar
- Piedmont Brain Tumor Center, Atlanta, Georgia, USA
| | - Herbert H Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - David R Macdonald
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael A Vogelbaum
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Martin van den Bent
- Brain Tumor Institute at Erasmus University Medical Center, Rotterdam, Netherlands
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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11
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Lau JC, Kosteniuk SE, Macdonald DR, Megyesi JF. Image-guided Ommaya reservoir insertion for intraventricular chemotherapy: a retrospective series. Acta Neurochir (Wien) 2018; 160:539-544. [PMID: 29305723 DOI: 10.1007/s00701-017-3454-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 08/31/2017] [Accepted: 12/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ayub Ommaya proposed a surgical technique for subcutaneous reservoir and pump placement in 1963 to allow access to intraventricular cerebrospinal fluid (CSF). Currently, the most common indication for Ommaya reservoir insertion (ORI) in adults is for patients with hematologic or leptomeningeal disorders requiring repeated injection of chemotherapy into the CSF space. Historically, the intraventricular catheter has been inserted blindly based on anatomical landmarks. The purpose of this study was to examine short-term complication rates with ORI with image guidance (IG) and without image guidance (non-IG). METHODS We retrospectively evaluated all operative cases of ORI from 2000 to 2014 by the senior author. Patient demographic data, surgical outcomes, and peri-operative complications were collected. Accurate placement and early (30-day) morbidity or mortality were considered primary outcomes. RESULTS Fifty-five consecutive patients underwent ORI by the senior author over the study period (43.5 ± 16.6 years; 40.0% female). Indications for placement included acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and leptomeningeal carcinomatosis. There were seven (12.7%) total complications: three (37.5%) with no-IG versus four (8.5%) with IG. Catheter malpositions were significantly higher in the non-IG group at 37.5% compared to 2.1%. Catheters were also more likely to require multiple passes with non-IG at 25% compare to 0% with IG. There were no early infections in either group. CONCLUSIONS We demonstrate improved accuracy and decreased complications using an image-guided approach compared with a traditional approach. Our results support routine use of intra-operative image guidance for proximal catheter insertion in elective ORI for intraventricular chemotherapy.
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Affiliation(s)
- Jonathan C Lau
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.
- London Health Sciences Centre, University Hospital, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
| | - Suzanne E Kosteniuk
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - David R Macdonald
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
- London Regional Cancer Program, London, Ontario, Canada
| | - Joseph F Megyesi
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
- Department of Pathology, Western University, London, Ontario, Canada
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12
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Abstract
Development of novel therapies for CNS tumors requires reliable assessment of response and progression. This requirement has been particularly challenging in neuro-oncology for which contrast enhancement serves as an imperfect surrogate for tumor volume and is influenced by agents that affect vascular permeability, such as antiangiogenic therapies. In addition, most tumors have a nonenhancing component that can be difficult to accurately quantify. To improve the response assessment in neuro-oncology and to standardize the criteria that are used for different CNS tumors, the Response Assessment in Neuro-Oncology (RANO) working group was established. This multidisciplinary international working group consists of neuro-oncologists, medical oncologists, neuroradiologists, neurosurgeons, radiation oncologists, neuropsychologists, and experts in clinical outcomes assessments, working in collaboration with government and industry to enhance the interpretation of clinical trials. The RANO working group was originally created to update response criteria for high- and low-grade gliomas and to address such issues as pseudoresponse and nonenhancing tumor progression from antiangiogenic therapies, and pseudoprogression from radiochemotherapy. RANO has expanded to include working groups that are focused on other tumors, including brain metastases, leptomeningeal metastases, spine tumors, pediatric brain tumors, and meningiomas, as well as other clinical trial end points, such as clinical outcomes assessments, seizures, corticosteroid use, and positron emission tomography imaging. In an effort to standardize the measurement of neurologic function for clinical assessment, the Neurologic Assessment in Neuro-Oncology scale was drafted. Born out of a workshop conducted by the Jumpstarting Brain Tumor Drug Development Coalition and the US Food and Drug Administration, a standardized brain tumor imaging protocol now exists to reduce variability and improve reliability. Efforts by RANO have been widely accepted and are increasingly being used in neuro-oncology trials, although additional refinements will be needed.
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Affiliation(s)
- Patrick Y. Wen
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Susan M. Chang
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Martin J. Van den Bent
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Michael A. Vogelbaum
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - David R. Macdonald
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Eudocia Q. Lee
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
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13
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Nayak L, DeAngelis LM, Brandes AA, Peereboom DM, Galanis E, Lin NU, Soffietti R, Macdonald DR, Chamberlain M, Perry J, Jaeckle K, Mehta M, Stupp R, Muzikansky A, Pentsova E, Cloughesy T, Iwamoto FM, Tonn JC, Vogelbaum MA, Wen PY, van den Bent MJ, Reardon DA. The Neurologic Assessment in Neuro-Oncology (NANO) scale: a tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria. Neuro Oncol 2017; 19:625-635. [PMID: 28453751 PMCID: PMC5464449 DOI: 10.1093/neuonc/nox029] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [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] [Indexed: 11/13/2022] Open
Abstract
Background The Macdonald criteria and the Response Assessment in Neuro-Oncology (RANO) criteria define radiologic parameters to classify therapeutic outcome among patients with malignant glioma and specify that clinical status must be incorporated and prioritized for overall assessment. But neither provides specific parameters to do so. We hypothesized that a standardized metric to measure neurologic function will permit more effective overall response assessment in neuro-oncology. Methods An international group of physicians including neurologists, medical oncologists, radiation oncologists, and neurosurgeons with expertise in neuro-oncology drafted the Neurologic Assessment in Neuro-Oncology (NANO) scale as an objective and quantifiable metric of neurologic function evaluable during a routine office examination. The scale was subsequently tested in a multicenter study to determine its overall reliability, inter-observer variability, and feasibility. Results The NANO scale is a quantifiable evaluation of 9 relevant neurologic domains based on direct observation and testing conducted during routine office visits. The score defines overall response criteria. A prospective, multinational study noted a >90% inter-observer agreement rate with kappa statistic ranging from 0.35 to 0.83 (fair to almost perfect agreement), and a median assessment time of 4 minutes (interquartile range, 3-5). Conclusion The NANO scale provides an objective clinician-reported outcome of neurologic function with high inter-observer agreement. It is designed to combine with radiographic assessment to provide an overall assessment of outcome for neuro-oncology patients in clinical trials and in daily practice. Furthermore, it complements existing patient-reported outcomes and cognition testing to combine for a global clinical outcome assessment of well-being among brain tumor patients.
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Affiliation(s)
- Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL-IRCCS Institute of Neurological Science, Bologna, Italy
| | - David M Peereboom
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Riccardo Soffietti
- Department of Neurology and Neuro-Oncology, University of Turin, Turin, Italy
| | - David R Macdonald
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Marc Chamberlain
- Department of Neurology, Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, University of Washington School of Medicine, Seattle, Washington, USA
| | - James Perry
- Division of Neurology, Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada
| | - Kurt Jaeckle
- Department of Neurology and Hematology/Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Minesh Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - Roger Stupp
- Department of Oncology, University of Zurich, Zurich, Switzerland
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elena Pentsova
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Timothy Cloughesy
- Neuro-Oncology Program, Ronald Reagan UCLA Medical Center, University of CaliforniaLos Angeles, Los Angeles, California, USA
| | - Fabio M Iwamoto
- Division of Neuro-Oncology, Neurological Institute of New York College of Physicians and Surgeons, Columbia University, New York, USA
| | | | - Michael A Vogelbaum
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Martin J van den Bent
- Neuro-Oncology Unit, Erasmus MC Cancer Center, Erasmus MC, Rotterdam, The Netherlands
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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14
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Cloughesy T, Finocchiaro G, Belda-Iniesta C, Recht L, Brandes AA, Pineda E, Mikkelsen T, Chinot OL, Balana C, Macdonald DR, Westphal M, Hopkins K, Weller M, Bais C, Sandmann T, Bruey JM, Koeppen H, Liu B, Verret W, Phan SC, Shames DS. Randomized, Double-Blind, Placebo-Controlled, Multicenter Phase II Study of Onartuzumab Plus Bevacizumab Versus Placebo Plus Bevacizumab in Patients With Recurrent Glioblastoma: Efficacy, Safety, and Hepatocyte Growth Factor and O6-Methylguanine–DNA Methyltransferase Biomarker Analyses. J Clin Oncol 2017; 35:343-351. [DOI: 10.1200/jco.2015.64.7685] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Bevacizumab regimens are approved for the treatment of recurrent glioblastoma in many countries. Aberrant mesenchymal-epithelial transition factor (MET) expression has been reported in glioblastoma and may contribute to bevacizumab resistance. The phase II study GO27819 investigated the monovalent MET inhibitor onartuzumab plus bevacizumab (Ona + Bev) versus placebo plus bevacizumab (Pla + Bev) in recurrent glioblastoma. Methods At first recurrence after chemoradiation, bevacizumab-naïve patients with glioblastoma were randomly assigned 1:1 to receive Ona (15 mg/kg, once every 3 weeks) + Bev (15 mg/kg, once every 3 weeks) or Pla + Bev until disease progression. The primary end point was progression-free survival by response assessment in neuro-oncology criteria. Secondary end points were overall survival, objective response rate, duration of response, and safety. Exploratory biomarker analyses correlated efficacy with expression levels of MET ligand hepatocyte growth factor, O6-methylguanine–DNA methyltransferase promoter methylation, and glioblastoma subtype. Results Among 129 patients enrolled (Ona + Bev, n = 64; Pla + Bev, n = 65), baseline characteristics were balanced. The median progression-free survival was 3.9 months for Ona + Bev versus 2.9 months for Pla + Bev (hazard ratio, 1.06; 95% CI, 0.72 to 1.56; P = .7444). The median overall survival was 8.8 months for Ona + Bev and 12.6 months for Pla + Bev (hazard ratio, 1.45; 95% CI, 0.88 to 2.37; P = .1389). Grade ≥ 3 adverse events were reported in 38.5% of patients who received Ona + Bev and 35.9% of patients who received Pla + Bev. Exploratory biomarker analyses suggested that patients with high expression of hepatocyte growth factor or unmethylated O6-methylguanine–DNA methyltransferase may benefit from Ona + Bev. Conclusion There was no evidence of further clinical benefit with the addition of onartuzumab to bevacizumab compared with bevacizumab plus placebo in unselected patients with recurrent glioblastoma in this phase II study; however, further investigation into biomarker subgroups is warranted.
