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Hannan CJ, McBain C, Whitfield G, Pathmanaban ON, Rutherford SA, Freeman SR, Lloyd SK, King AT, Evans DG. Letter: Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk. Neurosurgery 2023; 93:e98-e99. [PMID: 37489892 DOI: 10.1227/neu.0000000000002613] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 07/26/2023] Open
Affiliation(s)
- Cathal John Hannan
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool , UK
| | | | | | - Omar N Pathmanaban
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester , UK
- Division of Neuroscience, University of Manchester, Manchester , UK
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester , UK
| | - Scott A Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester , UK
| | - Simon R Freeman
- Department of Otolaryngology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester , UK
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester , UK
| | - Simon K Lloyd
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester , UK
- Department of Otolaryngology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester , UK
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester , UK
- Division of Cancer Sciences, University of Manchester, Manchester , UK
| | - Andrew T King
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester , UK
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester , UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester , UK
| | - D Gareth Evans
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester , UK
- Division of Evolution and Genomic Medicine, Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, University of Manchester, St Mary's Hospital, Manchester Universities NHS Foundation Trust, Manchester , UK
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Rooney AG, Hewins W, Walker A, Mackinnon M, Withington L, Robson S, Torrens C, Hopcroft LEM, Clark A, Anderson G, Bulbeck H, Dunlop J, Welsh M, Dyson A, Emerson J, Cochrane C, Hill R, Carruthers J, Day J, Gillespie D, Hewitt C, Molinari E, Wells M, McBain C, Chalmers AJ, Grant R. Lifestyle coaching is feasible in fatigued brain tumor patients: A phase I/feasibility, multi-center, mixed-methods randomized controlled trial. Neurooncol Pract 2023; 10:249-260. [PMID: 37188163 PMCID: PMC10180387 DOI: 10.1093/nop/npac086] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background There are no effective treatments for brain tumor-related fatigue. We studied the feasibility of two novel lifestyle coaching interventions in fatigued brain tumor patients. Methods This phase I/feasibility multi-center RCT recruited patients with a clinically stable primary brain tumor and significant fatigue (mean Brief Fatigue Inventory [BFI] score ≥ 4/10). Participants were randomized in a 1-1-1 allocation ratio to: Control (usual care); Health Coaching ("HC", an eight-week program targeting lifestyle behaviors); or HC plus Activation Coaching ("HC + AC", further targeting self-efficacy). The primary outcome was feasibility of recruitment and retention. Secondary outcomes were intervention acceptability, which was evaluated via qualitative interview, and safety. Exploratory quantitative outcomes were measured at baseline (T0), post-interventions (T1, 10 weeks), and endpoint (T2, 16 weeks). Results n = 46 fatigued brain tumor patients (T0 BFI mean = 6.8/10) were recruited and 34 were retained to endpoint, establishing feasibility. Engagement with interventions was sustained over time. Qualitative interviews (n = 21) suggested that coaching interventions were broadly acceptable, although mediated by participant outlook and prior lifestyle. Coaching led to significant improvements in fatigue (improvement in BFI versus control at T1: HC=2.2 points [95% CI 0.6, 3.8], HC + AC = 1.8 [0.1, 3.4], Cohen's d [HC] = 1.9; improvement in FACIT-Fatigue: HC = 4.8 points [-3.7, 13.3]; HC + AC = 12 [3.5, 20.5], d [HC and AC] = 0.9). Coaching also improved depressive and mental health outcomes. Modeling suggested a potential limiting effect of higher baseline depressive symptoms. Conclusions Lifestyle coaching interventions are feasible to deliver to fatigued brain tumor patients. They were manageable, acceptable, and safe, with preliminary evidence of benefit on fatigue and mental health outcomes. Larger trials of efficacy are justified.
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Affiliation(s)
- Alasdair G Rooney
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- The Robert Fergusson Unit, Royal Edinburgh Hospital, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William Hewins
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amie Walker
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Neuro-Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Mairi Mackinnon
- Neuro-Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Lisa Withington
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Sara Robson
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Claire Torrens
- Nursing, Midwifery, and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Lisa E M Hopcroft
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
| | - Antony Clark
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
| | | | | | - Joanna Dunlop
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
- Community Rehabilitation and Brain Injury Service, Livingston, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michelle Welsh
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Aimee Dyson
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Julie Emerson
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Robert Hill
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
| | - Jade Carruthers
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
| | - Julia Day
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
- Community Rehabilitation and Brain Injury Service, Livingston, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David Gillespie
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Emanuela Molinari
- Institute of Neurosciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mary Wells
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Catherine McBain
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Anthony J Chalmers
- Neuro-Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Neurosciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
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3
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Evans DG, Halliday D, Obholzer R, Afridi S, Forde C, Rutherford SA, Hammerbeck-Ward C, Lloyd SK, Freeman SM, Pathmanaban ON, Thomas OM, Laitt RD, Stivaros S, Kilday JP, Vassallo G, McBain C, Lavin T, Paterson C, Whitfield G, McCabe MG, Axon PR, Halliday J, Mackeith S, Parry A, Harkness EF, Buttimore J, King AT. Radiation treatment of benign tumours in NF2-related-schwannomatosis: a national study of 266 irradiated patients showing a significant increase in malignancy/malignant progression. Neurooncol Adv 2023; 5:vdad025. [PMID: 37051330 PMCID: PMC10084499 DOI: 10.1093/noajnl/vdad025] [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: 03/13/2023] Open
Abstract
Abstract
Background
Radiation treatment of benign tumours in tumour-predisposition syndromes is controversial, but short-term studies from treatment centres suggests safety despite apparent radiation associated malignancy being reported. We determined whether radiation treatment in NF2-related-schwannomatosis patients is associated with increased rates of subsequent malignancy-(M)/malignant progression-(MP).
Methods
All UK patients with NF2 were eligible if they had a clinical/molecular diagnosis. Cases were NF2 patients treated with radiation for benign tumours. Controls were matched for treatment location with surgical/medical treatments based on age and year of treatment. Prospective data collection began in 1990 with addition of retrospective cases to 1969. Kaplan-Meier analysis was performed for malignancy incidence and survival. Outcomes were CNS M/MP (2cm annualised diameter growth) and survival from index tumour treatment.
Results
1345 NF2 patients, 266 (133-Male) underwent radiation treatments between 1969-2021 with median first radiotherapy aged 32.9-(IQR=22.4-46.0). Nine subsequent CNS malignancies/malignant progressions were identified in cases with only four in 1079 untreated-(p<0.001). Lifetime and 20-year CNS M/MP was ~6% in all irradiated patients-(4.9% for VS radiotherapy) versus <1% in the non-irradiated population-(p<0.001/0.01). Controls were well-matched for age at NF2 diagnosis and treatment-(Males=133-50%) and had no M/MP in the CNS post index-tumour treatment-(p=0.0016). Thirty-year survival from index tumour treatment was 45.62%-(95%CI=34.0–56.5) for cases and 66.4%-(57.3–74.0) for controls-(p=0.02), but was non-significantly worse for VS radiotherapy.
Conclusion
-NF2 patients should not be offered radiotherapy as first line treatment of benign tumours and should be given a frank discussion of the potential 5% excess absolute risk of M/MP.
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Affiliation(s)
- D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine , University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
| | - Dorothy Halliday
- Department of Genomic Medicine, Neurology, Neurosurgery , ENT, Oxford University Hospitals NHS Foundation Trust
| | - Rupert Obholzer
- Department of ENT, and Neurology, 18 Guy’s and St Thomas’ NHS Trust , London, UK
| | | | - Claire Forde
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine , University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - Scott A Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Charlotte Hammerbeck-Ward
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Simon K Lloyd
- Department of Otolaryngology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Simon M Freeman
- Department of Otolaryngology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Omar N Pathmanaban
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health , University of Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
| | - Owen M Thomas
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Roger D Laitt
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Stavros Stivaros
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences , Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, United Kingdom
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust , Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
| | - John-Paul Kilday
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Oxford Road , Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health , University of Manchester, UK
| | - Grace Vassallo
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine , University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - Catherine McBain
- The Christie NHS Foundation Trust , Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
| | - Timothy Lavin
- Department of Neurology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Chay Paterson
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine , University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - Gillian Whitfield
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Oxford Road , Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health , University of Manchester, UK
- The Christie NHS Foundation Trust , Manchester, UK
| | - Martin G McCabe
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health , University of Manchester, UK
- The Christie NHS Foundation Trust , Manchester, UK
| | - Patrick R Axon
- Dept of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Jane Halliday
- Department of Genomic Medicine, Neurology, Neurosurgery , ENT, Oxford University Hospitals NHS Foundation Trust
| | - Samuel Mackeith
- Department of Genomic Medicine, Neurology, Neurosurgery , ENT, Oxford University Hospitals NHS Foundation Trust
| | - Allyson Parry
- Department of Genomic Medicine, Neurology, Neurosurgery , ENT, Oxford University Hospitals NHS Foundation Trust
| | - Elaine F Harkness
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences , Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, United Kingdom
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester Universities NHS Foundation Trust , Wythenshawe, Manchester, UK
| | - Juliette Buttimore
- Dept of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Andrew T King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health , University of Manchester, UK
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4
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Waqar M, Roncaroli F, Djoukhadar I, Akkari L, O'Leary C, Hewitt L, Forte G, Jackson R, Hessen E, Withington L, Beasley W, Richardson J, Golby C, Whitehurst P, Colaco R, Bailey M, Karabatsou K, D'Urso PI, McBain C, Coope DJ, Borst GR. Study protocol: PreOperative Brain Irradiation in Glioblastoma (POBIG) - A phase I trial. Clin Transl Radiat Oncol 2023; 39:100585. [PMID: 36845633 PMCID: PMC9947330 DOI: 10.1016/j.ctro.2023.100585] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Background Glioblastoma is a high-grade aggressive neoplasm whose outcomes have not changed in decades. In the current treatment pathway, tumour growth continues and remains untreated for several weeks post-diagnosis. Intensified upfront therapy could target otherwise untreated tumour cells and improve the treatment outcome. POBIG will evaluate the safety and feasibility of single-fraction preoperative radiotherapy for newly diagnosed glioblastoma, assessed by the maximum tolerated dose (MTD) and maximum tolerated irradiation volume (MTIV). Methods POBIG is an open-label, dual-centre phase I dose and volume escalation trial that has received ethical approval. Patients with a new radiological diagnosis of glioblastoma will be screened for eligibility. This is deemed sufficient due to the high accuracy of imaging and to avoid treatment delay. Eligible patients will receive a single fraction of preoperative radiotherapy ranging from 6 to 14 Gy followed by their standard of care treatment comprising maximal safe resection and postoperative chemoradiotherapy (60 Gy/30 fr) with concurrent and adjuvant temozolomide). Preoperative radiotherapy will be directed to the part of the tumour that is highest risk for remaining as postoperative residual disease (hot spot). Part of the tumour will remain unirradiated (cold spot) and sampled separately for diagnostic purposes. Dose/volume escalation will be guided by a Continual Reassessment Method (CRM) model. Translational opportunities will be afforded through comparison of irradiated and unirradiated primary glioblastoma tissue. Discussion POBIG will help establish the role of radiotherapy in preoperative modalities for glioblastoma. Trial registration NCT03582514 (clinicaltrials.gov).
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Affiliation(s)
- Mueez Waqar
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health & Manchester Cancer Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, United Kingdom
| | - Federico Roncaroli
- Department of Neuropathology, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health & Manchester Cancer Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, United Kingdom
| | - Ibrahim Djoukhadar
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
| | - Leila Akkari
- Division of Tumour Biology and Immunology, The Netherlands Cancer Institute, Oncode Institute, Amsterdam, The Netherlands
| | - Claire O'Leary
- Department of Neuropathology, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health & Manchester Cancer Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, United Kingdom
| | - Lauren Hewitt
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health & Manchester Cancer Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, United Kingdom
| | - Gabriella Forte
- Department of Neuropathology, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
| | - Richard Jackson
- Department of Statistics, Liverpool Clinical Trials Unit, University of Liverpool, United Kingdom
| | - Eline Hessen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisa Withington
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - William Beasley
- Department of Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jenny Richardson
- Department of Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Christopher Golby
- Department of Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Philip Whitehurst
- Department of Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Rovel Colaco
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Bailey
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
| | - Konstantina Karabatsou
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
| | - Pietro I. D'Urso
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David J. Coope
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences & Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, United Kingdom
| | - Gerben R. Borst
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health & Manchester Cancer Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, United Kingdom
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
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5
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Hoang-Xuan K, Deckert M, Ferreri AJM, Furtner J, Gallego Perez-Larraya J, Henriksson R, Hottinger AF, Kasenda B, Lefranc F, Lossos A, McBain C, Preusser M, Roth P, Rudà R, Schlegel U, Soffietti R, Soussain C, Taphoorn MJB, Touitou V, Weller M, Bromberg JEC. European Association of Neuro-Oncology (EANO) guidelines for treatment of primary central nervous system lymphoma (PCNSL). Neuro Oncol 2023; 25:37-53. [PMID: 35953526 PMCID: PMC9825335 DOI: 10.1093/neuonc/noac196] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [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: 03/14/2022] [Indexed: 01/12/2023] Open
Abstract
The management of primary central nervous system (PCNSL) is one of the most controversial topics in neuro-oncology because of the complexity of the disease and the limited number of controlled studies available. In 2021, given recent advances and the publication of practice-changing randomized trials, the European Association of Neuro-Oncology (EANO) created a multidisciplinary task force to update the previously published evidence-based guidelines for immunocompetent adult patients with PCNSL and added a section on immunosuppressed patients. The guideline provides consensus considerations and recommendations for the treatment of PCNSL, including intraocular manifestations and specific management of the elderly. The main changes from the previous guideline include strengthened evidence for the consolidation with ASCT in first-line treatment, prospectively assessed chemotherapy combinations for both young and elderly patients, clarification of the role of rituximab even though the data remain inconclusive, of the role of new agents, and the incorporation of immunosuppressed patients and primary ocular lymphoma. The guideline should aid the clinicians in everyday practice and decision making and serve as a basis for future research in the field.
