1
|
Haberberger JF, Pegram W, Britt N, Schiavone K, Severson E, Sharaf R, Albacker LA, Williams E, Lechpammer M, Hemmerich A, Lin D, Huang RSP, Hiemenz M, Elvin J, Graf R, Lesser G, Kram D, Strowd R, Bi WL, Ramkissoon LA, Cohen MB, Reddy P, Creeden J, Ross JS, Alexander BM, Ramkissoon SH. A Retrospective Genomic Landscape of 661 Young Adult Glioblastomas Diagnosed Using 2016 WHO Guidelines for Central Nervous System Tumors. Oncologist 2024; 29:e47-e58. [PMID: 37619245 PMCID: PMC10769808 DOI: 10.1093/oncolo/oyad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/21/2023] [Indexed: 08/26/2023] Open
Abstract
The authors present a cohort of 661 young adult glioblastomas diagnosed using 2016 WHO World Health Organization Classification of Tumors of the Central Nervous System, utilizing comprehensive genomic profiling (CGP) to explore their genomic landscape and assess their relationship to currently defined disease entities. This analysis explored variants with evidence of pathogenic function, common copy number variants (CNVs), and several novel fusion events not described in literature. Tumor mutational burden (TMB) mutational signatures, anatomic location, and tumor recurrence are further explored. Using data collected from CGP, unsupervised machine-learning techniques were leveraged to identify 10 genomic classes in previously assigned young adult glioblastomas. The authors relate these molecular classes to current World Health Organization guidelines and reference current literature to give therapeutic and prognostic descriptions where possible.
Collapse
Affiliation(s)
| | - Worthy Pegram
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | - Nicholas Britt
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | | | - Eric Severson
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | - Radwa Sharaf
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Lee A Albacker
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Erik Williams
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | | | | | - Douglas Lin
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | | | - Matthew Hiemenz
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Julia Elvin
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Ryon Graf
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Glenn Lesser
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - David Kram
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Roy Strowd
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lori A Ramkissoon
- Pathology Department, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael B Cohen
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Prasanth Reddy
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - James Creeden
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Jeffrey S Ross
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
- Pathology Department, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Shakti H Ramkissoon
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
2
|
Kleinberg L, Ye X, Supko J, Stevens GHJ, Shu HK, Mikkelsen T, Lieberman F, Lesser G, Lee E, Grossman S. A Multi-Site Phase I Trial of Veliparib with Standard Radiation and Temozolomide in Patients with Newly Diagnosed Glioblastoma Multiforme (GBM). Res Sq 2023:rs.3.rs-3466927. [PMID: 37961385 PMCID: PMC10635324 DOI: 10.21203/rs.3.rs-3466927/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Purpose A multi-site Phase I trial was conducted to determine the safety, maximum tolerated dose, and pharmacokinetics (PK) of Veliparib, a Poly (ADP-ribose) polymerase [PARP] enzyme inhibitor, when administered with temozolomide (TMZ) alone and then with temozolomide and radiation (RT) in patients with newly diagnosed glioblastoma. Methods Given the potential for myelosuppression when a PARP inhibitor is combined with chemotherapy, the first 6 patients accrued were given Veliparib 10 mg bid and TMZ 75 mg/m2/d daily for six weeks. If this was well tolerated, the same doses of Veliparib and TMZ would be tested along with standard radiation with plans to dose escalate the Veliparib in subsequent patient cohorts. Once a maximal tolerated dose was determined, a 78 patient phase II study was planned. Peripheral blood pharmacokinetics were assessed. Results Twenty-four patients were enrolled. In the first 6 patients who received 6 weeks of TMZ with Veliparib only one dose limiting toxicity (DLT) occurred. The next 12 patients received 6 weeks of RT + TMZ + veliparib and 4/12 (33%) had dose limiting hematologic toxicities. As a result, Veliparib was reduced by 50% to 10 mg BID every other week, but again 3/3 patients had dose limiting hematologic toxicities. The trial was then terminated. The mean clearance (± SD) CL/F of Veliparib for the initial dose (27.0 ± 9.0 L/h, n = 16) and at steady-state for 10 mg BID (23.5 ± 10.4 L/h, n = 18) were similar. Accumulation for BID dosing was 56% (± 33%). Conclusions Although Veliparib 10 mg BID administered with TMZ 75 mg/m2 for six weeks was well tolerated, when this regimen was combined with standard partial brain irradiation it was severely myelosuppressive even when the dose was reduced by 50%. This study again highlights the potential of localized cranial radiotherapy to significantly increase hematologic toxicity of marginally myelosuppressive systemic therapies.
Collapse
|
3
|
Severson EA, Haberberger J, Hemmerich A, Huang RSP, Edgerly C, Schiavone K, Najafian A, Hiemenz M, Lechpammer M, Vergilio JA, Lesser G, Strowd R, Elvin J, Ross JS, Hegde P, Alexander B, Singer S, Ramkissoon S. Genomic Profiling Reveals Differences in Primary Central Nervous System Lymphoma and Large B-Cell Lymphoma, With Subtyping Suggesting Sensitivity to BTK Inhibition. Oncologist 2023; 28:e26-e35. [PMID: 36342081 PMCID: PMC9847534 DOI: 10.1093/oncolo/oyac190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND B-cell primary central nervous system (CNS) lymphoma (PCL) is diffuse large B-cell lymphoma (DLBCL) confined to the CNS. Less than 50% of patients with PCL achieve complete remission with current therapies. We describe the findings from comprehensive genomic profiling (CGP) of a cohort of 69 patients with PCL, 36 cases of secondary CNS lymphoma (SCL), and 969 cases of DLBCL to highlight their differences and characterize the PCL cohort. In addition, we highlight the differences in frequency of germinal center B-cell like (GCB) and non-GCB subtypes and molecular subtypes, particularly MCD and EZH subtypes, between PCL and DLBCL. MATERIALS AND METHODS Sixty-nine cases of B-cell PCL, 36 cases of secondary CNS lymphoma (SCL), and 969 cases of DLBCL were evaluated by CGP of 405 genes via DNAseq and 265 genes via RNAseq for fusions (FoundationOne Heme). Tumor mutational burden (TMB) was calculated from 1.23 Mb of sequenced DNA. RESULTS Genomic alterations with significant differences between PCL and DLBCL included MYD88, ETV6, PIM1, PRDM1, CXCR4, TP53, and CREBBP, while only MYD88 was significantly different between SCL and DLBCL. PCL cases were significantly enriched for the MCD molecular subtypes, which have an excellent response to BTKi. We report a patient with a durable complete response to BTKi consistent with their genomic profile. EBV status, CD274 amplification, and TMB status suggest that 38% of PCL patients may benefit from ICPI; however further study is warranted. CONCLUSION CGP of PCLs reveals biomarkers, genomic alterations, and molecular classifications predictive of BTKi efficacy and potential ICPI efficacy. Given the limitations of standard of care for PCL, CGP is critical to identify potential therapeutic approaches for patients in this rare form of lymphoma.
Collapse
Affiliation(s)
- Eric A Severson
- Corresponding author: Eric Severson, MD, PhD, 7010 Kit Creek Road, Morrisville, NC 27560, USA. Tel: +1 919 748 5886; E-mail:
| | | | | | | | | | | | | | | | | | | | - Glenn Lesser
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Roy Strowd
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | | - Samuel Singer
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Shakti Ramkissoon
- Foundation Medicine, Morrisville, NC, USA,Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
4
|
Sloan AE, Nock CJ, Ye X, Buerki R, Chang S, Lesser G, Norden A, Cloughesy T, Olson J, Kerstetter-Fogle A, Rich J, Fisher J, Desideri S, Takebe N, Timmer W, Grossman S, Prados M. ABTC-0904: targeting glioma stem cells in GBM: a phase 0/II study of hedgehog pathway inhibitor GDC-0449. J Neurooncol 2023; 161:33-43. [PMID: 36581779 DOI: 10.1007/s11060-022-04193-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/04/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Gliomagenesis and resistance of glioblastoma (GBM) are believed to be mediated by glioma stem cells (GSC). Evidence suggests that SHH signaling promotes GSC proliferation and self-renewal. METHODS ABTC-0904 was a two-arm, multicenter phase 0/II study of GDC-0449, an oral inhibitor of Smoothened (SMO) in patients undergoing resection for recurrent GBM. All patients (Arms I and II) had surgery and received drug post-operatively. Only patients in Arm I received drug prior to surgery. The primary objective was to determine 6-month progression free survival (PFS-6). Secondary endpoints include median PFS (mPFS) and overall survival (mOS), response rate, and toxicity. Correlative studies included bioanalysis of GDC-0449, and inhibition of SHH signaling, GSC proliferation and self-renewal. RESULTS Forty-one patients were enrolled. Pharmacokinetics of GDC-0449 in plasma demonstrated levels within expected therapeutic range in 75% of patients. The proportion of tumorcells producing CD133+ neurospheres, neurosphere proliferation, self-renewal, and expression of the SHh downstream signaling was significantly decreased in Arm I following GDC-0449 treatment (p < 0.005; p < 0.001 respectively) compared to Arm II (no drug pre-op). Treatment was well tolerated. There were no objective responders in either arm. Overall PFS-6 was 2.4% (95% CI 0.9-11.1%). Median PFS was 2.3 months (95% CI 1.9-2.6) and mOS was 7.8 months (95% CI 5.4-10.1). CONCLUSIONS GDC-0449 was well tolerated, reached tumor, and inhibited CD133+ neurosphere formation, but had little clinical efficacy as a single agent in rGBM. This suggests growth and maintenance of rGBM is not solely dependent on the SHH pathway thus targeting SMO may require combined approaches.