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Affiliation(s)
- Timothy Cloughesy
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Gaetano Finocchiaro
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Cristóbal Belda-Iniesta
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Lawrence Recht
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Alba A. Brandes
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Estela Pineda
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Tom Mikkelsen
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Olivier L. Chinot
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Carmen Balana
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - David R. Macdonald
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Manfred Westphal
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Kirsten Hopkins
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Michael Weller
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Carlos Bais
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Thomas Sandmann
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Jean-Marie Bruey
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Hartmut Koeppen
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Bo Liu
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Wendy Verret
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - See-Chun Phan
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - David S. Shames
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
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15
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Lau JC, Macdonald DR, Megyesi J. BMET-33. MORBIDITY AND MORTALITY OF OMMAYA RESERVOIR PLACEMENT FOR INTRAVENTRICULAR CHEMOTHERAPY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Abstract
INTRODUCTION The post-treatment monitoring of glioma patients remains an area of active research and development. Conventional imaging with MRI is a highly sensitive modality for detecting and monitoring primary and secondary brain tumors and includes multi-parametric sequences to better characterize the disease. Standardized schemes for measuring response to treatment are in wide clinical use; however, the introduction of new therapeutics have introduced new patterns of response that can confound interpretation of conventional MRI and can cause uncertainty in the proper management following therapy. Areas covered: A summary of current and evolving techniques for assessing glioma response in this era of new therapies that address these challenges are presented in this review. While this review focuses more on clinical and early clinical methodologies for MRI and nuclear medicine techniques some promising pre-clinical techniques are also presented. Expert commentary: While successful single institution results have been widely reported in the literature, any new methodologies must be undertaken in multi-center settings. Additionally, the need for standardization of protocols in quantitative measured are an important area that must be addressed for new and promising techniques to be implemented to a wide array of patients.
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Affiliation(s)
- Jean-Guy Belliveau
- a Department of Medical Biophysics , University of Western Ontario , London , ON , Canada
| | - Glenn Bauman
- b Department of Medical Biophysics and Oncology , University of Western Ontario , London , ON , Canada
| | - David R Macdonald
- c Department of Oncology , University of Western Ontario , London , ON , Canada
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17
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Wolf A, Alghefari H, Krivosheya D, Staudt MD, Bowden G, Macdonald DR, Goobie S, Ramsay D, Hebb MO. Cerebellar liponeurocytoma: a rare intracranial tumor with possible familial predisposition. Case report. J Neurosurg 2016; 125:57-61. [DOI: 10.3171/2015.6.jns142965] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The biological origin of cerebellar liponeurocytomas is unknown, and hereditary forms of this disease have not been described. Here, the authors present clinical and histopathological findings of a young patient with a cerebellar liponeurocytoma who had multiple immediate family members who harbored similar intracranial tumors. A 37-year-old otherwise healthy woman presented with a history of progressive headaches. Lipomatous medulloblastoma had been diagnosed previously in her mother and maternal grandfather, and her maternal uncle had a supratentorial liponeurocytoma. MRI revealed a large, poorly enhancing, lipomatous mass emanating from the superior vermis that produced marked compression of posterior fossa structures. An uncomplicated supracerebellar infratentorial approach was used to resect the lesion. Genetic and histopathological analyses of the lesion revealed neuronal, glial, and lipomatous differentiation and confirmed the diagnosis of cerebellar liponeurocytoma. A comparison of the tumors resected from the patient and, 22 years previously, her mother revealed similar features. Cerebellar liponeurocytoma is a poorly understood entity. This report provides novel evidence of an inheritable predisposition for tumor development. Accurate diagnosis and reporting of clinical outcomes and associated genetic and histopathological changes are necessary for guiding prognosis and developing recommendations for patient care.
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Affiliation(s)
- Amparo Wolf
- Departments of 1Clinical Neurological Sciences,
| | | | | | | | | | | | - Sharan Goobie
- 4Pediatrics, London Health Sciences Centre, London Regional Cancer Centre, and Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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18
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Chang SM, Wen PY, Vogelbaum MA, Macdonald DR, van den Bent MJ. Response Assessment in Neuro-Oncology (RANO): more than imaging criteria for malignant glioma. Neurooncol Pract 2015; 2:205-209. [PMID: 31386074 PMCID: PMC6664617 DOI: 10.1093/nop/npv037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/11/2015] [Indexed: 12/12/2022] Open
Abstract
The introduction of antiangiogenic therapies for the treatment of malignant glioma and the effect of these agents on standard imaging studies were the stimuli for forming a small group of investigators to critically evaluate the limitations of the Macdonald criteria in assessing response to treatment. The initial goal of this group was to highlight the challenges in accurately determining the efficacy of therapeutic interventions for malignant glioma and to develop new criteria that could be implemented in clinical care as well as in the design and conduct of clinical trials. This initial Response Assessment in Neuro-Oncology (RANO) effort started in 2008 and over the last 7 years, it has expanded to include a critical review of response assessment across several tumor types as well as endpoint selection and trial design to improve outcome criteria for neuro-oncological trials. In this paper, we review the overarching principles of the RANO initiative and the efforts to date. We also highlight the diverse and expanding efforts of the multidisciplinary groups of investigators who have volunteered their time as part of this endeavor.
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Affiliation(s)
- Susan M. Chang
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Patrick Y. Wen
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Michael A. Vogelbaum
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - David R. Macdonald
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Martin J. van den Bent
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
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Vogelbaum MA, Hu C, Peereboom DM, Macdonald DR, Giannini C, Suh JH, Jenkins RB, Laack NN, Brachman DG, Shrieve DC, Souhami L, Mehta MP. Phase II trial of pre-irradiation and concurrent temozolomide in patients with newly diagnosed anaplastic oligodendrogliomas and mixed anaplastic oligoastrocytomas: long term results of RTOG BR0131. J Neurooncol 2015; 124:413-20. [PMID: 26088460 DOI: 10.1007/s11060-015-1845-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022]
Abstract
We report on the long-term results of a phase II study of pre-irradiation temozolomide followed by concurrent temozolomide and radiotherapy (RT) in patients with newly diagnosed anaplastic oligodendroglioma (AO) and mixed anaplastic oligoastrocytoma. Pre-RT temozolomide was given for up to 6 cycles. RT with concurrent temozolomide was administered to patients with less than a complete radiographic response. Forty eligible patients were entered and 32 completed protocol treatment. With a median follow-up time of 8.7 years (range 1.1-10.1), median progression-free survival (PFS) is 5.8 years (95 % CI 2.0, NR) and median overall survival (OS) has not been reached (5.9, NR). 1p/19q data are available in 37 cases; 23 tumors had codeletion while 14 tumors had no loss or loss of only 1p or 19q (non-codeleted). In codeleted patients, 9 patients have progressed and 4 have died; neither median PFS nor OS have been reached and two patients who received only pre-RT temozolomide and no RT have remained progression-free for over 7 years. 3-year PFS and 6-year OS are 78 % (95 % CI 61-95 %) and 83 % (95 % CI 67-98 %), respectively. Codeleted patients show a trend towards improved 6-year survival when compared to the codeleted procarbazine/CCNU/vincristrine (PCV) and RT cohort in RTOG 9402 (67 %, 95 % CI 55-79 %). For non-codeleted patients, median PFS and OS are 1.3 and 5.8 years, respectively. These updated results suggest that the regimen of dose intense, pre-RT temozolomide followed by concurrent RT/temozolomide has significant activity, particularly in patients with 1p/19q codeleted AOs and MAOs.
