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Opancina V, Esposito S, Di Meco F, Bruno E, Moscatelli M, Vetrano IG, Chiapparini L, Opancina M, Farinotti M, Zdravkovic N, Pollo B, Marucci G, Doniselli FM. Magnetic resonance imaging characteristics of pediatric pilocytic astrocytoma. Neurol Sci 2023; 44:4033-4040. [PMID: 37322312 DOI: 10.1007/s10072-023-06893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE MRI has an important role in diagnosing pilocytic astrocytoma and post-surgical follow-up since the surgical approach has a leading role in its treatment. The purpose of our study is to provide an overview of the typical and atypical MRI findings in a series of pediatric patients with isolated-not NF1-related-pilocytic astrocytomas and to correlate specific MRI patterns with clinical variables. METHODS This is a cross-sectional retrospective study providing the analysis of several clinical and neuroradiological findings from a cohort of pediatric pilocytic astrocytoma, starting from the data collected in the Fondazione IRCCS Istituto Neurologico Carlo Besta (FINCB) internal Cancer Registry during an 11-year time period (January 2008-January 2019). RESULTS Fifty-six patients were included in the study. Median age at diagnosis was 9.4 years; a slight female prevalence was noticed (m/f ratio 44.6%/55.4%). The majority of pPAs had well-defined contours: 51 (91.1%), 47 (88.7%) were hypointense on T1-wi, all of them were hyperintense on T2-wi, 46 (90.2%) were hyperintense on FLAIR, and 48 (85.7%) were heterogeneous on T1-wi and T2-wi sequences. We found positive correlation between pPAs location and age (r = 0.017), and small degree of connection between pPAs location and gender (Cramer's V = 0.268). CONCLUSIONS We presented typical and atypical pPAs MRI findings. Age and tumor location were positevely correlated, while degree of connection between gender and pPAs location was small. All of this may aid clinicians, most of all neuroradiologists, neurosurgeons, and neurologists in proper diagnoses and follow-up of these specific patient population.
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Affiliation(s)
- Valentina Opancina
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Silvia Esposito
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA
| | - Eleonora Bruno
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Biomedical Section, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Marco Moscatelli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luisa Chiapparini
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Diagnostic Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Miljan Opancina
- Faculty of Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mariangela Farinotti
- Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Nebojsa Zdravkovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fabio M Doniselli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Opancina V, Esposito S, Di Meco F, Bruno E, Moscatelli M, Vetrano IG, Chiapparini L, Opancina M, Farinotti M, Valentini LG, Zdravkovic N, Pollo B, Marucci G, Doniselli FM. Correction to: Magnetic resonance imaging characteristics of pediatric pilocytic astrocytoma. Neurol Sci 2023; 44:4165. [PMID: 37561234 DOI: 10.1007/s10072-023-07004-3] [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: 08/11/2023]
Affiliation(s)
- Valentina Opancina
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Silvia Esposito
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA
| | - Eleonora Bruno
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Biomedical Section, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Marco Moscatelli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luisa Chiapparini
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Diagnostic Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Miljan Opancina
- Faculty of Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mariangela Farinotti
- Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Laura G Valentini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nebojsa Zdravkovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fabio M Doniselli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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3
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Criscitiello C, Corti C, De Laurentiis M, Bianchini G, Pistilli B, Cinieri S, Castellan L, Arpino G, Conte P, Di Meco F, Gennari A, Guarneri V, Visani L, Livi L, Marchetti P, Puglisi F, Viale G, Del Mastro L, De Placido S, Curigliano G. Tucatinib's journey from clinical development to clinical practice: New horizons for HER2-positive metastatic disease and promising prospects for brain metastatic spread. Cancer Treat Rev 2023; 120:102618. [PMID: 37639757 DOI: 10.1016/j.ctrv.2023.102618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Approximately 20% of breast cancers (BCs) overexpress human epidermal growth factor receptor 2 (HER2), a transmembrane glycoprotein with tyrosine kinase activity, encoded by ERBB2 gene. Historically, HER2 overexpression has been linked with increased disease recurrence and a worse prognosis. However, the increasing availability of different anti-HER2 compounds and combinations is progressively improving HER2-positive BC outcome, thus requiring expertise to prioritize both overall survival (OS) prolongation and quality of life, without neglecting the accessibility to further treatment lines with a low attrition rate. In this context, tucatinib, an oral tyrosine kinase inhibitor, has recently been granted approval by regulatory agencies based on evidence from the HER2CLIMB, a clinical trial which randomized patients with metastatic BC to receive trastuzumab and capecitabine with either tucatinib or placebo. A distinctive feature of this study was the inclusion of patients with new or active brain metastases (BMs) at study entry, a population traditionally excluded from clinical trials. Thus, HER2CLIMB provides the first solid evidence of an OS benefit in patients with BC and BMs, addressing a long standing unmet medical need, especially given the high incidence of central nervous system metastatic spread in patients with HER2-positive disease. This review provides an overview of the molecular and clinical landscape of tucatinib for the treatment of advanced BC. It focuses on the technological journey that drove the development of this therapeutic innovation, from preclinical data to clinical practice.
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Affiliation(s)
- Carmen Criscitiello
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy.
| | - Chiara Corti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione Pascale', Napoli, Italy
| | - Giampaolo Bianchini
- Department of Medical Oncology, Ospedale San Raffaele, IRCCS, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
| | - Lucio Castellan
- Department of Diagnostic and Interventional Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | | | - Alessandra Gennari
- Medical Oncology, "Maggiore della Carità" University Hospital, Novara, Italy; Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), Novara, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Luca Visani
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, National Cancer Institute, IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Giuseppe Viale
- Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy; Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Sabino De Placido
- Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), Novara, Italy
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy
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4
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Ius T, Sabatino G, Panciani PP, Fontanella MM, Rudà R, Castellano A, Barbagallo GMV, Belotti F, Boccaletti R, Catapano G, Costantino G, Della Puppa A, Di Meco F, Gagliardi F, Garbossa D, Germanò AF, Iacoangeli M, Mortini P, Olivi A, Pessina F, Pignotti F, Pinna G, Raco A, Sala F, Signorelli F, Sarubbo S, Skrap M, Spena G, Somma T, Sturiale C, Angileri FF, Esposito V. Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review. J Neurooncol 2023; 162:267-293. [PMID: 36961622 PMCID: PMC10167129 DOI: 10.1007/s11060-023-04274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal. METHODS A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients. RESULTS A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early postoperative MRI, with CE II and SR B. The EOR was defined the strongest independent risk factor for both OS and tumor recurrence with CE II and SR B. For intraoperative imaging only the use of 5-ALA reached a CE II and SR B. The estimation of EOR was established to be fundamental in planning postoperative adjuvant treatments with CE II and SR B and the stereotactic image-guided brain biopsy to be the procedure of choice when an extensive surgical resection is not feasible (CE II and SR B). CONCLUSIONS A growing number of evidences evidence support the role of maximal safe resection as primary OS predictor in GG4 patients. The ongoing development of intraoperative techniques for a precise real-time identification of peritumoral functional pathways enables surgeons to maximize EOR minimizing the post-operative morbidity.
