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Tadipatri R, Plasto D, Hughes J, Nakaji P, Eschbacher J, Fonkem E, Azadi A, Braun K, Myers C, Ashby L. NIMG-57. MANAGEMENT OF TECTAL GLIOMAS IN ADULTS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Tectal gliomas (TG) are rare tumors occurring primarily in children but also found in adults during workup of various neurological symptoms. Surgery is not required in asymptomatic cases, so histopathological information is sparse. No consensus on timing of imaging surveillance or management has been established.
OBJECTIVE
We seek to standardize neuroimaging, including MRI protocol and surveillance time intervals, and clinical management of symptoms and disease progression, including surgery, radiotherapy, and chemotherapy.
METHODS
At our institution, patients with TG were identified through a search of radiology reports and clinic notes between 1989 and 2020. Initial and serial MRI exams were evaluated for tumor size, enhancement, edema, hydrocephalus, and other radiographic features. When tissue was available, cellularity, mitotic activity, and morphology were described. We documented neurological symptoms and signs potentially related to the tumor.
RESULTS
37 cases were identified: 22 female, 15 male; 5 children, 32 adults. Age of diagnosis ranged from 7 to 69 years. Presenting symptoms included headache (59%), visual symptoms (35%), and imbalance (14%), less commonly: seizure, weakness, nausea/vomiting, and dizziness. Surgical procedures included biopsy (9), resection (7), endoscopic third ventriculostomy (15), and shunt placement (11). Eight patients received radiotherapy, including IMRT, CyberKnife, GammaKnife, and Zap-X (all adults; 4 at diagnosis, 3 at progression, 1 at diagnosis and again at progression). Four patients received chemotherapy (all adults; 1 at diagnosis, 3 at progression), all with temozolomide. One additionally received bevacizumab for radionecrosis. Three patients died with progressive disease, two following treatment and one without. Of interest, 5 adult patients developed signs of parkinsonism during their follow-up period.
CONCLUSION
Management of TG encompasses both neoplastic progression and symptom control, either from local compression or infiltrative disease. We have developed an algorithm for imaging surveillance and treatment, including MRI protocol, definition of progressive disease, and indications for antineoplastic therapies.
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Affiliation(s)
| | | | | | | | | | | | - Amir Azadi
- Barrow Neurological Institute, Phoenix, AZ, USA
| | - Kelly Braun
- Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Lynn Ashby
- Dignity Health St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
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Wefel J, Pugh S, Choucair A, Fisher B, Fox S, Meyers C, Ashby L, Mikkelsen T, Glass J, Yu M, Howard S, Movsas B, Mehta M. NCOG-01. NEUROCOGNITIVE FUNCTION (NCF) AND QUALITY OF LIFE (QOL) RESULTS FROM A PHASE II STUDY OF TEMOZOLOMIDE-BASED CHEMORADIOTHERAPY REGIMEN FOR HIGH RISK LOW-GRADE GLIOMAS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
RTOG 0424 reported a 73.5% 3-year overall survival (OS) rate. This secondary analysis describes changes in NCF and QOL after therapy.
METHODS
Patients with HR-LGG were treated with radiation and concurrent and adjuvant temozolomide. Standardized NCF tests were performed at baseline, 6 and 12 months (mos). Rates of NCF decline were examined using the reliable change index on Hopkins Verbal Learning Test (HVLT), Trail Making Test (TMT), and Controlled Oral Word Association. Relationships between NCF and subjective cognitive concerns (MOS-Cognitive Function [MOS-CF] scale) were evaluated with Wilcoxon Rank Sum Test. QOL was assessed using FACT-Brain. Longitudinal modeling using maximum likelihood estimation evaluated predictors of change in QOL. Cox models assessed the association of baseline NCF with OS after adjusting for age, anticonvulsants, number of high risk factors, EORTC OS risk group, and tumor crossing the midline.
RESULTS
From 1/2005 to 8/2009, 129 evaluable patients were accrued, and 93 (72%) completed at least one NCF/QOL measurement with completers having better neurologic function than noncompleters (p=0.04). Compliance across measures was 55–59% and 54–57% at 6 and 12mos. Deterioration occurred in 50%/40% at 6mos/12mos, respectively, and was most frequent on HVLT (21%/20%), TMTA (29%/20%), and TMTB (22%/14%). Patients with HVLT deterioration at 12mos, compared to patients without deterioration, had significantly greater decrease in MOS-CF (p=0.01). No NCF test at baseline was independently associated with OS. FACT Emotional (p=0.02) and Functional Well-Being (p=0.004) subscales improved over time. EORTC OS high-risk group was associated with worse QOL on all subscales (p< 0.05 to 0.001) except Emotional Well-Being, tumor crossing the midline was associated with worse Emotional Well-Being (p=0.04), and unmethylated MGMT status was associated with better Physical Well-Being (p=0.05).
CONCLUSIONS
Approximately half of patients with HR-LGG experience NCF decline in the first year after treatment with temozolomide-based concurrent chemoradiation. QOL remained stable or improved.