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Affiliation(s)
- Michael A Vogelbaum
- Cleveland Clinic Foundation, 9500 Euclid Avenue, ND40, Cleveland, OH, 44195, USA.
| | - Chen Hu
- RTOG Statistical Center, 1818 Market Street, Suite 1600, Philadelphia, PA, 19103, USA
| | - David M Peereboom
- Cleveland Clinic Foundation, 9500 Euclid Avenue, ND40, Cleveland, OH, 44195, USA
| | - David R Macdonald
- University of Western Ontario London Regional Cancer Centre, 790 Commissioners Road East, London, ON, N6A 4L6, Canada
| | | | - John H Suh
- Cleveland Clinic Foundation, 9500 Euclid Avenue, ND40, Cleveland, OH, 44195, USA
| | | | - Nadia N Laack
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David G Brachman
- Arizona Oncology Services Foundation, PO Box 41700, Phoenix, AZ, 85080, USA
| | - Dennis C Shrieve
- University of Utah Health Science Center, 1950 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Luis Souhami
- McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Minesh P Mehta
- University of Maryland, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA
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Lin NU, Lee EQ, Aoyama H, Barani IJ, Barboriak DP, Baumert BG, Bendszus M, Brown PD, Camidge DR, Chang SM, Dancey J, de Vries EGE, Gaspar LE, Harris GJ, Hodi FS, Kalkanis SN, Linskey ME, Macdonald DR, Margolin K, Mehta MP, Schiff D, Soffietti R, Suh JH, van den Bent MJ, Vogelbaum MA, Wen PY. Response assessment criteria for brain metastases: proposal from the RANO group. Lancet Oncol 2015; 16:e270-8. [PMID: 26065612 DOI: 10.1016/s1470-2045(15)70057-4] [Citation(s) in RCA: 599] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
CNS metastases are the most common cause of malignant brain tumours in adults. Historically, patients with brain metastases have been excluded from most clinical trials, but their inclusion is now becoming more common. The medical literature is difficult to interpret because of substantial variation in the response and progression criteria used across clinical trials. The Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) working group is an international, multidisciplinary effort to develop standard response and progression criteria for use in clinical trials of treatment for brain metastases. Previous efforts have focused on aspects of trial design, such as patient population, variations in existing response and progression criteria, and challenges when incorporating neurological, neuro-cognitive, and quality-of-life endpoints into trials of patients with brain metastases. Here, we present our recommendations for standard response and progression criteria for the assessment of brain metastases in clinical trials. The proposed criteria will hopefully facilitate the development of novel approaches to this difficult problem by providing more uniformity in the assessment of CNS metastases across trials.
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Affiliation(s)
- Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hidefumi Aoyama
- Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Igor J Barani
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Daniel P Barboriak
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Brigitta G Baumert
- Department of Radiation-Oncology, MediClin Robert Janker Clinic & University of Bonn Medical Centre, Cooperation Unit Neuro-oncology, Bonn, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Paul D Brown
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Ross Camidge
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Denver, CO, USA
| | - Susan M Chang
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Janet Dancey
- NCIC Clinical Trials Group, Ontario Institute for Cancer Research, Queen's University, Kingston, ON, Canada
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, RB Groningen, Netherlands
| | - Laurie E Gaspar
- Department of Radiation Oncology, The Anschutz Medical Campus, University of Colorado Denver, Aurora, CO, USA
| | - Gordon J Harris
- MGH 3D Imaging Lab, Massachusetts General Hospital, Boston, MA, USA
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Mark E Linskey
- Department of Neurological Surgery, University of California, San Francisco, CA, USA; UC Irvine Medical Center, Orange, CA, USA
| | - David R Macdonald
- Department of Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Kim Margolin
- Division of Oncology, Stanford University, Stanford, CA, USA
| | - Minesh P Mehta
- Maryland Proton Treatment Center, University of Maryland School of Medicine, Baltimore, MA, USA
| | - David Schiff
- Division of Neuro-Oncology, University of Virginia, Charlottesville, VA, USA
| | - Riccardo Soffietti
- Department of Neurology/Neuro-Oncology, University of Turin, Turin, Italy
| | - John H Suh
- Department of Radiation Oncology/T28, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Martin J van den Bent
- Neuro-Oncology Unit, Daniel den Hoed Cancer Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Michael A Vogelbaum
- Department of Neurosurgery/ND40, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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21
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Cloughesy TF, Finocchiaro G, Belda C, Recht L, Brandes AA, Pineda E, Mikkelsen T, Chinot OL, Balana C, Macdonald DR, Westphal M, Hopkins K, Weller M, Liu B, Bruey JM, Verret W. Onartuzumab plus bevacizumab versus placebo plus bevacizumab in recurrent glioblastoma (GBM): HGF and MGMT biomarker data. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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)
| | | | - Cristobal Belda
- Centro Integral Oncológico Clara Campal, University Hospital MN Sanchinarro, Madrid, Spain
| | | | | | | | | | - Olivier L. Chinot
- Aix-Marseille University, Department of Neuro-Oncology, University Hospital La Timone, Marseille, France
| | - Carmen Balana
- Institut Catala Oncologia. Hospital Germans Trias I Pujol, Badalona/Barcelona, Spain
| | | | | | - Kirsten Hopkins
- Bristol Haematology and Oncology Center, Bristol, United Kingdom
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Bo Liu
- Genentech, Inc., San Francisco, CA
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22
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Fisher BJ, Hu C, Macdonald DR, Lesser GJ, Coons SW, Brachman DG, Ryu S, Werner-Wasik M, Bahary JP, Liu J, Chakravarti A, Mehta M. Phase 2 study of temozolomide-based chemoradiation therapy for high-risk low-grade gliomas: preliminary results of Radiation Therapy Oncology Group 0424. Int J Radiat Oncol Biol Phys 2015; 91:497-504. [PMID: 25680596 DOI: 10.1016/j.ijrobp.2014.11.012] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/06/2014] [Accepted: 11/10/2014] [Indexed: 01/03/2023]
Abstract
PURPOSE Radiation Therapy Oncology Group (RTOG) 0424 was a phase 2 study of a high-risk low-grade glioma (LGG) population who were treated with temozolomide (TMZ) and radiation therapy (RT), and outcomes were compared to those of historical controls. This study was designed to detect a 43% increase in median survival time (MST) from 40.5 to 57.9 months and a 20% improvement in 3-year overall survival (OS) rate from 54% to 65% at a 10% significance level (1-sided) and 96% power. METHODS AND MATERIALS Patients with LGGs with 3 or more risk factors for recurrence (age ≥40 years, astrocytoma histology, bihemispherical tumor, preoperative tumor diameter of ≥6 cm, or a preoperative neurological function status of >1) were treated with RT (54 Gy in 30 fractions) and concurrent and adjuvant TMZ. RESULTS From 2005 to 2009, 129 evaluable patients (75 males and 54 females) were accrued. Median age was 49 years; 91% had a Zubrod score of 0 or 1; and 69%, 25%, and 6% of patients had 3, 4, and 5 risk factors, respectively. Patients had median and minimum follow-up examinations of 4.1 years and 3 years, respectively. The 3-year OS rate was 73.1% (95% confidence interval: 65.3%-80.8%), which was significantly improved compared to that of prespecified historical control values (P<.001). Median survival time has not yet been reached. Three-year progression-free survival was 59.2%. Grades 3 and 4 adverse events occurred in 43% and 10% of patients, respectively. One patient died of herpes encephalitis. CONCLUSIONS The 3-year OS rate of 73.1% for RTOG 0424 high-risk LGG patients is higher than that reported for historical controls (P<.001) and the study-hypothesized rate of 65%.
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Affiliation(s)
| | - Chen Hu
- Radiation Therapy Oncology Group-Statistical Center, Philadelphia, Pennsylvania
| | | | - Glenn J Lesser
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | | | | | | | | | - Jean-Paul Bahary
- Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal, Quebec, Canada
| | | | | | - Minesh Mehta
- University of Maryland Medical Systems, Baltimore, Maryland
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Pitz MW, Eisenhauer EA, MacNeil MV, Thiessen B, Easaw JC, Macdonald DR, Eisenstat DD, Kakumanu AS, Salim M, Chalchal H, Squire J, Tsao MS, Kamel-Reid S, Banerji S, Tu D, Powers J, Hausman DF, Mason WP. Phase II study of PX-866 in recurrent glioblastoma. Neuro Oncol 2015; 17:1270-4. [PMID: 25605819 DOI: 10.1093/neuonc/nou365] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 10/16/2014] [Accepted: 12/26/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most aggressive malignancy of the central nervous system in adults. Increased activity of the phosphatidylinositol-3-OH kinase (PI3K) signal transduction pathway is common. We performed a phase II study using PX-866, an oral PI3K inhibitor, in participants with recurrent GBM. METHODS Patients with histologically confirmed GBM at first recurrence were given oral PX-866 at a dose of 8 mg daily. An MRI and clinical exam were done every 8 weeks. Tissue was analyzed for potential predictive markers. RESULTS Thirty-three participants (12 female) were enrolled. Median age was 56 years (range 35-78y). Eastern Cooperative Oncology Group performance status was 0-1 in 29 participants and 2 in the remainder. Median number of cycles was 1 (range 1-8). All participants have discontinued therapy: 27 for disease progression and 6 for toxicity (5 liver enzymes and 1 allergic reaction). Four participants had treatment-related serious adverse events (1 liver enzyme, 1 diarrhea, 2 venous thromboembolism). Other adverse effects included fatigue, diarrhea, nausea, vomiting, and lymphopenia. Twenty-four participants had a response of progression (73%), 1 had partial response (3%, and 8 (24%) had stable disease (median, 6.3 months; range, 3.1-16.8 months). Median 6-month progression-free survival was 17%. None of the associations between stable disease and PTEN, PIK3CA, PIK3R1, or EGFRvIII status were statistically significant. CONCLUSIONS PX-866 was relatively well tolerated. Overall response rate was low, and the study did not meet its primary endpoint; however, 21% of participants obtained durable stable disease. This study also failed to identify a statistically significant association between clinical outcome and relevant biomarkers in patients with available tissue.