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Affiliation(s)
- Khê Hoang-Xuan
- APHP, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière; Sorbonne Université; IHU; ICM. Paris, France
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Julia Furtner
- Department of Biomedical and Imaging Image-guided Therapy Medical University of Vienna, Vienna, Austria
| | - Jaime Gallego Perez-Larraya
- Health Research Institute of Navarra (IdiSNA), Program in Solid Tumors, Foundation for the Applied Medical Research, Department of Neurology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Roger Henriksson
- Department of Radiation Sciences, Oncology, University of Umeå, S-901 85 Umea, Sweden
| | - Andreas F Hottinger
- Department of Oncology and Clinical Neurosciences, CHUV University Hospital Lausanne and University of Lausanne, LausanneSwitzerland
| | - Benjamin Kasenda
- Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Belgium
| | - Alexander Lossos
- Head, Leslie and Michael Gaffin Center for Neuro-Oncology; Department of Oncology and Neurology; Hadassah-Hebrew University Medical Center; Jerusalem, Israel
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS FT; Manchester; United Kingdom
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna,Austria
| | - Patrick Roth
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roberta Rudà
- Department of Neurology, Castelfranco Veneto/Treviso Hospital, Italy
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, and City of Health and Science University Hospital, Turin, Italy
| | - Uwe Schlegel
- Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Germany
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, and City of Health and Science University Hospital, Turin, Italy
| | - Carole Soussain
- Department of Hematology, Institut Curie, Site Saint-Cloud, France and INSERM U932 Institut Curie, PSL Research University, Paris, France
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center and Department of Neurology, Haaglanden Medical Center The Hague, The Netherlands
| | - Valérie Touitou
- APHP, Department of Ophtalmology, Groupe Hospitalier Pitié-Salpêtrière; Sorbonne Université. Paris, France
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC University Medical Center Cancer Institute, Rotterdam. The Netherlands
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6
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Colombo F, Maye H, Rutherford S, King A, Hammerbeck-Ward C, Whitfield GA, McBain C, Colaco R, Entwistle H, Wadeson A, Lloyd S, Freeman S, Pathmanaban ON. Surgery versus radiosurgery for vestibular schwannoma: Shared decision making in a multidisciplinary clinic. Neurooncol Adv 2023; 5:vdad089. [PMID: 37547267 PMCID: PMC10403749 DOI: 10.1093/noajnl/vdad089] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Our neurosurgical unit adopted a model of shared decision-making (SDM) based on multidisciplinary clinics for vestibular schwannoma (VS). A unique feature of this clinic is the interdisciplinary counseling process with a surgeon presenting the option of surgery, an oncologist radiosurgery or radiotherapy, and a specialist nurse advocating for the patient. Methods This is a retrospective cohort study. All new patients seen in the combined VS clinic and referred from the skull base multidisciplinary team (MDT) from beginning of June 2013 to end of January 2019 were included. Descriptive statistics and frequency analysis were carried out for the full cohort. Results Three hundred and fifty-four patients presenting with new or previously untreated VS were included in the analysis. In our cohort, roughly one-third of patients fall into each of the treatment strategies with slightly smaller numbers of patients undergoing surgery than watch, wait and rescan (WWR) ,and SRS (26.6% vs. 32.8% and 37.9%, respectively). Conclusion In our experience, the combined surgery/oncology/specialist nurse clinic streamlines the patient experience for those with a VS suitable for either microsurgical or SRS/radiotherapy treatment. Decision-making in this population of patients is complex and when presented with all treatment options patients do not necessarily choose the least invasive option as a treatment. The unique feature of our clinic is the multidisciplinary counseling process with a specialist nurse advocating and guiding the patient. Treatment options are likely to become more rather than less complex in future years making combined clinics more valuable than ever in the SDM process.
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Affiliation(s)
- Francesca Colombo
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Helen Maye
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Scott Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Charlotte Hammerbeck-Ward
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Gillian A Whitfield
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Catherine McBain
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Rovel Colaco
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Helen Entwistle
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrea Wadeson
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Lloyd
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Freeman
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Omar N Pathmanaban
- Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine, and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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7
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Ismail N, Patel K, Colaco R, Borst G, Milanovic D, McBain C. Prolonged Transfusion-Dependent Temozolomide-Induced Thrombocytopaenia in Glioblastoma: Risk Factors Remain Elusive. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.105] [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
AIMS
Temozolomide-induced thrombocytopaenia is well-recognised; clinical-course varies widely. Aims: To identify risk factors for prolonged thrombocytopaenia; improve patient-care; inform trial design.
METHOD
Glioblastoma (GBM) patients requiring platelet transfusion were identified. (Local policy: transfuse when plt count ≤ 30 x 109/L). Inclusion criteria: First-line-standard-of-care temozolomide-chemo-radiotherapy (TMZ-CRT). Case-notes reviewed for demographics, blood-counts, radiotherapy and treatment parameters. Thrombocytopaenia grading: CTCAE V5. Date of onset measured from start of TMZ-CRT to date of platelets < 100 x 109/L, and to date of first instance of ≥ grade 3 thrombocytopaenia. Thrombocytopaenia duration: time to platelet count recovery to ≥ 100x109/L.
RESULTS
Between 2017-2021, 69 patients required platelet transfusion; 68/69 identified on routine monitoring. 49 patients were analysed (6:no CRT; 5:trial study drug; 7:≥ 2nd line treatment; 2:inadequate data). Median age: 59 (range 25-73); 61% female. First incidence of thrombocytopaenia during concurrent TMZ-CRT: 27/49 patients; during adjuvant TMZ in 22/49 (13/22 following 6-week-TMZ-CRT, 9/22 following 3-week-TMZ-CRT). In concurrent patients, median time to thrombocytopaenia: 33 days (range 23-38); median duration: 44 days (range 20-105; 5 not recovered); number of transfusions: 1-2:9 pts; 3-4:6pts; 5-7:3pts; 8-10:7pts; >10:2pts. Of 22 adjuvant patients transfused, 8/22 developed ≥G3 thrombocytopaenia post-cycle-2; 19/22 resolved after 1 or 2 transfusions. Thrombocyopaenia was associated with ≥G3 neutropaenia in 11% of patients requiring <5 transfusions vs 75% requiring ≥ 5. Comparison of < 5 vs ≥ 5 transfusion-patients did not identify differences in any demographic or treatment parameters.
CONCLUSION
Risk factors for prolonged TMZ-induced thrombocytopenia vs swiftly-resolving thrombocytopaenia remain elusive. This needs to be reflected in consent processes and in design of clinical trials.
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Affiliation(s)
| | - Karan Patel
- The Christie NHS Foundation Trust , Manchester
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8
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Maye H, Mavrovounis G, Roncaroli F, McBain C, Bailey M, D’Urso P, Coope D, Leach J, Leggate J, Karabatsou T. Multifocal and Multicentric Glioblastomas: A 10 Year Single Centre Experience. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.049] [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
AIMS
The aims of this study are to share our experience of a large series of multifocal/multicentric glioblastomas (mGBM) and analyse the clinical, histological/molecular and neuroimaging characteristics as well as the outcomes of the patients in order to inform and contribute to future patient care.
METHOD
We conducted a retrospective single centre study of all multifocal/multicentric glioblastomas treated at our institution over a 10 year period. Data was collected from electronic patient records including patient demographics, clinical presentation, diagnostic imaging, treatment plans and histopathology/molecular findings. Time to recurrence/progression and overall survival was assessed.
RESULTS
1158 glioblastomas were treated surgically over this time period of which 121 multifocal/multicentric tumours were identified (10.4%). The median age at diagnosis was 63 years with a slight male predominance (54.5%). Half of all patients (61/121) presented with focal neurological deficits. 69% of patients underwent a craniotomy for diagnosis/debulking of the larger enhancing component of the tumour whilst 31% underwent only a biopsy. The median time to recurrence/progression was 154 days. Median length of survival was 269 days. Those who underwent craniotomy had significantly prolonged survival compared to biopsy alone 301 vs 198 days (p= 0.027) as did those who had a near total resection 401 vs 269 for subtotal resection (P=0.006) and those < 60 years (p=< 0.001). 88% of patients were IDH1 wildtype. Radiotherapy and chemotherapy confer a significant survival advantage when compared with no further treatment (p<0.001).
CONCLUSION
Near total resection of the larger enhancing component and post-operative chemo/radiotherapy can offer prolonged survival in patients with mGBM.
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Affiliation(s)
- Helen Maye
- Department of Neurosurgery, Salford Royal NHS Foundation Trust , Manchester , UK
| | - Georgios Mavrovounis
- Department of Neurosurgery, Salford Royal NHS Foundation Trust , Manchester , UK
| | - Federico Roncaroli
- Department of Neuropathology, Manchester Centre for clinical neurosciences, Salford Royal Hospital , Manchester
| | | | - Matthew Bailey
- Department of Neurosurgery, Salford Royal NHS Foundation Trust , Manchester , UK
| | - Pietro D’Urso
- Department of Neurosurgery, Salford Royal NHS Foundation Trust , Manchester , UK
| | - David Coope
- Department of Neurosurgery, Salford Royal NHS Foundation Trust , Manchester , UK
| | - John Leach
- Department of Neurosurgery, Salford Royal NHS Foundation Trust , Manchester , UK
| | - James Leggate
- Department of Neurosurgery, Salford Royal NHS Foundation Trust , Manchester , UK
| | - Tina Karabatsou
- Department of Neurosurgery, Salford Royal NHS Foundation Trust , Manchester , UK
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9
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Short S, Kendall J, West E, Chalmers A, McBain C, Melcher A, Collinson F, Phillip R, Brown S, Samson A. P11.64.A Long-term follow up and translational data from the ReoGlio phase Ib trial of GM-CSF and intravenous pelareorep (Reovirus) alongside standard of care in GBM. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
We previously reported safety data from a phase Ib, open-label study of intravenous oncolytic virus pelareorep with GM-CSF alongside standard chemoradiotherapy in newly diagnosed glioblastoma confirming that the combination is well tolerated. We now report on long-term follow up and analysis of translational samples from tumour and blood in a subset of patients.
METHODS
15 patients with newly diagnosed GBM were treated with GM-CSF 50μg subcutaneously on days 1-3 and intravenous pelareorep on days 4-5 in weeks 1 and 4 of chemoradiotherapy, and subsequently in week 1 of each adjuvant temozolomide course: 7 patients received 1x1010TCID50 (dose level 1); 8 received 3x1010TCID50 (dose level 2). The primary objective was to determine the maximum tolerated dose of pelareorep and GM-CSF with standard chemoradiotherapy. Following a protocol amendment we also collected survival data in all patients up to August 2021. Serial blood samples were taken from three patients, at baseline, during chemoradiotherapy and in the first adjuvant cycle. Peripheral blood mononuclear cells were analysed for immune checkpoint expression by flow cytometry, RNAseq gene expression and T-cell receptor clonality, whilst plasma cytokines were quantified by Luminex.
RESULTS
This combination was well tolerated with 87% of patients completing treatment as planned. Survival data analysis showed that median OS was 12.6 months in dose level 1 and 16.1 months in dose level 2, median OS for all patients was 13.1 months. The 24-month survival estimate for all patients was 25.0%, 16.7% for dose level 1 and 33.3% for dose level 2. One patient in dose level 1 remains alive at 43 months post registration without further treatment. Laboratory data showed that pelareorep infusion resulted in inflammatory cytokine and chemokine secretion, immune checkpoint modulation, and upregulation of inflammatory pathways. There was also increased peripheral clonal tumour-specific T-cell proliferation following pelareorep infusion.
CONCLUSION
Although based on small numbers, these long-term follow up data suggest this may be an active combination in a subset of GBM patients. Translational data confirm that pelareorep potentially activates tumour-targeting immune pathways in GBM, with consequential immune checkpoint modulation. These data support a combination clinical trial of pelareorep, radiotherapy and immune checkpoint blockade in GBM.
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Affiliation(s)
- S Short
- University of Leeds , Leeds , United Kingdom
| | - J Kendall
- University of Leeds , Leeds , United Kingdom
| | - E West
- University of Leeds , Leeds , United Kingdom
| | - A Chalmers
- University of Glasgow , Glasgow , United Kingdom
| | - C McBain
- The Christie Hospital, Manchester , Manchester , United Kingdom
| | - A Melcher
- Institute of Cancer Research , London , United Kingdom
| | - F Collinson
- University of Leeds , Leeds , United Kingdom
| | - R Phillip
- University of Leeds , Leeds , United Kingdom
| | - S Brown
- University of Leeds , Leeds , United Kingdom
| | - A Samson
- University of Leeds , Leeds , United Kingdom
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10
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Kapacee ZA, Allison J, Dawod M, Wang X, Frizziero M, Chakrabarty B, Manoharan P, McBain C, Mansoor W, Lamarca A, Hubner R, Valle JW, McNamara MG. The Management and Outcomes of Patients with Extra-Pulmonary Neuroendocrine Neoplasms and Brain Metastases. Curr Oncol 2022; 29:5110-5125. [PMID: 35877265 PMCID: PMC9319979 DOI: 10.3390/curroncol29070405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Brain metastases (BMs) in patients with extra-pulmonary neuroendocrine neoplasms (EP–NENs) are rare, and limited clinical information is available. The aim of this study was to detail the clinicopathological features, management and outcomes in patients with EP–NENs who developed BMs. Methods: A retrospective single-centre analysis of consecutive patients with EP–NENs (August 2004–February 2020) was conducted. Median overall survival (OS)/survival from BMs diagnosis was estimated (Kaplan–Meier). Results: Of 730 patients, 17 (1.9%) had BMs, median age 61 years (range 15–77); 8 (53%) male, unknown primary NEN site: 40%. Patients with BMs had grade 3 (G3) EP–NENs 11 (73%), G2: 3 (20%), G1: 1 (7%). Eight (53%) had poorly differentiated NENs, 6 were well-differentiated and 1 was not recorded. Additionally, 2 (13%) patients had synchronous BMs at diagnosis, whilst 13 (87%) developed BMs metachronously. The relative risk of developing BMs was 7.48 in patients with G3 disease vs. G1 + G2 disease (p = 0.0001). Median time to the development of BMs after NEN diagnosis: 15.9 months (range 2.5–139.5). Five patients had a solitary BM, 12 had multiple BMs. Treatment of BMs were surgery (n = 3); radiotherapy (n = 5); 4: whole brain radiotherapy, 1: conformal radiotherapy (orbit). Nine (53%) had best supportive care. Median OS from NEN diagnosis was 23.6 months [95% CI 15.2–31.3]; median time to death from BMs diagnosis was 3.0 months [95% CI 0.0–8.3]. Conclusion: BMs in patients with EP–NENs are rare and of increased risk in G3 vs. G1 + G2 EP–NENs. Survival outcomes are poor, and a greater understanding is needed to improve therapeutic outcomes.
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Affiliation(s)
- Zainul-Abedin Kapacee
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (Z.-A.K.); (J.A.); (M.D.); (W.M.); (A.L.); (R.H.); (J.W.V.)
| | - Jennifer Allison
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (Z.-A.K.); (J.A.); (M.D.); (W.M.); (A.L.); (R.H.); (J.W.V.)
| | - Mohammed Dawod
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (Z.-A.K.); (J.A.); (M.D.); (W.M.); (A.L.); (R.H.); (J.W.V.)
| | - Xin Wang
- Statistics Group, Digital Services, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Melissa Frizziero
- Cancer Research UK Manchester Institute, University of Manchester, Manchester M20 4BX, UK;
| | - Bipasha Chakrabarty
- Department of Pathology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Prakash Manoharan
- Department of Nuclear Medicine/Radiology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Was Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (Z.-A.K.); (J.A.); (M.D.); (W.M.); (A.L.); (R.H.); (J.W.V.)
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (Z.-A.K.); (J.A.); (M.D.); (W.M.); (A.L.); (R.H.); (J.W.V.)
| | - Richard Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (Z.-A.K.); (J.A.); (M.D.); (W.M.); (A.L.); (R.H.); (J.W.V.)
| | - Juan W. Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (Z.-A.K.); (J.A.); (M.D.); (W.M.); (A.L.); (R.H.); (J.W.V.)