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Affiliation(s)
- Tamara Ius
- Division of Neurosurgery, Head-Neck and NeuroScience Department, University Hospital of Udine, Udine, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
- Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Pier Paolo Panciani
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Marco Maria Fontanella
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, 10094, Torino, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, 10094, Torino, Italy
- Neurology Unit, Hospital of Castelfranco Veneto, 31033, Castelfranco Veneto, Italy
| | - Antonella Castellano
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giuseppe Maria Vincenzo Barbagallo
- Department of Medical and Surgical Sciences and Advanced Technologies (G.F. Ingrassia), Neurological Surgery, Policlinico "G. Rodolico - San Marco" University Hospital, University of Catania, Catania, Italy
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Francesco Belotti
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Giuseppe Catapano
- Division of Neurosurgery, Department of Neurological Sciences, Ospedale del Mare, Naples, Italy
| | | | - Alessandro Della Puppa
- Neurosurgical Clinical Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Johns Hopkins Medical School, Baltimore, MD, USA
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, University of Turin, Torino, Italy
| | | | - Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica Delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | | | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Italy
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Italy
| | - Fabrizio Pignotti
- Institute of Neurosurgery, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
- Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Giampietro Pinna
- Unit of Neurosurgery, Department of Neurosciences, Hospital Trust of Verona, 37134, Verona, Italy
| | - Antonino Raco
- Division of Neurosurgery, Department of NESMOS, AOU Sant'Andrea, Sapienza University, Rome, Italy
| | - Francesco Sala
- Department of Neurosciences, Biomedicines and Movement Sciences, Institute of Neurosurgery, University of Verona, 37134, Verona, Italy
| | - Francesco Signorelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Neurosurgery Unit, University "Aldo Moro", 70124, Bari, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Miran Skrap
- Division of Neurosurgery, Head-Neck and NeuroScience Department, University Hospital of Udine, Udine, Italy
| | | | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | | | | | - Vincenzo Esposito
- Department of Neurosurgery "Giampaolo Cantore"-IRCSS Neuromed, Pozzilli, Italy
- Department of Human, Neurosciences-"Sapienza" University of Rome, Rome, Italy
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5
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Rubiu E, La Corte E, Bonomo G, Restelli F, Falco J, Mazzapicchi E, Broggi M, Schiariti MP, Pollo B, Pinzi V, Bruzzone MG, Di Meco F, Acerbi F, Ferroli P. Diagnostic and surgical management of primary central nervous system angioleiomyoma: A case report and literature review. Front Oncol 2022; 12:1072270. [PMID: 36591470 PMCID: PMC9800865 DOI: 10.3389/fonc.2022.1072270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Angioleiomyoma (ALM) is a benign smooth muscle neoplasm that mainly occurs in lower extremities subcutaneous tissue and generally affects middle-aged adults. This tumor histotype may rarely localize intracranially, although only a few cases have been described in the literature. We report a case of intracranial ALM, whose differential diagnosis has been particularly challenging, and firstly provide a comprehensive radiological and intra-operative evaluation of a such rare entity. This represents also the first report of the use of intraoperative confocal microscopy in ALM and the first documented short-term recurrence. At this regard, a scoping literature review has been conducted with the aim of presenting the major clinical and diagnostic features along with the proposed therapeutic strategies.
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Affiliation(s)
- Emanuele Rubiu
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy,*Correspondence: Giulio Bonomo,
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Paolo Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Department of Radiosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy,Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, United States
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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6
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Eoli M, Farina F, Gentner B, Capotondo A, Anghileri E, Barcella M, Brambilla V, Bruzzone MG, Carrabba M, Cuccarini V, d’Alessandris G, Meco FD, Ferla V, Franzin A, Ferroli P, Gagliardi F, Legnani F, Mazzoleni S, Mortini P, Naldini MM, Olivi A, Pallini R, Patanè M, Paterra R, Pollo B, Saini M, Snider S, Naldini L, Russo C, Finocchiaro G, Ciceri F. CLRM-08 TARGETING IMMUNE-PAYLOAD TO THE GLIOBLASTOMA TUMOR MICROENVIRONMENT USING A MACROPHAGE-BASED TREATMENT RELYING ON AUTOLOGOUS, GENETICALLY MODIFIED, HEMATOPOIETIC STEM CELL-BASED THERAPY: THE TEM-GBM STUDY (NCT03866109). Neurooncol Adv 2022. [PMCID: PMC9354155 DOI: 10.1093/noajnl/vdac078.028] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
We developed an autologous hematopoietic stem cell-based platform designed to deliver IFNa, by a transcriptional and post-transcriptional control mechanism mediated by miRNA target sequences, specifically into the tumor microenvironment (TME) via Tie-2 expressing monocytes (Temferon). As of Feb 2022, 3 escalating doses of Temferon (0.5-2.0x106/kg) were tested across 15 newly diagnosed, unmethylated MGMT GBM patients assigned to 5 cohorts. Follow-up from surgery is 6–28mo (2–25mo after Temferon). To date, no DLTs have been identified. As expected, 1mo after the administration of the highest tested dose, the hematopoietic system of Temferon-treated patients was composed of up to 30% of CD14+ modified cells. Temferon-derived progeny persisted, albeit at lower levels, up to 18mo (longest time of analysis). Despite the substantial proportion of engineered cells, very low concentrations of IFNα were detected in the plasma and in the CSF, indicating tight regulation of transgene expression. SAEs were mostly attributed to conditioning chemotherapy (infections) or disease progression (seizures). 1SUSAR (persistent GGT elevation) occurred. Median OS is 15mo from surgery. Homing of transduced cells to the tumor was demonstrated by the presence of gene-marked cells in the 2nd surgery specimens of 3 out 4 pts belonging to low dose cohorts. Single-cell RNA seq of the TME highlighted a Temferon signature associated with the induction IFNa responsive genes and macrophage repolarization. Potential long-term benefit with Temferon was identified in a patient from cohort 3, who had PD at D+120 with two distant enhancing lesions, and increased tumor necrosis. 1y following Temferon, with no 2nd-line therapy added, there was approximately 40% reduction in enhancing tumor volume compared to D+180 with a stable clinical and imaging picture thereafter. The results provide initial evidence of Temferon’s potential to modulate the TME of GBM patients, and anecdotal evidence for long lasting effects of Temferon in prevention of disease progression.
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Affiliation(s)
- Marica Eoli
- Neuro-Oncology Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | - Francesca Farina
- Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital , Milan , Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget) , Milan , Italy
| | - Alessia Capotondo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget) , Milan , Italy
| | - Elena Anghileri
- Neuro-Oncology Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | - Matteo Barcella
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget) , Milan , Italy
| | | | | | - Matteo Carrabba
- Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital , Milan , Italy
| | - Valeria Cuccarini
- Neuroradiology Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | | | | | - Valeria Ferla
- Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital , Milan , Italy
| | - Alberto Franzin
- Neurosurgery Unit – Fondazione Poliambulanza , Brescia , Italy
| | - Paolo Ferroli
- Neurosurgery Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | | | - Federico Legnani
- Neurosurgery Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | | | - Pietro Mortini
- Neurosurgery Unit - San Raffaele Hospital , Milan , Italy
| | | | | | | | - Monica Patanè
- Neuropathology Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | - Rosina Paterra
- Neuro-Oncology Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | - Bianca Pollo
- Neuropathology Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | - Massimo Saini
- Neurosurgery Unit - Istituto Neurologico Carlo Besta , Milan , Italy
| | - Silvia Snider
- Neurosurgery Unit - San Raffaele Hospital , Milan , Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget) , Milan , Italy
| | | | | | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital , Milan , Italy
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7
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Gentner B, Finocchiaro G, Farina F, Eoli M, Capotondo A, Anghileri E, Barcella M, Bruzzone MG, Carrabba MG, Cuccarini V, D'Alessandris G, Meco FD, Ferla V, Ferroli P, Gagliardi F, Legnani F, Mortini P, Naldini MM, Olivi A, Pallini R, Patanè M, Paterra R, Pollo B, Saini M, Snider S, Brambilla V, Mazzoleni S, Zambanini A, Russo C, Naldini L, Ciceri F. Abstract 5213: Genetically modified Tie-2 expressing monocytes target IFN-α2 to the glioblastoma tumor microenvironment (TME): Preliminary data from the TEM-GBM Phase 1/2a study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Increasing clinical use of immune checkpoint inhibitors testifies to the importance of modulating the immune TME to obtain meaningful anti-tumor immune responses. Acting only on T lymphocytes may, however, not be sufficient, e.g. in immunologically-cold tumors or due to de novo or acquired resistance. Moreover, immune-related AEs remain hurdles of T cell therapies. To overcome these limitations and to awaken the immune system in an agnostic way against the tumor, we have developed a genetically modified cell-based autologous hematopoietic stem cell platform (Temferon) delivering immunotherapeutic payloads into the TME through Tie-2 expressing monocytes (TEMs), a subset of tumor infiltrating macrophages. TEM-GBM is an ongoing open-label, Phase 1/2a dose-escalating study evaluating the safety & efficacy of Temferon in up to 21 newly diagnosed patients with glioblastoma & unmethylated MGMT promoter assigned to 7 different cohorts (3 pts each) differing by Temferon dose (0.5-4.0x106/kg) and conditioning regimen (BCNU+ or Busulfan+Thiotepa). By Oct 15th, 2021, 15 pts (cohort 1-5) had received escalating doses of Temferon with a median follow up of 267 days (range: 60-749). Rapid engraftment and hematological recovery from nonmyeloablative conditioning occurred in all pts. Temferon-derived differentiated cells, as determined by the presence of vector genomes in the DNA, were found at increasing proportions in PB and BM, reaching up to 30% at 1 month for the highest cohorts tested (2.0x106/kg) and persisting up to 18 months, albeit at lower levels. Despite the significant proportion of engineered cells, only very low median concentrations of IFNα were detected in the plasma (D+30, 5.9; D+90, 8.8pg/mL) and in the cerebrospinal fluid (D+30, 1.5; D+90, 2.4pg/mL), indicating tight regulation of vector expression. SAEs were mostly attributed to conditioning chemotherapy (e.g. infections) or disease progression (e.g. seizures). 1 SUSAR (persistent GGT elevation) has occurred. Median OS is 14 mth from surgery (11 mth post Temferon). Four pts from the low dose cohorts underwent 2nd surgery. These recurrent tumors contained gene-marked cells and expressed IFN-responsive genes, indicative of local IFNα release by TEMs. In 1 pt, a stable lesion (as defined by MRI) had a higher proportion of T cells & TEMs, an increased IFN-response signature and myeloid re-programming revealed by scRNAseq, as compared to a synchronous, progressing tumor. TCR sequencing of blood and tumor samples showed a post-treatment increase in the cumulative frequency of tumor-associated T cell clones identified in 1st and 2nd surgery specimens (up to 4 out of 9 subjects). These results provide initial evidence for on-target activity of Temferon in GBM, to be consolidated with longer follow up in the higher dose cohorts.