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Affiliation(s)
- Marshall W Pitz
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Elizabeth A Eisenhauer
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Mary V MacNeil
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Brian Thiessen
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Jacob C Easaw
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - David R Macdonald
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - David D Eisenstat
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Ankineedu S Kakumanu
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Muhammad Salim
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Haji Chalchal
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Jeremy Squire
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Ming Sound Tsao
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Suzanne Kamel-Reid
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Shantanu Banerji
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Dongsheng Tu
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Jean Powers
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Diana F Hausman
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
| | - Warren P Mason
- CancerCare Manitoba, Winnipeg, Canada (M.W.P., S.B.); Queen's University, Department of Oncology, Kingston, Canada (E.A.E.); Dalhousie University,Halifax, Canada (M.V.M.); BritishColumbia Cancer Agency, Vancouver, Canada (B.T.); Tom Baker Cancer Centre, Calgary, Canada (J.C.E.); London Regional Cancer Program, London, Canada (D.R.M.); University of Alberta, Edmonton, Canada (D.D.E.); Allan Blair Cancer Center, Regina, Canada (A.S.K., M.S., H.C.); Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (J.S.); Department of Pathology, University Health Network, University of Toronto, Toronto, Canada (M.S.T., S.K.-R.); NCIC Clinical Trials Group, Queen's University, Kingston, Canada (D.T., J.P.); Oncothyreon, Inc., Seattle, Washington (D.F.H.); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (W.P.M.)
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Lin NU, Lee EQ, Aoyama H, Barani IJ, Baumert BG, Brown PD, Camidge DR, Chang SM, Dancey J, Gaspar LE, Harris GJ, Hodi FS, Kalkanis SN, Lamborn KR, Linskey ME, Macdonald DR, Margolin K, Mehta MP, Schiff D, Soffietti R, Suh JH, van den Bent MJ, Vogelbaum MA, Wefel JS, Wen PY. Challenges relating to solid tumour brain metastases in clinical trials, part 1: patient population, response, and progression. A report from the RANO group. Lancet Oncol 2013; 14:e396-406. [PMID: 23993384 DOI: 10.1016/s1470-2045(13)70311-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Therapeutic outcomes for patients with brain metastases need to improve. A critical review of trials specifically addressing brain metastases shows key issues that could prevent acceptance of results by regulatory agencies, including enrolment of heterogeneous groups of patients and varying definitions of clinical endpoints. Considerations specific to disease, modality, and treatment are not consistently addressed. Additionally, the schedule of CNS imaging and consequences of detection of new or progressive brain metastases in trials mainly exploring the extra-CNS activity of systemic drugs are highly variable. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, collaborative effort to improve the design of trials in patients with brain tumours. In this two-part series, we review the state of clinical trials of brain metastases and suggest a consensus recommendation for the development of criteria for future clinical trials.
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Affiliation(s)
- Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Chinot OL, Macdonald DR, Abrey LE, Zahlmann G, Kerloëguen Y, Cloughesy TF. Response assessment criteria for glioblastoma: practical adaptation and implementation in clinical trials of antiangiogenic therapy. Curr Neurol Neurosci Rep 2013; 13:347. [PMID: 23529375 PMCID: PMC3631110 DOI: 10.1007/s11910-013-0347-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since 1990, the primary criteria used for assessing response to therapy in high-grade gliomas were those developed by Macdonald and colleagues, which incorporated 2-dimensional area measurements of contrast-enhancing tumor regions, corticosteroid dosing, and clinical assessment to arrive at a designation of response, stable disease, or progression. Recent advances in imaging technology and targeted therapeutics, however, have exposed limitations of the Macdonald criteria and have highlighted the need for reevaluation of response assessment criteria. In 2010, the Response Assessment in Neuro-Oncology (RANO) Working Group published updated criteria to address this need and to standardize response assessment for high-grade gliomas. In 2009, prior to the publication of the RANO criteria, the randomized, placebo-controlled, multicenter, phase 3 AVAglio trial was designed and initiated to investigate the effectiveness of radiotherapy and temozolomide with or without bevacizumab in newly diagnosed glioblastoma. The AVAglio protocol enacted specific measures to adapt the Macdonald criteria to the frontline treatment setting and to antiangiogenic agent evaluation, including the incorporation of a T2/fluid-attenuated inversion recovery component, qualitative assessment of irregularly shaped contrast-enhancing lesions, and a decision tree for confirming or ruling out pseudoprogression. Moreover, the protocol outlines practical means by which these adapted response criteria can be implemented in the clinic. This article describes the evolution of radiographic response criteria for high-grade gliomas and highlights the similarities and differences between those implemented in the AVAglio study and those subsequently published by RANO.
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Affiliation(s)
- Olivier L Chinot
- Aix-Marseille University, AP-HM, Service de Neuro-Oncologie, CHU Timone, 264 Rue Saint Pierre, 13005, Marseille, France.
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Lin NU, Wefel JS, Lee EQ, Schiff D, van den Bent MJ, Soffietti R, Suh JH, Vogelbaum MA, Mehta MP, Dancey J, Linskey ME, Camidge DR, Aoyama H, Brown PD, Chang SM, Kalkanis SN, Barani IJ, Baumert BG, Gaspar LE, Hodi FS, Macdonald DR, Wen PY. Challenges relating to solid tumour brain metastases in clinical trials, part 2: neurocognitive, neurological, and quality-of-life outcomes. A report from the RANO group. Lancet Oncol 2013; 14:e407-16. [PMID: 23993385 DOI: 10.1016/s1470-2045(13)70308-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Neurocognitive function, neurological symptoms, functional independence, and health-related quality of life are major concerns for patients with brain metastases. The inclusion of these endpoints in trials of brain metastases and the methods by which these measures are assessed vary substantially. If functional independence or health-related quality of life are planned as key study outcomes, then the reliability and validity of these endpoints can be crucial because methodological issues might affect the interpretation and acceptance of findings. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, and collaborative effort to improve the design of clinical trials in patients with brain tumours. In this report, the second in a two-part series, we review clinical trials of brain metastases in relation to measures of clinical benefit and provide a framework for the design and conduct of future trials.
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Affiliation(s)
- Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Bady P, Sciuscio D, Diserens AC, Bloch J, van den Bent MJ, Marosi C, Dietrich PY, Weller M, Mariani L, Heppner FL, Macdonald DR, Lacombe D, Stupp R, Delorenzi M, Hegi ME. Erratum to: MGMT methylation analysis of glioblastoma on the Infinium methylation BeadChip identifies two distinct CpG regions associated with gene silencing and outcome, yielding a prediction model for comparisons across datasets, tumor grades, and CIMP-status. Acta Neuropathol 2013. [PMCID: PMC4079675 DOI: 10.1007/s00401-013-1134-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Pierre Bady
- />Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
- />Bioinformatics Core Facility, Swiss Institute for Bioinformatics, Lausanne, Switzerland
- />Département de Formation et de recherche, Lausanne University Hospital, Lausanne, Switzerland
| | - Davide Sciuscio
- />Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Annie-Claire Diserens
- />Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Jocelyne Bloch
- />Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | - Michael Weller
- />Department of Neurology, University of Tübingen, Tübingen, Germany
- />Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Luigi Mariani
- />Department of Neurosurgery, Inselspital Berne, Berne, Switzerland
| | - Frank L. Heppner
- />Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - David R. Macdonald
- />Neurology and Neuro-Oncology, London Regional Cancer Program London Health Sciences Centre, University of Western Ontario, London, ON Canada
| | | | - Roger Stupp
- />Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Mauro Delorenzi
- />Bioinformatics Core Facility, Swiss Institute for Bioinformatics, Lausanne, Switzerland
- />Département de Formation et de recherche, Lausanne University Hospital, Lausanne, Switzerland
- />National Center of Competence in Research Molecular Oncology, ISREC-SV-EPFL, Lausanne, Switzerland
| | - Monika E. Hegi
- />Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
- />Department of Neurosurgery, Laboratory of Brain Tumor Biology and Genetics, Centre Hospitalier Universitaire Vaudois (CHUV BH19-110), 46 rue du Bugnon, Lausanne, 1011 Switzerland
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Fisher BJ, Lui J, Macdonald DR, Lesser GJ, Coons S, Brachman D, Ryu S, Werner-Wasik M, Bahary JP, Hu C, Mehta MP. A phase II study of a temozolomide-based chemoradiotherapy regimen for high-risk low-grade gliomas: Preliminary results of RTOG 0424. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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
2008 Background: The primary endpoint of RTOG 0424 was to compare the 3-year survival (OS) of a regimen of concurrent and adjuvant temozolomide (TMZ) and radiotherapy (RT) in a high-risk low-grade glioma (LGG) population to the 3 year (yr) OS rate of the high risk EORTC LGG patients (pts) reported by Pignatti et al (J Clin Oncol 2002;20(8):2076-84). Secondary endpoints were: progression-free survival (PFS), toxicity, neurocognitive and quality of life data and molecular analysis. Methods: Pts with LGG's and >=3 high risk factors (age> = 40, astrocytoma dominant histology, tumor crossing midline, tumor > = 6 cm or preoperative neurological function status >1) were eligible and treated with conformal RT (54 Gy/30 fractions) plus concurrent TMZ 75 mg/m2 /day for 6 weeks and post-RT TMZ 150-200 mg/m2/day days 1-5 q28 days for up to 12 cycles. The study was designed to detect a 43% increase in median survival time (MST) from 40.5 to 57.9 months, and a 20% improvement in 3 yr OS rate from 54% to 65%, at a 10% significance level (1 sided) and 96% power. Results: Between January 2005-August 2009 136 pts were accrued, 129 (75 males, 54 females) were evaluable. Median age was 49 years, 91% had a Zubrod score 0-1 and 69%, 25% and 6% of pts had 3,4 and 5 high risk factors respectively. With a median follow-up time of 4.1 yrs, minimum follow-up of 3 yrs, MST has not yet been reached. Three year OS rate was 73.1% (95%CI:65.3-80.8%), significantly improved from historical control with a p-value <0.0001. No difference in OS rates for pts with 3, 4 or 5 high risk factors was seen. 3 year PFS was 59.2% (95% CI:50.7-67.8%). Grade 3 adverse events (AE) occurred in 43% of pts and grade 4 AE in 10%, primarily hematologic, constitutional or gastrointestinal (nausea, anorexia) toxicity. One patient died of herpes encephalitis. Secondary analyses are ongoing. Radiation Quality Assurance was per protocol/ acceptable in 95% and 74% of pts completed chemotherapy per protocol. Conclusions: The 3 year OS rate of 73.1% for these high risk LGG pts is significantly higher than those reported for historical controls (54%, p < 0.0001, one-sided) and the study-hypothesized 65%. Supported by RTOG U10 CA21661 and CCOP U10 CA37422 grants from NCI and Merck Clinical trial information: NCT00114140.