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Mairéad G. McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (Z.-A.K.); (J.A.); (M.D.); (W.M.); (A.L.); (R.H.); (J.W.V.)
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
- Correspondence:
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11
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Short SC, Kendall J, Chalmers A, McBain C, Melcher A, Samson A, Phillip R, Brown S. Abstract CT569: Combination of reovirus (pelareorep) and granulocyte-macrophage colony-stimulating factor (GM-CSF) alongside standard chemoradiotherapy and adjuvant chemotherapy (temozolomide) for patients with glioblastoma multiforme (GBM): Long term follow up results of the ReoGlio phase Ib trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Oncolytic viruses are of increasing interest as an immunologic approach to treating glioma. We previously reported safety data from a phase Ib, open-label study of intravenous pelareorep with GM-CSF alongside standard chemoradiotherapy in newly diagnosed glioblastoma and confirmed that the combination is tolerable. Following agreement from the relevant ethics authorities we have now completed long term follow up data on all patients treated in the study to investigate whether there is a signal of impact on survival. METHODS: 15 patients with newly diagnosed GBM were treated with GM-CSF 50μg subcutaneously on days 1-3 and pelareorep on days 4-5 in weeks 1 and 4 of chemoradiotherapy, and subsequently in week 1 of each adjuvant temozolomide course: 7 patients received 1x1010TCID50 (dose level 1); 8 received 3x1010TCID50 (dose level 2). The primary objective was to determine the maximum tolerated dose of pelareorep and GM-CSF with standard chemoradiotherapy. Following end of study patients were followed up as per institutional practice. Ethical approval was granted to collect survival data in all patients who survived beyond study closure up to June 2021.
Results: We showed that using intravenous pelareorep with GM-CSF alongside standard chemoradiotherapy in patients with GBM was tolerable with 87% of patients completing treatment as planned. Survival data analysis showed that median OS was 12.6 months for patients in dose level 1 and 16.1 months in dose level 2, giving median OS for all patients 13.1 months. It was notable however that a small number of patients survived beyond 24 months. The 24-month survival estimate for all patients was 33%, 16.7% for dose level 1 and 50% for dose level 2. One patient in dose level 2 remains alive at 42 months.
Conclusion: We previously reported that intravenous delivery of pelareorep with standard chemoradiotherapy is tolerable in newly diagnosed GBM. Although based on small numbers, these long-term follow up data suggest that this may be an active combination in a subset of GBM patients and further randomized studies are warranted.
Citation Format: Susan C. Short, Jessica Kendall, Anthony Chalmers, Catherine McBain, Alan Melcher, Adel Samson, Rachel Phillip, Sarah Brown. Combination of reovirus (pelareorep) and granulocyte-macrophage colony-stimulating factor (GM-CSF) alongside standard chemoradiotherapy and adjuvant chemotherapy (temozolomide) for patients with glioblastoma multiforme (GBM): Long term follow up results of the ReoGlio phase Ib trial [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 CT569.
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Affiliation(s)
| | | | | | | | - Alan Melcher
- 4Institute of Cancer Research, London, United Kingdom
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12
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Tesileanu CMS, Sanson M, Wick W, Brandes AA, Clement PM, Erridge SC, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Rudà R, Weller M, McBain C, van Linde ME, Aldape K, Jenkins RB, Kros JM, Wesseling P, von Deimling A, Hoogstrate Y, de Heer I, Atmodimedjo PN, Dubbink HJ, Brouwer RWW, van IJcken WFJ, Cheung KJ, Golfinopoulos V, Baumert BG, Gorlia T, French PJ, van den Bent MJ. Temozolomide and radiotherapy versus radiotherapy alone in patients with glioblastoma, IDH-wildtype: post-hoc analysis of the EORTC randomized phase 3 CATNON trial. Clin Cancer Res 2022; 28:2527-2535. [PMID: 35275197 DOI: 10.1158/1078-0432.ccr-21-4283] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/10/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE In a post-hoc analysis of the CATNON trial (NCT00626990), we explored whether adding temozolomide to radiotherapy improves outcome in patients with IDH1/2wt anaplastic astrocytomas with molecular features of glioblastoma (redesignated as glioblastoma, IDH-wildtype in the 2021 WHO classification of CNS tumors). EXPERIMENTAL DESIGN From the randomized phase 3 CATNON study examining the addition of adjuvant and concurrent temozolomide to radiotherapy in anaplastic astrocytomas, we selected a subgroup of IDH1/2wt and H3F3Awt tumors with presence of TERT promoter mutations and/or EGFR amplifications and/or combined gain of chromosome 7 and loss of chromosome 10. Molecular abnormalities including MGMT promoter methylation status were determined by next-generation sequencing, DNA methylation profiling, and SNaPshot analysis. RESULTS Of the 751 patients entered in the CATNON study, 670 had fully molecularly characterized tumors. 159 of these tumors met the WHO 2021 molecular criteria for glioblastoma, IDH-wildtype. Of these patients, 47 received radiotherapy only and 112 received a combination of radiotherapy and temozolomide. There was no added effect of temozolomide on either overall survival (HR 1.19, 95%CI 0.82-1.71) or progression-free survival (HR 0.87, 95%CI 0.61-1.24). MGMT promoter methylation was prognostic for overall survival, but was not predictive for outcome to temozolomide treatment either with respect to overall survival or progression-free survival. CONCLUSIONS In this cohort of patients with glioblastoma, IDH-wildtype temozolomide treatment did not add benefit beyond that observed from radiotherapy, regardless of MGMT promoter status. These findings require a new well-powered prospective clinical study to explore the efficacy of temozolomide treatment in this patient population.
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Affiliation(s)
- C Mircea S Tesileanu
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marc Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Paris Brain Institute - Institut du Cerveau (ICM), AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Wolfgang Wick
- Neurology Department, University of Heidelberg, and Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alba A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Paul M Clement
- Oncology Department, KU Leuven and General Medical Oncology Department, UZ Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Anna K Nowak
- Medical School, University of Western Australia, Crawley, Western Australia
- Medical Oncology Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia
- CoOperative Group for NeuroOncology, University of Sydney, New South Wales, Australia
| | - Jean-Francois Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Warren P Mason
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Helen Wheeler
- Northern Sydney Cancer Centre, University of Sydney, St Leonards, New South Wales, Australia
| | - Olivier L Chinot
- Aix-Marseille University, AP-HM, Neuro-Oncology division, Marseille, France
| | - Sanjeev Gill
- Medical Oncology Department, Alfred Hospital, Melbourne, Australia
| | - Matthew Griffin
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Leland Rogers
- Radiation Oncology Department, Gammawest Cancer Services, Salt Lake City, Utah
| | - Walter Taal
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Roberta Rudà
- Neuro-Oncology Department, City of Health and Science Hospital and University of Turin, Turin, Italy
| | - Michael Weller
- Neurology Department, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Catherine McBain
- Clinical Oncology Department, The Christie NHS FT, Manchester, United Kingdom
| | - Myra E van Linde
- Medical Oncology Department, Brain Tumor Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kenneth Aldape
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Johan M Kros
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Pieter Wesseling
- Pathology Department, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Andreas von Deimling
- Neuropathology Department, Ruprecht-Karls-University, and CCU Neuropathology German Cancer Institute and Consortium, DKFZ, and DKTK, Heidelberg, Germany
| | - Youri Hoogstrate
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Iris de Heer
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Peggy N Atmodimedjo
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Hendrikus J Dubbink
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | | | | | - Brigitta G Baumert
- Radiation-Oncology Department (MAASTRO), Maastricht University Medical Center (MUMC) and GROW (School for Oncology), Maastricht, the Netherlands
- Institute of Radiation-Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Pim J French
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martin J van den Bent
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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13
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Waqar M, Trifiletti DM, McBain C, O'Connor J, Coope DJ, Akkari L, Quinones-Hinojosa A, Borst GR. Early Therapeutic Interventions for Newly Diagnosed Glioblastoma: Rationale and Review of the Literature. Curr Oncol Rep 2022; 24:311-324. [PMID: 35119629 PMCID: PMC8885508 DOI: 10.1007/s11912-021-01157-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Glioblastoma is the commonest primary brain cancer in adults whose outcomes are amongst the worst of any cancer. The current treatment pathway comprises surgery and postoperative chemoradiotherapy though unresectable diffusely infiltrative tumour cells remain untreated for several weeks post-diagnosis. Intratumoural heterogeneity combined with increased hypoxia in the postoperative tumour microenvironment potentially decreases the efficacy of adjuvant interventions and fails to prevent early postoperative regrowth, called rapid early progression (REP). In this review, we discuss the clinical implications and biological foundations of post-surgery REP. Subsequently, clinical interventions potentially targeting this phenomenon are reviewed systematically. RECENT FINDINGS Early interventions include early systemic chemotherapy, neoadjuvant immunotherapy, local therapies delivered during surgery (including Gliadel wafers, nanoparticles and stem cell therapy) and several radiotherapy techniques. We critically appraise and compare these strategies in terms of their efficacy, toxicity, challenges and potential to prolong survival. Finally, we discuss the most promising strategies that could benefit future glioblastoma patients. There is biological rationale to suggest that early interventions could improve the outcome of glioblastoma patients and they should be investigated in future trials.
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Affiliation(s)
- Mueez Waqar
- Department of Academic Neurological Surgery, Geoffrey Jefferson Brain Research Centre, Salford Royal Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, UK
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic Florida, 4500 San Pablo Road S, Mayo 1N, Jacksonville, FL, 32224, USA
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Catherine McBain
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Dept 58, Floor 2a, Room 21-2-13, Wilmslow Road, Manchester, M20 4BX, UK
| | - James O'Connor
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Dept 58, Floor 2a, Room 21-2-13, Wilmslow Road, Manchester, M20 4BX, UK
| | - David J Coope
- Department of Academic Neurological Surgery, Geoffrey Jefferson Brain Research Centre, Salford Royal Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, UK
| | - Leila Akkari
- Division of Tumour Biology and Immunology, The Netherlands Cancer Institute, Oncode Institute, Amsterdam, The Netherlands
| | - Alfredo Quinones-Hinojosa
- Department of Radiation Oncology, Mayo Clinic Florida, 4500 San Pablo Road S, Mayo 1N, Jacksonville, FL, 32224, USA
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gerben R Borst
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, UK.
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Dept 58, Floor 2a, Room 21-2-13, Wilmslow Road, Manchester, M20 4BX, UK.
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Saran F, Welsh L, James A, McBain C, Gattamaneni R, Jefferies S, Harris F, Pemberton K, Schaible J, Bender S, Cseh A, Brada M. Afatinib and radiotherapy, with or without temozolomide, in patients with newly diagnosed glioblastoma: results of a phase I trial. J Neurooncol 2021; 155:307-317. [PMID: 34787778 PMCID: PMC8651574 DOI: 10.1007/s11060-021-03877-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/03/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022]
Abstract
Background Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults. Amplification or overexpression of the epidermal growth factor receptor gene, part of the ErbB family, occur in approximately 40% and 60% of patients with GBM, respectively. We present data from a dose-finding study of the ErbB inhibitor afatinib in combination with radiotherapy (RT), with or without temozolomide (TMZ), in patients with GBM. Methods This was a phase I, open-label, 3 + 3 dose-escalation trial in patients with newly-diagnosed, histologically-confirmed grade 4 malignant glioma and proven O6-methylguanine-DNA methyltransferase gene promoter methylation status. The primary endpoint was the maximum tolerated dose (MTD) of continuous daily afatinib when given in combination with RT, with (regimen M) or without (regimen U) concomitant TMZ treatment. Results Fifty-five patients were enrolled; 36 received ≥ 1 dose of trial medication (regimen M, n = 20, regimen U, n = 16). Afatinib was discontinued by all patients during the study. Reasons for afatinib discontinuation (regimen M/U) included disease progression (45%/50%), dose-limiting toxicity (10%/0%), and other adverse events (AEs; 35%/38%). The most frequently reported AEs with either regimen were diarrhea and rash, with no new safety signals identified. The MTD was determined as afatinib 30 mg in combination with daily TMZ and RT, and afatinib 40 mg in combination with RT alone. Conclusions This study identified the MTD for afatinib in combination with RT, with and without TMZ, in patients with GBM. Further studies of afatinib in patients with GBM are warranted and should be based on appropriate biomarker-based preselection. Trial registration NCT00977431 (first posted September 15, 2009). Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03877-6.
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Affiliation(s)
- Frank Saran
- The Royal Marsden NHS Foundation Trust, London, UK. .,Cancer and Blood Service, Auckland City Hospital, Building 8, 99 Park Road, Grafton, Private Bag 92024, Auckland, 1142, New Zealand.
| | - Liam Welsh
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Allan James
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fiona Harris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Agnieszka Cseh
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Michael Brada
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
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15
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Forde C, King AT, Rutherford SA, Hammerbeck-Ward C, Lloyd SK, Freeman SR, Pathmanaban ON, Stapleton E, Thomas OM, Laitt RD, Stivaros S, Kilday JP, Vassallo G, McBain C, Kerrigan S, Smith MJ, McCabe MG, Harkness EF, Evans DG. Disease course of neurofibromatosis type 2: a 30-year follow-up study of 353 patients seen at a single institution. Neuro Oncol 2021; 23:1113-1124. [PMID: 33336705 DOI: 10.1093/neuonc/noaa284] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Limited data exist on the disease course of neurofibromatosis type 2 (NF2) to guide clinical trial design. METHODS A prospective database of patients meeting NF2 diagnostic criteria, reviewed between 1990 and 2020, was evaluated. Follow-up to first vestibular schwannoma (VS) intervention and death was assessed by univariate analysis and stratified by age at onset, era referred, and inheritance type. Interventions for NF2-related tumors were assessed. Cox regression was performed to determine the relationship between individual factors from time of diagnosis to NF2-related death. RESULTS Three hundred and fifty-three patients were evaluated. During 4643.1 follow-up years from diagnosis to censoring, 60 patients (17.0%) died. The annual mean number of patients undergoing VS surgery or radiotherapy declined, from 4.66 and 1.65, respectively, per 100 NF2 patients in 1990-1999 to 2.11 and 1.01 in 2010-2020, as the number receiving bevacizumab increased (2.51 per 100 NF2 patients in 2010-2020). Five patients stopped bevacizumab to remove growing meningioma or spinal schwannoma. 153/353 (43.3%) had at least one neurosurgical intervention/radiation treatment within 5 years of diagnosis. Patients asymptomatic at diagnosis had longer time to intervention and better survival compared to those presenting with symptoms. Those symptomatically presenting <16 and >40 years had poorer overall survival than those presenting at 26-39 years (P = .03 and P = .02, respectively) but those presenting between 16 and 39 had shorter time to VS intervention. Individuals with de novo constitutional variants had worse survival than those with de novo mosaic or inherited disease (P = .004). CONCLUSION Understanding disease course improves prognostication, allowing for better-informed decisions about care.