Collapse
Affiliation(s)
- Andrew E Sloan
- Chief of Neuroscience, Piedmont Healthcare, Atlanta, USA.
| | - Charles J Nock
- Department of Medicine, UH-Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Xiaobu Ye
- Adult Brain Tumor Consortium, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Buerki
- Department of Neurology, UH-Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Susan Chang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Glenn Lesser
- Department of Radiation Oncology, Wake Forest University, Wake Forest, NC, USA
| | - Andrew Norden
- Department of Medicine, Dana Farber Cancer Institute, Boston, MA, USA
| | - Timothy Cloughesy
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeffrey Olson
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | | | - Jeremy Rich
- Department of Neurology and Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joy Fisher
- Adult Brain Tumor Consortium, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Serena Desideri
- Adult Brain Tumor Consortium, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Naoko Takebe
- National Cancer Institute, Clinical Investigations Branch, National Institutes of Health, Bethesda, MD, USA
| | - William Timmer
- National Cancer Institute, Clinical Investigations Branch, National Institutes of Health, Bethesda, MD, USA
| | - Stuart Grossman
- Adult Brain Tumor Consortium, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael Prados
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
5
|
Romo C, Ellingson B, Strowd R, Lesser G, Raymond C, Kral B, Ye X, Desideri S, Fisher J, Grossman S. DDEL-11. DETERMINING THE DOSE OF REGADENOSON MOST LIKELY TO TRANSIENTLY ALTER THE INTEGRITY OF THE BLOOD-BRAIN BARRIER IN PATIENTS WITH GLIOMAS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
The blood brain barrier (BBB) is a major obstacle to the delivery of chemotherapy to the CNS. Regadenoson is an FDA approved adenosine A2 agonist used for cardiac stress tests. In murine models, it transiently increases BBB permeability to a 70KD dextran. This multi-institutional, NIH funded, Adult Brain Tumor Consortium trial was designed to discover a dose of regadenoson that substantially increases vascular permeability in normal appearing white matter (NAWM) where drug delivery is particularly challenging.
METHODS
Adults ages 18-45 with supratentorial gliomas at low-risk for regadenoson complications were recruited (n = 7). One patient was treated at each of seven dose levels (from 0.05 to 1.4 mg) that are known to be safe in humans. The primary outcome measure is change in vascular permeability via dynamic contrast enhanced (DCE) perfusion MRI estimates of Ktrans. The primary outcome measure was a 10-fold higher Ktrans in NAWM than reported in literature (Ktrans > 0.04 min-1). Contrast-enhanced T1 subtraction map estimates of change in contrast enhancement and other measurements in normal brain and non-enhancing tumor were quantified.
RESULTS
Ktrans measures in NAWM averaged 1.13x10-3 ± 0.44x10-3 (SEM) min-1, lower than the target of 0.04 min-1. Normalized, contrast enhanced T1-weighted MR signal intensity in NAWM increased an average of 74.0 ± 22.4% min-1 (SEM) min-1, which was significantly higher than zero (P = 0.0163). Data available from this limited sample failed to meet the target goal in Ktrans increase or change in contrast enhancing signal intensity.
CONCLUSION
Administration of regadenoson at seven different doses did not significantly elevate Ktrans for gadolinium in NAWM. This data suggests that single doses of regadenoson are unlikely to substantially increase the delivery of therapeutic agents in non-enhancing brain tissue. This trial design is appropriate for further human testing of other regadenoson schedules and other novel approaches aimed at transiently modifying BBB permeability.
Collapse
Affiliation(s)
- Carlos Romo
- Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | | | - Roy Strowd
- Wake Forest Baptist Health, Department of Neuro-Oncology, Winston-Salem , NC , USA
| | | | | | - Brian Kral
- Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Xiaobu Ye
- Johns Hopkins University School of Medicine , Baltimore , USA
| | - Serena Desideri
- Johns Hopkins University School of Medicine , Baltimore , USA
| | - Joy Fisher
- Johns Hopkins University School of Medicine , Baltimore , USA
| | - Stuart Grossman
- Johns Hopkins University School of Medicine , Baltimore, MD , USA
| |
Collapse
|
6
|
Zarabi H, Wicks R, Russel G, Banderage D, Strowd R, Mott R, Laxton A, Tatter S, White J, Lo HW, Debinski W, Chan M, Lesser G, Cramer C. RADT-16. CLINICAL OUTCOMES FOR HIGH RISK WHO GRADE II GLIOMA PATIENTS TREATED WITH UPFRONT TMZ-BASED CHEMORADIOTHERAPY. Neuro Oncol 2022. [PMCID: PMC9661176 DOI: 10.1093/neuonc/noac209.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
OBJECTIVE
RTOG 9802 demonstrated improved survival using chemoradiotherapy (CRT) over radiotherapy (RT) alone for WHO Grade II gliomas (LGG) using PCV with RT. We analyze our retrospective dataset of predominantly temozolomide (TMZ)-based CRT in LGG patients who would have been eligible for RTOG 9802.
METHODS
Retrospective review of LGG patients (2000–2017) treated at a single institution (67 patients). Histologies included oligodendroglioma(OD), astrocytoma(AC) or astrocytoma (OA). Those who received upfront RT +/- chemotherapy were included. The CRT cohort (n=40) consisted primarily of TMZ (n=36) administered concurrently with RT. 27 patients received RT alone. RT for both cohorts consisted of a median dose of 54 Gy (range 50.4 - 54 Gy). 65/67 patients had “high risk” LGG as defined by RTOG 9802 criteria. Kaplan Meier analysis was used to assess overall survival (OS) and progression free survival (PFS).
RESULTS
5-year PFS for patients receiving CRT was 64% vs. 44% in those receiving RT alone (log rank p=0.009). Difference in PFS due to chemotherapy was driven by AC histology (57% vs. 21% PFS at 5 years, log rank p=0.002) while OD/OA PFS was not statistically altered (79% vs. 72% PFS at 5 years, p=0.21). 5-year OS for patients receiving CRT was 76% vs. 69% in those receiving RT alone (p=0.11). Cox Proportional Hazards analysis showed that use of upfront CRT (HR=0.4, p=0.009) was the only factor that decreased the risk of earlier progression.
CONCLUSION
Use of upfront, predominantly TMZ-based CRT, has a PFS benefit over RT alone in a population of WHO grade II gliomas. This benefit appears to be driven by AC histology and also appears to extend beyond the “very high risk” cohort from RTOG 0424 to include the “high risk” group from RTOG 9802.
Collapse
Affiliation(s)
| | | | | | | | - Roy Strowd
- Wake Forest Baptist Health, Department of Neuro-Oncology, Winston-Salem , NC , USA
| | - Ryan Mott
- Wake Forest SOM , Winston Salem , USA
| | - Adrian Laxton
- Wake Forest Baptist Health, Department of Neurosurgery , Winston Salem , USA
| | - Stephen Tatter
- Wake Forest Baptist Health, Department of Neurosurgery , Winston Salem , USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Dorsey J, Mott R, Lack C, Britt N, Ramkissoon S, Morris B, Carter A, Detroye A, Chan M, Tatter S, Lesser G. PTCH1 mutant small cell glioblastoma in a patient with Gorlin syndrome: A case report. Oncol Lett 2022; 24:326. [PMID: 35949590 PMCID: PMC9353864 DOI: 10.3892/ol.2022.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022] Open
Abstract
Gorlin syndrome or nevoid basal cell carcinoma syndrome is a rare genetic disease characterized by predisposition to congenital defects, basal cell carcinomas and medulloblastoma. The syndrome results from a heritable mutation in PATCHED1 (PTCH1), causing constitutive activation of the Hedgehog pathway. The present study described a patient with Gorlin syndrome who presented early in life with characteristic basal cell carcinomas and later developed a small cell glioblastoma (GBM), World Health Organization grade IV, associated with a Patched 1 (PTCH1) N97fs*43 mutation. Comprehensive genomic profiling of GBM tissues also revealed multiple co-occurring alterations including cyclin-dependent kinase 4 (CDK4) amplification, receptor tyrosine-protein kinase 3 (ERBB3) amplification, a fibroblast growth factor receptor 1 and transforming acidic coiled-coil containing protein 1 (FGFR1-TACC1) fusion, zinc finger protein (GLI1) amplification, E3 ubiquitin-protein ligase (MDM2) amplification and spectrin α chain, erythrocytic 1 (SPTA1) T1151fs*24. After the biopsy, imaging revealed extensive leptomeningeal enhancement intracranially and around the cervical spinal cord due to leptomeningeal disease. The patient underwent craniospinal radiation followed by 6 months of adjuvant temozolomide (150 mg/m2) with good response. She was then treated with vismodegib for 11 months, first combined with temozolomide and then with bevacizumab, until disease progression was noted on MRI, with no significant toxicities associated with the combination therapy. She received additional therapies but ultimately succumbed to the disease four months later. The current study presents the first documentation in the literature of a primary (non-radiation induced) glioblastoma secondary to Gorlin syndrome. Based on this clinical experience, vismodegib should be considered in combination with standard-of-care therapies for patients with known Gorlin syndrome-associated glioblastomas and sonic hedgehog pathway mutations.