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Affiliation(s)
- Barbara Jean Fisher
- Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Jeff Lui
- Radiation Therapy Oncology Group, Philadelphia, PA
| | | | | | | | | | | | | | - Jean-Paul Bahary
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Chen Hu
- Radiation Therapy Oncology Group, Philadelphia, PA
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Pitz MW, Eisenhauer EA, MacNeil MV, Thiessen B, Macdonald DR, Easaw JC, Eisenstat DD, Kakumanu AS, Squire J, Tsao MS, Kamel-Reid S, Tassignon A, Hausman DF, Mason WP. Phase II study of PX-866 in recurrent glioblastoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2053] [Citation(s) in RCA: 2] [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
2053 Background: Glioblastoma (GBM) is the most aggressive malignancy of the central nervous system. The majority have genetic changes that increase the activity of the phosphatidylinositol-3-OH kinase (PI3K) signal transduction pathway, critical for cell motility, proliferation, and survival. We present the results of PX-866, an oral PI3K inhibitor, in patients (pts) with recurrent GBM. Methods: A multinomial design of response and early progression (< 8 weeks on study) was used. In stage 1 (15 pts), 0 responses and ≥ 10 early progressions would stop accrual; after full accrual, ≥ 4 responses OR ≤ 13 early progressions was prespecified as of interest. Pts with histologically confirmed GBM, at first recurrence after chemoradiation and adjuvant temozolomide were given PX-866 8 mg daily on this single-arm phase II study. MRI and clinical exam were done every cycle (8 weeks). Tumour tissue was collected for analysis of potential markers of PI3K inhibitory activity (PTEN, EGFRviii, PIK3CA mutations). Results: A total of 33 pts were enrolled, eligible and evaluable. Median age was 56 (range 35-78), 12 were female; 29 had performance status (PS) 0-1 and 4 had PS 2. Median time from initial diagnosis to enrolment was 308 days (range 141-1256). Median number of cycles was 1 (range 1-7). Thirty-two pts have discontinued therapy, 26 due to disease/symptomatic progression and 6 due to toxicity (5 LFT elevation and 1 allergic reaction). Other adverse effects (AE): fatigue (16 pts/2 grade 3), diarrhea (11 pts/5 grade 3), nausea (19 pts/1 grade 3), vomiting (11 pts/1 grade 3) and lymphopenia (29 pts/7 grade 3/4). Five pts had related serious AEs (1 LFTs, 1 GI and 3 venous thromboembolism) All pts were evaluable for response; 25 had a best response of progression, 1 had partial response (overall response rate 3%) and seven (21%) had stable disease (SD, median 7.3 months; range 3.1-13.6). Six month PFS was 17%. In preliminary analyses, no statistical association was found between SD and PTEN or EGFRviii status (results pending in 16 pts). Conclusions: PX-866 was relatively well tolerated. Overall response rate was low, and the study did not meet its primary endpoint; however, 21% of pts obtained durable stable disease. Further correlative work is required to identify the predictor of this effect. Clinical trial information: NCT01259869.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jeremy Squire
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Ming Sound Tsao
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Suzanne Kamel-Reid
- University Health Network, Department of Pathology and Laboratory Medicine, Toronto, ON, Canada
| | | | | | - Warren P. Mason
- Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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Fisher BJ, Bauman GS, Leighton CE, Stitt L, Cairncross JG, Macdonald DR. Low-grade gliomas in children: tumor volume response to radiation. Neurosurg Focus 2012; 4:e5. [PMID: 17168505 DOI: 10.3171/foc.1998.4.4.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. The authors conducted a retrospective review to examine and document the frequency, degree, and timing of the radiologically confirmed response to radiotherapy of low-grade gliomas in children. Methods. Between 1963 and 1995, 80 patients 17 years of age or younger were referred to the London Regional Cancer Centre in London, Ontario, after diagnosis of a low-grade glioma. All patients underwent surgical resection or biopsy procedures and 47 underwent radiotherapy (40 postoperatively and seven at the time of tumor progression). Nineteen patients with residual measurable lesions who received radiation therapy were selected for volumetric analysis of tumor response to this treatment. The extent and timing of response to radiation were determined by the process of comparing postoperative, preirradiation computerized tomography (CT) scans with postirradiation, follow-up CT scans. For one patient the comparison was made by using serial magnetic resonance images. Residual tumor was found on postoperative CT scans in all cases. The mean preradiotherapy tumor volume was 17.1 cm(3), and the postradiotherapy volume was reduced to a mean of 11.5 cm(3). A reduction in tumor was demonstrated in eight patients by the time of their first postirradiation follow-up CT scan and in two patients a slower reduction in volume over time was shown, bringing the total number of "responders" to 10. In five of these 10 patients the tumor had shown a maximum response by the time of the first postirradiation CT scan; the median time to response was 3.3 months. A 25% or greater reduction in tumor volume was seen in eight (42%) of the 19 patients. A 50% or greater reduction was noted in five (26%) of the patients. A complete response was demonstrated at 7, 12, and 15 months, and 5 years, respectively, in four patients (21%). One responder's tumor eventually increased in size after radiotherapy and he died of his disease. The magnitude of the radiographically demonstrated response to radiation did not correlate significantly with clinical outcome (that is, survival or symptom improvement). Conclusions. On the basis of this CT scan analysis of the response of low-grade gliomas in children to radiotherapy, the authors suggest that these lesions respond to radiation, as demonstrated by tumor shrinkage on serial imaging. Major or complete responses occur occasionally. However, low-grade gliomas in children mimic other benign brain tumors such as pituitary adenomas and meningiomas in that, although growth is frequently arrested after radiotherapy, residual tumor can persist for many years, illustrating that tumor shrinkage may not be a good measure of treatment efficacy. Nevertheless, radiation therapy can result in improvement of clinical symptomatology in association with or independent of visible tumor reduction. As radiation treatment techniques become increasingly conformal and because studies indicate that lower doses of radiation may be equally effective, improvement of symptoms may be an important consideration when weighing treatment options, particularly in patients with residual or unresectable disease.
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Affiliation(s)
- B J Fisher
- Department of Radiation Oncology, Medical Oncology, and Biometry, London Regional Cancer Centre and University of Western Ontario, London, Ontario, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
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31
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Pitz MW, MacNeil MV, Macdonald DR, Kakumanu AS, Thiessen B, Tsao MS, Kamel-Reid S, Squire J, Sederias J, Walsh W, Eisenhauer EA, Mason WP. Phase II study of PX-866 in recurrent glioblastoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2051 Background: Glioblastoma (GBM) is the most aggressive malignancy of the central nervous system. The majority of GBM have genetic changes that increase the activity of the phosphatidylinositol-3-OH kinase (PI3K) signal transduction pathway, critical for cell motility, proliferation, and survival. We present the interim results of PX-866, an oral PI3K inhibitor, in patients (pts) with recurrent GBM. Methods: Pts with histologically confirmed GBM at first recurrence after treatment with chemoradiation and adjuvant temozolomide are given PX-866 8 mg daily on this single-arm phase II study. MRI and clinical exam are done every 8 weeks to determine treatment response. The trial has a 2-stage design with dual endpoints of objective response and early progression (within 8 weeks). In Stage I, 15 pts are evaluated and if 0 responses and 10 or more early progressions are seen, enrolment will stop. Otherwise, Stage II will enrol another 15 pts for efficacy analysis. Tumour tissue is collected for analysis of potential markers of PI3K inhibitory activity (PTEN, EGFRvIII, PIK3CA mutations). Results: Seventeen pts have been enroled to date: 14 evaluable for response and 15 for toxicity. Median age was 54 years (range 35-70), with 7 females and 10 males. No pts had received treatment for recurrent GBM, and median time between initial diagnosis and study enrolment was 300 days (range: 113-447 days). Pts have received a median of one 8-week cycle of PX-866 (range: 1-4). Twelve pts have discontinued therapy, 9 due to disease progression and 3 due to grade 3/4 liver enzyme abnormalities. Other adverse effects have included fatigue (10 pts/1 grade 3), diarrhea (6 pts/3 grade 3), nausea (7 pts/0 grade 3), vomiting (6 pts/0 grade 3), lymphopenia (14 pts/3 grade 3). Stage I response data are premature; it is not yet known if the trial will continue to Stage II. Archival tissue is available on all patients and is undergoing analysis. Conclusions: This is one of the first trials of a PI3K inhibitor in pts with recurrent GBM. PX-866 has been relatively well tolerated. Stage I response data are premature; while it is not yet known if the criteria will be met to continue to Stage II, prolonged SD has been observed in some pts. The correlative biomarker assays underway will be important to understand this observation.