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Affiliation(s)
- Claire Forde
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine, University of Manchester, St. Mary's Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | | | | | | | | | | | | | | | | | | | - Stavros Stivaros
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester Universities NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John-Paul Kilday
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Manchester, UK.,The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Grace Vassallo
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine, University of Manchester, St. Mary's Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - Catherine McBain
- Departments of Paediatric and Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Simon Kerrigan
- Neurology.,Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Miriam J Smith
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine, University of Manchester, St. Mary's Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - Martin G McCabe
- Departments of Paediatric and Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Elaine F Harkness
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine, University of Manchester, St. Mary's Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
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16
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van den Bent MJ, Tesileanu CMS, Wick W, Sanson M, Brandes AA, Clement PM, Erridge S, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Rudà R, Weller M, McBain C, Reijneveld J, Enting RH, Caparrotti F, Lesimple T, Clenton S, Gijtenbeek A, Lim E, Herrlinger U, Hau P, Dhermain F, de Heer I, Aldape K, Jenkins RB, Dubbink HJ, Kros JM, Wesseling P, Nuyens S, Golfinopoulos V, Gorlia T, French P, Baumert BG. Adjuvant and concurrent temozolomide for 1p/19q non-co-deleted anaplastic glioma (CATNON; EORTC study 26053-22054): second interim analysis of a randomised, open-label, phase 3 study. Lancet Oncol 2021; 22:813-823. [PMID: 34000245 PMCID: PMC8191233 DOI: 10.1016/s1470-2045(21)00090-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The CATNON trial investigated the addition of concurrent, adjuvant, and both current and adjuvant temozolomide to radiotherapy in adults with newly diagnosed 1p/19q non-co-deleted anaplastic gliomas. The benefit of concurrent temozolomide chemotherapy and relevance of mutations in the IDH1 and IDH2 genes remain unclear. METHODS This randomised, open-label, phase 3 study done in 137 institutions across Australia, Europe, and North America included patients aged 18 years or older with newly diagnosed 1p/19q non-co-deleted anaplastic gliomas and a WHO performance status of 0-2. Patients were randomly assigned (1:1:1:1) centrally using a minimisation technique to radiotherapy alone (59·4 Gy in 33 fractions; three-dimensional conformal radiotherapy or intensity-modulated radiotherapy), radiotherapy with concurrent oral temozolomide (75 mg/m2 per day), radiotherapy with adjuvant oral temozolomide (12 4-week cycles of 150-200 mg/m2 temozolomide given on days 1-5), or radiotherapy with both concurrent and adjuvant temozolomide. Patients were stratified by institution, WHO performance status score, age, 1p loss of heterozygosity, the presence of oligodendroglial elements on microscopy, and MGMT promoter methylation status. The primary endpoint was overall survival adjusted by stratification factors at randomisation in the intention-to-treat population. A second interim analysis requested by the independent data monitoring committee was planned when two-thirds of total required events were observed to test superiority or futility of concurrent temozolomide. This study is registered with ClinicalTrials.gov, NCT00626990. FINDINGS Between Dec 4, 2007, and Sept 11, 2015, 751 patients were randomly assigned (189 to radiotherapy alone, 188 to radiotherapy with concurrent temozolomide, 186 to radiotherapy and adjuvant temozolomide, and 188 to radiotherapy with concurrent and adjuvant temozolomide). Median follow-up was 55·7 months (IQR 41·0-77·3). The second interim analysis declared futility of concurrent temozolomide (median overall survival was 66·9 months [95% CI 45·7-82·3] with concurrent temozolomide vs 60·4 months [45·7-71·5] without concurrent temozolomide; hazard ratio [HR] 0·97 [99·1% CI 0·73-1·28], p=0·76). By contrast, adjuvant temozolomide improved overall survival compared with no adjuvant temozolomide (median overall survival 82·3 months [95% CI 67·2-116·6] vs 46·9 months [37·9-56·9]; HR 0·64 [95% CI 0·52-0·79], p<0·0001). The most frequent grade 3 and 4 toxicities were haematological, occurring in no patients in the radiotherapy only group, 16 (9%) of 185 patients in the concurrent temozolomide group, and 55 (15%) of 368 patients in both groups with adjuvant temozolomide. No treatment-related deaths were reported. INTERPRETATION Adjuvant temozolomide chemotherapy, but not concurrent temozolomide chemotherapy, was associated with a survival benefit in patients with 1p/19q non-co-deleted anaplastic glioma. Clinical benefit was dependent on IDH1 and IDH2 mutational status. FUNDING Merck Sharpe & Dohme.
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Affiliation(s)
| | | | - Wolfgang Wick
- Neurologische Klinik und Nationales Zentrum für Tumorerkrankungen Universitätsklinik Heidelberg, Heidelberg, Germany
| | - Marc Sanson
- Sorbonne Universités, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM AP-HP, Paris, France; Hôpital Univeristaires Pitié-salpêtrière -Chales Foix, service de Neurologie 2-Mazarin, Paris, France
| | - Alba Ariela Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Paul M Clement
- Department of Oncology, KU Leuven and Department of General Medical Oncology, UZ Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Sarah Erridge
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | | | - Anna K Nowak
- Medical School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia; CoOperative Group for NeuroOncology, University of Sydney, Camperdown, NSW, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Jean Français Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Warren P Mason
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Helen Wheeler
- Northern Sydney Cancer Centre, St Leonards, Sydney, NSW, Australia
| | - Olivier L Chinot
- Aix-Marseille University, AP-HM, Neuro-Oncology division, Marseille, France
| | - Sanjeev Gill
- Department of Medical Oncology, Alfred Hospital, Melbourne, QLD, Australia
| | - Matthew Griffin
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Leland Rogers
- Department of Radiation Oncology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Walter Taal
- Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science Hospital and University of Turin, Turin, Italy
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jaap Reijneveld
- Brain Tumor Center Amsterdam and Department of Neurology, VU University Medical Center, Amsterdam, Netherlands; Department of Neurology, Academic Medical Center, Amsterdam, Netherlands
| | - Roelien H Enting
- Department of Neurology, UMCG, University of Groningen, Groningen, Netherlands
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Thierry Lesimple
- Department of Clinical Oncology, Comprehensive Cancer Center Eugène Marquis, Rennes, France
| | | | - Anja Gijtenbeek
- Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Elizabeth Lim
- Department of Clinical Oncology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Peter Hau
- Wilhelm Sander-NeuroOncology Unit and Department of Neurology, University Hospital, Regensburg, Regensburg, Germany
| | - Frederic Dhermain
- Radiotherapy Department, Gustave Roussy University Hospital, Villejuif, Cedex, France
| | - Iris de Heer
- Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | | | - Johan M Kros
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pieter Wesseling
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | | | | | - Pim French
- Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Brigitta G Baumert
- Department of Radiation-Oncology (MAASTRO), Maastricht University Medical Center (MUMC) GROW (School for Oncology), Maastricht, Netherlands; Institute of Radiation-Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
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17
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Tesileanu CMS, Vallentgoed WR, Sanson M, Taal W, Clement PM, Wick W, Brandes AA, Baurain JF, Chinot OL, Wheeler H, Gill S, Griffin M, Rogers L, Rudà R, Weller M, McBain C, Reijneveld J, Enting RH, Caparrotti F, Lesimple T, Clenton S, Gijtenbeek A, Lim E, de Vos F, Mulholland PJ, Taphoorn MJB, de Heer I, Hoogstrate Y, de Wit M, Boggiani L, Venneker S, Oosting J, Bovée JVMG, Erridge S, Vogelbaum MA, Nowak AK, Mason WP, Kros JM, Wesseling P, Aldape K, Jenkins RB, Dubbink HJ, Baumert B, Golfinopoulos V, Gorlia T, van den Bent M, French PJ. Non-IDH1-R132H IDH1/2 mutations are associated with increased DNA methylation and improved survival in astrocytomas, compared to IDH1-R132H mutations. Acta Neuropathol 2021; 141:945-957. [PMID: 33740099 PMCID: PMC8113211 DOI: 10.1007/s00401-021-02291-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023]
Abstract
Somatic mutations in the isocitrate dehydrogenase genes IDH1 and IDH2 occur at high frequency in several tumour types. Even though these mutations are confined to distinct hotspots, we show that gliomas are the only tumour type with an exceptionally high percentage of IDH1R132H mutations. Patients harbouring IDH1R132H mutated tumours have lower levels of genome-wide DNA-methylation, and an associated increased gene expression, compared to tumours with other IDH1/2 mutations ("non-R132H IDH1/2 mutations"). This reduced methylation is seen in multiple tumour types and thus appears independent of the site of origin. For 1p/19q non-codeleted glioma (astrocytoma) patients, we show that this difference is clinically relevant: in samples of the randomised phase III CATNON trial, patients harbouring tumours with IDH mutations other than IDH1R132H have a better outcome (hazard ratio 0.41, 95% CI [0.24, 0.71], p = 0.0013). Such non-R132H IDH1/2-mutated tumours also had a significantly lower proportion of tumours assigned to prognostically poor DNA-methylation classes (p < 0.001). IDH mutation-type was independent in a multivariable model containing known clinical and molecular prognostic factors. To confirm these observations, we validated the prognostic effect of IDH mutation type on a large independent dataset. The observation that non-R132H IDH1/2-mutated astrocytomas have a more favourable prognosis than their IDH1R132H mutated counterpart indicates that not all IDH-mutations are identical. This difference is clinically relevant and should be taken into account for patient prognostication.
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18
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McBain C, Lawrie TA, Rogozińska E, Kernohan A, Robinson T, Jefferies S. Treatment options for progression or recurrence of glioblastoma: a network meta-analysis. Cochrane Database Syst Rev 2021; 5:CD013579. [PMID: 34559423 PMCID: PMC8121043 DOI: 10.1002/14651858.cd013579.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 11/09/2022]
Abstract
BACKGROUND Glioblastoma (GBM) is a highly malignant brain tumour that almost inevitably progresses or recurs after first line standard of care. There is no consensus regarding the best treatment/s to offer people upon disease progression or recurrence. For the purposes of this review, progression and recurrence are considered as one entity. OBJECTIVES To evaluate the effectiveness of further treatment/s for first and subsequent progression or recurrence of glioblastoma (GBM) among people who have received the standard of care (Stupp protocol) for primary treatment of the disease; and to prepare a brief economic commentary on the available evidence. SEARCH METHODS We searched MEDLINE and Embase electronic databases from 2005 to December 2019 and the Cochrane Central Register of Controlled Trials (CENTRAL, in the Cochrane Library; Issue 12, 2019). Economic searches included the National Health Service Economic Evaluation Database (NHS EED) up to 2015 (database closure) and MEDLINE and Embase from 2015 to December 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) and comparative non-randomised studies (NRSs) evaluating effectiveness of treatments for progressive/recurrent GBM. Eligible studies included people with progressive or recurrent GBM who had received first line radiotherapy with concomitant and adjuvant temozolomide (TMZ). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data to a pre-designed data extraction form. We conducted network meta-analyses (NMA) and ranked treatments according to effectiveness for each outcome using the random-effects model and Stata software (version 15). We rated the certainty of evidence using the GRADE approach. MAIN RESULTS We included 42 studies: these comprised 34 randomised controlled trials (RCTs) and 8 non-randomised studies (NRSs) involving 5236 participants. We judged most RCTs to be at a low risk of bias and NRSs at high risk of bias. Interventions included chemotherapy, re-operation, re-irradiation and novel therapies either used alone or in combination. For first recurrence, we included 11 interventions in the network meta-analysis (NMA) for overall survival (OS), and eight in the NMA for progression-free survival (PFS). Lomustine (LOM; also known as CCNU) was the most common comparator and was used as the reference treatment. No studies in the NMA evaluated surgery, re-irradiation, PCV (procarbazine, lomustine, vincristine), TMZ re-challenge or best supportive care. We could not perform NMA for second or later recurrence due to insufficient data. Quality-of-life data were sparse. First recurrence (NMA findings) Median OS across included studies in the NMA ranged from 5.5 to 12.6 months and median progression-free survival (PFS) ranged from 1.5 months to 4.2 months. We found no high-certainty evidence that any treatments tested were better than lomustine. These treatments included the following. Bevacizumab plus lomustine: Evidence suggested probably little or no difference in OS between bevacizumab (BEV) combined with lomustine (LOM) and LOM monotherapy (hazard ratio (HR) 0.91, 0.75 to 1.10; moderate-certainty evidence), although BEV + LOM may improve PFS (HR 0.57, 95% confidence interval (CI) 0.44 to 0.74; low-certainty evidence). Bevacizumab monotherapy: Low-certainty evidence suggested there may be little or no difference in OS (HR 1.22, 95% CI 0.84 to 1.76) and PFS (HR 0.90, 95% CI 0.58 to 1.38; low-certainty evidence) between BEV and LOM monotherapies; more evidence on BEV is needed. Regorafenib (REG): REG may improve OS compared with LOM (HR 0.50, 95% CI 0.33 to 0.76; low-certainty evidence). Evidence on PFS was very low certainty and more evidence on REG is needed. Temozolomide (TMZ) plus Depatux-M (ABT414): For OS, low-certainty evidence suggested that TMZ plus ABT414 may be more effective than LOM (HR 0.66, 95% CI 0.47 to 0.92) and may be more effective than BEV (HR 0.54, 95% CI 0.33 to 0.89; low-certainty evidence). This may be due to the TMZ component only and more evidence is needed. Fotemustine (FOM): FOM and LOM may have similar effects on OS (HR 0.89, 95% CI 0.51 to 1.57, low-certainty evidence). Bevacizumab and irinotecan (IRI): Evidence on BEV + irinotecan (IRI) versus LOM for both OS and PFS is very uncertain and there is probably little or no difference between BEV + IRI versus BEV monotherapy (OS: HR 0.95, 95% CI 0.70 to 1.30; moderate-certainty evidence). When treatments were ranked for OS, FOM ranked first, BEV + LOM second, LOM third, BEV + IRI fourth, and BEV fifth. Ranking does not take into account the certainty of the evidence, which also suggests there may be little or no difference between FOM and LOM. Other treatments Three studies evaluated re-operation versus no re-operation, with or without re-irradiation and chemotherapy, and these suggested possible survival advantages with re-operation within the context of being able to select suitable candidates for re-operation. A cannabinoid treatment in the early stages of evaluation, in combination with TMZ, merits further evaluation. Second or later recurrence Limited evidence from three heterogeneous studies suggested that radiotherapy with or without BEV may have a beneficial effect on survival but more evidence is needed. Evidence was insufficient to draw conclusions about the best radiotherapy dosage. Other evidence suggested that there may be little difference in survival with tumour-treating fields compared with physician's best choice of treatment. We found no reliable evidence on best supportive care. Severe adverse events (SAEs) The BEV+LOM combination was associated with significantly greater risk of SAEs than LOM monotherapy (RR 2.51, 95% CI 1.72 to 3.66, high-certainty evidence), and ranked joint worst with cediranib + LOM (RR 2.51, 95% CI 1.29 to 4.90; high-certainty evidence). LOM ranked best and REG ranked second best. Adding novel treatments to BEV was generally associated with a higher risk of severe adverse events compared with BEV alone. AUTHORS' CONCLUSIONS For treatment of first recurrence of GBM, among people previously treated with surgery and standard chemoradiotherapy, the combination treatments evaluated did not improve overall survival compared with LOM monotherapy and were often associated with a higher risk of severe adverse events. Limited evidence suggested that re-operation with or without re-irradiation and chemotherapy may be suitable for selected candidates. Evidence on second recurrence is sparse. Re-irradiation with or without bevacizumab may be of value in selected individuals, but more evidence is needed.