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Affiliation(s)
- Jeffrey Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | - Lynn Ashby
- Barrow Neurological Institute/Arizona Oncology Services Foundation, Phoenix, AZ, USA
| | | | - Jon Glass
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Steven Howard
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Lassman A, Won M, Gregory Cairncross J, Shaw E, Ashby L, Souhami L, Laack N, Fink K, Macdonald D, Bahary JP, Hartford A, Whitton A, Werner-Wasik M, Laperriere N, Suh J, Robinson C, Mehta M. ACTR-13. FINAL RESULTS WITH CHEMORADIOTHERAPY FOR ANAPLASTIC OLIGODENDROGLIAL TUMORS FROM NRG ONCOLOGY/RTOG 9402. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Adding intensive-procarbazine, lomustine, and vincristine (iPCV) to radiotherapy (RT) prolonged progression-free (PFS) and overall survival (OS) for patients with 1p19q codeleted anaplastic oligodendroglial tumors (AOTs); some benefit was also observed for IDH-mutant non-codeleted cases (Cairncross et al 2013, 2014, 2016). Now, 25 years after study activation, we updated survival, further assessed IDH as a predictive biomarker, and are exploring the benefit from vincristine.
METHODS
Eligible adults (KPS ≥ 60, adequate end-organ function) were randomized to pre-RT iPCV (4 cycles x 6 weeks each) vs. RT alone, stratified by age (< or ≥ 50), KPS (60–70 or ≥ 80), and level of anaplasia. Histology (anaplastic oligodendroglioma/oligo-astrocytoma required) and biomarkers (IDH and 1p19q, post-hoc) were determined centrally. Survival was estimated by Kaplan-Meier and Hazard Ratios (HRs) by Cox-regression.
RESULTS
Overall (n=289), median follow-up was 16.4 years vs. 11.3 years at last report. In codeleted cases, 40% randomized to iPCV remained alive vs. 53% at last report; 5, 10, and 14 year-PFS and -OS rates were 62%, 50%, 41% and 70%, 57%, 46%, respectively; and iPCV unequivocally prolonged PFS (median 9.8 vs. 2.9 years, HR 0.46, 95% CI 0.3–0.7, p< 0.001) and OS (median 13.2 vs. 7.3 years, HR 0.61, 95% CI 0.40–0.94; p=0.02). With IDH mutation but without codeletion (n=66), iPCV prolonged PFS (median 2.8 vs. 1.9 years, HR 0.58, 95% CI 0.34–0.99, p=0.046); OS was longer with a trend for significance (median 5.5 vs. 3.3 years, HR 0.6, 95% CI 0.34–1.03, p=0.06) on this underpowered exploratory post-hoc analysis.
CONCLUSION
For codeleted AOTs, long-term analyses confirmed that pre-RT iPCV produced meaningful and significant prolongations of PFS and OS. With IDH mutation but without codeletion, iPCV significantly prolonged PFS and showed a trend for prolonged OS. The value of vincristine is being assessed. Supported by NCI grants U10CA180868, U10CA180822, U24CA196067, and UG1CA189867.
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Affiliation(s)
- Andrew Lassman
- Columbia University Irving Medical Center, New York, NY, USA
| | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | | | - Edward Shaw
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Lynn Ashby
- Barrow Neurological Institute/Arizona Oncology Services Foundation, Phoenix, AZ, USA
| | | | - Nadia Laack
- Mayo Clinic/Accruals for Rochester Methodist Hospital (NCCTG), Rochester, MN, USA
| | - Karen Fink
- Baylor University Medical Center Accruals for University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Jean-Paul Bahary
- CHUM - Centre Hospitalier de l’Universite de Montreal, Montreal, QC, Canada
| | - Alan Hartford
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Anthony Whitton
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Normand Laperriere
- Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - John Suh
- Cleveland Clinic Foundation, Cleveland, OH, USA
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Peereboom D, Nabors LB, Kumthekar P, Badruddoja M, Fink K, Lieberman F, Phuphanich S, Dunbar E, Walbert T, Schiff D, Tran D, Ashby L, Butowski N, Iwamoto F, Lindsay R, Bullington J, Schulder M, Sherman J, Brooks C, Reardon D. ATIM-06. PHASE 2 TRIAL OF SL-701 + BEVACIZUMAB IN PATIENTS WITH PREVIOUSLY TREATED GLIOBLASTOMA (GBM) MEETS PRIMARY ENDPOINT OF OS-12, WITH PRELIMINARY CORRELATION BETWEEN LONG-TERM SURVIVAL AND TARGET-SPECIFIC CD8+ T CELL IMMUNE RESPONSE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - L Burt Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | - Erin Dunbar
- Piedmont Brain Tumor Center, Atlanta, GA, USA
| | | | - David Schiff
- University of Virginia, Charlottesville, VA, USA
| | - David Tran
- University of Florida, Gainesville, FL, USA
| | - Lynn Ashby
- St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Fabio Iwamoto
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
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Weller M, Butowski N, Tran DD, Recht LD, Lim M, Hirte H, Ashby L, Mechtler L, Goldlust SA, Iwamoto F, Drappatz J, O'Rourke DM, Wong M, Hamilton MG, Finocchiaro G, Perry J, Wick W, Green J, He Y, Turner CD, Yellin MJ, Keler T, Davis TA, Stupp R, Sampson JH. Go, no-go decision making for phase 3 clinical trials: ACT IV revisited - Authors' reply. Lancet Oncol 2018; 18:e709-e710. [PMID: 29208433 DOI: 10.1016/s1470-2045(17)30856-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Nicholas Butowski
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | | | - Michael Lim
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hal Hirte
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Lynn Ashby
- Barrow Neurological Institute, Phoenix, AZ, USA
| | | | | | - Fabio Iwamoto
- Columbia University Medical Center, New York, NY, USA