Citation Format: Bernhard Gentner, Gaetano Finocchiaro, Francesca Farina, Marica Eoli, Alessia Capotondo, Elena Anghileri, Matteo Barcella, Maria Grazia Bruzzone, Matteo Giovanni Carrabba, Valeria Cuccarini, Giorgio D'Alessandris, Francesco Di Meco, Valeria Ferla, Paolo Ferroli, Filippo Gagliardi, Federico Legnani, Pietro Mortini, Matteo Maria Naldini, Alessandro Olivi, Roberto Pallini, Monica Patanè, Rosina Paterra, Bianca Pollo, Marco Saini, Silvia Snider, Valentina Brambilla, Stefania Mazzoleni, Andrew Zambanini, Carlo Russo, Luigi Naldini, Fabio Ciceri. Genetically modified Tie-2 expressing monocytes target IFN-α2 to the glioblastoma tumor microenvironment (TME): Preliminary data from the TEM-GBM Phase 1/2a study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5213.
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Affiliation(s)
- Bernhard Gentner
- 1San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Milano, Italy
| | | | - Francesca Farina
- 3Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital, Milano, Italy
| | - Marica Eoli
- 4Neuro-Oncology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessia Capotondo
- 1San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Milano, Italy
| | - Elena Anghileri
- 4Neuro-Oncology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Matteo Barcella
- 1San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Milano, Italy
| | | | | | - Valeria Cuccarini
- 5Neuroradiology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Francesco Di Meco
- 7Neurosurgery Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Valeria Ferla
- 3Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital, Milano, Italy
| | - Paolo Ferroli
- 7Neurosurgery Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Federico Legnani
- 7Neurosurgery Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Pietro Mortini
- 8Neurosurgery Unit - San Raffaele Hospital, Milano, Italy
| | | | | | | | - Monica Patanè
- 9Neuropathology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Rosina Paterra
- 4Neuro-Oncology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Bianca Pollo
- 9Neuropathology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Saini
- 7Neurosurgery Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Silvia Snider
- 8Neurosurgery Unit - San Raffaele Hospital, Milano, Italy
| | | | | | | | | | - Luigi Naldini
- 1San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Milano, Italy
| | - Fabio Ciceri
- 3Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital, Milano, Italy
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Eoli M, Gentner B, Farina F, Anghileri E, Bisdas S, Bruzzone MG, Cuccarini V, D'Alessandris QG, Di Meco F, Ferroli P, Franzin A, Gagliardi F, Legnani F, Saini M, Olivi A, Pallini R, Russo C, Naldini L, Finocchiaro G, Ciceri F. Harnessing genetically engineered hematopoietic progenitor cells to redirect the tumor immune microenvironment against glioblastoma (TEM-GBM Study). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2040] [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
2040 Background: Immunotherapies represent powerful tools that are transforming the treatment of many cancers. However, immune dysfunction in cancer is multifactorial requiring multiple points of action, especially in immunologically-cold tumors. Methods: We have developed a genetically modified, autologous hematopoietic stem cell-based platform designed to deliver Interferon-alpha (IFNa) specifically into the tumor microenvironment through Tie-2 expressing monocytes (Temferon), in order to activate the immune system in an agnostic way against the tumor and re-establish immunosurveillance. Results: As of Jan 2022, 3 escalating doses of Temferon (from 0.5 to 2.0x106/kg) were tested across 15 patients assigned to 5 cohorts affected by newly diagnosed, unmethylated MGMT glioblastoma (GBM). The follow-up range from surgery is 5 – 27 mo (3 – 24 mo after Temferon). In all patients, we observed rapid engraftment of gene modified progenitors and fast recovery from sub-myeloablative conditioning (median engraftment across all the cohorts: Neu D+13, PLT D+14). Temferon-derived differentiated cells, as determined by the presence of vector genomes in the DNA, were found at increasing proportions in blood and bone marrow, reaching up to 30% at 1 mo for the highest dose cohorts tested and persisting up to 18 mo, albeit at lower levels. Despite the significant proportion of engineered cells, only very low median concentrations of IFNα were detected in the plasma (D+30, 5.9; D+90, 8.8pg/mL) and in the CSF (D+30, 1.5; D+90, 2.4pg/mL), indicating tight regulation of vector expression. SAEs were mostly attributed to conditioning chemotherapy (e.g. infections) or disease progression (e.g. seizures). 1 SUSAR (persistent GGT elevation) has occurred. Median OS is 14 mo from surgery (10 mo post Temferon). A patient from cohort 3, had at D+120 disease progression with two distant enhancing lesions, and increased tumor necrosis. One year following Temferon, with no 2nd line therapy added, there was approximately 40% reduction in enhancing tumor volume compared to D+180. Four pts from the low dose cohorts underwent 2nd surgery. Vector genomes were detectable in tumor biopsies. Single cell RNA seq performed on CD45+ cells purified from the GBM TME highlighted the presence of an Interferon gene signature in all patients, resulting in macrophage repolarization in some of them. Conclusions: Our interim results show that Temferon is well tolerated, with no dose limiting toxicities identified to date. The results provide initial evidence of Temferon’s potential to modulate the TME of GBM patients. Clinical trial information: NCT03866109.