Collapse
Affiliation(s)
- John Dorsey
- Department of Hematology‑Oncology, Cone Health Cancer Center, Greensboro, NC 27403, USA
| | - Ryan Mott
- Department of Pathology, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| | - Christopher Lack
- Department of Radiology, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| | - Nicholas Britt
- Department of Pathology, Foundation Medicine, Morrisville, NC 27560, USA
| | - Shakti Ramkissoon
- Department of Pathology, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| | - Bonny Morris
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| | - Annette Carter
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| | - Alisha Detroye
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| | - Michael Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| | - Stephen Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| | - Glenn Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston‑Salem, NC 27157, USA
| |
Collapse
|
8
|
Li T, Mehraein-Ghomi F, Forbes ME, Namjoshi SV, Ballard EA, Song Q, Chou PC, Wang X, Parker Kerrigan BC, Lang FF, Lesser G, Debinski W, Yang X, Zhang W. HSP90-CDC37 functions as a chaperone for the oncogenic FGFR3-TACC3 fusion. Mol Ther 2022; 30:1610-1627. [PMID: 35151844 PMCID: PMC9077375 DOI: 10.1016/j.ymthe.2022.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/21/2021] [Revised: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
The FGFR3-TACC3 (F3-T3) fusion gene was discovered as an oncogenic molecule in glioblastoma and bladder cancers, and has subsequently been found in many cancer types. Notably, F3-T3 was found to be highly expressed in both untreated and matched recurrence glioblastoma under the concurrent radiotherapy and temozolomide (TMZ) treatment, suggesting that targeting F3-T3 is a valid strategy for treatment. Here, we show that the F3-T3 protein is a client of heat shock protein 90 (HSP90), forming a ternary complex with the cell division cycle 37 (CDC37). Deprivation of HSP90 or CDC37 disrupts the formation of the ternary complex, which destabilizes glycosylated F3-T3, and thereby suppresses F3-T3 oncogenic activity. Gliomas harboring F3-T3 are resistant to TMZ chemotherapy. HSP90 inhibitors sensitized F3-T3 glioma cells to TMZ via the inhibition of F3-T3 activation and potentiated TMZ-induced DNA damage. These results demonstrate that F3-T3 oncogenic function is dependent on the HSP90 chaperone system and suggests a new clinical option for targeting this genetic aberration in cancer.
Collapse
Affiliation(s)
- Tao Li
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA; Laboratory of Neuro-Oncology, Tianjin Neurological Institute, Tianjin 300052, China
| | - Farideh Mehraein-Ghomi
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - M Elizabeth Forbes
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Sanjeev V Namjoshi
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - E Ashley Ballard
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Qianqian Song
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Ping-Chieh Chou
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Xuya Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Laboratory of Neuro-Oncology, Tianjin Neurological Institute, Tianjin 300052, China
| | | | - Frederick F Lang
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Glenn Lesser
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Waldemar Debinski
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Xuejun Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Laboratory of Neuro-Oncology, Tianjin Neurological Institute, Tianjin 300052, China; Department of Neurosurgery, Tsinghua University Beijing Tsinghua Changgung Hospital, Beijing 102218, China.
| | - Wei Zhang
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.
| |
Collapse
|
9
|
Mackert J, Stirling E, Kooshki M, Zhao D, Thomas A, Lesser G, Triozzi P, Soto-Pantoja D. 270 Anti-CD47 immunotherapy as a therapeutic strategy for the treatment of breast cancer brain metastasis. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundTriple-negative breast cancer (TNBC) is a highly aggressive subtype of breast cancer characterized by a lack of specific targets and a 35% incidence of brain metastasis. There is no targeted treatment for managing brain metastasis associated with TNBC; therefore, new strategies are urgently needed to overcome disease mortality. The presence of cell surface protein CD47 allows cancer cells to evade innate and adaptive immune surveillance resulting in metastatic spread. CD47 binds to and activates SIRPα on the surface of myeloid cells, inhibiting their phagocytic activity. On the other hand, CD47 binds the matricellular protein Thrombospondin-1 limiting T cell activation. Thus, blocking the CD47 is a potential therapeutic strategy for the prevention of brain metastasis.MethodsBreast cancer patient biopsies were stained with antibodies against CD47. An anti-CD47 antibody was used in a syngeneic model of orthotopic triple-negative breast cancer. CD47 null mice were used in a breast cancer brain metastasis model by intracardiac injection of the E0071-Br-Luc cell line. Brain metastatic burden was measured by the in vivo imaging system (IVIS) and quantified by luciferase luminescence. Immunohistochemical analysis was performed to quantify tumor-infiltrating macrophages. Gene expression analysis of tumors was carried out by RNA-sequencing.ResultsImmunohistochemical staining of patient biopsies revealed an 89% increase in CD47 expression in metastatic brain tumors compared to primary lesions (p ≤ 0.05). Anti-CD47 treatment in mice bearing brain metastatic 4T1br3 orthotopic tumors reduced tumor volume and tumor weight by over 50% compared to control mice (p ≤ 0.05) and increased F4/80 macrophage marker 5-fold tumors compared to control (p ≤ 0.05). CD47 null mice had a 60% increase in survival (p ≤ 0.05) and an 89% decrease in metastatic brain lesions (p ≤ 0.05) compared to control mice in a brain metastasis model. Additionally, RNA sequencing revealed 318 uniquely expressed genes and a significant reduction of genes related to extracellular matrix organization in tumors treated with an anti-CD47 antibody.ConclusionsCD47 was increased in metastatic brain tumors compared to primary lesions in breast cancer patients. CD47 blockade reduced orthotopic brain-metastatic tumor burden associated with increased macrophage infiltration and reduced extracellular matrix-associated gene expression. Additionally, CD47 null mice had improved overall survival and reduced brain metastatic lesions. Thus, CD47 blockade may be an effective therapeutic for triple-negative breast cancer brain metastasis.AcknowledgementsThis work is supported by a NCI R21 CA249349 and the American Cancer Society Research Scholar Grant (133727-RSG-19-150-01-LIB).Ethics ApprovalAnimal studies were approved by the Wake Forest School of Medicine Animal Care and UseCommittee (ACAUC). Human subject studies were approved by the institutional review board (IRB).
Collapse
|
10
|
Abousaud M, Faroqui NM, Lesser G, Strowd RE, Ramkissoon SH, Kwatra M, Houston KS, Hsu FC, Carter A, Petro R, DeTroye AT. Clinical Experience using Osimertinib in Patients with Recurrent Malignant Gliomas Containing EGFR Alterations. J Cancer Sci Clin Ther 2021; 5:210-220. [PMID: 35601813 PMCID: PMC9121798 DOI: 10.26502/jcsct.5079114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background EGFR alterations are commonly observed in malignant gliomas (MG). Osimertinib, an irreversible EGFR-tyrosine kinase inhibitor, effectively penetrates the blood brain barrier and achieves therapeutic concentrations in brain tissue. Materials and Methods This retrospective chart review identified six patients with recurrent MG and EGFR alterations who received osimertinib. Results Four patients were assessed for response. One patient had a partial response, two patients achieved stable disease and one was refractory. One patient with an EGFR vIII rearrangement remained on treatment for 236 days and a second patient with an EGFR vIII mutation remained on treatment for 294 days and continued on treatment at the time of analysis. Thrombocytopenia occurred in two patients, one patient developed grade 1 diarrhea and pneumonia, and another patient developed grade 1 mucositis. Conclusion Osimertinib had a tolerable safety profile in this heavily pretreated brain tumor population. Osimertinib may benefit select patients with recurrent MG containing EGFR alterations.