| | - Jan Drappatz
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Donald M O'Rourke
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Wong
- Westmead Hospital, Westmead, NSW, Australia
| | - Mark G Hamilton
- University of Calgary, Department of Clinical Neurosciences, Division of Neurosurgery, Foothills Hospital, Calgary, AB, Canada
| | | | - James Perry
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Wolfgang Wick
- The University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | | | - Yi He
- Celldex Therapeutics, Inc, Hampton, NJ, USA
| | | | | | | | | | - Roger Stupp
- Department of Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - John H Sampson
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
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Rogers L, Zhang P, Vogelbaum M, Perry A, Ashby L, Modi J, Alleman A, Galvin J, Youssef E, Bovi J, Sneed P, McMillan W, de Groot J, Shrieve D, Chen Y, Shu H, Chakravarti A, Mehta M. Low-Risk Meningioma: Initial Outcomes from NRG Oncology/RTOG 0539. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Weller M, Butowski N, Tran D, Recht L, Lim M, Hirte H, Ashby L, Mechtler L, Goldlust S, Iwamoto F, Drappatz J, O’Rourke D, Wong M, Finocchiaro G, Perry J, Wick W, He Y, Davis T, Stupp R, Sampson J. ATIM-03. ACT IV: AN INTERNATIONAL, DOUBLE-BLIND, PHASE 3 TRIAL OF RINDOPEPIMUT IN NEWLY DIAGNOSED, EGFRvIII-EXPRESSING GLIOBLASTOMA. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.068] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Reardon D, Peereboom D, Nabors B, Fink K, Phuphanich S, Mikkelsen T, Dunbar E, Badruddoja M, Schiff D, Lieberman F, Tran D, Schulder M, Butowski N, Ashby L, Moertel C, Iwamoto F, Sherman J, Chen J, McDonald P, Poradosu E, Brooks C, Shemesh S, Raizer J. ATIM-11. PHASE 2 TRIAL OF SL-701, A NOVEL IMMUNOTHERAPY COMPRISED OF SYNTHETIC SHORT PEPTIDES AGAINST GBM TARGETS IL-13Rα2, EphA2, AND SURVIVIN, IN ADULTS WITH SECOND-LINE RECURRENT GBM: INTERIM RESULTS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ashby L, Hasselle M, Chowdhary S, Fathallah-Shaykh H, Zhu JJ. ATCT-04RETROSPECTIVE ANALYSIS OF TUMOR TREATING FIELDS (TTFIELDS) IN ADULTS WITH GLIOBLASTOMA: SAFETY PROFILE OF THE OPTUNE™ MEDICAL DEVICE IN PATIENTS WITH IMPLANTED NON-PROGRAMMABLE SHUNTS, PROGRAMMABLE SHUNTS, AND PACEMAKERS/DEFIBRILLATORS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov206.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dardis C, Ashby L, Shapiro W, Sanai N. Biopsy vs. extensive resection for first recurrence of glioblastoma: is a prospective clinical trial warranted? BMC Res Notes 2015; 8:414. [PMID: 26341541 PMCID: PMC4560929 DOI: 10.1186/s13104-015-1386-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/24/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Glioblastoma is an aggressive and almost universally fatal tumor. The prognosis at the time of recurrence has generally been poor, with overall survival typically in the range of 4-40 weeks. The merits of surgical resection (vs. open biopsy, to confirm recurrence via histology) in addition to conventional adjuvant chemotherapy have been the subject of longstanding debate. We wondered whether it would possible to conduct a trial at our institution to settle this question definitively with Class I evidence. RESULTS Initially, we had hoped to conduct a randomized, unblinded prospective clinical trial. However on closer inspection it appeared that such an undertaking would pose significant practical challenges. Thus we present our protocol in draft form. In keeping with recommended outcomes for these tumors, the primary endpoint would be median progression free survival. Secondary end points would be: median overall survival (mOS, from time of recurrence) and change in Karnofsky Performance Status over time. Patients would be eligible at the time of first recurrence if they had received conventional treatment until that point and at least 1 month had elapsed since the time of radiation. All patients would be considered potentially eligible for enrollment (unless the decision regarding resection was already clear-cut in view of other factors). Using Cox's proportional hazards model, we estimate that at least 456 patients would be necessary to demonstrate an increase in the hazard ratio to 1.3 for those undergoing biopsy alone. This magnitude of benefit is estimated based on a review of retrospective studies. DISCUSSION If restricted to our Institution alone, which sees approximately 100-150 new cases of glioblastoma each year, a trial of this nature would be likely to take around 10 years. Furthermore, there may be significant reluctance on the part of patients and physicians to participate. There is also the opportunity cost of excluding patients from other trials to consider. We recognize that the estimate of the magnitude of effect may be conservative. As things stand, we feel that multi-institutional collaboration would almost certainly be required for an undertaking of this kind.
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Affiliation(s)
- Christopher Dardis
- Department of Neurology, Barrow Neurological Institute, Suite 300, 500 West Thomas Road, Phoenix, AZ, 85013, USA.
| | - Lynn Ashby
- Department of Neurology, Barrow Neurological Institute, Suite 300, 500 West Thomas Road, Phoenix, AZ, 85013, USA.
| | - William Shapiro
- Department of Neurology, Barrow Neurological Institute, Suite 300, 500 West Thomas Road, Phoenix, AZ, 85013, USA.
| | - Nader Sanai
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, 85013, USA.