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Affiliation(s)
- Marica Eoli
- Neuro-Oncology Unit-Istituto Neurologico Carlo Besta-Milano, Milan, Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy-IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Farina
- Hematology and Bone Marrow Transplantation Unit-IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Anghileri
- Neuro-Oncology Unit-Istituto Neurologico Carlo Besta-Milano, Milan, Italy
| | - Sotiros Bisdas
- Department of Neuroradiology at the National Hospital for Neurology, London, London, United Kingdom
| | | | - Valeria Cuccarini
- Neuroradiology Unit-Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Francesco Di Meco
- Neurosurgery Unit-Istituto Neurologico Carlo Besta-Milano, Milan, Italy
| | - Paolo Ferroli
- Neurosurgery Unit- Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Federico Legnani
- Neurosurgery Unit-Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Saini
- Neurosurgery Unit-Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | | | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Milan, Italy
| | | | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit-San Raffaele Hospital, Milan, Italy
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Finocchiaro G, Gentner B, Marica E, Francesca F, Capotondo A, Ferla V, Carrabba M, Cuccarini V, Meco FD, Legnani F, Pollo B, Saini M, Ferroli P, Pallini R, D'Alessandris G, Patanè M, Paterra R, Garramone M, Antonarelli G, Naldini M, Barcella M, Brambilla V, Magnani T, Mazzoleni S, Bashir Z, Olivi A, Bruzzone M, Russo C, Naldini L, Ciceri F. CTIM-19. TEM-GBM: A PHASE I-IIA DOSE-ESCALATION STUDY DELIVERING IFN-Α WITHIN GLIOBLASTOMA MULTIFORME TUMOR MICROENVIRONMENT BY GENETICALLY MODIFIED TIE-2 EXPRESSING MONOCYTES. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Temferon is an ex vivo gene therapy consisting of autologous HSPCs genetically modified to deliver IFN-α2 within the tumor microenvironment (TME) by Tie-2 expressing macrophages. TEM-GBM is an open-label, Phase I/IIa dose-escalation study evaluating safety and efficacy of Temferon in up to 21 newly diagnosed GBM patients with unmethylated MGMT. Autologous HSPCs are transduced with a LVV encoding for IFN-a2 gene. As of 30th April 2021, 18 patients have been enrolled; 13 received Temferon (D+0) with follow-up of 8 – 662 days. After conditioning and Temferon infusion, a rapid engraftment and hematological recovery occurred, with median neutrophil and platelet engraftment at D+13 and D+12, respectively. No dose limiting toxicities were reported. Temferon-derived cells were found within 14 days post treatment and persisted albeit at lower levels in the long-term. Five deaths occurred: one at +478, three at +322, +340 and +402 days due to PD, and the fourth at +60 due to complications following the conditioning regimen. Eight patients had PD (-12 to +239). SAEs include respiratory tract infections, pulmonary embolism, CMV and C.Diff infections, febrile neutropenia, hemiparesis, seizure, brain abscess, worsening of performance status and respiratory failure compatible with ASCT, concomitant medications and PD. Four patients underwent second surgery. Recurrent tumors had gene-marked cells present and increased expression of ISGs compared to diagnosis, indicative of local IFNa release by TEMs. In one patient, a stable lesion had a higher proportion of T cells and TEMs within the myeloid infiltrate and an increased IFN-response signature than in a progressing lesion. Characterization of T-cell immune repertoire suggests the expansion of tumor-associated clones. TME characterization by scRNA and TCR sequencing is ongoing. Interim results show that Temferon is well tolerated, with no dose limiting toxicities identified to date and provide initial evidence of potential immune system activation within the TME.
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Affiliation(s)
| | | | - Eoli Marica
- Neuro-Oncology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Farina Francesca
- Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital, Milano, Italy
| | | | - Valeria Ferla
- Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital, Milano, Italy
| | - Matteo Carrabba
- Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital, Milano, Italy
| | - Valeria Cuccarini
- Neuroradiology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Federico Legnani
- Neurosurgery Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Bianca Pollo
- Neuropathology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Saini
- Neurosurgery Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Ferroli
- Neurosurgery Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | | | | | - Monica Patanè
- Neuropathology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | - Rosina Paterra
- Neuro-Oncology Unit - Istituto Neurologico Carlo Besta, Milano, Italy
| | | | | | - Matteo Naldini
- San Raffaele Telethon Institute for Gene Therapy, Milano, Italy
| | - Matteo Barcella
- San Raffaele Telethon Institute for Gene Therapy, Milano, Italy
| | | | | | | | | | | | | | | | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy, Milano, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit - San Raffaele Hospital, Milano, Italy
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10
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Gentner B, Finocchiaro G, Farina F, Capotondo A, Eoli M, Anghileri E, Ganzetti M, Carabba M, Cuccarini V, Meco FD, Legnani F, Pollo B, Bruzzone MG, Saini M, Ferroli P, Pallini R, Olivi A, Paterra R, Garramone M, Mazzoleni S, Brambilla V, Magnani T, Antonarelli G, Naldini M, Barcella M, Russo C, Naldini L, Ciceri F. Abstract CT180: Changes in immunologic responses and in the tumor microenvironment in patients with glioblastoma multiforme treated with IFN-a immune cell and gene therapy (TEM-GBM_001 Study). Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Genetically modified cell-based therapies are of increasing relevance in immuno-oncology due to their potential for tumor specificity, long term efficacy & limiting off-target effects. We have developed a genetically modified cell-based platform, with ex-vivo transduction of autologous hematopoietic stem & progenitor cells with a lentiviral vector expressing the IFN-α transgene (Temferon) & delivery by autologous stem cell transplantation (ASCT). Specific control mechanisms restrict transgene expression to Tie-2 expressing macrophages (TEMs) thanks to a specific Tie-2 promoter & a post-transcriptional regulation layer represented by miRNA target sequences.
TEM-GBM is an ongoing open-label, Phase I/IIa dose-escalation study evaluating safety & efficacy of Temferon in newly diagnosed patients with glioblastoma & unmethylated MGMT promoter. Part A includes 15 patients to optimize the dose & conditioning regimen (completion expected end of Q2/21), & Part B includes 6 patients.
By 10th Nov 2020, 13 patients had enrolled; 8 received Temferon with a median follow up of 298 days (53-491). One patient died from progressive disease (PD) at D+403. PD occurred in 6 patients after a median 123 days (83-229) from treatment, within expectations for this tumor type. 4 patients underwent second surgery. Temferon was well tolerated, with median neutrophil & platelet engraftment occurring at D+13 & D+12, respectively, post submyeloablative BCNU + Thiotepa conditioning, & without dose-limiting toxicities. SAEs attributed to ASCT, concomitant medications & GBM progression included febrile neutropenia & other infectious complications, venous thromboembolism, poor performance status, liver enzyme elevation, brain abscess & hemiparesis. Temferon-derived differentiated cells, as determined by the presence of vector genomes in peripheral blood & bone marrow, were evident within 14 days from treatment & persisted, albeit at lower levels, in the long term (up to 1 year). The built-in transgene expression control mechanism was effective as suggested by the very low concentrations of IFN-α detected in the plasma & cerebrospinal fluid. The T-cell immune repertoire changed after treatment, with evidence for expansion of tumor-associated clones in peripheral blood. Preliminary data on tumor specimens from second surgery confirmed the presence of TEMs & increased expression of IFN-responsive gene signatures compared to diagnosis indicative of local IFN-α release. Biopsies of a stable as compared to a progressing lesion in 1 patient had a higher proportion of T cells & TEMs within the myeloid infiltrate & a markedly increased IFN-response signature. Comprehensive characterization of the tumor microenvironment by scRNA sequencing is ongoing. The results provide initial evidence of the biological effects of Temferon in patients with GBM.
Citation Format: Bernhard Gentner, Gaetano Finocchiaro, Francesca Farina, Alessia Capotondo, Marica Eoli, Elena Anghileri, Maya Ganzetti, Matteo Carabba, Valeria Cuccarini, Francesco Di Meco, Federico Legnani, Bianca Pollo, Maria Grazia Bruzzone, Marco Saini, Paolo Ferroli, Roberto Pallini, Alessandro Olivi, Rosina Paterra, Mariagrazia Garramone, Stefania Mazzoleni, Valentina Brambilla, Tiziana Magnani, Gabriele Antonarelli, Matteo Naldini, Matteo Barcella, Carlo Russo, Luigi Naldini, Fabio Ciceri. Changes in immunologic responses and in the tumor microenvironment in patients with glioblastoma multiforme treated with IFN-a immune cell and gene therapy (TEM-GBM_001 Study) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT180.