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Affiliation(s)
- Catherine McBain
- Clinical Oncology, The Christie NHS FT, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
| | | | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Jefferies
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
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19
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Tesileanu CMS, van den Bent MJ, Sanson M, Wick W, Brandes AA, Clement PM, Erridge SC, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Rudà R, Weller M, McBain C, van Linde ME, Sabedot TS, Hoogstrate Y, von Deimling A, de Heer I, van IJcken WFJ, Brouwer RWW, Aldape K, Jenkins RB, Dubbink HJ, Kros JM, Wesseling P, Cheung KJ, Golfinopoulos V, Baumert BG, Gorlia T, Noushmehr H, French PJ. Prognostic significance of genome-wide DNA methylation profiles within the randomised, phase 3, EORTC CATNON trial on non-1p/19q deleted anaplastic glioma. Neuro Oncol 2021; 23:1547-1559. [PMID: 33914057 PMCID: PMC8408862 DOI: 10.1093/neuonc/noab088] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Indexed: 12/27/2022] Open
Abstract
Background Survival in patients with IDH1/2-mutant (mt) anaplastic astrocytomas is highly variable. We have used the prospective phase 3 CATNON trial to identify molecular factors related to outcome in IDH1/2mt anaplastic astrocytoma patients. Methods The CATNON trial randomized 751 adult patients with newly diagnosed 1p/19q non-codeleted anaplastic glioma to 59.4 Gy radiotherapy +/− concurrent and/or adjuvant temozolomide. The presence of necrosis and/or microvascular proliferation was scored at central pathology review. Infinium MethylationEPIC BeadChip arrays were used for genome-wide DNA methylation analysis and the determination of copy number variations (CNV). Two DNA methylation-based tumor classifiers were used for risk stratification. Next-generation sequencing (NGS) was performed using 1 of the 2 glioma-tailored NGS panels. The primary endpoint was overall survival measured from the date of randomization. Results Full analysis (genome-wide DNA methylation and NGS) was successfully performed on 654 tumors. Of these, 432 tumors were IDH1/2mt anaplastic astrocytomas. Both epigenetic classifiers identified poor prognosis patients that partially overlapped. A predictive prognostic Cox proportional hazard model identified that independent prognostic factors for IDH1/2mt anaplastic astrocytoma patients included; age, mini-mental state examination score, treatment with concurrent and/or adjuvant temozolomide, the epigenetic classifiers, PDGFRA amplification, CDKN2A/B homozygous deletion, PI3K mutations, and total CNV load. Independent recursive partitioning analysis highlights the importance of these factors for patient prognostication. Conclusion Both clinical and molecular factors identify IDH1/2mt anaplastic astrocytoma patients with worse outcome. These results will further refine the current WHO criteria for glioma classification.
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Affiliation(s)
- C M S Tesileanu
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | | | - M Sanson
- Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - W Wick
- Neurology Department, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - A A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - P M Clement
- Oncology Department, KU Leuven and Medical Oncology Department, UZ Leuven, Leuven, Belgium
| | - S C Erridge
- Neuro-Oncology Centre Edinburgh, Western General Hospital, Edinburgh, UK
| | - M A Vogelbaum
- Neuro-Oncology Department, Moffitt Cancer Center, Tampa, Florida, USA
| | - A K Nowak
- University of Western Australia, Perth, Australia; Co-Operative Group for Neuro-Oncology, University of Sydney, Sydney, Australia; Medical Oncology Department, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - J F Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - W P Mason
- Princess Margaret Cancer Centre, Toronto, Canada
| | - H Wheeler
- Northern Sydney Cancer Centre, Sydney, Australia
| | - O L Chinot
- Neuro-Oncology Department, Aix-Marseille University, Marseille, France
| | - S Gill
- Medical Oncology Department, Alfred Hospital, Melbourne, Australia
| | - M Griffin
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Rogers
- Radiation Oncology Department, Gammawest Cancer Services, Salt Lake City, UT, USA
| | - W Taal
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | - R Rudà
- Neuro-Oncology Department, University of Turin, Turin, Italy
| | - M Weller
- Neurology Department, University Hospital of Zurich, Zurich, Switzerland
| | - C McBain
- Clinical Oncology Department, The Christie NHS FT, Manchester, UK
| | - M E van Linde
- Medical Oncology Department, Amsterdam UMC, Amsterdam, the Netherlands
| | - T S Sabedot
- Neurosurgery Department, Henry Ford Health System, Detroit, MI, USA
| | - Y Hoogstrate
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | - A von Deimling
- Neuropathology Department, Ruprecht-Karls-University and, CCU Neuropathology, German Cancer Institute and Consortium, DKFZ, and DKTK, Heidelberg, Germany
| | - I de Heer
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | | | - R W W Brouwer
- Biomics Center, Erasmus MC, Rotterdam, the Netherlands
| | - K Aldape
- Princess Margaret Cancer Centre, Toronto, Canada
| | - R B Jenkins
- Pathology Department, Mayo Clinic, Rochester, MN, USA
| | - H J Dubbink
- Pathology Department, Erasmus MC, Rotterdam, the Netherlands
| | - J M Kros
- Pathology Department, Erasmus MC, Rotterdam, the Netherlands
| | - P Wesseling
- Pathology Department, Amsterdam UMC, Amsterdam, the Netherlands; Princess Máxima Center, Utrecht, the Netherlands
| | | | | | - B G Baumert
- Radiation-Oncology Department, Maastricht UMC, Maastricht, the Netherlands; Radiation-Oncology Institute, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - H Noushmehr
- Neurosurgery Department, Henry Ford Health System, Detroit, MI, USA
| | - P J French
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
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20
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Taylor JT, Ellison S, Pandele A, Wood S, Nathan E, Forte G, Parker H, Zindy E, Elvin M, Dickson A, Williams KJ, Karabatsou K, McCabe M, McBain C, Bigger BW. Actinomycin D downregulates Sox2 and improves survival in preclinical models of recurrent glioblastoma. Neuro Oncol 2021; 22:1289-1301. [PMID: 32227096 PMCID: PMC7523458 DOI: 10.1093/neuonc/noaa051] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) has been extensively researched over the last few decades, yet despite aggressive multimodal treatment, recurrence is inevitable and second-line treatment options are limited. Here, we demonstrate how high-throughput screening (HTS) in multicellular spheroids can generate physiologically relevant patient chemosensitivity data using patient-derived cells in a rapid and cost-effective manner. Our HTS system identified actinomycin D (ACTD) to be highly cytotoxic over a panel of 12 patient-derived glioma stemlike cell (GSC) lines. ACTD is an antineoplastic antibiotic used in the treatment of childhood cancers. Here, we validate ACTD as a potential repurposed therapeutic for GBM in 3-dimensional GSC cultures and patient-derived xenograft models of recurrent glioblastoma. METHODS Twelve patient-derived GSC lines were screened at 10 µM, as multicellular spheroids, in a 384-well serum-free assay with 133 FDA-approved compounds. GSCs were then treated in vitro with ACTD at established half-maximal inhibitory concentrations (IC50). Downregulation of sex determining region Y-box 2 (Sox2), a stem cell transcription factor, was investigated via western blot and through immunohistological assessment of murine brain tissue. RESULTS Treatment with ACTD was shown to significantly reduce tumor growth in 2 recurrent GBM patient-derived models and significantly increased survival. ACTD is also shown to specifically downregulate the expression of Sox2 both in vitro and in vivo. CONCLUSION These findings indicate that, as predicted by our HTS, ACTD could deplete the cancer stem cell population within the tumor mass, ultimately leading to a delay in tumor progression. KEY POINTS 1. High-throughput chemosensitivity data demonstrated the broad efficacy of actinomycin D, which was validated in 3 preclinical models of glioblastoma.2. Actinomycin D downregulated Sox2 in vitro and in vivo, indicating that this agent could target the stem cell population of GBM tumors.
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Affiliation(s)
- Jessica T Taylor
- Brain Tumor Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
| | - Stuart Ellison
- Brain Tumor Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
| | - Alina Pandele
- Brain Tumor Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
| | - Shaun Wood
- Brain Tumor Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
| | - Erica Nathan
- CRUK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - Gabriella Forte
- Brain Tumor Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
| | - Helen Parker
- Brain Tumor Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
| | - Egor Zindy
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mark Elvin
- Manchester Institute of Biotechnology, Faculty of Science and Engineering, University of Manchester, Manchester, UK
| | - Alan Dickson
- Manchester Institute of Biotechnology, Faculty of Science and Engineering, University of Manchester, Manchester, UK
| | - Kaye J Williams
- Division of Pharmacy and Optometry, School of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Martin McCabe
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS FT, Manchester, UK
| | - Brian W Bigger
- Brain Tumor Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
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21
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Booth TC, Thompson G, Bulbeck H, Boele F, Buckley C, Cardoso J, Dos Santos Canas L, Jenkinson D, Ashkan K, Kreindler J, Huskens N, Luis A, McBain C, Mills SJ, Modat M, Morley N, Murphy C, Ourselin S, Pennington M, Powell J, Summers D, Waldman AD, Watts C, Williams M, Grant R, Jenkinson MD. A Position Statement on the Utility of Interval Imaging in Standard of Care Brain Tumour Management: Defining the Evidence Gap and Opportunities for Future Research. Front Oncol 2021; 11:620070. [PMID: 33634034 PMCID: PMC7900557 DOI: 10.3389/fonc.2021.620070] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022] Open
Abstract
Objectiv e To summarise current evidence for the utility of interval imaging in monitoring disease in adult brain tumours, and to develop a position for future evidence gathering while incorporating the application of data science and health economics. Methods Experts in 'interval imaging' (imaging at pre-planned time-points to assess tumour status); data science; health economics, trial management of adult brain tumours, and patient representatives convened in London, UK. The current evidence on the use of interval imaging for monitoring brain tumours was reviewed. To improve the evidence that interval imaging has a role in disease management, we discussed specific themes of data science, health economics, statistical considerations, patient and carer perspectives, and multi-centre study design. Suggestions for future studies aimed at filling knowledge gaps were discussed. Results Meningioma and glioma were identified as priorities for interval imaging utility analysis. The "monitoring biomarkers" most commonly used in adult brain tumour patients were standard structural MRI features. Interval imaging was commonly scheduled to provide reported imaging prior to planned, regular clinic visits. There is limited evidence relating interval imaging in the absence of clinical deterioration to management change that alters morbidity, mortality, quality of life, or resource use. Progression-free survival is confounded as an outcome measure when using structural MRI in glioma. Uncertainty from imaging causes distress for some patients and their caregivers, while for others it provides an important indicator of disease activity. Any study design that changes imaging regimens should consider the potential for influencing current or planned therapeutic trials, ensure that opportunity costs are measured, and capture indirect benefits and added value. Conclusion Evidence for the value, and therefore utility, of regular interval imaging is currently lacking. Ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.
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Affiliation(s)
- Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Florien Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, United Kingdom.,Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Liane Dos Santos Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | | | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Nicky Huskens
- The Tessa Jowell Brain Cancer Mission, London, United Kingdom
| | - Aysha Luis
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Catherine McBain
- Department of Oncology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nick Morley
- Department of Radiology, Wales Research and Diagnostic PET Imaging Centre, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Caroline Murphy
- King's College Trials Unit, King's College London, London, United Kingdom
| | - Sebastian Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Pennington
- King's Health Economics, King's College London, London, United Kingdom
| | - James Powell
- Department of Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
| | - David Summers
- Department of Neuroradiology, Western General Hospital, Edinburgh, United Kingdom
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Colin Watts
- Birmingham Brain Cancer Program, University of Birmingham, Birmingham, United Kingdom.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Matthew Williams
- Department of Neuro-oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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22
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Hanna C, Kurian KM, Williams K, Watts C, Jackson A, Carruthers R, Strathdee K, Cruickshank G, Dunn L, Erridge S, Godfrey L, Jefferies S, McBain C, Sleigh R, McCormick A, Pittman M, Halford S, Chalmers AJ. Pharmacokinetics, safety, and tolerability of olaparib and temozolomide for recurrent glioblastoma: results of the phase I OPARATIC trial. Neuro Oncol 2020; 22:1840-1850. [PMID: 32347934 PMCID: PMC7746945 DOI: 10.1093/neuonc/noaa104] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The poly(ADP-ribose) polymerase (PARP) inhibitor olaparib potentiated radiation and temozolomide (TMZ) chemotherapy in preclinical glioblastoma models but brain penetration was poor. Clinically, PARP inhibitors exacerbate the hematological side effects of TMZ. The OPARATIC trial was conducted to measure penetration of recurrent glioblastoma by olaparib and assess the safety and tolerability of its combination with TMZ. METHODS Preclinical pharmacokinetic studies evaluated olaparib tissue distribution in rats and tumor-bearing mice. Adult patients with recurrent glioblastoma received various doses and schedules of olaparib and low-dose TMZ in a 3 + 3 design. Suitable patients received olaparib prior to neurosurgical resection; olaparib concentrations in plasma, tumor core and tumor margin specimens were measured by mass spectrometry. A dose expansion cohort tested tolerability and efficacy of the recommended phase II dose (RP2D). Radiosensitizing effects of olaparib were measured by clonogenic survival in glioblastoma cell lines. RESULTS Olaparib was a substrate for multidrug resistance protein 1 and showed no brain penetration in rats but was detected in orthotopic glioblastoma xenografts. Clinically, olaparib was detected in 71/71 tumor core specimens (27 patients; median, 496 nM) and 21/21 tumor margin specimens (9 patients; median, 512.3 nM). Olaparib exacerbated TMZ-related hematological toxicity, necessitating intermittent dosing. RP2D was olaparib 150 mg (3 days/week) with TMZ 75 mg/m2 daily for 42 days. Fourteen (36%) of 39 evaluable patients were progression free at 6 months. Olaparib radiosensitized 6 glioblastoma cell lines at clinically relevant concentrations of 100 and 500 nM. CONCLUSION Olaparib reliably penetrates recurrent glioblastoma at radiosensitizing concentrations, supporting further clinical development and highlighting the need for better preclinical models.