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Affiliation(s)
- Christopher Dardis
- Department of Neurology, Barrow Neurological Institute, Suite 300, 500 W Thomas Road, Phoenix, AS, 85014, USA.
| | - Kelly Milton
- Department of Neurology, Barrow Neurological Institute, Suite 300, 500 W Thomas Road, Phoenix, AS, 85014, USA
| | - Lynn Ashby
- Department of Neurology, Barrow Neurological Institute, Suite 300, 500 W Thomas Road, Phoenix, AS, 85014, USA
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Burri SH, Prabhu RS, Sumrall AL, Brick W, Blaker BD, Heideman BE, Boltes P, Kelly R, Symanowski JT, Wiggins WF, Ashby L, Norton HJ, Judy K, Asher AL. BCNU wafer placement with temozolomide (TMZ) in the immediate postoperative period after tumor resection followed by radiation therapy with TMZ in patients with newly diagnosed high grade glioma: final results of a prospective, multi-institutional, phase II trial. J Neurooncol 2015; 123:259-66. [DOI: 10.1007/s11060-015-1793-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/25/2015] [Indexed: 12/20/2022]
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13
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Nabors LB, Fink KL, Mikkelsen T, Grujicic D, Tarnawski R, Nam DH, Mazurkiewicz M, Salacz M, Ashby L, Zagonel V, Depenni R, Perry JR, Hicking C, Picard M, Hegi ME, Lhermitte B, Reardon DA. Two cilengitide regimens in combination with standard treatment for patients with newly diagnosed glioblastoma and unmethylated MGMT gene promoter: results of the open-label, controlled, randomized phase II CORE study. Neuro Oncol 2015; 17:708-17. [PMID: 25762461 DOI: 10.1093/neuonc/nou356] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [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: 09/30/2014] [Accepted: 12/12/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Survival outcomes for patients with glioblastoma remain poor, particularly for patients with unmethylated O(6)-methylguanine-DNA methyltransferase (MGMT) gene promoter. This phase II, randomized, open-label, multicenter trial investigated the efficacy and safety of 2 dose regimens of the selective integrin inhibitor cilengitide combined with standard chemoradiotherapy in patients with newly diagnosed glioblastoma and an unmethylated MGMT promoter. METHODS Overall, 265 patients were randomized (1:1:1) to standard cilengitide (2000 mg 2×/wk; n = 88), intensive cilengitide (2000 mg 5×/wk during wk 1-6, thereafter 2×/wk; n = 88), or a control arm (chemoradiotherapy alone; n = 89). Cilengitide was administered intravenously in combination with daily temozolomide (TMZ) and concomitant radiotherapy (RT; wk 1-6), followed by TMZ maintenance therapy (TMZ/RT→TMZ). The primary endpoint was overall survival; secondary endpoints included progression-free survival, pharmacokinetics, and safety and tolerability. RESULTS Median overall survival was 16.3 months in the standard cilengitide arm (hazard ratio [HR], 0.686; 95% CI: 0.484, 0.972; P = .032) and 14.5 months in the intensive cilengitide arm (HR, 0.858; 95% CI: 0.612, 1.204; P = .3771) versus 13.4 months in the control arm. Median progression-free survival assessed per independent review committee was 5.6 months (HR, 0.822; 95% CI: 0.595, 1.134) and 5.9 months (HR, 0.794; 95% CI: 0.575, 1.096) in the standard and intensive cilengitide arms, respectively, versus 4.1 months in the control arm. Cilengitide was well tolerated. CONCLUSIONS Standard and intensive cilengitide dose regimens were well tolerated in combination with TMZ/RT→TMZ. Inconsistent overall survival and progression-free survival outcomes and a limited sample size did not allow firm conclusions regarding clinical efficacy in this exploratory phase II study.
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Affiliation(s)
- L Burt Nabors
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Karen L Fink
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Tom Mikkelsen
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Danica Grujicic
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Rafal Tarnawski
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Do Hyun Nam
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Maria Mazurkiewicz
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Michael Salacz
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Lynn Ashby
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Vittorina Zagonel
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Roberta Depenni
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - James R Perry
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Christine Hicking
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Martin Picard
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Monika E Hegi
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Benoit Lhermitte
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - David A Reardon
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
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Reardon D, Schuster J, Tran D, Fink K, Nabors L, Li G, Lukas R, Desjardins A, Ashby L, Duic JP, Aneiro L, Hawthorne T, Green J, Yellin M, Davis T, Sampson J. IT-30 * ReACT: A PHASE II STUDY OF RINDOPEPIMUT VACCINE (CDX-110) PLUS BEVACIZUMAB IN RELAPSED GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou258.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dardis C, Milton K, Ashby L, Shapiro W. Leptomeningeal metastases in high-grade adult glioma: development, diagnosis, management, and outcomes in a series of 34 patients. Front Neurol 2014; 5:220. [PMID: 25404928 PMCID: PMC4217477 DOI: 10.3389/fneur.2014.00220] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 04/22/2014] [Accepted: 10/09/2014] [Indexed: 11/13/2022] Open
Abstract
METHODS Leptomeningeal metastases (LM) in the setting of glioma have often been thought to carry a particularly poor prognosis. We sought to better characterize this phenomenon through a review of patients with glioma seen in our institution over the preceding 10 years. We focus here on 34 cases with LM due to grade III or IV glioma. Over the period in question, we estimate a prevalence of almost 4% in those affected by grade IV tumors. RESULTS Leptomeningeal spread was present at the time of initial diagnosis in 4 patients. Among the others, LM occurred at the time of first progression of disease in 17. The median time to development of LM (excluding those where it was present at initial diagnosis) was 16.4 months [95% confidence interval (CI) 8.2-43.9]. The median time to further progression of disease following LM was 4.9 months (95% CI 3.1-6.9). Twenty-five patients were known to have died at the time of writing. Thus, median overall survival (OS) was 10.2 months (95% CI 8.8-14.7) following LM. At the time of diagnosis of LM, some form of treatment (chemotherapy and/or radiation vs. no treatment) increased OS (median 11.7 vs. 3.3 months, p < 0.001 by log-rank test). Use of radiation therapy (vs. no radiation) also increased OS, although the effect was more modest (7.8 vs. 16.8 months, p = 0.07). Higher Karnofsky Performance Status (KPS) at the time of diagnosis of LM was associated with OS (p = 0.007, median OS for KPS ≥90 19 months vs. 7.8 for KPS <90). In a two-variable model incorporating the use any treatment (vs. none) and KPS, the latter tended to be a more significant predictor of survival (p = 0.22 vs. p = 0.06 by likelihood-ratio test). This was also true for radiation (vs. none) and KPS (p = 0.27 vs. p = 0.02). No significant benefit could be demonstrated for the use of chemotherapy considered alone, either systemic or intrathecal. It should be noted that 4 of 9 patients receiving intrathecal chemotherapy had a ventriculo-peritoneal shunt in place during these injections, which may have reduced its effectiveness. CONCLUSION Overall, treatment appears to improve outcomes. We favor maximal treatment, as tolerated, particularly with a KPS of ≥70. Such treatment would typically include radiation to the maximum tolerated dose, concurrent, and adjuvant chemotherapy (preferably with an alkyating agent), in addition to intrathecal treatment.