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Affiliation(s)
| | | | - Francesca Farina
- 3Hematology and Bone Marrow Transplantation Unit - San Raffaele Hospital, Milan, Italy
| | - Alessia Capotondo
- 4San Raffaele Telethon Institute for Gene Therapy Clinical Lab, Milan, Italy
| | - Marica Eoli
- 5Neuro-Oncology Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Elena Anghileri
- 5Neuro-Oncology Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Maya Ganzetti
- 3Hematology and Bone Marrow Transplantation Unit - San Raffaele Hospital, Milan, Italy
| | - Matteo Carabba
- 3Hematology and Bone Marrow Transplantation Unit - San Raffaele Hospital, Milan, Italy
| | - Valeria Cuccarini
- 6Neuroradiology Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Israel
| | - Francesco Di Meco
- 7Neurosurgery Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Federico Legnani
- 7Neurosurgery Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- 8Neurophatology Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | | | - Marco Saini
- 7Neurosurgery Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- 7Neurosurgery Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Roberto Pallini
- 10Neurosurgery Unit - Policlinico Gemelli Hospital, Rome, Italy
| | | | - Rosina Paterra
- 8Neurophatology Unit - Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | | | | | | | | | | | - Matteo Naldini
- 1San Raffaele Telethon Institute for Gene Therapy, Milan, Italy
| | - Matteo Barcella
- 3Hematology and Bone Marrow Transplantation Unit - San Raffaele Hospital, Milan, Italy
| | | | - Luigi Naldini
- 1San Raffaele Telethon Institute for Gene Therapy, Milan, Italy
| | - Fabio Ciceri
- 3Hematology and Bone Marrow Transplantation Unit - San Raffaele Hospital, Milan, Italy
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11
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Raspagliesi L, D'Ammando A, Gionso M, Sheybani ND, Lopes MB, Moore D, Allen S, Gatesman J, Porto E, Timbie K, Franzini A, Di Meco F, Sheehan J, Xu Z, Prada F. Intracranial Sonodynamic Therapy With 5-Aminolevulinic Acid and Sodium Fluorescein: Safety Study in a Porcine Model. Front Oncol 2021; 11:679989. [PMID: 34235081 PMCID: PMC8256685 DOI: 10.3389/fonc.2021.679989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 02/02/2023] Open
Abstract
Background Sonodynamic therapy (SDT) is an emerging ultrasound-based treatment modality for malignant gliomas which combines ultrasound with sonosensitizers to produce a localized cytotoxic and modulatory effect. Tumor-specificity of the treatment is achieved by the selective extravasation and accumulation of sonosensitizers in the tumor-bearing regions. The aim of this study is to demonstrate the safety of low-intensity ultrasonic irradiation of healthy brain tissue after the administration of FDA-approved sonosensitizers used for SDT in experimental studies in an in vivo large animal model. Methods In vivo safety of fluorescein (Na-Fl)- and 5 aminolevulinic acid (5-ALA)-mediated low-intensity ultrasound irradiation of healthy brain parenchyma was assessed in two sets of four healthy swine brains, using the magnetic resonance imaging (MRI)-guided Insightec ExAblate 4000 220 kHz system. After administration of the sonosensitizers, a wide fronto-parietal craniotomy was performed in pig skulls to allow transmission of ultrasonic beams. Sonication was performed on different spots within the thalamus and periventricular white matter with continuous thermal monitoring. Sonication-related effects were investigated with MRI and histological analysis. Results Post-treatment MRI images acquired within one hour following the last sonication, on day one, and day seven did not visualize any sign of brain damage. On histopathology, no signs of necrosis or apoptosis attributable to the ultrasonic treatments were shown in target areas. Conclusions The results of the present study suggest that either Na-FL or 5-ALA-mediated sonodynamic therapies under MRI-guidance with the current acoustic parameters are safe towards healthy brain tissue in a large in vivo model. These results further support growing interest in clinical translation of sonodynamic therapy for intracranial gliomas and other brain tumors.
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Affiliation(s)
- Luca Raspagliesi
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio D'Ammando
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Natasha D Sheybani
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, United States
| | - Maria-Beatriz Lopes
- Department of Pathology, University of Virginia, Charlottesville, VA, United States
| | - David Moore
- Focused Ultrasound Foundation, Charlottesville, VA, United States
| | - Steven Allen
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Jeremy Gatesman
- Center for Comparative Medicine, University of Virginia, Charlottesville, VA, United States
| | - Edoardo Porto
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Kelsie Timbie
- Focused Ultrasound Foundation, Charlottesville, VA, United States
| | - Andrea Franzini
- Department of Neurosurgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Francesco Di Meco
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy.,Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, United States
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Francesco Prada
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Focused Ultrasound Foundation, Charlottesville, VA, United States.,Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States.,Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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12
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D’Ammando A, Raspagliesi L, Gionso M, Franzini A, Porto E, Di Meco F, Durando G, Pellegatta S, Prada F. Sonodynamic Therapy for the Treatment of Intracranial Gliomas. J Clin Med 2021; 10:1101. [PMID: 33800821 PMCID: PMC7961476 DOI: 10.3390/jcm10051101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
High-grade gliomas are the most common and aggressive malignant primary brain tumors. Current therapeutic schemes include a combination of surgical resection, radiotherapy and chemotherapy; even if major advances have been achieved in Progression Free Survival and Overall Survival for patients harboring high-grade gliomas, prognosis still remains poor; hence, new therapeutic options for malignant gliomas are currently researched. Sonodynamic Therapy (SDT) has proven to be a promising treatment combining the effects of low-intensity ultrasound waves with various sound-sensitive compounds, whose activation leads to increased immunogenicity of tumor cells, increased apoptotic rates and decreased angiogenetic potential. In addition, this therapeutic technique only exerts its cytotoxic effects on tumor cells, while both ultrasound waves and sensitizing compound are non-toxic per se. This review summarizes the present knowledge regarding mechanisms of action of SDT and currently available sonosensitizers and focuses on the preclinical and clinical studies that have investigated its efficacy on malignant gliomas. To date, preclinical studies implying various sonosensitizers and different treatment protocols all seem to confirm the anti-tumoral properties of SDT, while first clinical trials will soon start recruiting patients. Accordingly, it is crucial to conduct further investigations regarding the clinical applications of SDT as a therapeutic option in the management of intracranial gliomas.
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Affiliation(s)
- Antonio D’Ammando
- Acoustic Neuroimaging and Therapy Laboratory Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.D.); (L.R.); (M.G.)
| | - Luca Raspagliesi
- Acoustic Neuroimaging and Therapy Laboratory Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.D.); (L.R.); (M.G.)
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.P.); (F.D.M.)
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
| | - Matteo Gionso
- Acoustic Neuroimaging and Therapy Laboratory Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.D.); (L.R.); (M.G.)
- Faculty of Medicine and Surgery, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Italy;
| | - Edoardo Porto
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.P.); (F.D.M.)
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
| | - Francesco Di Meco
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.P.); (F.D.M.)
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD 21205, USA
| | - Giovanni Durando
- Istituto Nazionale di Ricerca Metrologica I.N.Ri.M., 10135 Torino, Italy;
| | - Serena Pellegatta
- Laboratory of Immunotherapy of Brain Tumors, Unit of Molecular Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Francesco Prada
- Acoustic Neuroimaging and Therapy Laboratory Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.D.); (L.R.); (M.G.)