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Affiliation(s)
- Marshall W. Pitz
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | | | | | | | | | - Ming Sound Tsao
- Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Suzanne Kamel-Reid
- University Health Network, Princess Margaret Hospital, and University of Toronto, Toronto, ON, Canada
| | - Jeremy Squire
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | | | - Wendy Walsh
- NCIC Clinical Trials Group, Kingston, ON, Canada
| | | | - Warren P. Mason
- Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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32
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Cao JQ, Fisher BJ, Bauman GS, Megyesi JF, Watling CJ, Macdonald DR. Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: a review of ten-year single institutional experience. J Neurooncol 2011; 107:395-405. [PMID: 22105851 DOI: 10.1007/s11060-011-0766-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 11/14/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Jeffrey Q Cao
- Department of Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, N6A 4L6, Canada
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33
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Weller M, Gorlia T, Cairncross JG, van den Bent MJ, Mason W, Belanger K, Brandes AA, Bogdahn U, Macdonald DR, Forsyth P, Rossetti AO, Lacombe D, Mirimanoff RO, Vecht CJ, Stupp R. Prolonged survival with valproic acid use in the EORTC/NCIC temozolomide trial for glioblastoma. Neurology 2011; 77:1156-64. [PMID: 21880994 DOI: 10.1212/wnl.0b013e31822f02e1] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This analysis was performed to assess whether antiepileptic drugs (AEDs) modulate the effectiveness of temozolomide radiochemotherapy in patients with newly diagnosed glioblastoma. METHODS The European Organization for Research and Treatment of Cancer (EORTC) 26981-22981/National Cancer Institute of Canada (NCIC) CE.3 clinical trial database of radiotherapy (RT) with or without temozolomide (TMZ) for newly diagnosed glioblastoma was examined to assess the impact of the interaction between AED use and chemoradiotherapy on survival. Data were adjusted for known prognostic factors. RESULTS When treatment began, 175 patients (30.5%) were AED-free, 277 (48.3%) were taking any enzyme-inducing AED (EIAED) and 135 (23.4%) were taking any non-EIAED. Patients receiving valproic acid (VPA) only had more grade 3/4 thrombopenia and leukopenia than patients without an AED or patients taking an EIAED only. The overall survival (OS) of patients who were receiving an AED at baseline vs not receiving any AED was similar. Patients receiving VPA alone (97 [16.9%]) appeared to derive more survival benefit from TMZ/RT (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.24-0.63) than patients receiving an EIAED only (252 [44%]) (HR 0.69, 95% CI 0.53-0.90) or patients not receiving any AED (HR 0.67, 95% CI 0.49-0.93). CONCLUSIONS VPA may be preferred over an EIAED in patients with glioblastoma who require an AED during TMZ-based chemoradiotherapy. Future studies are needed to determine whether VPA increases TMZ bioavailability or acts as an inhibitor of histone deacetylases and thereby sensitizes for radiochemotherapy in vivo.
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Affiliation(s)
- M Weller
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland.
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Hallock A, Hamilton B, Ang LC, Tay KY, Meygesi JF, Fisher BJ, Watling CJ, Macdonald DR, Bauman GS. Neurocytomas: long-term experience of a single institution. Neuro Oncol 2011; 13:943-9. [PMID: 21824889 DOI: 10.1093/neuonc/nor074] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is a lack of studies reporting on outcomes of control and treatment toxicities for neurocytomas. A 25-year retrospective review of a tertiary center's experience with neurocytomas was completed to report on these outcomes. All cerebral neurocytoma cases (19 patients; median age, 31 years; range, 18-62 years; 18 intraventricular and 1 extraventricular) treated between 1984 and 2009 were analyzed, including central pathology and radiology reviews. Median follow-up was 104.5 months (range, 0.75-261.7 months). Primary treatment was surgery alone (n = 18 patients), followed by surgery and adjuvant radiotherapy (n = 1). The crude local control rate after surgery was 68% for all cases (cerebral neurocytomas) and 74% for central neurocytomas. Salvage therapies included further surgery (n = 4), radiation (n = 3), and chemotherapy (n = 1). Ten-year Kaplan-Meier overall and relapse-free survival rates were 82% and 62% and 81% and 57%, respectively, for all cases and for central neurocytomas only. The median overall survival and relapse-free survival were 104.5 and 79.3 months, respectively, for all cases and for central neurocytomas. Ten patients had grade 3/4 toxicity, and 1 patient had a grade 5 perioperative hemorrhage that resulted in death 23 days after surgery. Late grade 3/4 toxicities occurred in 9 patients. Three patients had permanent grade 2 motor or cognitive deficits. We provide the first report outlining toxicities and survival outcomes in a series of 19 patients. Our experience suggests that initial surgery provides durable local control rates in two-thirds of patients, with low risk for significant permanent deficits. Salvage therapy with surgery and/or radiation provides durable local control in tumors that recur after surgery.
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Affiliation(s)
- A Hallock
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
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Abstract
OBJECTIVE Discordance between HbA(1c) and fructosamine estimations in the assessment of glycemia is often encountered. A number of mechanisms might explain such discordance, but whether it is consistent is uncertain. This study aims to coanalyze paired glycosylated hemoglobin (HbA(1c))-fructosamine estimations by using fructosamine to determine a predicted HbA(1c), to calculate a glycation gap (G-gap) and to determine whether the G-gap is consistent over time. RESEARCH DESIGN AND METHODS We included 2,263 individuals with diabetes who had at least two paired HbA(1c)-fructosamine estimations that were separated by 10 ± 8 months. Of these, 1,217 individuals had a third pair. The G-gap was calculated as G-gap = HbA(1c) minus the standardized fructosamine-derived HbA(1c) equivalent (FHbA(1c)). The hypothesis that the G-gap would remain consistent in individuals over time was tested. RESULTS The G-gaps were similar in the first, second, and third paired samples (0.0 ± 1.2, 0.0 ± 1.3, and 0.0 ± 1.3, respectively). Despite significant changes in the HbA(1c) and fructosamine, the G-gap did not differ in absolute or relative terms and showed no significant within-subject variability. The direction of the G-gap remained consistent. CONCLUSIONS The G-gap appears consistent over time; thus, by inference any key underlying mechanisms are likely to be consistent. G-gap calculation may be a method of exploring and evaluating any such underlying mechanisms.
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Affiliation(s)
- Ananth U Nayak
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
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36
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Vogelbaum MA, Jost S, Aghi MK, Heimberger AB, Sampson JH, Wen PY, Macdonald DR, Van den Bent MJ, Chang SM. Application of Novel Response/Progression Measures for Surgically Delivered Therapies for Gliomas. Neurosurgery 2011; 70:234-43; discussion 243-4. [DOI: 10.1227/neu.0b013e318223f5a7] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
BACKGROUND
The Response Assessment in Neuro-Oncology (RANO) Working Group is an international, multidisciplinary effort to develop new standardized response criteria for clinical trials in brain tumors. The RANO group identified knowledge gaps relating to the definitions of tumor response and progression after the use of surgical or surgically based treatments.
OBJECTIVE
To outline a proposal for new response and progression criteria for the assessment of the effects of surgery and surgically delivered therapies for patients with gliomas.
METHODS
The Surgery Working Group of RANO identified surgically related end-point evaluation problems that were not addressed in the original Macdonald criteria, performed an extensive literature review, and used a consensus-building process to develop recommendations for how to address these issues in the setting of clinical trials.
RESULTS
Recommendations were formulated for surgically related issues, including imaging changes associated with surgical resection or surgically mediated adjuvant local therapies, the determination of progression in the setting where all enhancing tumor has been removed, and how new enhancement should be interpreted in the setting where local therapies that are known to produce nonspecific enhancement have been used. Additionally, the terminology used to describe the completeness of surgical resections has been recognized to be inconsistently applied to enhancing vs nonenhancing tumors, and a new set of descriptors is proposed.
CONCLUSION
The RANO process is intended to produce end-point criteria for clinical trials that take into account the effects of prior and ongoing therapies. The RANO criteria will continue to evolve as new therapies and technologies are introduced into clinical trial and/or practice.