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Affiliation(s)
- Christopher Dardis
- Department of Neurology, Barrow Neurological Institute , Phoenix, AZ , USA
| | - Kelly Milton
- Department of Neurology, Barrow Neurological Institute , Phoenix, AZ , USA
| | - Lynn Ashby
- Department of Neurology, Barrow Neurological Institute , Phoenix, AZ , USA
| | - William Shapiro
- Department of Neurology, Barrow Neurological Institute , Phoenix, AZ , USA
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Dardis C, Milton K, Ashby L, Shapiro W. BM-11 * LEPTOMENINGEAL METASTASES IN HIGH-GRADE ADULT GLIOMA: DEVELOPMENT, DIAGNOSIS, MANAGEMENT AND OUTCOMES IN A SERIES OF 34 PATIENTS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou240.11] [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: 11/14/2022] Open
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Zieman G, Dardis C, Gomes A, Scheck A, Eschbacher J, Coons S, Ashby L. ED-39 * GANGLIOGLIOMA IN CHILDREN; IDENTIFICATION OF CASES AT RISK OF DEATH DUE TO PROGRESSION FOLLOWING INITIAL SURGERY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou253.39] [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: 11/12/2022] Open
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Snyder LA, Wolf AB, Oppenlander ME, Bina R, Wilson JR, Ashby L, Brachman D, Coons SW, Spetzler RF, Sanai N. The impact of extent of resection on malignant transformation of pure oligodendrogliomas. J Neurosurg 2014; 120:309-14. [DOI: 10.3171/2013.10.jns13368] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Recent evidence suggests that a greater extent of resection (EOR) extends malignant progression-free survival among patients with low-grade gliomas (LGGs). These studies, however, rely on the combined analysis of oligodendrogliomas, astrocytomas, and mixed oligoastrocytomas—3 histological subtypes with distinct genetic and molecular compositions. To assess the value of EOR in a homogeneous LGG patient population and delineate its impact on LGG transformation, the authors examined its effect on newly diagnosed supratentorial oligodendrogliomas.
Methods
The authors identified 93 newly diagnosed adult patients with WHO Grade II oligodendrogliomas treated with microsurgical resection at Barrow Neurological Institute. Clinical, laboratory, and radiographic data were collected retrospectively, including 1p/19q codeletion status and volumetric analysis based on T2-weighted MRI.
Results
The median preoperative and postoperative tumor volumes and EOR were 29.0 cm3 (range 1.3–222.7 cm3), 5.2 cm3 (range 0–156.1 cm3), and 85% (range 6%–100%), respectively. Median follow-up was 75.4 months, and there were 14 deaths (15%). Progression and malignant progression were identified in 31 (33%) and 20 (22%) cases, respectively. A greater EOR was associated with longer overall survival (p = 0.005) and progression-free survival (p = 0.004); however, a greater EOR did not prolong the interval to malignant progression, even when controlling for 1p/19q codeletion.
Conclusions
A greater EOR is associated with an improved survival profile for patients with WHO Grade II oligodendrogliomas. However, for this particular LGG patient population, the interval to tumor transformation is not influenced by cytoreduction. These data raise the possibility that the capacity for microsurgical resection to modulate malignant progression is mediated through biological mechanisms specific to nonoligodendroglioma LGG histologies.