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA
- Focused Ultrasound Foundation, Charlottesville, VA 22903, USA
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13
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Schellekes N, Barbotti A, Abramov Y, Sitt R, Di Meco F, Ram Z, Grossman R. Resection of primary central nervous system lymphoma: impact of patient selection on overall survival. J Neurosurg 2021; 135:1016-1025. [PMID: 33636699 DOI: 10.3171/2020.9.jns201980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/25/2020] [Accepted: 09/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Primary central nervous system lymphoma (PCNSL) is a rare CNS tumor with a poor prognosis. It is usually diagnosed by needle biopsy and treated mainly with high-dose chemotherapy. Resection is currently not considered a standard treatment option. A possible prolonged survival after resection of PCNSL lesions in selected patients has been suggested, but selection criteria for surgery, especially for solitary lesions, have never been established. METHODS The authors retrospectively searched their patient database for records of adult patients (≥ 18 years) who were diagnosed and treated for a solitary PCNSL between 2005 and 2019. Patients were divided into groups according to whether they underwent resection or needle biopsy. Statistical analyses were performed in an attempt to identify variables affecting outcome and possible survival advantage and to characterize subgroups of patients who would benefit from resection of their tumor compared with undergoing biopsy only. RESULTS A total of 113 patients with a solitary lesion of PCNSL were identified; 36 patients underwent resection, and 77 had a diagnostic stereotactic biopsy only. The statically significant preoperative risk factors included age ≥ 70 years (adjusted HR 9.61, 95% CI 2.42-38.11; p = 0.001), deep-seated lesions (adjusted HR 3.33, 95% CI 1.13-9.84; p = 0.030), and occipital location (adjusted HR 4.26, 95% CI 1.08-16.78; p = 0.039). Having a postoperative Karnofsky Performance Scale (KPS) score < 80 (adjusted HR 3.21, 95% CI 1.05-9.77; p = 0.040) and surgical site infection (adjusted HR 4.27, 95% CI 1.18-15.47; p = 0.027) were significant postoperative risk factors after the adjustment and selection by means of other possible risk factors. In a subgroup analysis, patients younger than 70 years who underwent resection had a nonsignificant trend toward longer survival than those who underwent needle biopsy (median survival 35.0 months vs 15.2 months, p = 0.149). However, patients with a superficial tumor who underwent resection had significantly longer survival times than those who underwent needle biopsy (median survival 34.3 months vs 8.9 months, p = 0.014). Patients younger than 70 years who had a superficial tumor and underwent resection had significantly prolonged survival, with a median survival of 35.0 months compared with 8.9 months in patients from the same group who underwent needle biopsy (p = 0.007). CONCLUSIONS Specific subgroups of patients with a solitary PCNSL lesion might gain a survival benefit from resection compared with undergoing only a diagnostic biopsy.
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Affiliation(s)
- Nadav Schellekes
- 1Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Arianna Barbotti
- 2Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Yael Abramov
- 1Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Razi Sitt
- 1Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Francesco Di Meco
- 2Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Zvi Ram
- 1Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Rachel Grossman
- 1Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
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Schiavolin S, Mariniello A, Broggi M, Acerbi F, Schiariti M, Franzini A, Di Meco F, Ferroli P, Leonardi M. Characteristics of Patients Returning to Work After Brain Tumor Surgery. Front Hum Neurosci 2021; 14:609080. [PMID: 33613204 PMCID: PMC7886680 DOI: 10.3389/fnhum.2020.609080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the differences between patients returning to work and those who did not after brain tumor surgery. Methods: Patients were evaluated before surgery and after 3 months. The Montreal Cognitive Assessment test, Trail-Making Test (parts A and B), 15-word Rey–Osterrieth Word List (immediate and delayed recall), F-A-S tests, and Karnosfky Performance Status were used to assess cognitive status, attention, executive functions, memory, word fluency, and functional status. Patient-reported outcome measures (PROMs) used to evaluate emotional distress and disability were the Hospital Anxiety and Depression Scale and World Health Organization Disability Assessment Schedule. Clinical and work-related variables, PROMs, and cognitive tests were compared using chi-squared, t-test or Mann–Whitney U test. Results: Sixty patients were included. Patients returning to work were 61.3 and 31.0% among people with meningioma and glioma, respectively. They reported lower postoperative disability and lesser home-to-work travel time. Patients with meningioma also showed better preoperative and postoperative attention and executive functions, better postoperative functional and cognitive status, and lower frequency of treatments. Conclusions: These variables should be considered in a clinical context to plan interventions for people who need support during return to work and in future research to investigate preoperative and postoperative predictive factors of going back to work.
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Affiliation(s)
- Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Arianna Mariniello
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Angelo Franzini
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
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15
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Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fontanella MM. Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir (Wien) 2020; 162:1221-1222. [PMID: 32222820 PMCID: PMC7103098 DOI: 10.1007/s00701-020-04305-w] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Bongetta
- Department of Neurosurgery, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Pierlorenzo Veiceschi
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127, Bergamo, Italy.
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Carlo Besta Institute of Neurology, IRCCS and Foundation, Milan, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Ospedale di Circolo ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Davide Boeris
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco M Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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16
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Perin A, Messina G, Di Meco F, Franzini A. Conservative treatment for bilateral subdural hematomas. J Neurosurg Sci 2020; 64:124-125. [DOI: 10.23736/s0390-5616.18.04332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Oddo L, Paradossi G, Cerroni B, Ben-Harush C, Ariel E, Di Meco F, Ram Z, Grossman R. In Vivo Biodistribution of Engineered Lipid Microbubbles in Rodents. ACS Omega 2019; 4:13371-13381. [PMID: 31460465 PMCID: PMC6704434 DOI: 10.1021/acsomega.9b01544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/25/2019] [Indexed: 05/08/2023]
Abstract
Maximal resection of intrinsic brain tumors is a major prognostic factor for survival. Real-time intraoperative imaging tools, including ultrasound (US), are crucial for maximal resection of such tumors. Microbubbles (MBs) are clinically used in daily practice as a contrast agent for ultrasound and can be further developed to serve combined therapeutic and diagnostic purposes. To achieve this goal, we have developed novel MBs conjugated to specific ligands to receptors which are overexpressed in brain tumors. These MBs are designed to target a tumor tissue, visualize it, and deliver therapeutic molecules into it. The objective of this study was to assess the biodistribution of the test items: We used MBs labeled with indocyanine green (MB-ICG) for visualization and MBs conjugated to a cyclic molecule containing the tripeptide Arg-Gly-Asp (RGD) labeled with ICG (MB-RGD-ICG) to target brain tumor integrins as the therapeutic tools. Male Sprague Dawley rats received a single dose of each MB preparation. The identification of the MB in various organs was monitored by fluorescence microscopy in anesthetized animals as well as real-time US for brain imaging. Equally sized control groups under identical conditions were used in this study. One control group was used to establish fluorescence background conditions (ICG), and two control groups were used to test autofluorescence from the test items (MBs and MB-RGD). ICG with or without MBs (naked or RGD-modified) was detected in the brain vasculature and also in other organs. The pattern, duration, and intensity of the fluorescence signal could not be differentiated between animals treated with ICG alone and animals treated with microbubbles MBs-ICG or MBs-RGD-ICG. Following MB injection, either naked or combined with RGD, there was a sharp rise in the Doppler signal within seconds of injection in the brain. The signal was mainly located at the choroid plexus, septum pellucidum, and the meninges of the brain. The signal subsided within a few minutes. Injection of saline or ICG alone to respective animals did not result in a similar raised signal. Following a single intravenous administration of MB-ICG and MB-RGD-ICG to rats, the MBs were found to be effectively present in the brain.
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Affiliation(s)
- Letizia Oddo
- Dipartimento di Scienze e Tecnologie Chimiche, Universitá degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Gaio Paradossi
- Dipartimento di Scienze e Tecnologie Chimiche, Universitá degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Barbara Cerroni
- Dipartimento di Scienze e Tecnologie Chimiche, Universitá degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Carmit Ben-Harush
- Department of Neurosurgery,
Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6997801 Tel-Aviv, Israel
| | - Eti Ariel
- Department of Neurosurgery,
Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6997801 Tel-Aviv, Israel
| | - Francesco Di Meco
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Zvi Ram
- Department of Neurosurgery,
Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6997801 Tel-Aviv, Israel
| | - Rachel Grossman
- Department of Neurosurgery,
Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6997801 Tel-Aviv, Israel
- E-mail: . Phone: +972-3-6974273. Fax: +972-3-6974860
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18
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Paradossi G, Oddo L, Cerroni B, Ben-Harush C, Ariel E, Di Meco F, Ram Z, Grossman R. In Vivo Toxicity Study of Engineered Lipid Microbubbles in Rodents. ACS Omega 2019; 4:5526-5533. [PMID: 31497678 PMCID: PMC6715268 DOI: 10.1021/acsomega.8b03161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/16/2019] [Indexed: 05/08/2023]
Abstract
Real-time intraoperative imaging for brain tumor surgery is crucial for achieving complete resection. We are developing novel lipid-based microbubbles (MBs), engineered with specific ligands, which are able to interact with the integrins overexpressed in the endothelium of the brain tumor vasculature. These MBs are designed to visualize the tumor and to carry therapeutic molecules into the tumor tissue, preserving the ultrasound acoustic properties of the starting plain lipid MBs. The potential toxicity of this novel technology was assessed in rats by intravenous injections of two doses of plain MBs and MBs engineered for targeting and near-infrared fluorescence visualization at two time-points, 10 min and 7 days, for potential acute and chronic responses in rats [(1) MB, (2) MB-ICG, (3) MB-RGD, and (4) MB-ICG-RGD]. No mortality occurred during the 7-day study period in any of the dosing groups. All animals demonstrated a body weight gain during the study period. Minor, mostly reversible changes in hematological and biochemical analysis were observed in some of the treated animals. All changes were reversible by the 7-day time-point. Histopathology examination in the high-dose animals showed development of foreign body granulomatous inflammation. We concluded that the low-dose tested items appear to be safe. The results allow for proceeding to clinical testing of the product.