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Affiliation(s)
- Catherine Hanna
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Karin Williams
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Alan Jackson
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Ross Carruthers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Karen Strathdee
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Garth Cruickshank
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Laurence Dunn
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Sara Erridge
- Edinburgh Centre for Neuro-Oncology, NHS Lothian, Edinburgh, UK
| | - Lisa Godfrey
- Cancer Research UK Centre for Drug Development, London, UK
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | - Marc Pittman
- Cancer Research UK Centre for Drug Development, London, UK
| | - Sarah Halford
- Cancer Research UK Centre for Drug Development, London, UK
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23
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G Rooney A, Hewins W, Walker A, Withington L, Mackinnon M, Robson S, Green A, Anderson G, Bulbeck H, Torrens C, Emerson J, Dunlop J, Welsh M, McEleney T, Hopcroft L, Wells M, McBain C, Chalmers A, Grant R. INNV-27. BT-LIFE (BRAIN TUMOURS, LIFESTYLE INTERVENTIONS, AND FATIGUE EVALUATION): LESSONS LEARNED FROM RUNNING A NOVEL MULTI-SECTORAL RESEARCH TRIAL. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
BT-LIFE is a multi-centre RCT of novel lifestyle coaching treatments for fatigued brain tumour patients. To our knowledge it is also the first example of ‘multi-sectoral research’ to combine healthcare, private, and charity sectors in this population. To maximise learning, the trial team devised a structured reflection opportunity to ask, “What went well and what would we do differently next time?”
METHOD
After trial closedown we convened a six-hour ‘focus group’ for management, principle investigators, research assistants, interventionists, qualitative researchers, trial statisticians, and the funder. Discussion was structured using a ‘timeline’ wall-chart which attendees freely populated with post-it notes summarising learning points from the trial. Minutes were taken in duplicate.
RESULTS
In total n=19 team members contributed. Many points were study-specific and will be used internally to plan a larger trial. Among points of wider interest, examples of success included: using regular teleconferences to co-ordinate a cohesive and highly collaborative team; obtaining secure nhs.net email addresses to facilitate multi-sectoral communication; and the clear value of employing one part-time research assistant per centre instead of relying on busy clinical staff to recruit. General future learning points included: speak to the prospective sponsor and ethical committees when writing the grant application to avoid pitfalls and facilitate faster opening if funding is secured; consider preceding emails with a phone call to ‘lay the ground’ in time-sensitive situations; identify staff training requirements as early as possible and cascade aggressively; and be sensitive to the fact that inter-sectoral attitudes and practices may vary widely and need actively monitored and managed. Therefore frequent and secure communication, pro-active problem-spotting, and inter-sectoral value alignment appear critical for success.
CONCLUSION
BT-LIFE provides many useful lessons for anyone interested in running multi-sectoral research.
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Affiliation(s)
| | | | - Amie Walker
- University of Edinburgh, Glasgow, United Kingdom
| | | | | | - Sara Robson
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Aimee Green
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Julie Emerson
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jo Dunlop
- Public Health Scotland, Edinburgh, United Kingdom
| | | | | | | | - Mary Wells
- Imperial College Healthcare NHS Trust, London, United Kingdom
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24
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Kendall J, Chalmers A, McBain C, Melcher A, Samson A, Phillip R, Brown S, Short S. CTIM-14. PELAREOREP AND GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR (GM-CSF) WITH STANDARD CHEMORADIOTHERAPY/ADJUVANT TEMOZOLOMIDE FOR GLIOBLASTOMA MULTIFORME (GBM) PATIENTS: REOGLIO PHASE I TRIAL RESULTS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Oncolytic viruses represent a novel treatment approach in GBM through oncolytic targeting as well as local immune activation. We designed a phase Ib, open-label study of intravenous reovirus (pelareorep) with GM-CSF alongside standard chemoradiotherapy to assess safety and tolerability.
METHODS
15 patients with newly diagnosed GBM were treated with GM-CSF 50mg subcutaneously (days 1–3) and pelareorep (days 4–5) in weeks 1 and 4 of chemoradiotherapy, and week 1 of adjuvant temozolomide course: 7 patients received 1x1010TCID50 (dose level 1); 8 received 3x1010TCID50 (dose level 2). The primary objective was to determine the maximum tolerated dose of pelareorep and GM-CSF with standard chemoradiotherapy. Secondary objectives were to gain preliminary assessment of the activity of the combination and assess treatment compliance.
RESULTS
1 dose limiting toxicity (DLT) and 20 SAEs were experienced overall; median number of SAEs per patient was 2. Commonest SAEs were nervous system disorders, predominantly seizures. SARs included fever/flu-like episodes (n=5), fall (n=1) and headache (n=1). Two SUSARs occurred in dose level 2, classed as vascular disorders manifesting as hypotension episodes – one was a DLT. Suspected relationship of SARs: pelareorep (n=6); temozolomide (n=1); radiotherapy (n=1); all study drugs (n=1). 87% of patients (n=13) completed chemoradiotherapy without unplanned delays. Adjuvant treatment was delayed in 21% of cycles overall, with the majority due to inadequate haematology/biochemistry values (44% of delays). Pelareorep was omitted in 4 instances in 4 patients during chemoradiotherapy and omitted in 4 instances in 3 patients during adjuvant treatment.
CONCLUSION
We present the first clinical data using intravenous pelareorep with GM-CSF alongside standard chemoradiotherapy in patients with GBM, suggesting that the combination is tolerable. Further analysis is underway and efficacy results will be ready for presentation at the conference. This work was supported by CRUK, The Brain Tumour Charity, Yorkshire Cancer Research and Oncolytics Biotech Inc.
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Affiliation(s)
| | | | | | - Alan Melcher
- The Royal Marsden/Institute of Cancer Research National Institute of Health Research Biomedical Research Centre, London, United Kingdom
| | - Adel Samson
- Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, United Kingdom
| | | | - Sarah Brown
- CTRU, University of Leeds, Leeds, United Kingdom
| | - Susan Short
- Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, United Kingdom
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25
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Abedin Kapacee Z, Dawod M, Allison J, Frizziero DM, Chakrabarty B, Manoharan P, McBain C, Mansoor W, Lamarca A, Hubner R, Valle J, McNamara M. NCMP-04. INCIDENCE AND OUTCOMES OF BRAIN METASTASES IN PATIENTS WITH EXTRA-PULMONARY NEUROENDOCRINE NEOPLASMS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Brain metastases (BMs) incidence in patients with extra-pulmonary neuroendocrine neoplasms (EP-NENs) is unclear, with no available management recommendations. This study aimed to review the clinical presentation, management and survival outcomes of patients with EP-NENs and BMs at a European Centre of Excellence.
METHODS
A retrospective single-centre analysis of consecutive patients with EP-NENs (Aug 2004-Feb 2020) was conducted. Median overall survival (OS)/survival from BMs diagnosis were estimated (Kaplan Meier).
RESULTS
Of 786 patients, 15 (1.9%) had BMs, median age 61y (range 15–77); 8 (53%) male, primary NEN site: unknown 40%; oesophageal 13%; small bowel 13%; pancreas 13%; gastric 7%; cervix 7% and bladder 7%. Most patients with BMs had grade 3 (G3) NENs (11, 73%), 3 (20%) were G2 and 1 (7%)G1. Eight (53%) had poorly-differentiated NENs, 6 well-differentiated and 1 not recorded. Two (13%) patients had synchronous BMs at diagnosis, whilst 13 (87%) developed BMs metachronously. Median time to development of BMs after initial NEN diagnosis: 15.9 months (range 2.5–139.5). Five patients had a solitary BM, 4 had 2–9 lesions and 6 had >10 BMs. The most commonly affected sites were the cerebrum (13, 87%), cerebellum (6, 40%), leptomeninges (2, 13%) and orbit (1, 7%). The most common presenting symptoms were limb weakness, headache, confusion, visual disturbance (each n=3, 20%), seizures (2, 13%), word-finding difficulty (2, 13%) and facial weakness/ptosis (1, 7%). Median OS from initial NEN diagnosis was 23.6-months [95%-CI 15.2–31.3]; median time to death from BMs diagnosis was 3.0-months [95%-CI 0.0–8.3]. Treatment of BMs was surgery (n=3); radiotherapy (n=6); 5 had WBRT, one localised radiotherapy (orbit). Six (40%) had best supportive care.
CONCLUSION
BMs in patients with EP-NENs are rare and predominantly in G3 NENs, with diverse intracranial distribution. Although uncommon, BMs from NENs behave aggressively and greater understanding is needed to improve therapeutic outcomes.
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Affiliation(s)
| | - Mohammed Dawod
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | | | - Was Mansoor
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Angela Lamarca
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Hubner
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Juan Valle
- University of Manchester, Manchester, United Kingdom
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26
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Torrens C, Emerson J, Hewins W, Walker A, Withington L, Mackinnon M, Robson S, Dunlop J, Welsh M, McBain C, Chalmers A, Grant R, Rooney AG, Wells M. INNV-24. THE EXPERIENCE OF FATIGUED BRAIN TUMOUR PATIENTS RECEIVING INNOVATIVE LIFESTYLE INTERVENTIONS: QUALITATIVE RESULTS FROM THE BT-LIFE RANDOMISED CONTROLLED TRIAL. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Most brain tumour patients report clinically significant fatigue. Here, we aimed to explore patients’ views of the experience, acceptability and usefulness of participating in a trial of novel lifestyle interventions for fatigue.
METHODS
Qualitative sub-study within the ‘BT-LIFE’ multi-centre phase II RCT (submitted separately). Fatigued adult primary brain tumour patients in receipt of one of the trial interventions (‘Health Coaching’: eight coaching sessions targeting lifestyle behaviours; plus or minus ‘Activation Coaching’: two additional interviews targeting motivation to change) took part in a semi-structured interview following completion of the interventions. A realist approach to the ‘framework’ method was used to analyse verbatim transcripts, with inductive and deductive codes assigned to the realist domains of Context-Mechanism-Outcome.
RESULTS
Twenty themes and 53 sub-themes were derived from the data. Patients’ (n= 21) understanding of and engagement with the interventions were influenced by their expectations, attitudes to life, and experience of living with a brain tumour. Behaviour change was supported by goal-setting, monitoring using a weekly diary, the motivational ‘push’ by coaches, and family/ social support where available. Barriers to engagement included technical diary difficulties, time limitations including work and holiday schedules, and interference from life events. Most patients described beneficial changes in health behaviours, self-efficacy, and general health and wellbeing. About half indicated actual improvement in fatigue levels; others reported no direct change but they could now cope better with fatigue. A minority experienced no change or worsening fatigue.
CONCLUSION
Most fatigued brain tumour patients were able to make positive changes after lifestyle coaching, despite physical and cognitive impairments. However, their experiences were varied. Those for whom the interventions were a good ‘fit’ with their pre-existing outlook, lifestyle, and physical and emotional capabilities, appeared to achieve most benefit. These qualitative findings will inform further work addressing the disabling symptom of brain tumour-related fatigue.
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Affiliation(s)
| | - Julie Emerson
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Amie Walker
- University of Edinburgh, Glasgow, United Kingdom
| | | | | | - Sara Robson
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jo Dunlop
- Public Health Scotland, Edinburgh, United Kingdom
| | | | | | | | | | | | - Mary Wells
- Imperial College Healthcare NHS Trust, London, United Kingdom
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27
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Lawrie TA, McBain C, Rogozińska E, Kernohan A, Robinson T, Lawrie I, Jefferies S. Treatment options for recurrent glioblastoma: a network meta-analysis. Cochrane Database Syst Rev 2020. [DOI: 10.1002/14651858.cd013579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Theresa A Lawrie
- The Evidence-Based Medicine Consultancy Ltd; 3rd Floor Northgate House Upper Borough Walls Bath UK BA1 1RG
| | - Catherine McBain
- The Christie NHS FT; Clinical Oncology; Wilmslow Road Withington Manchester Greater Manchester UK M20 4BX
| | - Ewelina Rogozińska
- The Evidence-Based Medicine Consultancy Ltd; 3rd Floor Northgate House Upper Borough Walls Bath UK BA1 1RG
| | - Ashleigh Kernohan
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
| | - Tomos Robinson
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
| | - Imogen Lawrie
- The Evidence-Based Medicine Consultancy Ltd; 3rd Floor Northgate House Upper Borough Walls Bath UK BA1 1RG
| | - Sarah Jefferies
- Addenbrooke's Hospital; Department of Oncology; Hills Road Cambridge UK CB2 0QQ
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Chong MY, Lorimer CF, Mehta S, Ibrahim E, Brock J, McBain C, McLoone P, Chalmers AJ. An audit of the management of elderly patients with glioblastoma in the UK: have recent trial results changed treatment? CNS Oncol 2019; 8:CNS47. [PMID: 31818127 PMCID: PMC6974914 DOI: 10.2217/cns-2019-0017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: We investigated uptake of short-course chemo-radiotherapy and compared outcomes with other treatment schedules in elderly patients with glioblastoma (GBM). Methods: Patients aged 65 or over with a diagnosis of GBM were identified from an 18-month period from three centers in the UK. The primary end point of this study was overall survival from the date of diagnosis. Results: The analysis included 210 patients. Overall median survival was 5.0 months. Approximately 31.9% of patients received combined chemoradiation; multivariate analysis showed that patients who received standard chemoradiation were at a reduced risk of death than those receiving hypofractionated chemoradiation. Discussion: In this retrospective study, patients treated with standard chemoradiation experienced better outcomes than patients receiving hypofractionated chemoradiation. Patient selection likely contributed to these findings.