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Affiliation(s)
- Laura A. Snyder
- 1Divisions of Neurological Surgery and
- 2Barrow Brain Tumor Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Andrew B. Wolf
- 2Barrow Brain Tumor Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Mark E. Oppenlander
- 1Divisions of Neurological Surgery and
- 2Barrow Brain Tumor Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Robert Bina
- 2Barrow Brain Tumor Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Jeffrey R. Wilson
- 3Division of Biostatistics, Arizona State University, Tempe, Arizona
| | - Lynn Ashby
- 2Barrow Brain Tumor Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - David Brachman
- 2Barrow Brain Tumor Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | | | | | - Nader Sanai
- 1Divisions of Neurological Surgery and
- 2Barrow Brain Tumor Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
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Ahmed I, Biswas A, Krishnamurthy S, Julka P, Rath G, Back M, Huang D, Gzell C, Chen J, Kastelan M, Gaur P, Wheeler H, Badiyan SN, Robinson CG, Simpson JR, Tran DD, Rich KM, Dowling JL, Chicoine MR, Leuthardt EC, Kim AH, Huang J, Michaelsen SR, Christensen IJ, Grunnet K, Stockhausen MT, Broholm H, Kosteljanetz M, Poulsen HS, Tieu M, Lovblom E, Macnamara M, Mason W, Rodin D, Tai E, Ubhi K, Laperriere N, Millar BA, Menard C, Perkins B, Chung C, Clarke J, Molinaro A, Phillips J, Butowski N, Chang S, Perry A, Costello J, DeSilva A, Rabbitt J, Prados M, Cohen AL, Anker C, Shrieve D, Hall B, Salzman K, Jensen R, Colman H, Farber O, Weinberg U, Palti Y, Fisher B, Chen H, Macdonald D, Lesser G, Coons S, Brachman D, Ryu S, Werner-Wasik M, Bahary JP, Chakravarti A, Mehta M, Gupta T, Nair V, Epari S, Godasastri J, Moiyadi A, Shetty P, Juvekar S, Jalali R, Herrlinger U, Schafer N, Steinbach J, Weyerbrock A, Hau P, Goldbrunner R, Kohnen R, Urbach H, Stummer W, Glas M, Houillier C, Ghesquieres H, Chabrot C, Soussain C, Ahle G, Choquet S, Faurie P, Bay JO, Vargaftig J, Gaultier C, Nicolas-Virelizier E, Hoang-Xuan K, Iskanderani O, Izar F, Benouaich-Amiel A, Filleron T, Moyal E, Iweha C, Jain S, Melian E, Sethi A, Albain K, Shafer D, Emami B, Kong XT, Green S, Filka E, Green R, Yong W, Nghiemphu P, Cloughesy T, Lai A, Mallick S, Biswas A, Roy S, Purkait S, Gupta S, Julka PK, Rath GK, Marosi C, Thaler J, Ay C, Kaider A, Reitter EM, Haselbock J, Preusser M, Flechl B, Zielinski C, Pabinger I, Miyatake SI, Furuse M, Miyata T, Yoritsune E, Kawabata S, Kuroiwa T, Muragaki Y, Maruyama T, Iseki H, Akimoto J, Ikuta S, Nitta M, Maebayashi K, Saito T, Okada Y, Kaneko S, Matsumura A, Kuroiwa T, Karasawa K, Nakazato Y, Kayama T, Nabors LB, Fink KL, Mikkelsen T, Grujicic D, Tarnawski R, Nam DH, Mazurkiewicz M, Salacz M, Ashby L, Thurzo L, Zagonel V, Depenni R, Perry JR, Henslee-Downey J, Picard M, Reardon DA, Nambudiri N, Nayak L, LaFrankie D, Wen P, Ney D, Carlson J, Damek D, Blatchford P, Gaspar L, Kavanagh B, Waziri A, Lillehei K, Reddy K, Chen C, Rashed I, Melian E, Sethi A, Barton K, Anderson D, Prabhu V, Rusch R, Belongia M, Maheshwari M, Firat S, Schiff D, Desjardins A, Cloughesy T, Mikkelsen T, Glantz M, Chamberlain M, Reardon DA, Wen P, Shapiro W, Gopal S, Judy K, Patel S, Mahapatra A, Shan J, Gupta D, Shih K, Bacha JA, Brown D, Garner WJ, Steino A, Schwart R, Kanekal S, Li M, Lopez L, Burris HA, Soderberg-Naucler C, Rahbar A, Stragliotto G, Song AJ, Kumar AMS, Murphy ES, Tekautz T, Suh JH, Recinos V, Chao ST, Spoor J, Korami K, Kloezeman J, Balvers R, Dirven C, Lamfers M, Leenstra S, Sumrall A, Haggstrom D, Crimaldi A, Symanowski J, Giglio P, Asher A, Burri S, Sunkersett G, Khatib Z, Prajapati CM, Magalona EE, Mariano M, Sih IM, Torcuator R, Taal W, Oosterkamp H, Walenkamp A, Beerenpoot L, Hanse M, Buter J, Honkoop A, Boerman D, de Vos F, Jansen R, van der Berkmortel F, Brandsma D, Enting R, Kros J, Bromberg J, van Heuvel I, Smits M, van der Holt R, Vernhout R, van den Bent M, Weinberg U, Farber O, Palti Y, Wick W, Suarez C, Rodon J, Desjardins A, Forsyth P, Gueorguieva I, Cleverly A, Burkholder T, Desaiah D, Lahn M, Zach L, Guez D, Last D, Daniels D, Nissim O, Grober Y, Hoffmann C, Nass D, Talianski A, Spiegelmann R, Cohen Z, Mardor Y. MEDICAL RADIATION THERAPIES. Neuro Oncol 2013; 15:iii75-iii84. [PMCID: PMC3823894 DOI: 10.1093/neuonc/not179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