Collapse
Affiliation(s)
- Marin Abousaud
- Department of Pharmacy, Emory Healthcare, Atlanta, GA, USA
| | - Naqeeb M Faroqui
- Department of General Surgery, Wellstar Atlanta Medical Center, Atlanta, GA, USA
| | - Glenn Lesser
- Wake Forest Baptist Health Comprehensive Cancer Center, Department of Internal Medicine, Section on Hematology and Oncology, Winston-Salem, NC, USA
| | - Roy E Strowd
- Wake Forest Baptist Health Comprehensive Cancer Center, Department of Internal Medicine, Section on Hematology and Oncology, Winston-Salem, NC, USA
| | - Shakti H Ramkissoon
- Wake Forest Baptist Health Comprehensive Cancer Center, Department of Pathology, Winston-Salem, NC, USA
- Foundation Medicine, Morrisville, NC, USA
| | - Madan Kwatra
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Kristin S Houston
- Wake Forest Baptist Health Comprehensive Cancer Center, Department of Internal Medicine, Section on Hematology and Oncology, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Annette Carter
- Wake Forest Baptist Health Comprehensive Cancer Center, Department of Internal Medicine, Section on Hematology and Oncology, Winston-Salem, NC, USA
| | - Robin Petro
- Wake Forest Baptist Health Comprehensive Cancer Center, Department of Internal Medicine, Section on Hematology and Oncology, Winston-Salem, NC, USA
| | - Alisha T DeTroye
- Wake Forest Baptist Health Comprehensive Cancer Center, Department of Internal Medicine, Section on Hematology and Oncology, Winston-Salem, NC, USA
| |
Collapse
|
11
|
Weaver KE, Sutfin EL, Dressler E, Bellinger C, Miller DP, Chiles C, Petty WJ, Lesser G, Foley KL. Abstract PO-009: Rural/urban and race differences in factors related to cessation readiness among cigarette smokers presenting for lung cancer screening in community settings. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Many patients presenting for lung cancer screening are current smokers; screening may be a teachable moment for cessation. The objective of the current analysis is to compare cessation readiness among lung screening patients by rural/urban residence and race/ethnicity to identify populations who may benefit from tailored support. Methods: We enrolled 1,095 current smokers presenting for low dose CT lung cancer screening at 24 NCI Community Oncology Research Program (NCORP) imaging clinics as part of the OaSiS trial (WF 20817CD). Prior to screening, we collected data regarding perceived risk and worry about lung cancer, perceived impact of cessation on lung cancer risk, cessation readiness, and quitting self-efficacy (both 1-10 Likert type scales). We classified participants as rural vs urban using the zip-code-based definitions of the Federal Office of Rural Health Policy. We summarized group differences using chi-square analyses. Results: Participants were 50.2% female; average age 64 years (range 55-79); 81.9% non-Hispanic White (NHW), 13.3% non-Hispanic Black (NHB), 2.6% Hispanic, 2.2% American Indian; 20.2% rural residence). The median cigarettes smoked per day was 20 and the median pack years smoked was 44. NHW participants were less likely than other groups to report being “extremely” worried about lung cancer [15.5% vs NHB (31.4%), Hispanic (35.7%), and American Indian (25%), p<.0001]. When queried about their perceived risk of developing lung cancer, NHB (21.8%), Hispanic (14.3%), and American Indian (12.5%) participants were also more likely to report that they didn’t know, compared to NHW participants (9.7%, p <.0001). NHB participants were more likely to believe that quitting smoking would “very much” reduce their risk of lung cancer (52.1%), compared to NHW (36.3%), Hispanic (35.7%), and American Indian (37.5%) participants (p<.001). NHWs reported lower cessation readiness compared to NHB, Hispanic, and American Indian participants (p<.001). NHB and Hispanic participants also reported high quitting self-efficacy compared to NHW and American Indian participants (p<.0001). With regard to rural/urban differences, compared to urban residents, rural residents reported lower or unknown perceived impact of cessation on lung cancer risk (9.5 vs 6.8% no impact & 13.2 vs 6.9% unknown, p<.01). There were no other differences in cessation readiness factors by rural-urban residence. Conclusions: To advance health equity, it is important to understand cessation readiness, among patients presenting to community-based imaging clinics for lung cancer screening. Evidence-based cessation treatment for racial/ethnic minorities within these settings may be enhanced by tailoring for higher cessation readiness. Rural and racial/ethnic minority patients may benefit from enhanced education regarding lung cancer risk and the impact of cessation. This work was supported by the National Cancer Institute (R01CA207158 & UG1CA189824).
Citation Format: Kathryn E. Weaver, Erin L. Sutfin, Emily Dressler, Christina Bellinger, David P. Miller, Caroline Chiles, W. J. Petty, Glenn Lesser, Kristie L. Foley. Rural/urban and race differences in factors related to cessation readiness among cigarette smokers presenting for lung cancer screening in community settings [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-009.
Collapse
Affiliation(s)
| | | | | | | | | | | | - W. J. Petty
- Wake Forest School of Medicine, Winston-Salem, NC
| | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC
| | | |
Collapse
|
12
|
Park S, Giles A, Liberatore G, Morgan K, DeBruhl C, Hsu FC, Cramer C, Strowd R, Chan M, Lesser G, Laxton A, Tatter S, Cummings T. NCOG-76. BASELINE COGNITIVE ASSESSMENT IN GLIOMA PATIENTS WITH MGMT PROMOTOR METHYLATION AND/OR 1p19q CODELETION. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.613] [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
INTRODUCTION
Methylguanine methyltransferase (MGMT) methylation status is associated with better overall survival while 1p19q co-deletion is associated with long-term survival. Cognitive dysfunction is a common complication of brain tumors and treatment; however, information regarding the relationship between MGMT status, 1p19q codeletion, and cognition is limited.
METHOD
Baseline neuropsychological testing was performed in patients with malignant glioma prior to radiation and/or chemotherapy administration. A retrospective data analysis was conducted. We calculated composite and subdomain scores for attention/executive functioning, memory, and language in patients with or without MGMT promotor methylation and/or 1p19q codeletion.
RESULTS
Thirty-eight patients (Age M = 48.73 ± 14.98; 50% female) diagnosed with glioma (29% grade II, 16% grade III, 21% grade IV; Karnofsky Performance Status score (KPS) M = 88.75 ± 14.24) were selected from a retrospective. Memory was marginally significant, such that methylated participants performed better on memory tasks than the unmethylated group (p = .053). Independent samples t-test revealed no significant differences between either marker across the overall cognitive composite (methylated M = 41.35; unmethylated: M = 39.91; p = .955; 1p19q co-deleted: M = 50.94; 1p19q intact: M = 43.66; p = .158) and subdomains attention/executive functioning (p = .585; p = .157) and language (p = .581; p = .765). Logistic regression showed MGMT does not predict cognitive status (p =.052) and there were not enough cases to complete the model with 1p19q.
CONCLUSION
MGMT status may be correlated with baseline cognitive status as MGMT methylated patients had better memory scores than their unmethylated counterparts. We did not find any significant association between the remaining cognitive domains and MGMT or 1p19q although sample size is a significant limitation. These results suggest further assessment of changes in cognition during treatment through serial neuropsychological testing of glioma populations with defined marker status is warranted.
Collapse
Affiliation(s)
| | | | | | | | | | - Fang-Chi Hsu
- Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | | | - Roy Strowd
- Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Michael Chan
- Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Glenn Lesser
- Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Adrian Laxton
- Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Stephen Tatter
- Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | | |
Collapse
|
13
|
Hutchinson A, Marshall A, Hsu FC, Weaver K, DeTroye A, Houston KS, Carter A, Chan M, Cramer C, Laxton A, Tatter S, Lesser G, Canzona M, Strowd R. EPID-09. QUANTIFYING SOCIAL DETERMINANTS OF HEALTH AMONG GLIOMA PATIENTS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.327] [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
Social determinants of health (SDH) are modifiable factors that contribute to health outcomes. Despite studies linking SDHs with cervical, ovarian, and prostate cancer outcomes, few studies have explored SDHs in glioma patients. We conducted a cross-sectional survey to characterize and contextualize SDHs in glioma patients by community income, rural/urban residence, and treatment status.
METHODS
Two validated instruments: PRAPARE (Protocol for responding to and assessing patents’ assets risks and experiences) and AHC (accountable health communities instrument) quantified SDHs; along with study-specific supplemental questions. Risk scores were calculated and combined into an overall and domain-specific (economic, education, neighborhood environment, social context, and healthcare) SDH risk, with a higher score being indicative of higher SDH risk. Scores were compared between low-income (LIC) vs high-income (HIC) communities (defined by median household income), urban vs rural (defined by zip code), and active treatment vs surveillance (determined by patient medical record) using Wilcoxon rank-sum test.
RESULTS
100 glioma patients were enrolled: mean age 53 years (range: 22–78); 49% male; 18% oligodendroglioma, 34% diffuse astrocytoma, 38% glioblastoma, 10% other glioma; 68% resided in LICs, 27% in rural zip codes, and 51% were on active treatment. Overall, SDH risk scores were low (mean= 4.43-out-of-38). Scores in the healthcare domain were the highest. Compared to patients from LICs, patients from HICs had higher healthcare risk scores (p< 0.05). Surveillance patients had higher overall SDH risk on the AHC than patients in active treatment (p< 0.05), with age being a confounder. In multivariable analysis, younger age, and astrocytoma histology were associated with higher social health risk.
CONCLUSION
Glioma patients report relatively few SDH risk factors on standardized instruments designed for general clinic populations. The higher health risk observed in patients in HICs and higher AHC risk for those in surveillance will be further explored in planned qualitative analysis.