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Affiliation(s)
- Ming Yao Chong
- NHS Greater Glasgow & Clyde, Glasgow, Scotland, G51 4TF, UK
| | - Cressida F Lorimer
- Brighton & Sussex University Hospitals NHS Trust, Brighton, England, BN2 5BB, UK
| | - Shaveta Mehta
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - Ehab Ibrahim
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - Juliet Brock
- Brighton & Sussex University Hospitals NHS Trust, Brighton, England, BN2 5BB, UK
| | - Catherine McBain
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - Philip McLoone
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8RZ, UK
| | - Anthony J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, G12 0YN, UK
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Saran F, James A, McBain C, Jefferies S, Harris F, Cseh A, Pemberton K, Schaible J, Bender S, Brada M. ACTR-38. A PHASE I TRIAL OF AFATINIB AND RADIOTHERAPY (RT) WITH OR WITHOUT TEMOZOLOMIDE (TMZ) IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (GBM). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank Saran
- Royal Marsden NHS Foundation Trust, Sutton, England, United Kingdom
| | - Allan James
- The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, United Kingdom
| | - Catherine McBain
- The Christie NHS Foundation Trust, Manchester, England, United Kingdom
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Fiona Harris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Agnieszka Cseh
- Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Wien, Austria
| | | | - Jennifer Schaible
- Boehringer Ingelheim Pharma GmbH Co. KG, Biberach, Baden-Wurttemberg, Germany
| | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Michael Brada
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, England, United Kingdom
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Marti FM, McGurk A, Alam N, Bhatt L, Braun M, Hubner R, Mansoor W, McBain C, McNamara M, Mullamitha S, Saunders M, Sheikh H, Thistlethwaite F, Valle J, Wilson G, Hasan J. 30-day mortality associated with systemic anti-cancer therapy (SACT) in gastrointestinal malignancies: The Christie experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.116] [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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31
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Wilson G, Bentley D, Mullamitha S, Braun M, Nasralla M, Bell J, Mullan D, Hasan J, Saunders M, Marti F, McBain C, Alam N, Laasch H, Najran P, Westwood T, Jeans S, Tipping J, Manoharan P, Lawrance J. Selective internal radiation therapy (SIRT) with yttrium-90 microspheres and peri-procedural FOLFIRI/irinotecan in pre-treated colorectal liver metastases patients: An analysis of outcomes from a UK Cancer Centre between 2009 and 2017. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.274] [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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32
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Colaco R, Kainth H, McBain C, Whitfield G. Radiation Necrosis following SRS for Brain Metastases: is there an Increased Incidence with Immunotherapy and Targeted Therapy? Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Saran F, Welsh L, James A, McBain C, Gattamaneni R, Jefferies S, Harris F, Cseh A, Pemberton K, Schaible J, Bender S, Brada M. Phase I study of afatinib and radiotherapy (RT) with or without temozolomide (TMZ) in newly diagnosed glioblastoma (GB). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Frank Saran
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Liam Welsh
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Allan James
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Rao Gattamaneni
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Fiona Harris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | | | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | - Michael Brada
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
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34
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Chalmers AJ, Short S, Watts C, Herbert C, Morris A, Stobo J, Cruickshank G, Dunn L, Erridge S, Godfrey L, Jefferies S, Lopez JS, McBain C, Pittman M, Dillon S, James A, Nowicki SA, Williamson A, Kelly C, Halford SER. Phase I clinical trials evaluating olaparib in combination with radiotherapy (RT) and/or temozolomide (TMZ) in glioblastoma patients: Results of OPARATIC and PARADIGM phase I and early results of PARADIGM-2. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Colin Watts
- University of Cambridge, Cambridge, United Kingdom
| | | | - Anna Morris
- University of Glasgow, Glasgow, United Kingdom
| | - Jamie Stobo
- Cancer Research UK Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Garth Cruickshank
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Laurence Dunn
- Greater Glasgow and Clyde Health Board, Glasgow, United Kingdom
| | - Sara Erridge
- University of Edinbugh, Edinburgh, United Kingdom
| | - Lisa Godfrey
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Marc Pittman
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | | | - Allan James
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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35
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Yu KKH, Taylor JT, Pathmanaban ON, Youshani AS, Beyit D, Dutko-Gwozdz J, Benson R, Griffiths G, Peers I, Cueppens P, Telfer BA, Williams KJ, McBain C, Kamaly-Asl ID, Bigger BW. High content screening of patient-derived cell lines highlights the potential of non-standard chemotherapeutic agents for the treatment of glioblastoma. PLoS One 2018; 13:e0193694. [PMID: 29499065 PMCID: PMC5834163 DOI: 10.1371/journal.pone.0193694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/19/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most common primary brain malignancy in adults, yet survival outcomes remain poor. First line treatment is well established, however disease invariably recurs and improving prognosis is challenging. With the aim of personalizing therapy at recurrence, we have established a high content screening (HCS) platform to analyze the sensitivity profile of seven patient-derived cancer stem cell lines to 83 FDA-approved chemotherapy drugs, with and without irradiation. METHODS Seven cancer stem cell lines were derived from patients with GBM and, along with the established cell line U87-MG, each patient-derived line was cultured in tandem in serum-free conditions as adherent monolayers and three-dimensional neurospheres. Chemotherapeutics were screened at multiple concentrations and cells double-stained to observe their effect on both cell death and proliferation. Sensitivity was classified using high-throughput algorithmic image analysis. RESULTS Cell line specific drug responses were observed across the seven patient-derived cell lines. Few agents were seen to have radio-sensitizing effects, yet some drug classes showed a marked difference in efficacy between monolayers and neurospheres. In vivo validation of six drugs suggested that cell death readout in a three-dimensional culture scenario is a more physiologically relevant screening model and could be used effectively to assess the chemosensitivity of patient-derived GBM lines. CONCLUSION The study puts forward a number of non-standard chemotherapeutics that could be useful in the treatment of recurrent GBM, namely mitoxantrone, bortezomib and actinomycin D, whilst demonstrating the potential of HCS to be used for personalized treatment based on the chemosensitivity profile of patient tumor cells.
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Affiliation(s)
- Kenny Kwok-Hei Yu
- Brain Tumour Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology & Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| | - Jessica T. Taylor
- Brain Tumour Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology & Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| | - Omar N. Pathmanaban
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester Academic Health Sciences Centre, Salford, United Kingdom
| | - Amir Saam Youshani
- Brain Tumour Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology & Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| | - Deniz Beyit
- Imagen Therapeutics, Manchester, United Kingdom
| | | | | | | | - Ian Peers
- Inferstats Consulting, Alderley Park, Biohub, Cheshire, United Kingdom
| | - Peter Cueppens
- Inferstats Consulting, Alderley Park, Biohub, Cheshire, United Kingdom
| | - Brian A. Telfer
- Division of Pharmacy & Optometry, School of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kaye J. Williams
- Division of Pharmacy & Optometry, School of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS FT, Manchester, United Kingdom
| | - Ian D. Kamaly-Asl
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Manchester, United Kingdom
- Department of Neurosurgery, Royal Manchester Children’s Hospital, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Brian W. Bigger
- Brain Tumour Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology & Regenerative Medicine, University of Manchester, Manchester, United Kingdom
- * E-mail:
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36
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Emerson J, Robson S, Molloy L, Smith C, Gilston-hope A, Cundliffe S, Wadeson A, McBain C. Investigation of the survivorship needs of patients with primary brain tumours and the provision of a health & wellbeing event. Neuro Oncol 2018. [DOI: 10.1093/neuonc/nox238.096] [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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37
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Taylor J, Yu K, Pathmanaban O, Beyit D, Dutko-Gwozdz J, Benson R, Griffiths G, McBain C, Peers I, Ceuppens P, Kamaly-asl I, Bigger B. High content screening of patient-derived cell lines highlights the potential of non-standard chemotherapeutic agents for the treatment of recurrent glioblastoma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/nox237.024] [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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38
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Robson S, Molloy L, Smith C, Emerson J, Whitfield G, Colaco R, Leggate J, McBain C. Improving survivorship in brain metastases patents: assessing and addressing educational needs in non-neuro-oncology health professionals. Neuro Oncol 2018. [DOI: 10.1093/neuonc/nox238.048] [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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39
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Fulton B, Short SC, James A, Nowicki S, McBain C, Jefferies S, Kelly C, Stobo J, Morris A, Williamson A, Chalmers AJ. PARADIGM-2: Two parallel phase I studies of olaparib and radiotherapy or olaparib and radiotherapy plus temozolomide in patients with newly diagnosed glioblastoma, with treatment stratified by MGMT status. Clin Transl Radiat Oncol 2018; 8:12-16. [PMID: 29594237 PMCID: PMC5862667 DOI: 10.1016/j.ctro.2017.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/12/2017] [Accepted: 11/17/2017] [Indexed: 01/08/2023] Open
Abstract
Glioblastoma has a dismal prognosis and molecular targeted agents have failed to improve outcomes to date. PARADIGM-2 is a phase I dose escalation study evaluating olaparib plus radiotherapy ± temozolomide in newly diagnosed glioblastoma, using MGMT methylation status to stratify patients and inform treatment schedules.
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Affiliation(s)
- Ben Fulton
- Institute of Cancer Sciences, University of Glasgow, UK
| | - Susan C. Short
- Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | - Allan James
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Stefan Nowicki
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | - Sarah Jefferies
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Jon Stobo
- Institute of Cancer Sciences, University of Glasgow, UK
| | - Anna Morris
- Institute of Cancer Sciences, University of Glasgow, UK
| | - Aoife Williamson
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
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McBain C, Emerson J, Molloy E, Robson S, Cundliffe S, Gilston-Hope A, Smith C, Wadeson A. QLIF-06. DESIGN AND IMPLEMENTATION OF A SURVIVORSHIP PROGRAMME IN AN UNSELECTED COHORT OF NEWLY DIAGNOSED BRAIN TUMOUR PATIENTS: FEASIBILITY AND APPLICATION OF ROUTINE HOLISTIC NEEDS ASSESSMENT. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.817] [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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41
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Taylor J, Yu K, Pathmanaban O, Beyit D, Dutko-Gwozdz J, Benson R, Griffiths G, Telfer B, Williams K, Peers I, Ceuppens P, McBain C, Kamaly-Asl I, Bigger B. EXTH-57. HIGH CONTENT SCREENING OF PATIENT-DERIVED CELL LINES HIGHLIGHTS THE POTENTIAL OF NON-STANDARD CHEMOTHERAPEUTIC AGENTS FOR THE TREATMENT OF RECURRENT GLIOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.349] [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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42
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Chalmers A, Cruickshank G, Dunn L, Erridge S, Godfrey L, Herbert C, Jefferies S, Lopez J, McBain C, Pittman M, Sleigh R, Watts C, Webster-Smith M, Halford S. ACTR-16. RESULTS OF THE OPARATIC TRIAL: A PHASE I DOSE ESCALATION STUDY OF OLAPARIB IN COMBINATION WITH TEMOZOLOMIDE (TMZ) IN PATIENTS WITH RELAPSED GLIOBLASTOMA (GBM). Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.012] [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: 11/15/2022] Open
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43
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McBain C, Robson S, Molloy E, Emerson J, Smith C, Leggate J, Colaco R, Whitfield G. QLIF-37. SURVIVORSHIP IN BRAIN METASTASES PATIENTS: THE ROLE OF THE NEURO-ONCOLOGY TEAM IN ADDRESSING EDUCATIONAL NEEDS IN NON-NEURO-ONCOLOGY PROFESSIONALS? Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.846] [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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44
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van den Bent MJ, Baumert B, Erridge SC, Vogelbaum MA, Nowak AK, Sanson M, Brandes AA, Clement PM, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Brachman DG, Taal W, Rudà R, Weller M, McBain C, Reijneveld J, Enting RH, Weber DC, Lesimple T, Clenton S, Gijtenbeek A, Pascoe S, Herrlinger U, Hau P, Dhermain F, van Heuvel I, Stupp R, Aldape K, Jenkins RB, Dubbink HJ, Dinjens WNM, Wesseling P, Nuyens S, Golfinopoulos V, Gorlia T, Wick W, Kros JM. Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study. Lancet 2017; 390:1645-1653. [PMID: 28801186 PMCID: PMC5806535 DOI: 10.1016/s0140-6736(17)31442-3] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 03/26/2017] [Accepted: 03/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The role of temozolomide chemotherapy in newly diagnosed 1p/19q non-co-deleted anaplastic gliomas, which are associated with lower sensitivity to chemotherapy and worse prognosis than 1p/19q co-deleted tumours, is unclear. We assessed the use of radiotherapy with concurrent and adjuvant temozolomide in adults with non-co-deleted anaplastic gliomas. METHODS This was a phase 3, randomised, open-label study with a 2 × 2 factorial design. Eligible patients were aged 18 years or older and had newly diagnosed non-co-deleted anaplastic glioma with WHO performance status scores of 0-2. The randomisation schedule was generated with the electronic EORTC web-based ORTA system. Patients were assigned in equal numbers (1:1:1:1), using the minimisation technique, to receive radiotherapy (59·4 Gy in 33 fractions of 1·8 Gy) alone or with adjuvant temozolomide (12 4-week cycles of 150-200 mg/m2 temozolomide given on days 1-5); or to receive radiotherapy with concurrent temozolomide 75 mg/m2 per day, with or without adjuvant temozolomide. The primary endpoint was overall survival adjusted for performance status score, age, 1p loss of heterozygosity, presence of oligodendroglial elements, and MGMT promoter methylation status, analysed by intention to treat. We did a planned interim analysis after 219 (41%) deaths had occurred to test the null hypothesis of no efficacy (threshold for rejection p<0·0084). This trial is registered with ClinicalTrials.gov, number NCT00626990. FINDINGS At the time of the interim analysis, 745 (99%) of the planned 748 patients had been enrolled. The hazard ratio for overall survival with use of adjuvant temozolomide was 0·65 (99·145% CI 0·45-0·93). Overall survival at 5 years was 55·9% (95% CI 47·2-63·8) with and 44·1% (36·3-51·6) without adjuvant temozolomide. Grade 3-4 adverse events were seen in 8-12% of 549 patients assigned temozolomide, and were mainly haematological and reversible. INTERPRETATION Adjuvant temozolomide chemotherapy was associated with a significant survival benefit in patients with newly diagnosed non-co-deleted anaplastic glioma. Further analysis of the role of concurrent temozolomide treatment and molecular factors is needed. FUNDING Schering Plough and MSD.
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Affiliation(s)
- Martin J van den Bent
- Neuro-Oncology Unit, Brain Tumour Centre at Erasmus MC Cancer Institute, Rotterdam, Netherlands.
| | - Brigitta Baumert
- Department of Radiation-Oncology (MAASTRO), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands; Department of Radiation-Oncology, University of Münster, Münster, Germany; Paracelsus Clinic, Osnabrück, Germany
| | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Michael A Vogelbaum
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Anna K Nowak
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia; Co-Operative Group for Neuro-Oncology, University of Sydney, Camperdown, NSW, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, Australia
| | - Marc Sanson
- Sorbonne Universités UPMC, University Paris VI, INSERM, CNRS, APHP, Institut du Cerveau et de la Moelle (ICM), Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Alba Ariela Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Paul M Clement
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, UZ Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Jean Francais Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Warren P Mason
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Helen Wheeler
- Northern Sydney Cancer Centre, North Shore Hospital, St Leonards, NSW, Australia; Department of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Olivier L Chinot
- Neuro-Oncology Division, Aix-Marseille University, AP-HM, Marseille, France
| | - Sanjeev Gill
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
| | - Matthew Griffin
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David G Brachman
- Department of Radiation Oncology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Walter Taal
- Neuro-Oncology Unit, Brain Tumour Centre at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science Hospital and University of Turin, Turin, Italy
| | - Michael Weller
- Department of Neurology and Brain Tumour Centre, University Hospital and University of Zurich, Zurich, Switzerland
| | - Catherine McBain
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Jaap Reijneveld
- VUmc Cancer Centre Amsterdam, VU University Medical Centre, Amsterdam, Netherlands; Department of Neurology, VU University Medical Centre, Amsterdam, Netherlands; Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands
| | - Roelien H Enting
- Department of Neurology, UMCG, University of Groningen, Groningen, Netherlands
| | - Damien C Weber
- Department of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Thierry Lesimple
- Department of Clinical Oncology, Comprehensive Cancer Center Eugène Marquis, Rennes, France
| | | | - Anja Gijtenbeek
- Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sarah Pascoe
- Department of Clinical Oncology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany
| | - Peter Hau
- Wilhelm Sander-Neuro-Oncology Unit and Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Frederic Dhermain
- Radiotherapy Department, Gustave Roussy University Hospital, Villejuif, France
| | - Irene van Heuvel
- Neuro-Oncology Unit, Brain Tumour Centre at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Roger Stupp
- Department of Medical Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ken Aldape
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Hendrikus Jan Dubbink
- Department of Pathology, Brain Tumour Centre at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Winand N M Dinjens
- Department of Pathology, Brain Tumour Centre at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pieter Wesseling
- Department of Pathology, VU University Medical Centre, Amsterdam, Netherlands; Department of Pathology, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | | | | | - Wolfgang Wick
- Neurologische Klinik und Nationales Zentrum für Tumorerkrankungen Universitätsklinik, Heidelberg, Germany
| | - Johan M Kros
- Department of Pathology, Brain Tumour Centre at Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Kurian KM, Jenkinson MD, Brennan PM, Grant R, Jefferies S, Rooney AG, Bulbeck H, Erridge SC, Mills S, McBain C, McCabe MG, Price SJ, Marino S, Moyes E, Qian W, Waldman A, Vaqas B, Keatley D, Burchill P, Watts C. Brain tumor research in the United Kingdom: current perspective and future challenges. A strategy document from the NCRI Brain Tumor CSG. Neurooncol Pract 2017; 5:10-17. [PMID: 31385960 DOI: 10.1093/nop/npx022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Cancer Research Institute (NCRI) is a partnership of charity and government research funders whose purpose is to improve health and quality of life by accelerating progress in cancer-related research through collaboration. Under this umbrella, the NCRI Brain Tumor Clinical Studies Group is focused on improving clinical outcomes for adult patients with brain and central nervous system tumors, including those with brain metastasis from other primary sites. This document discusses the current state of clinical brain tumor research in the United Kingdom and the challenges to increasing study and trial opportunities for patients. The clinical research priorities are defined along with a strategy to strengthen the existing brain tumor research network, improve access to tissue and imaging and to develop the future leadership for brain tumor research in the United Kingdom. This strategy document may serve as a framework for other organizations and countries.