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Adachi JI, Totake K, Shirahata M, Mishima K, Suzuki T, Yanagisawa T, Fukuoka K, Nishikawa R, Arimappamagan A, Manoj N, Mahadevan A, Bhat D, Arvinda H, Indiradevi B, Somanna S, Chandramouli B, Petterson SA, Hermansen SK, Dahlrot RH, Hansen S, Kristensen BW, Carvalho F, Jalali S, Singh S, Croul S, Aldape K, Zadeh G, Choi J, Park SH, Khang SK, Suh YL, Kim SP, Lee YS, Kim SH, Coberly S, Samayoa K, Liu Y, Kiaei P, Hill J, Patterson S, Damore M, Dahiya S, Emnett R, Phillips J, Haydon D, Leonard J, Perry A, Gutmann D, Epari S, Ahmed S, Gurav M, Raikar S, Moiyadi A, Shetty P, Gupta T, Jalali R, Georges J, Zehri A, Carlson E, Martirosyan N, Elhadi A, Nichols J, Ighaffari L, Eschbacher J, Feuerstein B, Anderson T, Preul M, Jensen K, Nakaji P, Girardi H, Monville F, Carpentier S, Giry M, Voss J, Jenkins R, Boisselier B, Frayssinet V, Poggionovo C, Catteau A, Mokhtari K, Sanson M, Peyro-Saint-Paul H, Giannini C, Hide T, Nakamura H, Makino K, Yano S, Anai S, Shinojima N, Kuroda JI, Takezaki T, Kuratsu JI, Higuchi F, Matsuda H, Iwata K, Ueki K, Kim P, Kong J, Cooper L, Wang F, Gao J, Teodoro G, Scarpace L, Mikkelsen T, Schniederjan M, Moreno C, Saltz J, Brat D, Cho U, Hong YK, Lee YS, Lober R, Lu L, Gephart MH, Fisher P, Miyazaki M, Nishihara H, Itoh T, Kato M, Fujimoto S, Kimura T, Tanino M, Tanaka S, Nguyen N, Moes G, Villano JL, Nishihara H, Kanno H, Kato Y, Tanaka S, Ohnishi T, Harada H, Ohue S, Kouno S, Inoue A, Yamashita D, Okamoto S, Nitta M, Muragaki Y, Maruyama T, Sawada T, Komori T, Saito T, Okada Y, Omay SB, Gunel JM, Clark VE, Li J, Omay EZE, Serin A, Kolb LE, Hebert RM, Bilguvar K, Ozduman K, Pamir MN, Kilic T, Baehring J, Piepmeier JM, Brennan CW, Huse J, Gutin PH, Yasuno K, Vortmeyer A, Gunel M, Perry A, Pugh S, Rogers CL, Brachman D, McMillan W, Jenrette J, Barani I, Shrieve D, Sloan A, Mehta M, Prabowo A, Iyer A, Veersema T, Anink J, Meeteren ASV, Spliet W, van Rijen P, Ferrier T, Capper D, Thom M, Aronica E, Chharchhodawala T, Sable M, Sharma MC, Sarkar C, Suri V, Singh M, Santosh V, Thota B, Srividya M, Sravani K, Shwetha S, Arivazhagan A, Thennarasu K, Chandramouli B, Hegde A, Kondaiah P, Somasundaram K, Rao M, Santosh V, Kumar VP, Thota B, Shastry A, Arivazhagan A, Thennarasu K, Kondaiah P, Shastry A, Narayan R, Thota B, Somanna S, Thennarasu K, Arivazhagan A, Santosh V, Shastry A, Naz S, Thota B, Thennarasu K, Arivazhagan A, Somanna S, Santosh V, Kondaiah P, Venneti S, Garimella M, Sullivan L, Martinez D, Huse J, Heguy A, Santi M, Thompson C, Judkins A, Voronovich Z, Chen L, Clark K, Walsh M, Mannas J, Horbinski C, Wiestler B, Capper D, Holland-Letz T, Korshunov A, von Deimling A, Pfister SM, Platten M, Weller M, Wick W, Zieman G, Dardis C, Ashby L, Eschbacher J. PATHOLOGY. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ashby L, LaRocca R, Ryken T. Treatment of brain tumors. N Engl J Med 2005; 352:2350-3; author reply 2350-3. [PMID: 15938013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Bentley TA, Parker RJ, Ashby L, Moore DJ, Tappin DC. The role of the New Zealand forest industry injury surveillance system in a strategic ergonomics, safety and health research programme. Appl Ergon 2002; 33:395-403. [PMID: 12236648 DOI: 10.1016/s0003-6870(02)00037-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Forestry is among the most hazardous of all industry sectors internationally. In New Zealand, highest work-related morbidity and mortality incidence rates are found in the logging sector. The New Zealand Forest Industry Accident Reporting Scheme (ARS) is a forestry injury surveillance system maintained by the Centre for Human Factors and Ergonomics (COHFE). The paper highlights the pivotal role of an industry-wide injury surveillance system in an industry-specific strategic research programme, giving examples of the use of ARS data in identification of priority areas for ergonomics, safety and health research attention, for safety awareness feedback to the industry, and in the evaluation of injury countermeasures. An analysis of injury patterns and trends for one high-risk forestry operation (skid work) is presented to illustrate both the capabilities and limitations of the ARS in its present stage of development.
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Pinckard JK, Zahn J, Ashby L, Parvin CA, Scott MG. Falsely increased i-STAT chloride results for blood samples with increased urea. Clin Chem 2001; 47:2064-6. [PMID: 11673386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- J K Pinckard
- Washington University School of Medicine, Division of Laboratory Medicine, Box 8118, 660 South Euclid Ave., St. Louis, MO 63110, USA
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Abstract
Temperament (EAS teacher and parent questionnaire) and mental state (modified DISC-C interview with adolescent) was systematically assessed in 193 11 to 16 year olds (112 girls, 81 boys) screened for major depression in the community. Sex differences in the structure of temperament were noted from both parent and teacher reports. High (negative) emotionality alone was associated with major depression, particularly (but not exclusively) in girls.