Collapse
Affiliation(s)
- Angelica Hutchinson
- Wake Forest Graduate School of the Arts and Sciences, Winston Salem, NC, USA
| | | | | | - Kathryn Weaver
- Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | | | | | | | - Michael Chan
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | | | | | | | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | |
Collapse
|
14
|
Abousaud M, Faroqui N, Hsu FC, Lesser G, Strowd R, Ramkissoon S, Kwatra M, Houston KS, Carter A, DeTroye A. DDRE-17. INITIAL CLINICAL EXPERIENCE USING OSIMERTINIB IN PATIENTS WITH RECURRENT MALIGNANT GLIOMAS WITH EGFR ALTERATIONS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.262] [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
EGFR alterations are commonly observed in malignant gliomas (MG), especially glioblastomas, making this pathway an appealing therapeutic target. Unlike other EGFR tyrosine kinase inhibitors (TKIs), osimertinib (osi), a third-generation, irreversible EGFR-TKI commonly used to treat EGFR-mutant lung cancer, is able to effectively penetrate the blood brain barrier (BBB) and achieve therapeutic concentrations in brain tissue. METHODS: A retrospective chart review identified six patients (pts) aged 46–74 years with recurrent MG and known EGFR alterations identified by next generation sequencing who received at least one dose of osi between 1/1/2018 and 5/26/2020. Patients received osi 80 mg by mouth once daily and continued treatment until disease progression, the development of unacceptable side effects, medical complications, or death. RESULTS: All patients had EGFR amplification. Other EGFR alterations identified included EGFRvIII (1 pt), deletion of introns 1–7 (3 pts) and deletion of introns 13–15 (2 pts). Four of the six patients were evaluable for response. Three patients (75.0%) had stable disease (SD) as best response and one patient (25.0%) was refractory to treatment. One patient with an EGFRvIII mutation achieved stable disease on osi and remained on treatment for 236 days. Thrombocytopenia developed in 2 patients (grade 2 (1), grade 3 (1) in patient also on concurrent bevacizumab) and 1 patient developed grade 1 diarrhea and pneumonia. Overall, this heavily pretreated patient population tolerated osi therapy and half of the patients had a best response of SD which lasted from 77 to 236 days. CONCLUSIONS: Osi has a tolerable safety profile in this heavily pretreated brain tumor population, and it may benefit selected patients with recurrent MG containing EGFR alterations. Further clinical investigations are needed, particularly in patients whose tumors express an EGFRvIII mutation, to identify which EGFR alterations may sensitize tumors to this BBB penetrant EGFR-TKI.
Collapse
Affiliation(s)
- Marin Abousaud
- Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | | | | | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Cramer C, Page B, Wefel JS, Dressler E, Ip E, Rapp S, Shaw E, Weaver K, Lesser G, Chan M. NCOG-24. WAKE FOREST NCORP RESEARCH BASE FEASIBILITY STUDY OF RAMIPRIL FOR PREVENTING COGNITIVE DECLINE IN GLIOBLASTOMA PATIENTS RECEIVING BRAIN RADIOTHERAPY (WF-1801). Neuro Oncol 2020. [PMCID: PMC7651320 DOI: 10.1093/neuonc/noaa215.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Chronic neuro-inflammation after brain radiotherapy (RT) contributes to radiation-induced cognitive decline (RICD). The renin angiotensin system (RAS) may mediate this inflammatory cascade after RT. Ramipril is an angiotensin-converting enzyme inhibitor used to treat hypertension and has good blood-brain barrier penetration. By blocking RAS activation, ramipril reduces neuro-inflammation and preclinical data show that ramipril administration during RT can prevent RICD. METHODS WF-1801 is an ongoing feasibility study that will enroll a total of 75 patients. Patients ≥ 18 with newly diagnosed and pathologically confirmed GBM who will receive chemoradiation are eligible. All participants take ramipril daily during RT and for 4 months thereafter. Ramipril is titrated from 1.25mg to 5mg daily over 3 weeks. A cognitive battery that includes the Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT), and Controlled Oral Word Association test (COWA) is administered at baseline, end of RT, and 1-month and 4-months post-RT. The co-primary endpoints are retention rate (with retention defined as compliance with > 75% of drug therapy doses) and neurocognitive function at 1-month post-RT. To estimate the effect of ramipril on cognitive function, performance on the cognitive battery will be compared to a historical control (cognitive data from the control arm of RTOG 0825). ApoE genotyping is being performed as a correlative study. RESULTS 31 of a planned 75 participants have been enrolled over 14 months. 20 of 31 (64.5%) are male. 21 (67.7%) are between the age of 40-64. 20 (95.6%) are white and 29 (93.6%) are not Hispanic or Latino. CONCLUSION Despite a pause in accrual due to COVID-19, we are easily meeting planned accrual goals. Community oncology-based clinical trials of interventions to prevent cognitive toxicity appear to be feasible. GBM patients seem eager to enroll in studies seeking to prevent cognitive decline. Supported by NCI grant UG1CA189824.
Collapse
Affiliation(s)
| | - Brandi Page
- Johns Hopkins University School of Medicine, Bethesda, MD, USA
| | | | | | - Edward Ip
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steve Rapp
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward Shaw
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael Chan
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
16
|
Ramkissoon LA, Pegram W, Haberberger J, Danziger N, Lesser G, Strowd R, Dahiya S, Cummings TJ, Bi WL, Abedalthagafi M, Sathyan P, McGregor K, Reddy P, Severson E, Williams E, Lin D, Edgerly C, Huang RSP, Hemmerich A, Creeden J, Brown C, Venstrom J, Hegde P, Ross JS, Alexander BM, Elvin J, Ramkissoon SH. Genomic Profiling of Circulating Tumor DNA From Cerebrospinal Fluid to Guide Clinical Decision Making for Patients With Primary and Metastatic Brain Tumors. Front Neurol 2020; 11:544680. [PMID: 33192972 PMCID: PMC7604477 DOI: 10.3389/fneur.2020.544680] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/09/2020] [Indexed: 12/04/2022] Open
Abstract
Despite advances in systemic therapies for solid tumors, the development of brain metastases remains a significant contributor to overall cancer mortality and requires improved methods for diagnosing and treating these lesions. Similarly, the prognosis for malignant primary brain tumors remains poor with little improvement in overall survival over the last several decades. In both primary and metastatic central nervous system (CNS) tumors, the challenge from a clinical perspective centers on detecting CNS dissemination early and understanding how CNS lesions differ from the primary tumor, in order to determine potential treatment strategies. Acquiring tissue from CNS tumors has historically been accomplished through invasive neurosurgical procedures, which restricts the number of patients to those who can safely undergo a surgical procedure, and for which such interventions will add meaningful value to the care of the patient. In this review we discuss the potential of analyzing cell free DNA shed from tumor cells that is contained within the cerebrospinal fluid (CSF) as a sensitive and minimally invasive method to detect and characterize primary and metastatic tumors in the CNS.
Collapse
Affiliation(s)
- Lori A Ramkissoon
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Worthy Pegram
- Foundation Medicine, Inc., Morrisville, NC, United States
| | | | | | - Glenn Lesser
- Section of Medical Oncology and Hematology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Roy Strowd
- Section of Medical Oncology and Hematology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MI, United States
| | - Thomas J Cummings
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | | | | | | | - Eric Severson
- Foundation Medicine, Inc., Morrisville, NC, United States
| | - Erik Williams
- Foundation Medicine, Inc., Morrisville, NC, United States
| | - Douglas Lin
- Foundation Medicine, Inc., Cambridge, MA, United States
| | - Claire Edgerly
- Foundation Medicine, Inc., Morrisville, NC, United States
| | | | | | - James Creeden
- Foundation Medicine, Inc., Cambridge, MA, United States
| | | | | | - Priti Hegde
- Foundation Medicine, Inc., Cambridge, MA, United States
| | | | | | - Julia Elvin
- Foundation Medicine, Inc., Cambridge, MA, United States
| | - Shakti H Ramkissoon
- Foundation Medicine, Inc., Morrisville, NC, United States.,Department of Pathology and Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, United States
| |
Collapse
|
17
|
Bower A, Hsu FC, Weaver KE, Yelton C, Merrill R, Wicks R, Soike M, Hutchinson A, McTyre E, Laxton A, Tatter S, Cramer C, Chan M, Lesser G, Strowd RE. Community economic factors influence outcomes for patients with primary malignant glioma. Neurooncol Pract 2020; 7:453-460. [PMID: 32765895 DOI: 10.1093/nop/npaa010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/15/2022] Open
Abstract
Background Community economics and other social health determinants influence outcomes in oncologic patient populations. We sought to explore their impact on presentation, treatment, and survival in glioma patients. Methods A retrospective cohort of patients with glioma (World Health Organization grades III-IV) diagnosed between 1999 and 2017 was assembled with data abstracted from medical record review. Patient factors included race, primary care provider (PCP) identified, marital status, insurance status, and employment status. Median household income based on zip code was used to classify patients as residing in high-income communities (HICs; ie, above the median state income) or low-income communities (LICs; ie, below the median state income). The Kaplan-Meier method was used to assess overall survival (OS); Cox proportional hazards regression was used to explore associations with OS. Results Included were 312 patients, 73% from LICs. Survivors residing in LICs and HICs did not differ by age, sex, race, tumor grade, having a PCP, employment status, insurance, time to presentation, or baseline performance status. Median OS was 4.1 months shorter for LIC patients (19.7 vs 15.6 mo; hazard ratio [HR], 0.75; 95% CI: 0.56-0.98, P = 0.04); this difference persisted with 1-year survival of 66% for HICs versus 61% for LICs at 1 year, 34% versus 24% at 3 years, and 29% versus 17% at 5 years. Multivariable analysis controlling for age, grade, and chemotherapy treatment showed a 25% lower risk of death for HIC patients (HR, 0.75; 95% CI: 0.57-0.99, P < 0.05). Conclusions The economic status of a glioma patient's community may influence survival. Future efforts should investigate potential mechanisms such as health care access, stress, treatment adherence, and social support.