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Affiliation(s)
- Gaio Paradossi
- Dipartimento di Scienze e Tecnologie Chimiche, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Letizia Oddo
- Dipartimento di Scienze e Tecnologie Chimiche, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Barbara Cerroni
- Dipartimento di Scienze e Tecnologie Chimiche, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Carmit Ben-Harush
- Department of Neurosurgery,
Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6997801 Tel-Aviv, Israel
| | - Eti Ariel
- Department of Neurosurgery,
Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6997801 Tel-Aviv, Israel
| | - Francesco Di Meco
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Zvi Ram
- Department of Neurosurgery,
Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6997801 Tel-Aviv, Israel
| | - Rachel Grossman
- Department of Neurosurgery,
Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6997801 Tel-Aviv, Israel
- E-mail: . Phone: +972-3-6974273. Fax: +972-3-6974860
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19
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Stupp R, Taillibert S, Kanner A, Read W, Steinberg DM, Lhermitte B, Toms S, Idbaih A, Ahluwalia MS, Fink K, Di Meco F, Lieberman F, Zhu JJ, Stragliotto G, Tran DD, Brem S, Hottinger AF, Kirson ED, Lavy-Shahaf G, Weinberg U, Kim CY, Paek SH, Nicholas G, Burna J, Hirte H, Weller M, Palti Y, Hegi ME, Ram Z. Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients With Glioblastoma: A Randomized Clinical Trial. JAMA 2017; 318:2306-2316. [PMID: 29260225 PMCID: PMC5820703 DOI: 10.1001/jama.2017.18718] [Citation(s) in RCA: 1359] [Impact Index Per Article: 194.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Tumor-treating fields (TTFields) is an antimitotic treatment modality that interferes with glioblastoma cell division and organelle assembly by delivering low-intensity alternating electric fields to the tumor. OBJECTIVE To investigate whether TTFields improves progression-free and overall survival of patients with glioblastoma, a fatal disease that commonly recurs at the initial tumor site or in the central nervous system. DESIGN, SETTING, AND PARTICIPANTS In this randomized, open-label trial, 695 patients with glioblastoma whose tumor was resected or biopsied and had completed concomitant radiochemotherapy (median time from diagnosis to randomization, 3.8 months) were enrolled at 83 centers (July 2009-2014) and followed up through December 2016. A preliminary report from this trial was published in 2015; this report describes the final analysis. INTERVENTIONS Patients were randomized 2:1 to TTFields plus maintenance temozolomide chemotherapy (n = 466) or temozolomide alone (n = 229). The TTFields, consisting of low-intensity, 200 kHz frequency, alternating electric fields, was delivered (≥ 18 hours/d) via 4 transducer arrays on the shaved scalp and connected to a portable device. Temozolomide was administered to both groups (150-200 mg/m2) for 5 days per 28-day cycle (6-12 cycles). MAIN OUTCOMES AND MEASURES Progression-free survival (tested at α = .046). The secondary end point was overall survival (tested hierarchically at α = .048). Analyses were performed for the intent-to-treat population. Adverse events were compared by group. RESULTS Of the 695 randomized patients (median age, 56 years; IQR, 48-63; 473 men [68%]), 637 (92%) completed the trial. Median progression-free survival from randomization was 6.7 months in the TTFields-temozolomide group and 4.0 months in the temozolomide-alone group (HR, 0.63; 95% CI, 0.52-0.76; P < .001). Median overall survival was 20.9 months in the TTFields-temozolomide group vs 16.0 months in the temozolomide-alone group (HR, 0.63; 95% CI, 0.53-0.76; P < .001). Systemic adverse event frequency was 48% in the TTFields-temozolomide group and 44% in the temozolomide-alone group. Mild to moderate skin toxicity underneath the transducer arrays occurred in 52% of patients who received TTFields-temozolomide vs no patients who received temozolomide alone. CONCLUSIONS AND RELEVANCE In the final analysis of this randomized clinical trial of patients with glioblastoma who had received standard radiochemotherapy, the addition of TTFields to maintenance temozolomide chemotherapy vs maintenance temozolomide alone, resulted in statistically significant improvement in progression-free survival and overall survival. These results are consistent with the previous interim analysis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00916409.
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Affiliation(s)
- Roger Stupp
- Lou and Jean MalnatiBrain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sophie Taillibert
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | | | - William Read
- University of California, San Diego
- Emory University, Atlanta, Georgia
| | | | - Benoit Lhermitte
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Steven Toms
- Geisinger Health System, Danville, Pennsylvania
| | - Ahmed Idbaih
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | | | - Karen Fink
- Baylor University Medical Center, Houston, Texas
| | | | - Frank Lieberman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jay-Jiguang Zhu
- University of Texas Health Sciences Center at Houston
- Tufts Medical Center, Boston, Massachusetts
| | | | - David D. Tran
- Washington University Barnes-Jewish Hospital, St Louis, Missouri
| | - Steven Brem
- Moffitt Cancer Center, Tampa, Florida
- University of Pennsylvania, Philadelphia
| | - Andreas F. Hottinger
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Chae-Yong Kim
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, Korea
| | | | - Garth Nicholas
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jordi Burna
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Hal Hirte
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Michael Weller
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Monika E. Hegi
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Zvi Ram
- Tel Aviv Medical Center, Tel Aviv, Israel
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20
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Binda E, Visioli A, Giani F, Trivieri N, Palumbo O, Restelli S, Dezi F, Mazza T, Fusilli C, Legnani F, Carella M, Di Meco F, Duggal R, Vescovi AL. Wnt5a Drives an Invasive Phenotype in Human Glioblastoma Stem-like Cells. Cancer Res 2016; 77:996-1007. [PMID: 28011620 DOI: 10.1158/0008-5472.can-16-1693] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/11/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022]
Abstract
Brain invasion by glioblastoma determines prognosis, recurrence, and lethality in patients, but no master factor coordinating the invasive properties of glioblastoma has been identified. Here we report evidence favoring such a role for the noncanonical WNT family member Wnt5a. We found the most invasive gliomas to be characterized by Wnt5a overexpression, which correlated with poor prognosis and also discriminated infiltrating mesenchymal glioblastoma from poorly motile proneural and classical glioblastoma. Indeed, Wnt5a overexpression associated with tumor-promoting stem-like characteristics (TPC) in defining the character of highly infiltrating mesenchymal glioblastoma cells (Wnt5aHigh). Inhibiting Wnt5a in mesenchymal glioblastoma TPC suppressed their infiltrating capability. Conversely, enforcing high levels of Wnt5a activated an infiltrative, mesenchymal-like program in classical glioblastoma TPC and Wnt5aLow mesenchymal TPC. In intracranial mouse xenograft models of glioblastoma, inhibiting Wnt5a activity blocked brain invasion and increased host survival. Overall, our results highlight Wnt5a as a master regulator of brain invasion, specifically TPC, and they provide a therapeutic rationale to target it in patients with glioblastoma. Cancer Res; 77(4); 996-1007. ©2016 AACR.