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Affiliation(s)
- I M Goodyer
- Department of Psychiatry, University of Cambridge, U.K
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Abstract
Interviews with parents of a non-referred sample of 11-16-year-old girls (n = 82) revealed that a significantly greater proportion of mothers with a lifetime history of any psychiatric disorder also reported one or more recent undesirable life events focused on the adolescent compared with mothers with no such history. Lifetime episodes of maternal depression and recent undesirable life events exerted significant additive effects on the likelihood of depression occurring in the previous 12 months in adolescent girls. Some families may be "life event prone" as a consequence of lifetime episodes of parental psychopathology.
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Affiliation(s)
- I M Goodyer
- Department of Psychiatry, University of Cambridge, U.K
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Abstract
Three boys are described with a mixed developmental disorder, which so far appears to have a relatively good prognosis. Each boy presented in early infancy with visual unresponsiveness, which spontaneously resolved. This delayed visual maturation was accompanied or followed by severe autistic impairment, general developmental delay, hypotonia and clumsiness. Subsequent progress has been unexpectedly favourable, with striking improvements in language, play, social interest and social competence. Widespread, patchy delay in brain maturation could possibly account for this combination of delayed visual maturation and autism, with a good prognosis.
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Affiliation(s)
- R Goodman
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London
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Ashby L, Shepherd B. The nurse's role in the withdrawal of medical treatment. Adv Clin Care 1990; 5:35-6. [PMID: 2393503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ethical issues involved in the withdrawal of medical treatment are discussed from a nursing perspective. Arguments pro and con are presented.
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Ashby L, Shepherd B. Call that code! Simulated code practices. Adv Clin Care 1990; 5:24-6. [PMID: 2310470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article deals with the planning and implementation of simulated code blue practice sessions for licensed staff. Use of situational role play utilizing the actual equipment is emphasized. Strategies for implementing a program as well as strengths and weaknesses of one such program are discussed.
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Ashby L, Travis S. Teach yourself how to teach an older patient. RN 1988; 51:25-8. [PMID: 3358067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Cohen AF, Ashby L, Crowley D, Land G, Peck AW, Miller AA. Lamotrigine (BW430C), a potential anticonvulsant. Effects on the central nervous system in comparison with phenytoin and diazepam. Br J Clin Pharmacol 1985; 20:619-29. [PMID: 4091994 PMCID: PMC1400839 DOI: 10.1111/j.1365-2125.1985.tb05120.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Twelve healthy male volunteers received phenytoin 0.5 and 1 g, lamotrigine (a new anticonvulsant) 120 and 240 mg, diazepam 10 mg and placebo orally in a double-blind, cross-over, randomized trial. Maximum drug concentrations at 4 h, measured in plasma were 11.5 +/- 2.2 micrograms ml-1 for phenytoin and 2.7 +/- 0.4 micrograms ml-1 for lamotrigine. These levels were in the therapeutic range for phenytoin and the putative therapeutic range for lamotrigine. Side effects after diazepam (mainly sedation) and phenytoin (mainly unsteadiness) differed markedly from lamotrigine which produced no important side effects. Subjective effects as measured by visual analogue scales were caused by phenytoin and diazepam but not by lamotrigine. Diazepam impaired eye movements, adaptive tracking and body sway. Phenytoin impaired adaptive tracking, increased body sway and impaired smooth pursuit eye movement. Lamotrigine produced only a possible slight increase in body sway. There were significant correlations between performance and saliva levels of phenytoin and diazepam. It was concluded that the tests used were suitable for monitoring CNS effects of anticonvulsants and that lamotrigine possibly could have a more favourable CNS side effect profile than phenytoin.
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Cohen AF, Posner J, Ashby L, Smith R, Peck AW. A comparison of methods for assessing the sedative effects of diphenhydramine on skills related to car driving. Eur J Clin Pharmacol 1984; 27:477-82. [PMID: 6519156 DOI: 10.1007/bf00549598] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A double blind cross-over study was performed to compare the sensitivity of "oof road" driving with that of laboratory tests of driving-related skills to drug induced sedation. Twelve experienced drivers (6 M, 6 F) received single oral doses of the H1-antagonist diphenhydramine 25, 50 and 100 mg and placebo. Each treatment was administered on 2 separate occasions, once in the driving school when real driving skills were assessed and again in the laboratory when performance of an adaptive tracking task, body sway and visual reaction were measured. On all occasions subjects assessed their own performance and alertness/sedation using visual analogue scales. Data were subjected to analysis of variance and differences assessed by Newman Keul's test. Diphenhydramine failed to impair driving performance at any dose while all doses produced significant changes in each of the 3 laboratory tests. Subjects rated themselves sedated after all 3 doses of active drug in the laboratory but only after the 100 mg dose in the driving school. Tests performed in the psychopharmacology laboratory appear to be more sensitive to the sedative effects of diphenhydramine than tests of "off road" driving. The implications are discussed.
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Ashby L, Anderson M. Studies in the politics of environmental protection: the historical roots of the British Clean Air Act, 1956: III. The ripening of public opinion, 1898-1952. Int Sci Rev Ser 1977; 2:190-206. [PMID: 11614658 DOI: 10.1179/030801877789826277] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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Ashby L. Prospect for pollution. Community Health (Bristol) 1973; 5:92-100. [PMID: 4787597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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