Collapse
Affiliation(s)
- Aaron Bower
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Departments of Social Sciences and Health Policy and Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caleb Yelton
- Wake Forest Baptist Medical Center Department of Neurology, Winston-Salem, North Carolina
| | - Rebecca Merrill
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert Wicks
- Wake Forest Baptist Medical Center Department of Neurosurgery, Winston-Salem, North Carolina
| | - Mike Soike
- Wake Forest Baptist Medical Center Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Angelica Hutchinson
- Wake Forest Baptist Medical Center Department of Social Sciences and Health Policy, Winston-Salem, North Carolina
| | - Emory McTyre
- Wake Forest Baptist Medical Center Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Adrian Laxton
- Wake Forest Baptist Medical Center Department of Neurosurgery, Winston-Salem, North Carolina
| | - Stephen Tatter
- Wake Forest Baptist Medical Center Department of Neurosurgery, Winston-Salem, North Carolina
| | - Christina Cramer
- Wake Forest Baptist Medical Center Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Michael Chan
- Wake Forest Baptist Medical Center Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Glenn Lesser
- Wake Forest Baptist Medical Center Department of Neurology, Winston-Salem, North Carolina
| | - Roy E Strowd
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
18
|
Foley KL, Miller DP, Weaver K, Sutfin EL, Petty WJ, Bellinger C, Spangler J, Stone RJ, Lawler D, Davis W, Dressler E, Lesser G, Chiles C. The OaSiS trial: A hybrid type II, national cluster randomized trial to implement smoking cessation during CT screening for lung cancer. Contemp Clin Trials 2020; 91:105963. [PMID: 32087340 PMCID: PMC7378998 DOI: 10.1016/j.cct.2020.105963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION When the Centers for Medicare and Medicaid Services announced coverage for low dose CT lung cancer screening, they also mandated that imaging centers offer smoking cessation services. We designed the Optimizing Lung Screening (OaSiS) trial to evaluate strategies to implement the Public Health Service Guidelines for Treating Tobacco Use and Dependence during CT screening for lung cancer. METHODS AND DESIGN OaSiS was implemented using a pragmatic effectiveness-implementation hybrid design in 26 imaging clinics across the United States affiliated with the National Cancer Institute's National Community Oncology Research Program (NCORP). The 26 sites selected for participation in the OaSiS trial were randomized to receive either a compendium of implementation strategies to add or enhance smoking cessation services during lung screening or to usual care. Usual care sites were given the option to receive the full compendium of implementation strategies at the conclusion of data collection. We have evaluated both the effectiveness of the implementation strategies to improve smoking cessation at six months among patients undergoing LDCT screening as well as the adoption and sustainability of evidence-based tobacco cessation strategies in imaging clinics. DISCUSSION The OaSiS trial was designed to identify opportunities for implementing evidence-based smoking cessation into LDCT lung cancer screening imaging facilities and to establish the effectiveness of these services. We report our study design and evaluation, including strengths of the pragmatic design and the inclusion of a diverse range of screening programs. Establishing these tobacco cessation services will be critical to reducing smoking related morbidity and mortality.
Collapse
Affiliation(s)
- Kristie Long Foley
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America.
| | - David P Miller
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Internal Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Kathryn Weaver
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Social Sciences and Health Policy, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Erin L Sutfin
- Social Sciences and Health Policy, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - W Jeffrey Petty
- Hematology and Oncology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Christina Bellinger
- Pulmonology and Critical Care, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - John Spangler
- Family and Community Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Rebecca J Stone
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Donna Lawler
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Whitney Davis
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Emily Dressler
- Biostatistics and Data Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Glenn Lesser
- Internal Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Hematology and Oncology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Caroline Chiles
- Radiology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| |
Collapse
|
19
|
Ahluwalia M, Dhruv H, Fallah J, Berens M, Drappatz J, Ye X, Lesser G, Cloughesy T, Walbert T, Holdhoff M, Peereboom D, Nabors L, Wen P, Grossman S, Rogers L. ACTR-43. GENOMIC ANALYSIS OF RESPONDERS OF PHASE II TRIAL OF TEMOZOLOMIDE AND TRC-102 (BASE EXCISION REPAIR INHIBITOR) IN BEVACIZUMAB-NAÏVE GLIOBLASTOMA AT FIRST RECURRENCE. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Temozolomide forms O6-methylguanine (O6mG), 7-methylguanine (N7mG), and 3- methyladenine (N3mA) DNA adducts. The O6mG DNA adduct is repaired by MGMT. N7mG and N3mA DNA adducts are removed by the base excision repair (BER) pathway, initiated by N- methylpurine DNA glycosolase (MPG). TRC-102 is a BER inhibitor that binds to the apurinic site created through the action of MPG.
METHODS
A phase II study of adult glioblastoma in first recurrence was performed in the Adult Brain Tumor Consortium with temozolomide, 150 mg/ m2 and TRC-102, 150 mg (1–5/ 28 days). Primary objective included radiographic response rate. Secondary objectives included safety and PFS-6. Exploratory objectives included tumor expression of N-methylpurine DNA glycosylase (MPG). The study tested hypothesis that combination therapy will achieve 30% RR. To understand the context of vulnerability to TRC102 we performed RNA sequencing on treatment naïve tissue from 7 patients.
RESULTS
Nineteen patients were enrolled in first stage. Median age was 60 years (range: 48–76), 53% females, median KPS was 80 (range: 70–90). Median cycles of treatment was 2 (range: 1–12). No responses were observed. Median OS was 11.0 months (95% CI: 8–18 months), median PFS was 2.0 months (95% CI: 1.8–3.6 months). PFS-6 rate was 10.5 % (2/19). The combination was safe. MPG staining was negative in six, 1+ in five and 2+ in three patients. PFS of 11 + months in two patients (exceptional responders) was associated with MPG expression. Preliminary analysis on RNA sequencing revealed significant enrichment for DNA Damage Response pathways (MsigDB), chromosomal instability gene signature (CIN70 and CIN25), and proliferative gene signature (PCNA25) in these 2 patients.
CONCLUSIONS
TRC 102 with temozolomide has acceptable safety but did not meet the primary endpoint of response. Gene signature of MsigDB, CIN70, CIN25 and PCNA25 was seen in exceptional responders and biomarker driven study is planned.
Collapse
Affiliation(s)
- Manmeet Ahluwalia
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | - Jan Drappatz
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Xiaobu Ye
- Johns Hopkins University, Baltimore, MD, USA
| | - Glenn Lesser
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | | | | | | | - Louis Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stuart Grossman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | |
Collapse
|
20
|
Cummings T, Giles A, Liberatore M, Laxton A, Carter A, Tatter S, Chan M, Lesser G, Strowd R, Cramer C. NCMP-11. THE CANCER AND COGNITION CLINIC AT WAKE FOREST BAPTIST HOSPITAL: SATISFYING AN UNMET NEED. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.757] [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
Preservation of cognitive functioning is a top priority for brain tumor patients but is often not addressed in a systematic manner. To address this unmet need, we established a virtual neurocognitive clinic within our brain tumor center. The aim was to incorporate standardized neuropsychological examinations into routine care. To make neuropsychological testing achievable for patients with primary brain tumors, we developed a one-hour battery to measure core cognitive functions. We established a process where patients are offered cognitive testing at initial consult by neuro-oncology or radiation oncology. To reduce the burden of an extra appointment, patients are seen by neuropsychology in the Cancer Center (as opposed to the main hospital). Appointments are coordinated on the same day as other essential visits. Results are reviewed in multidisciplinary tumor boards. When possible, patients are seen for serial cognitive assessments at 3, 6 and 12 months after RT treatment. Providers in neuro-oncology, neurosurgery, and radiation oncology were encouraged to refer survivors to neuropsychology. After the clinic launch in 2017, 143 brain tumor patients were referred to neuropsychology. Prior to the clinic launch, 22 referrals were made over a comparable timeframe. Cognitive deficits were identified in most patients. After testing, patients received education on the brain-function relationship pertaining to their deficits. The patients’ referring provider received a full report containing recommendations for interventions based on testing outcomes 11 of the 38 patients who underwent pre-treatment assessments underwent testing 6 months post-RT. With the recent addition of a dedicated clinical coordinator, the rate of successful post-treatment cognitive evaluation is increasing. The cognitive, emotional, behavioral, and psychosocial impact of a brain tumor can be difficult to categorize and treat without formal evaluation. Integrating neuropsychological examination into routine care has resulted in a massive increase in the number of brain tumor patients getting a neuropsychologic assessment.