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Affiliation(s)
- Kathreena M Kurian
- Institute of Clinical Neurosciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Paul M Brennan
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh
| | - Sarah Jefferies
- Department of Oncology, Cambridge University Hospitals, Foundation Trust, Cambridge, CB2, UK
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh
| | | | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh
| | - Samantha Mills
- Blizard Institute, Barts and The London Medical School, Queen Mary University of London, London, UK
| | - Catherine McBain
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Martin G McCabe
- Department of Clinical Oncology, The Christie NHS Foundation Trust Hospital, Manchester, UK
| | - Stephen J Price
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, UK
| | - Silvia Marino
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool and Informatics, Imaging and Data Sciences, University of Manchester
| | | | - Wendy Qian
- Cambridge Cancer Trials Centre
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust
| | - Adam Waldman
- Imaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Babar Vaqas
- Department of Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
| | | | | | - Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, UK
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Halford SER, Cruickshank G, Dunn L, Erridge S, Godfrey L, Herbert C, Jefferies S, Lopez JS, McBain C, Pittman M, Sleigh R, Watts C, Webster-Smith MF, Chalmers AJ. Results of the OPARATIC trial: A phase I dose escalation study of olaparib in combination with temozolomide (TMZ) in patients with relapsed glioblastoma (GBM). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2022 Background: Olaparib, a small molecule inhibitor of poly (ADP-ribose) polymerase (PARP), may improve GBM outcomes by enhancing cytotoxic effects of ionising radiation and TMZ. Clinical development of PARP inhibitors has been restricted by exacerbation of hematological toxicity. We investigated tumor pharmacokinetics (PK) of olaparib and safety and tolerability of its combination with TMZ. Methods: Dose escalation explored different schedules of olaparib (tablet formulation) with 42 day cycles of daily low dose TMZ. A dose expansion cohort evaluated the maximum tolerated schedule. PK analysis was performed on tumor and blood samples from patients undergoing neurosurgical resection, who received 4 olaparib doses pre-operatively. Results: 48 patients were recruited (median age 51(18-68); 29 male, 19 female) of whom 27 underwent surgery and 35 received olaparib/TMZ and were evaluable. 13 evaluable patients received expansion dose schedule (median age 54(21-67); 9 male, 4 female). Olaparib was detected in 73 of 74 tumor core specimens from 27 patients; mean conc. 588nM (97-1374nM), and in 27 of 28 tumor margin specimens from 10 patients; mean conc. 500nM (97-1237nM). Margin: core ratios ranged from 0.2–3.9(mean 1.2); tumor: plasma ratios ranged from 0.01 to 0.9 (mean 0.25). Olaparib dosing on days 1-5 was hindered by myelosuppression. Expansion cohort dose was defined as TMZ 75 mg/m2daily plus olaparib 150 mg (OD) days 1-3 weekly. Of 13 evaluable patients receiving expansion dose-schedule, 9 completed cycle 1, 2 completed cycle 2 and 2 completed cycle 3. Currently 45% of the evaluable patients remain progression-free at 6 months, with 2 still on treatment (full data set May2017). Of 35 evaluable patients, 24 experienced AE Grade ≥3 (see Table). Conclusions: Olaparib penetrates both core and margins of recurrent GBM despite failing to penetrate the intact brain barrier in pre-clinical heathy rodent models. Combination with extended low dose TMZ is safe and well tolerated, yielding encouraging 6 month progression-free survival rates. Clinical trial information: NCT01390571. [Table: see text]
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Affiliation(s)
| | - Garth Cruickshank
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Laurence Dunn
- Greater Glasgow and Clyde Health Board, Glasgow, United Kingdom
| | | | | | | | | | | | - Catherine McBain
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Colin Watts
- University of Cambridge, Cambridge, United Kingdom
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Rampling R, Peoples S, Mulholland PJ, James A, Al-Salihi O, Twelves CJ, McBain C, Jefferies S, Jackson A, Stewart W, Lindner J, Kutscher S, Hilf N, McGuigan L, Peters J, Hill K, Schoor O, Singh-Jasuja H, Halford SE, Ritchie JWA. A Cancer Research UK First Time in Human Phase I Trial of IMA950 (Novel Multipeptide Therapeutic Vaccine) in Patients with Newly Diagnosed Glioblastoma. Clin Cancer Res 2016; 22:4776-4785. [PMID: 27225692 PMCID: PMC5026298 DOI: 10.1158/1078-0432.ccr-16-0506] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/11/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To perform a two-cohort, phase I safety and immunogenicity study of IMA950 in addition to standard chemoradiotherapy and adjuvant temozolomide in patients with newly diagnosed glioblastoma. IMA950 is a novel glioblastoma-specific therapeutic vaccine containing 11 tumor-associated peptides (TUMAP), identified on human leukocyte antigen (HLA) surface receptors in primary human glioblastoma tissue. EXPERIMENTAL DESIGN Patients were HLA-A*02-positive and had undergone tumor resection. Vaccination comprised 11 intradermal injections with IMA950 plus granulocyte macrophage colony-stimulating factor (GM-CSF) over a 24-week period, beginning 7 to 14 days prior to initiation of chemoradiotherapy (Cohort 1) or 7 days after chemoradiotherapy (Cohort 2). Safety was assessed according to NCI CTCAE Version 4.0 and TUMAP-specific T-cell immune responses determined. Secondary observations included progression-free survival (PFS), pretreatment regulatory T cell (Treg) levels, and the effect of steroids on T-cell responses. RESULTS Forty-five patients were recruited. Related adverse events included minor injection site reactions, rash, pruritus, fatigue, neutropenia and single cases of allergic reaction, anemia and anaphylaxis. Two patients experienced grade 3 dose-limiting toxicity of fatigue and anaphylaxis. Of 40 evaluable patients, 36 were TUMAP responders and 20 were multi-TUMAP responders, with no important differences between cohorts. No effect of pretreatment Treg levels on IMA950 immunogenicity was observed, and steroids did not affect TUMAP responses. PFS rates were 74% at 6 months and 31% at 9 months. CONCLUSIONS IMA950 plus GM-CSF was well-tolerated with the primary immunogenicity endpoint of observing multi-TUMAP responses in at least 30% of patients exceeded. Further development of IMA950 is encouraged. Clin Cancer Res; 22(19); 4776-85. ©2016 AACRSee related commentary by Lowenstein and Castro, p. 4760.
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Affiliation(s)
- Roy Rampling
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Sharon Peoples
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, United Kingdom
| | - Paul J Mulholland
- Department of Oncology, University College London Hospitals, London, United Kingdom
| | - Allan James
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Omar Al-Salihi
- Adult Neuro-Oncology, Southampton University Hospitals NHS Trust, Southampton, United Kingdom
| | - Christopher J Twelves
- Cancer Research UK Clinical Centre, St James's University Hospital, Leeds, United Kingdom
| | - Catherine McBain
- The Christie NHS Foundation Trust, Withington, Manchester, United Kingdom
| | - Sarah Jefferies
- Cambridge Cancer Trials Centre, Oncology Clinical Trials, Addensbrooke's Hospital, Cambridge, United Kingdom
| | - Alan Jackson
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, United Kingdom
| | - Willie Stewart
- Department of Neuropathology, The Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Juha Lindner
- Immatics Biotechnologies GmbH, Tübingen, Germany
| | | | - Norbert Hilf
- Immatics Biotechnologies GmbH, Tübingen, Germany
| | - Lesley McGuigan
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Jane Peters
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Karen Hill
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | | | | | - Sarah E Halford
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - James W A Ritchie
- Cancer Research UK Centre for Drug Development, London, United Kingdom.
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Brown N, McBain C, Nash S, Hopkins K, Sanghera P, Saran F, Phillips M, Dungey F, Clifton-Hadley L, Wanek K, Krell D, Jeffries S, Khan I, Smith P, Mulholland P. Multi-Center Randomized Phase II Study Comparing Cediranib plus Gefitinib with Cediranib plus Placebo in Subjects with Recurrent/Progressive Glioblastoma. PLoS One 2016; 11:e0156369. [PMID: 27232884 PMCID: PMC4883746 DOI: 10.1371/journal.pone.0156369] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/12/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cediranib, an oral pan-vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitor, failed to show benefit over lomustine in relapsed glioblastoma. One resistance mechanism for cediranib is up-regulation of epidermal growth factor receptor (EGFR). This study aimed to determine if dual therapy with cediranib and the oral EGFR inhibitor gefitinib improved outcome in recurrent glioblastoma. METHODS AND FINDINGS This was a multi-center randomized, two-armed, double-blinded phase II study comparing cediranib plus gefitinib versus cediranib plus placebo in subjects with first relapse/first progression of glioblastoma following surgery and chemoradiotherapy. The primary outcome measure was progression free survival (PFS). Secondary outcome measures included overall survival (OS) and radiologic response rate. Recruitment was terminated early following suspension of the cediranib program. 38 subjects (112 planned) were enrolled with 19 subjects in each treatment arm. Median PFS with cediranib plus gefitinib was 3.6 months compared to 2.8 months for cediranib plus placebo (HR; 0.72, 90% CI; 0.41 to 1.26). Median OS was 7.2 months with cediranib plus gefitinib and 5.5 months with cediranib plus placebo (HR; 0.68, 90% CI; 0.39 to 1.19). Eight subjects (42%) had a partial response in the cediranib plus gefitinib arm versus five patients (26%) in the cediranib plus placebo arm. CONCLUSIONS Cediranib and gefitinib in combination is tolerated in patients with glioblastoma. Incomplete recruitment led to the study being underpowered. However, a trend towards improved survival and response rates with the addition of gefitinib to cediranib was observed. Further studies of the combination incorporating EGFR and VEGF inhibition are warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01310855.
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Affiliation(s)
- Nicholas Brown
- University College London Hospitals, London, United Kingdom
| | | | - Stephen Nash
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Kirsten Hopkins
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Paul Sanghera
- Hall Edwards Radiotherapy Research Group, University Hospital Birmingham, Birmingham, United Kingdom
| | - Frank Saran
- Department of Radiotherapy and Paediatric Oncology, Royal Marsden NHS Trust, Sutton, United Kingdom
| | - Mark Phillips
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Fiona Dungey
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Katharina Wanek
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Daniel Krell
- Department of Academic Oncology, Royal Free Hospital, London, United Kingdom
| | - Sarah Jeffries
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Iftekhar Khan
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Paul Smith
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Paul Mulholland
- UCL Cancer Institute, University College London, London, United Kingdom
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Li KL, Djoukhadar I, Zhu X, Zhao S, Lloyd S, McCabe M, McBain C, Evans DG, Jackson A. Vascular biomarkers derived from dynamic contrast-enhanced MRI predict response of vestibular schwannoma to antiangiogenic therapy in type 2 neurofibromatosis. Neuro Oncol 2016; 18:275-82. [PMID: 26311690 PMCID: PMC4724182 DOI: 10.1093/neuonc/nov168] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/18/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Antiangiogenic therapy of vestibular schwannoma (VS) in type 2 neurofibromatosis can produce tumor shrinkage with response rates of 40%-60%. This study examines the predictive value of parameter-derived MRI in this setting. METHODS Twelve patients with 20 VSs were recruited. Each had at least one rapidly growing tumor. Patients were treated with bevacizumab, 5 mg/kg every 2 weeks. Patients with stable or reduced VS volume were maintained at 2.5-5 mg every 4 weeks after 6 months. Those who failed treatment had their bevacizumab discontinued. Dynamic contrast-enhanced (DCE) MRI performed prior to treatment using a high temporal resolution technique, and data were analyzed to allow measurement of contrast transfer coefficient (K(trans)), vascular fraction (v(p)), extravascular-extracellular fraction (v(e)). Relaxation rate (R1(N)) was measured using a variable flip angle technique. Apparent diffusional coefficient (ADC) was calculated from diffusion-weighted imaging. The predictive power of microvascular parameters and ADC were examined using logistic regression modeling. RESULTS Responding tumors were larger (P < .001), had lower R1(N) (P < .001), and higher K(trans) (P < .05) and ADC (P < .01). They showed increases in R1(N) (P < .01) and reduction of K(trans) (P < .01) and ADC (P < .01). Modeling to predict response demonstrated significant independent predictive power for R1(N) (Β = - 0.327, P < .001), and K(trans) (Β = 0.156, P < .05). Modeling to predict percentage change in tumor volume at 90 days identified baseline tumor volume (Β = 5.503, P < .05), R1(N) (Β = - 5.844, P < .05), and K(trans) (Β = 5.622, P < .05) as independent significant predictors. CONCLUSIONS In patients with type 2 neurofibromatosis, biomarkers from DCE-MRI are predictive of VS volume response to inhibition of vascular endothelial growth factor inhibition.
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Affiliation(s)
- Ka-Loh Li
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
| | - Ibrahim Djoukhadar
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
| | - Xiaoping Zhu
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
| | - Sha Zhao
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
| | - Simon Lloyd
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
| | - Martin McCabe
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
| | - Catherine McBain
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
| | - D Gareth Evans
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
| | - Alan Jackson
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (K.-L.L., I.D., X.Z., S.Z., A.J.); Institute of Population Health, The University of Manchester, Manchester, UK (K.-L.L., I.D., A.J.); Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Institute of Human Development, Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK (S.L., D.G.E.); Centre for Paediatric, Adolescent and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, UK (M.M.); The Christie NHS Foundation Trust, Manchester, UK (C.M.)
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Lavin V, Whitfield G, Colaco R, McBain C. PO84WHOLE BRAIN RADIOTHERAPY (WBRT) FOLLOWING RESECTION OF BRAIN METASTASES: WHO DECIDES? AN AUDIT OF OUTCOMES AND CLINICIAN CONFIDENCE. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov284.73] [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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