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Affiliation(s)
- Elena Binda
- IRCSS Casa Sollievo della Sofferenza, ISBReMIT- Institute for Stem Cell Biology, Regenerative Medicine and Innovative Therapies, Italy.
| | | | - Fabrizio Giani
- Dept. of Biotechnology and Biosciences, University of Milan Bicocca, Milan, Italy
| | - Nadia Trivieri
- IRCSS Casa Sollievo della Sofferenza, c/o Instituto Mendel, Rome, Italy
| | - Orazio Palumbo
- Medical Genetics Unit, IRCSS Casa Sollievo della Sofferenza, Opera di San Pio da Pietrelcina, Italy
| | | | - Fabio Dezi
- IRCSS Casa Sollievo della Sofferenza, ISBReMIT- Institute for Stem Cell Biology, Regenerative Medicine and Innovative Therapies, Italy
| | - Tommaso Mazza
- IRCSS Casa Sollievo della Sofferenza, c/o Instituto Mendel, Rome, Italy
| | - Caterina Fusilli
- IRCSS Casa Sollievo della Sofferenza, c/o Instituto Mendel, Rome, Italy
| | | | - Massimo Carella
- Medical Genetics Unit, IRCSS Casa Sollievo della Sofferenza, Opera di San Pio da Pietrelcina, Italy
| | - Francesco Di Meco
- National Neurological Institute "C. Besta," Milan, Italy
- Department of Neurosurgery, John Hopkins University, Baltimore, Maryland
| | - Rohit Duggal
- Stem Cell Research Unit, Sorrento Therapeutics Inc., San Diego, California
| | - Angelo L Vescovi
- IRCSS Casa Sollievo della Sofferenza, ISBReMIT- Institute for Stem Cell Biology, Regenerative Medicine and Innovative Therapies, Italy.
- StemGen SpA, Milan, Italy
- Dept. of Biotechnology and Biosciences, University of Milan Bicocca, Milan, Italy
- IRCSS Casa Sollievo della Sofferenza, c/o Instituto Mendel, Rome, Italy
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Cordella R, Nava S, Prada F, Agnoletti A, Legnani F, Di Meco F. Ultrasound guided mini-invasive tailored approach and intraoperative neurophysiological monitoring: a synergistic strategy for the removal of tumors near the motor cortex. A preliminary experience. J Neurosurg Sci 2016; 62:255-264. [PMID: 26967717 DOI: 10.23736/s0390-5616.16.03565-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this paper was to evaluate the synergic strategy comprising intraoperative neurophysiological monitoring and ultrasound sonography in terms of clinical motor scores and extent of resection. METHODS Patients harboring tumors in close relationship with the motor cortex were operated on with image-guided mini-invasive approach and multimodal neurophysiological monitoring. The peculiarity is the partial exposure of the motor cortex and the limited electrophysiological mapping used to search for negative spots. Multimodal neurophysiological monitoring comprised the electrocortical stimulation, somatosensory evoked potentials, motor evoked potentials and subcortical stimulation. Ultrasound sonography guided the tumor removal. The post-op clinical motor scores and the extent of resection were assessed. RESULTS Twelve patients were operated on with the combined approach and were further analyzed. Six had high grade gliomas, 1 anaplastic astrocytoma, 1 oligodendroglioma, 1 pilocytic astrocytoma and three had metastasis. One out of 12 had a worsening of the motor scores at the last follow-up. The mean extent of resection was 90% ranging from 60% to 100%, but in 9 out of 12 patients, it reached or exceeded 90%. CONCLUSIONS The synergic strategy comprising intraoperative multimodal neurophysiological monitoring and the ultrasound sonography is feasible in all surgeries. Data are promising in terms of both clinical motor scores and extent of resection. This strategy represents an alternative approach to the treatment of supratentorial tumors, although further studies are necessary to confirm the long-term efficacy of this procedure.
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Affiliation(s)
- Roberto Cordella
- Department of Neurosurgery, IRCCS Neurologic Institute "C. Besta" Foundation, Milan, Italy -
| | - Simone Nava
- Department of Neuroradiology, IRCCS Neurologic Institute "C. Besta" Foundation, Milan, Italy
| | - Francesco Prada
- Department of Neurosurgery, IRCCS Neurologic Institute "C. Besta" Foundation, Milan, Italy
| | - Alessandro Agnoletti
- Division of Neurosurgery, Department of Neuroscience, Molinette Hospital, University of Turin, Turin, Italy
| | - Federico Legnani
- Department of Neurosurgery, IRCCS Neurologic Institute "C. Besta" Foundation, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, IRCCS Neurologic Institute "C. Besta" Foundation, Milan, Italy
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Nicola G, Lasio G, Roccucci P, Tonnarelli G, Visintini S, Valentini L, Solero CL, Di Meco F. Craniopharyngiomas: A Review of 74 Surgical Cases. Skull Base Surg 2015. [DOI: 10.1159/000429884] [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: 11/19/2022]
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23
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Salmaggi A, Duri S, Silvani A, Gaviani P, Milanesi I, Casali C, Di Meco F. Loco-regional treatments in first-diagnosis glioblastoma: literature review on association between Stupp protocol and Gliadel. Neurol Sci 2012; 32 Suppl 2:S241-5. [PMID: 21983866 DOI: 10.1007/s10072-011-0797-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Loco-regional chemotherapy with carmustine wafers (Gliadel) positioned at surgery and followed by radiotherapy has been shown to prolong survival in first-diagnosis glioblastoma, as well as concomitant radiochemotherapy with temozolomide. The combination of Gliadel with the Stupp protocol has mostly been investigated in retrospective studies. objective of this study was to review the literature of efficacy and toxicities in patients with first-diagnosis glioblastoma treated with surgery, Gliadel, radiotherapy and temozolomide chemotherapy. The data in the literature regarding the combined use of Gliadel with chemotherapy, concomitant with radiotherapy and adjuvant temozolomide for glioblastoma was analyzed and compared. The results on survival and toxicity are summarized. The combination of Gliadel and radiotherapy with temozolomide is well tolerated and may increase survival without a substantial increase in major toxicity. However, only prospective comparative studies will be able to address the issue of true advantage in survival with this combination.
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Affiliation(s)
- Andrea Salmaggi
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy.
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Calatozzolo C, Canazza A, Pollo B, Di Pierro E, Ciusani E, Maderna E, Salce E, Sponza V, Frigerio S, Di Meco F, Schinelli S, Salmaggi A. Expression of the new CXCL12 receptor, CXCR7, in gliomas. Cancer Biol Ther 2011; 11:242-53. [PMID: 21084856 DOI: 10.4161/cbt.11.2.13951] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Gliomas are very invasive brain tumors with poor prognosis and therefore any attempt to limit tumor cell dissemination in the brain is expected to improve glioma treatment. The recent deorphanization of CXCR7 as additional receptor for CXCL12 and CXCL11 has raised key issues on its interaction with the CXCL12/CXCR4 axis as a mechanism to modulate glioma cell migration. In this work we investigated protein and mRNA expression of the two chemokines CXCL12 and CXCL11, together with their receptors CXCR4 and CXCR7 in human glioma specimens and cell lines by immunohistochemistry, flow cytometry and quantitative real-time PCR. The main purpose of this study was to find out whether and at what extent CXCR4 and CXCR7 are differentially expressed in glioma cells. In human glioma specimens the levels of CXCL11 and CXCR4 mRNA were significantly higher in glioblastomas compared to non-tumor controls or low grade gliomas, whilst no difference was found for CXCL12 and CXCR7 mRNA expression. In cell lines, flow cytometry and immunocytochemical experiments showed CXCR4 was mainly expressed irrespective of its membrane or intracellular localization. In contrast, a predominant intracellular localization together with a negligible membrane expression of CXCR7 was found in all cells examined. In in vitro experiments CXCR4 and CXCR7 antagonists and the silencing of CXCR4 showed complete inhibition of glioma proliferation. Our findings, in agreement with previous data, suggest that in human glioma cells the prevalent intracellular localization of CXCR7 might modulate the functionality of CXCL11/12 either acting as a scavenger for these chemokines or interfering with the signaling pathways activated by the stimulation of CXCR4.
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Affiliation(s)
- Chiara Calatozzolo
- Neuropathology Unit, Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
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