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Affiliation(s)
- Michael A. Vogelbaum
- Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Cleveland Clinic, Cleveland Ohio
| | - Sarah Jost
- Ivy Center for Advanced Brain Tumor Treatment, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Manish K. Aghi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Amy B. Heimberger
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John H. Sampson
- Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center and Division of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David R. Macdonald
- Department of Oncology, Medical Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada
| | - Martin J. Van den Bent
- Neuro-Oncology Unit, Daniel den Hoed Cancer Center/Erasmus University Hospital Rotterdam, Rotterdam, the Netherlands
| | - Susan M. Chang
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, California
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Wen PY, Van den Bent MJ, Macdonald DR, Vogelbaum MA, Chang SM. Reply to A.A. Brandes et al. J Clin Oncol 2011. [DOI: 10.1200/jco.2010.33.4383] [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: 11/20/2022] Open
Affiliation(s)
- Patrick Y. Wen
- Center For Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | | | - David R. Macdonald
- London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada
| | | | - Susan M. Chang
- Center For Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
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Mirsattari SM, Chong JJ, Hammond RR, Megyesi JF, Macdonald DR, Lee DH, Cairncross JG. Do epileptic seizures predict outcome in patients with oligodendroglioma? Epilepsy Res 2011; 94:39-44. [DOI: 10.1016/j.eplepsyres.2011.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 11/26/2010] [Accepted: 01/02/2011] [Indexed: 10/18/2022]
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Reardon DA, Galanis E, DeGroot JF, Cloughesy TF, Wefel JS, Lamborn KR, Lassman AB, Gilbert MR, Sampson JH, Wick W, Chamberlain MC, Macdonald DR, Mehta MP, Vogelbaum MA, Chang SM, Van den Bent MJ, Wen PY. Clinical trial end points for high-grade glioma: the evolving landscape. Neuro Oncol 2011; 13:353-61. [PMID: 21310734 PMCID: PMC3064608 DOI: 10.1093/neuonc/noq203] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/26/2010] [Indexed: 01/13/2023] Open
Abstract
To review the strengths and weaknesses of primary and auxiliary end points for clinical trials among patients with high-grade glioma (HGG). Recent advances in outcome for patients with newly diagnosed and recurrent HGG, coupled with the development of multiple promising therapeutics with myriad antitumor actions, have led to significant growth in the number of clinical trials for patients with HGG. Appropriate clinical trial design and the incorporation of optimal end points are imperative to efficiently and effectively evaluate such agents and continue to advance outcome. Growing recognition of limitations weakening the reliability of traditional clinical trial primary end points has generated increasing uncertainty of how best to evaluate promising therapeutics for patients with HGG. The phenomena of pseudoprogression and pseudoresponse have made imaging-based end points, including overall radiographic response and progression-free survival, problematic. Although overall survival is considered the "gold-standard" end point, recently identified active salvage therapies such as bevacizumab may diminish the association between presalvage therapy and overall survival. Finally, advances in imaging as well as the assessment of patient function and well being have strengthened interest in auxiliary end points assessing these aspects of patient care and outcome. Better appreciation of the strengths and limitations of primary end points will lead to more effective clinical trial strategies. Technical advances in imaging as well as improved survival for patients with HGG support the further development of auxiliary end points evaluating novel imaging approaches as well as measures of patient function and well being.
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Affiliation(s)
- David A Reardon
- The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Box 3624, Durham, NC 27710, USA.
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40
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Wen PY, van den Bent MJ, Macdonald DR, Tsien C, Vogelbaum MA, Chang SM. Reply to P. Farace et al. J Clin Oncol 2011. [DOI: 10.1200/jco.2010.33.1215] [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: 11/20/2022] Open
Affiliation(s)
- Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, and Brigham and Women's Hospital, Boston, MA
| | - Martin J. van den Bent
- Neuro-Oncology Unit, Daniel den Hoed Cancer Center/Erasmus University Hospital Rotterdam, Rotterdam, the Netherlands
| | - David R. Macdonald
- London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada
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Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF. Phase II Trial of Continuous Dose-Intense Temozolomide in Recurrent Malignant Glioma: RESCUE Study. J Clin Oncol 2010; 28:2051-7. [PMID: 20308655 DOI: 10.1200/jco.2009.26.5520] [Citation(s) in RCA: 258] [Impact Index Per Article: 18.4] [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
Purpose Concomitant temozolomide (TMZ)/radiotherapy followed by adjuvant TMZ has increased survival in patients with glioblastoma multiforme (GBM). However, few options are effective for patients who experience treatment failure. We conducted a multicenter, phase II study to assess the efficacy and safety of continuous dose-intense TMZ for recurrent GBM. Patients and Methods Patients with malignant glioma at progression after standard TMZ 150 to 200 mg/m2 × 5 days in a 28-day cycle for three or more cycles were stratified by tumor type (anaplastic glioma group A, GBM, group B). Ninety-one patients with GBM were prospectively divided into three groups (early [B1], extended [B2], and rechallenge [B3]) according to the timing of progression during adjuvant therapy. All patients received continuous dose-intense TMZ 50 mg/m2/d for up to 1 year or until progression occurred. Response was assessed by using RECIST (Response Evaluation Criteria in Solid Tumors). Results A total of 116 of 120 patients were evaluable for efficacy. For patients with GBM, 6-month progression-free survival (PFS) was 23.9% (B1, 27.3%; B2, 7.4%; B3, 35.7%). One-year survival from time of study entry was 27.3%, 14.8%, and 28.6% for the B1, B2 and B3 groups, respectively. For patients with anaplastic glioma, 6-month PFS was 35.7%; 1-year survival was 60.7%. The most common grades 3 and 4 nonhematologic toxicities were nausea/vomiting (6.7%) and fatigue (5.8%). Grades 3 and 4 hematologic toxicities were uncommon. Conclusion Rechallenge with continuous dose-intense TMZ 50 mg/m2/d is a valuable therapeutic option for patients with recurrent GBM. Patients who experience progression during the first six cycles of conventional adjuvant TMZ therapy or after a treatment-free interval get the most benefit from therapy.
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Affiliation(s)
- James R. Perry
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Karl Bélanger
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Warren P. Mason
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Dorcas Fulton
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Petr Kavan
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Jacob Easaw
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Claude Shields
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Sarah Kirby
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - David R. Macdonald
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - David D. Eisenstat
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Brian Thiessen
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Peter Forsyth
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Jean-François Pouliot
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
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Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 2010; 28:1963-72. [PMID: 20231676 DOI: 10.1200/jco.2009.26.3541] [Citation(s) in RCA: 2695] [Impact Index Per Article: 192.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Currently, the most widely used criteria for assessing response to therapy in high-grade gliomas are based on two-dimensional tumor measurements on computed tomography (CT) or magnetic resonance imaging (MRI), in conjunction with clinical assessment and corticosteroid dose (the Macdonald Criteria). It is increasingly apparent that there are significant limitations to these criteria, which only address the contrast-enhancing component of the tumor. For example, chemoradiotherapy for newly diagnosed glioblastomas results in transient increase in tumor enhancement (pseudoprogression) in 20% to 30% of patients, which is difficult to differentiate from true tumor progression. Antiangiogenic agents produce high radiographic response rates, as defined by a rapid decrease in contrast enhancement on CT/MRI that occurs within days of initiation of treatment and that is partly a result of reduced vascular permeability to contrast agents rather than a true antitumor effect. In addition, a subset of patients treated with antiangiogenic agents develop tumor recurrence characterized by an increase in the nonenhancing component depicted on T2-weighted/fluid-attenuated inversion recovery sequences. The recognition that contrast enhancement is nonspecific and may not always be a true surrogate of tumor response and the need to account for the nonenhancing component of the tumor mandate that new criteria be developed and validated to permit accurate assessment of the efficacy of novel therapies. The Response Assessment in Neuro-Oncology Working Group is an international effort to develop new standardized response criteria for clinical trials in brain tumors. In this proposal, we present the recommendations for updated response criteria for high-grade gliomas.
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Affiliation(s)
- Patrick Y Wen
- Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center, SW430D, 44 Binney St, Boston, MA 02115, USA.
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Macdonald DR, Kiebert G, Prados M, Yung A, Olson J. Benefit of Temozolomide Compared to Procarbazine in Treatment of Glioblastoma Multiforme at First Relapse: Effect on Neurological Functioning, Performance Status, and Health Related Quality of Life. Cancer Invest 2009. [DOI: 10.1081/cnv-50453] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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44
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van den Bent MJ, Vogelbaum MA, Wen PY, Macdonald DR, Chang SM. End point assessment in gliomas: novel treatments limit usefulness of classical Macdonald's Criteria. J Clin Oncol 2009; 27:2905-8. [PMID: 19451418 DOI: 10.1200/jco.2009.22.4998] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [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
Recent trials in glioma have revealed significant limitations in the end points used. This requires a critical and comprehensive review of how brain tumor trials are conducted, particularly of which end points are defined and how response and progression are defined.