Collapse
Affiliation(s)
- Tiffany Cummings
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Abigail Giles
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Mary Liberatore
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Adrian Laxton
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Annette Carter
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Stephen Tatter
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Michael Chan
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Glenn Lesser
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Roy Strowd
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| | - Christina Cramer
- Wake Forest Baptist Medical Center, School of Medicine, Winston Salem, NC, USA
| |
Collapse
|
21
|
Giles A, Moore DeBruhl C, Liberatore G, Strowd R, Lesser G, Tatter S, Laxton A, Feldman J, Sam M, Chan M, Cramer C, Cummings T. C-51 Long Term Neuropsychological Follow-Up of Radiation Induced Cognitive Decline (RICD) in Cerebellar Medulloblastoma. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
We expanded upon an early case study suggesting long-term, sequential neurocognitive evaluation and academic interventions following pediatric cerebellar medulloblastoma. This five-year-old patient (now forty) has indeed undergone lifespan assessment and clearly benefitted from appropriate interventions to date.
Method
This left-handed, white, male is status post (s/p) gross total resection and whole brain radiation. In adulthood, he developed radiation necrosis with hemorrhage and refractory seizures (s/p right temporal lobectomy). More recently, radiation induced bilateral parietal meningiomas were identified (s/p gamma knife).
Results
We analyzed cognitive, medical/oncological, imaging and interventional data at developmentally meaningful time points and found consistent declines in intellectual skills and cognitive function spanning attention/concentration, processing speed, visual perceptual/organization and visually based learning/memory; however, we noted stabilization and even improvement in important areas. Areas of age-appropriate functioning were noted in expressive vocabulary, verbal abstract reasoning, delayed verbal memory, and problem-solving, among others.
Conclusions
Although some studies have addressed long-term outcomes in pediatric medulloblastoma, we provide a unique perspective to the literature by documenting serial neurocognitive findings in addition to interventions across the lifespan. Our findings suggest that appropriate academic interventions/neurocognitive rehabilitation strategies are in fact meaningful at the individual level and propose that a focus on strengths can improve outcomes. We propose that this previously recommended model of assessment/intervention truly become the available standard of care in all pediatric oncologic populations.
Collapse
|
22
|
Fisher B, Zhang P, Macdonald D, Chakravarti A, Lesser G, Fox S, Coons S, Rogers L, Werner-Wasik M, Doyle T, Bahary JP, Fiveash J, Bovi J, Howard S, Yu M, Dsouza D, Laack N, Roach M, Kwok Y, Wahl D, Stasser J, Won M, Mehta MP. ACTR-02. NRG ONCOLOGY/RTOG 0424: LONG-TERM RESULTS OF A PHASE II STUDY OF TEMOZOLOMIDE-BASED CHEMORADIOTHERAPY REGIMEN FOR HIGH-RISK LOW-GRADE GLIOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC, NC, USA
| | - Sherry Fox
- Cullather Brain Tumor Quality of Life Center, Richmond, VA, USA
| | - Stephen Coons
- St Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | | | | | - Joseph Bovi
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Michael Yu
- H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David Dsouza
- London Regional Cancer Program, London, ON, Canada
| | | | - Mack Roach
- University of California at San Francisco, San Francisco, CA, USA
| | - Young Kwok
- University of Maryland, Baltimore, MD, USA
| | | | - John Stasser
- Christiana Care Health Services, Delaware, MD, USA
| | | | | |
Collapse
|
23
|
Ahluwalia M, Drappatz J, Ye X, Walbert T, Holdhoff M, Lesser G, Cloughesy T, Peereboom D, Burt Nabors L, Wen P, Grossman S, Rogers L. ACTR-18. PHASE II TRIAL OF TEMOZOLOMIDE AND TRC 102, BASE EXCISION REPAIR INHIBITOR, IN BEVACIZUMAB NAÏVE GLIOBLASTOMA AT FIRST RECURRENCE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Xiaobu Ye
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | | | - Matthias Holdhoff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Glenn Lesser
- Comprehensive Cancer Center at Wake Forest Baptist Health, Wake Forest, NC, USA
| | | | | | - L Burt Nabors
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Stuart Grossman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Lisa Rogers
- University Hospitals - Case Medical Center, Cleveland, OH, USA
| |
Collapse
|
24
|
Fernandez E, Steino A, Lesser G, Bacha J, Brown D, Kwatra M. CSIG-02. VAL-083 INHIBITS PROLIFERATION OF A PANEL OF EIGHT GLIOBLASTOMA STEM CELL LINES: DOWNREGULATION OF BDR4 AS A NOVEL ANTI-NEOPLASTIC MECHANISM. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.168] [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: 11/15/2022] Open
Affiliation(s)
| | - Anne Steino
- DelMar Pharmaceuticals, Inc, Vancouver, BC, Canada
| | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC, NC, USA
| | | | - Dennis Brown
- DelMar Pharmaceuticals, Inc, Menlo Park, CA, USA
| | | |
Collapse
|
25
|
Jimenez H, Blackman C, Lesser G, Debinski W, Chan M, Sharma S, Watabe K, Lo HW, Thomas A, Godwin D, Blackstock W, Mudry A, Posey J, O'Connor R, Brezovich I, Bonin K, Kim-Shapiro D, Barbault A, Pasche B. Use of non-ionizing electromagnetic fields for the treatment of cancer. Front Biosci (Landmark Ed) 2018; 23:284-297. [PMID: 28930547 DOI: 10.2741/4591] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cancer treatment and treatment options are quite limited in circumstances such as when the tumor is inoperable, in brain cancers when the drugs cannot penetrate the blood-brain-barrier, or when there is no tumor-specific target for generation of effective therapeutic antibodies. Despite the fact that electromagnetic fields (EMF) in medicine have been used for therapeutic or diagnostic purposes, the use of non-ionizing EMF for cancer treatment is a new emerging concept. Here we summarize the history of EMF from the 1890's to the novel and new innovative methods that target and treat cancer by non-ionizing radiation.
Collapse
Affiliation(s)
- Hugo Jimenez
- Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Carl Blackman
- Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Glenn Lesser
- Department of Internal Medicine, Section of Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Waldemar Debinski
- Brain Tumor Center of Excellence (BTCOE), Thomas K Hearn, Jr. Brain Tumor Research Center, Comprehensive Cancer Center Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Michael Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sambad Sharma
- Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27157
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Alexandra Thomas
- Department of Internal Medicine, Section of Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Dwayne Godwin
- Department of Neurobiology and Anatomy, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - William Blackstock
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Albert Mudry
- Department of Otolaryngology, Stanford University, Stanford, CA
| | - James Posey
- Department of Medical Oncology, Division of Solid Tumor, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Rodney O'Connor
- Bioelectronics Department, Ecole des Mines de Saint-Etienne, France
| | - Ivan Brezovich
- Department of Radiation Oncology, University of Alabama at Birmingham, AL
| | - Keith Bonin
- Department of Physics, Wake Forest University, Winston-Salem, NC
| | | | | | - Boris Pasche
- Comprehensive Cancer Center of Wake Forest Baptist Medical Center, Winston-Salem, NC,
| |
Collapse
|
26
|
Lamar ZS, Dothard A, Kennedy L, Isom S, Robinson M, Vaidya R, Hurd D, McClain D, Lesser G. Hyperglycemia during first-line R-CHOP or dose adjusted R-EPOCH chemotherapy for non-Hodgkin lymphoma is prevalent and associated with chemotherapy alteration - a retrospective study. Leuk Lymphoma 2017; 59:1871-1877. [PMID: 29252084 DOI: 10.1080/10428194.2017.1410889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 02/06/2023]
Abstract
High-dose glucocorticoids such as prednisone are combined with cytotoxic chemotherapy in the R-CHOP or dose adjusted R-EPOCH regimens used for non-Hodgkin lymphoma (NHL). In this retrospective study, our primary objective was to evaluate the incidence of hyperglycemia during first-line R-CHOP or DA-EPOCH-R. The secondary objectives were to evaluate the incidence of chemotherapy alteration and overall survival in those with and without hyperglycemia. One hundred and sixty patients were eligible. We found that 47% of all patients had at least one hyperglycemic episode and hyperglycemia was associated with chemotherapy alteration (p = .028). Multivariate analysis revealed international prognostic index (IPI) ≥ 3 (p = .045) and chemotherapy alteration (p = .001) were associated with decreased overall survival. We conclude that hyperglycemia is common during first-line NHL treatment with R-CHOP or DA-EPOCH-R, even in the absence of known diabetes and is associated with alterations of chemotherapy. Baseline pre-PET scan fasting blood glucose of 100 mg/dL or higher may predict hyperglycemia during therapy.