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Affiliation(s)
- Martin J van den Bent
- Neuro-Oncology Unit, Daniel den Hoed Cancer Center, Erasmus University Hospital, Rotterdam, The Netherlands
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45
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Macdonald DR, Hanson AM, Holland MR, Singh BM. Clinical impact of variability in HbA1c as assessed by simultaneously measuring fructosamine and use of error grid analysis. Ann Clin Biochem 2008; 45:421-5. [PMID: 18583630 DOI: 10.1258/acb.2008.007259] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Haemoglobin A1c (HbA1c) is the only measure of glycaemic control used for many patients with diabetes, but it has limitations and might sometimes be misleading. HbA(1c) concentrations are influenced by conditions that alter red-cell life and there is evidence that biochemical variation in intracellular glycation rates also influence HbA1c concentrations. This paper is the first to propose a method of using simultaneously measured HbA1c and fructosamine, and error grid analysis, in the clinical setting, to gain a better understanding of glycaemic control. METHODS Cross-sectional analytical study using HbA1c and fructosamine measures on the same blood sample from 1744 patients having blood taken for hospital diabetes clinic appointments. No other selection or exclusion criteria were applied. RESULTS The fructosamine results were converted to a HbA1c equivalent which was then compared with the HbA1c. In an Altman-Bland plot, the paired result differences ranged between -6.9% and +5.5% HbA1c with 1139 (65%), 438 (25%), 130 (8%) and 37 (2%) being < or =1%, 1-2%, 2-3% or >3% of HbA1c difference, respectively. In clinical error grid analysis, 864 (50%) results had tight concordance for clinical interpretation, 761 (43%) had one block disunity of probably little clinical significance, but 105 (6%) were two blocks and 14 (1%) were three blocks discordant. CONCLUSION HbA1c may not accurately reflect glucose control. Our method, utilizing co-assessment with serum fructosamine, evaluates the possible clinical impact of this. We suggest the analysis used in this paper should be used routinely in diabetes practice.
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Affiliation(s)
- David R Macdonald
- Albrighton Medical Practice, Shaw Lane, Albrighton, Wolverhampton, West Midlands WV7 3DT, UK.
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46
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Abrey LE, Childs BH, Paleologos N, Kaminer L, Rosenfeld S, Salzman D, Finlay JL, Gardner S, Peterson K, Hu W, Swinnen L, Bayer R, Forsyth P, Stewart D, Smith AM, Macdonald DR, Weaver S, Ramsay DA, Nimer SD, DeAngelis LM, Cairncross JG. High-dose chemotherapy with stem cell rescue as initial therapy for anaplastic oligodendroglioma: long-term follow-up. Neuro Oncol 2006; 8:183-8. [PMID: 16524945 PMCID: PMC1871935 DOI: 10.1215/15228517-2005-009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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: 11/19/2022] Open
Abstract
We previously reported a phase 2 trial of 69 patients with newly diagnosed anaplastic or aggressive oligodendroglioma who were treated with intensive procarbazine, CCNU (lomustine), and vincristine (PCV) followed by high-dose thiotepa with autologous stem cell rescue. This report summarizes the long-term follow-up of the cohort of 39 patients who received high-dose thiotepa with autologous stem cell support. Thirty-nine patients with a median age of 43 (range, 18-67) and a median KPS of 100 (range, 70-100) were treated. Surviving patients now have a median follow-up of 80.5 months (range, 44-142). The median progression-free survival is 78 months, and median overall survival has not been reached. Eighteen patients (46%) have relapsed. Neither histology nor prior low-grade oligodendroglioma correlated with risk of relapse. Persistent nonenhancing tumor at transplant was identified in our initial report as a significant risk factor for relapse; however, long-term follow-up has not confirmed this finding. Long-term neurotoxicity has developed only in those patients whose disease relapsed and required additional therapy; no patient in continuous remission has developed a delayed neurologic injury. This treatment strategy affords long-term disease control to a subset of patients with newly diagnosed anaplastic oligodendroglioma without evidence of delayed neurotoxicity or myelodysplasia.
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Affiliation(s)
- Lauren E Abrey
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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47
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Macdonald DR, Kiebert G, Prados M, Yung A, Olson J. Benefit of temozolomide compared to procarbazine in treatment of glioblastoma multiforme at first relapse: effect on neurological functioning, performance status, and health related quality of life. Cancer Invest 2005; 23:138-44. [PMID: 15813507] [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: 05/02/2023]
Abstract
Since high-grade malignant gliomas can seldom be treated curatively, the main aim of first line therapy is to improve progression free survival (PFS), to reduce morbidity, and to preserve, if not restore neurological functions and the capacity to perform daily activities. Focusing on a single clinical efficacy parameter in clinical trials may provide a potentially biased result, as for patients the overall result of treatment entails a more complex picture of weighing and balancing gains and losses on different outcome measures. In this paper we address different clinical outcomes measures separately and we illustrate the value of multiple outcome measures using the results of a recent clinical trial comparing temozolomide with procarbazine in the treatment of Glioblastoma Multiforme. Compared with procarbazine, temozolomide not only prolonged PFS, but also maintained neurological functioning and performance status for a longer period of time, and also improved health-related quality of life (HRQL). All these statistically significant outcomes demonstrate a remarkable consistency. In addition, temozolomide showed a trend of extending overall survival over procarbazine.
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Abstract
Despite many technologic advances in neuroimaging, neurosurgery, and radiation therapy, there has been little improvement in survival for patients with malignant glioma. Given the failure of traditional treatment approaches to significantly improve survival in patients with malignant gliomas, research in this field has focused on gaining a better understanding of the molecular pathogenesis of gliomas with the goal of identifying novel drug targets and therapeutic strategies. The influence of molecular genetics on response and survival has been best shown in oligodendrogliomas. The hallmarks of low-grade and anaplastic oligodendrogliomas are their exquisite sensitivity to chemotherapy and favorable prognosis, which are correlated with loss of heterozygosity of chromosomes 1p and 19q. Together, loss of heterozygosity of 1p and 19q appears to confer responsiveness to chemotherapy and to correlate with improved survival. In contrast, deletion of the CDKN2A gene is correlated with poor response to chemotherapy and poor survival, and loss of heterozygosity of chromosome 10q is associated with shorter progression-free and overall survival compared with intact 10q. A variety of other molecular genetic abnormalities have been recognized in gliomas, and these genetic changes are not only important prognostic factors, but also offer new therapeutic targets. With the increased use of improved surgical and radiotherapy techniques and targeted biologic therapy over the next 20 years, many patients with malignant gliomas may be cured or their disease may be controlled for the long term. Molecular profiling of patients using gene chip technology will likely become commonplace, and many patients will receive a tailored treatment regimen based on the unique genetic profile of their tumor.
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Affiliation(s)
- David R Macdonald
- London Regional Cancer Centre, 790 Commissioners Road East, London, Ontario N6A 4L6 Canada
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49
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Abrey LE, Childs BH, Paleologos N, Kaminer L, Rosenfeld S, Salzman D, Finlay JL, Gardner S, Peterson K, Hu W, Swinnen L, Bayer R, Forsyth P, Stewart D, Smith AM, Macdonald DR, Weaver S, Ramsey DA, Nimer SD, DeAngelis LM, Cairncross JG. High-dose Chemotherapy with Stem Cell Rescue as Initial Therapy for Anaplastic Oligodendroglioma. J Neurooncol 2003; 65:127-34. [PMID: 14686732 DOI: 10.1023/b:neon.0000003645.82791.2a] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [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 Anaplastic oligodendroglioma is a chemosensitive glial neoplasm. To improve disease control and postpone cranial radiotherapy, we designed a phase II study of intensive procarbazine, lomunstine and vincristine followed by high-dose thiotepa with autologous stem cell rescue for patients with newly diagnosed anaplastic or aggressive oligodendroglioma. PATIENTS AND METHODS Sixty-nine patients with a median age of 42 (range: 18-67) and a median Karnofsky Performance Score of 90 (range: 70-100) were enrolled. Sixteen patients had a prior diagnosis of low-grade oligodendroglioma and 16 had mixed oligoastrocytoma pathology. Only patients with demonstrably chemosensitive enhancing tumors or those free of enhancing tumor after surgery and induction therapy were eligible to receive high-dose thiotepa. RESULTS Thirty-nine patients (57%) completed the transplant regimen; their estimated median progression-free survival is 69 months and median overall survival has not been reached. Twelve transplanted patients (31%) relapsed. Neither histology nor prior low-grade oligodendroglioma correlated with relapse; however, persistent non-enhancing tumor at transplant conferred an increased risk of relapse (p = 0.028). The transplant regimen was well-tolerated; median hospital stay was 20 days (range: 7-43) with a median time to ANC and platelet engraftment of 10 days. Thirty patients (43%) did not receive high-dose thiotepa because of stable or progressive disease (n = 21), excessive toxicity (n = 4), refusal of further therapy (n = 2), failure to obtain insurance coverage (n = 2), or other (n = 1). No treatment-related or long-term neurotoxicity was seen in the transplanted patients. CONCLUSIONS High-dose chemotherapy with stem cell rescue as initial treatment for anaplastic oligodendroglioma is feasible and associated with prolonged tumor control in some patients.
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Affiliation(s)
- Lauren E Abrey
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York 10021, USA.
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50
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Macdonald DR. Regarding "Sweet time unafflicted". J Clin Oncol 2003; 21:958. [PMID: 12610206 DOI: 10.1200/jco.2003.99.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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