Collapse
Affiliation(s)
- Zanetta S Lamar
- a Department of Internal Medicine - Section of Hematology and Oncology , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA.,b Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - Andrew Dothard
- a Department of Internal Medicine - Section of Hematology and Oncology , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - LeAnne Kennedy
- c Department of Pharmacy , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - Scott Isom
- a Department of Internal Medicine - Section of Hematology and Oncology , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA.,d Department of Biostatistical Sciences , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - Mac Robinson
- b Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - Rakhee Vaidya
- a Department of Internal Medicine - Section of Hematology and Oncology , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA.,b Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - David Hurd
- a Department of Internal Medicine - Section of Hematology and Oncology , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA.,b Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - Donald McClain
- e Department of Internal Medicine - Section of Endocrinology and Metabolism , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - Glenn Lesser
- a Department of Internal Medicine - Section of Hematology and Oncology , Wake Forest Baptist Medical Center , Winston-Salem , NC , USA.,b Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| |
Collapse
|
27
|
Meléndez GC, Sukpraphrute B, D'Agostino RB, Jordan JH, Klepin HD, Ellis L, Lamar Z, Vasu S, Lesser G, Burke GL, Weaver KE, Ntim WO, Hundley WG. Frequency of Left Ventricular End-Diastolic Volume-Mediated Declines in Ejection Fraction in Patients Receiving Potentially Cardiotoxic Cancer Treatment. Am J Cardiol 2017; 119:1637-1642. [PMID: 28341361 DOI: 10.1016/j.amjcard.2017.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 01/02/2023]
Abstract
We sought to determine the frequency by which decreases in left ventricular (LV) end-diastolic volume (LVEDV) with and without increases in end-systolic volume (LVESV) influenced early cancer treatment-associated declines in LV ejection fraction (LVEF) or LV mass. One hundred twelve consecutively recruited subjects (aged 52 ± 14 years) with cancer underwent blinded cardiovascular magnetic resonance measurements of LV volumes, mass, and LVEF before and 3 months after initiating potentially cardiotoxic chemotherapy (72% of participants received anthracyclines). Twenty-six participants developed important declines in LVEF of >10% or to values <50% at 3 months, in whom 19% versus 60%, respectively, experienced their decline in LVEF due to isolated declines in LVEDV versus an increase in LVESV; participants who dropped their LVEF due to decreases in LVEDV lost more LV mass than those who dropped their LVEF due to an increase in LVESV (p = 0.03). Nearly one fifth of subjects experience marked LVEF declines due to an isolated decline in LVEDV after initiating potentially cardiotoxic chemotherapy. Because reductions in intravascular volume (which could be treated by volume repletion) may account for LVEDV-related declines in LVEF, these data indicate that LV volumes should be reviewed along with LVEF when acquiring imaging studies for cardiotoxicity during the treatment for cancer.
Collapse
Affiliation(s)
- Giselle C Meléndez
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina; Section of Comparative Medicine, Department of Pathology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Bunyapon Sukpraphrute
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Jennifer H Jordan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Heidi D Klepin
- Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Leslie Ellis
- Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Zanetta Lamar
- Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Sujethra Vasu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Glenn Lesser
- Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Gregory L Burke
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - William O Ntim
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - W Gregory Hundley
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina; Department of Radiological Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
| |
Collapse
|
28
|
Greven KM, Case LD, Nycum LR, Zekan PJ, Hurd DD, Balcueva EP, Mills GM, Zon R, Flynn PJ, Biggs D, Shaw EG, Lesser G, Naughton MJ. Effect of ArginMax on sexual functioning and quality of life among female cancer survivors: results of the WFU CCOP Research Base Protocol 97106. J Community Support Oncol 2016; 13:87-94. [PMID: 26287032 DOI: 10.12788/jcso.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Problems with sexual functioning are common following therapy for breast and gynecologic cancers, although there are few effective treatments. OBJECTIVE To assess the impact of ArginMax, a nutritional supplement comprised of extracts of L-arginine, ginseng, gingko, and damiana, as well as multivitamins and minerals, on sexual functioning and quality of life in female cancer survivors. METHODS This was a 12-week, randomized, placebo-controlled trial of eligible patients who were 6 months or more from active treatment and reporting problems with sexual interest, satisfaction, and functioning after therapy. The participants took 3 capsules of Arginmax or placebo twice daily. Outcome measures were the Female Sexual Function Inventory (FSFI) and the Functional Assessment of Cancer Therapy - General (FACT-G). Assessments were done at baseline, 4, 8, and 12 weeks. RESULTS 186 patients with a median age of 50 years were accrued between May 10, 2007 and March 24, 2010. 76% of the patients were non-Hispanic white. Most had breast or a gynecologic cancer (78% and 12%, respectively). At 12 weeks, there were no differences between the ArginMax group (n = 96) and placebo (n = 92) group in sexual desire, arousal, lubrication, orgasm,satisfaction or pain. However, FACT-G total scores were significantly better for participants who took ArginMax compared with those who took placebo (least squares [LS] means, 87.5 vs 82.9, respectively; P = .009). The Fact-G subscales that were most affected were Physical (25.37 vs. 23.51, P = .001) and Functional Well-Being (22.46 vs. 20.72, P = .007). Toxicities were similar for both groups. LIMITATIONS Study results are limited by a lack of data on the participants' psychological and physical symptoms and sexual partner variables. CONCLUSIONS ArginMax had no significant impact on sexual functioning, but patient quality of life was significantly better at 12 weeks in participants who received ArginMax.
Collapse
Affiliation(s)
- Kathryn M Greven
- Comprehensive Cancer Center of Wake Forest University CCOP Research Base, Winston-Salem, North Carolina, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Clinical outcome assessments (COAs) are increasingly being used in determining the efficacy of new treatment regimens. This was typified in the recent use of a symptom-based instrument combined with an organ-based measure of response for the approval of ruxolitinib in myelofibrosis. There are challenges in incorporating these COAs into clinical trials, including designating the level of priority, incorporating these measures into a combined or composite endpoint, and dealing with issues related to compliance and interpretation of results accounting for missing data. This article describes the results of a recent panel discussion that attempted to address these issues and provide guidance to the incorporation of COAs into clinical trials, including novel statistical designs, so that the testing of new treatments in patients with cancers of the central nervous system can incorporate these important clinical endpoints.
Collapse
Affiliation(s)
- Mark R Gilbert
- Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.)
| | - Lawrence Rubinstein
- Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.)
| | - Glenn Lesser
- Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.)
| |
Collapse
|
30
|
Wen P, Reardon D, Phuphanich S, Aiken R, Landolfi J, Curry W, Zhu JJ, Glantz M, Peereboom D, Markert J, Larocca R, O'Rourke D, Fink K, Kim L, Gruber M, Lesser G, Pan E, Santos R, Pinilla C, Yu J. IMCT-20ASSOCIATION OF SURVIVAL AND PROGRESSION-FREE SURVIVAL WITH IMMUNE RESPONSE IN HLA-A2+ NEWLY-DIAGNOSED GBM PATIENTS IN RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED PHASE 2 TRIAL OF DENDRITIC CELL (DC) IMMUNOTHERAPY WITH ICT-107. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov218.20] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
|
31
|
Spangler J, Weaver KE, Case D, Lesser G, Burton GV, Dy IA, Dul C, Reddy P, Wade JL, Esparaz B, Shaw EG. Feasibility of using memantine in smoking cessation among cancer survivors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1559] [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)
- John Spangler
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | - Doug Case
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | | | - Carrie Dul
- Great Lakes Cancer Management Specialists, Grosse Point Woods, MI
| | | | | | | | | |
Collapse
|
32
|
Gifford A, Lawrence J, Case D, Rapp S, Baker L, Craft S, Groteluschen DL, Klepin H, Lesser G, Naughton MJ, Sachs B, Samuel TA, Sink K, Williamson J, Shaw EG. Mild cognitive impairment (MCI) in chemotherapy-treated breast cancer survivors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Abigail Gifford
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | - Doug Case
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Steve Rapp
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Laura Baker
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Suzanne Craft
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | | | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | - Bonnie Sachs
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | - Kaycee Sink
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Jeff Williamson
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | |
Collapse
|
33
|
Holdhoff M, Ye X, Nabors LB, Desai AS, Mikkelsen T, Lesser G, Read WL, Lieberman FS, Supko J, Fisher JD, Desideri S, Grossman SA, Schiff D. Timed-sequential therapy with mibefradil and temozolomide in patients with recurrent high-grade gliomas: A phase I Adult Brain Tumor Consortium study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2033] [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)
- Matthias Holdhoff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Xiaobu Ye
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | | | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | | | - Jeff Supko
- Massachusetts General Hospital, Boston, MA
| | - Joy D. Fisher
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Serena Desideri
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Stuart A. Grossman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - David Schiff
- University of Virginia Med Ctr, Charlottesville, VA
| | | |
Collapse
|
34
|
Strowd RE, Russell G, Harmon M, Carter AF, Chan MD, Tatter SB, Laxton AW, High K, Lesser G. Immunologic response to high-dose influenza vaccination in patients with primary central nervous system malignancy (PCNSM). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20669] [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)
| | - Gregory Russell
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Michele Harmon
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | - Michael D Chan
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | - Adrian W Laxton
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Kevin High
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston-Salem, NC
| |
Collapse
|
35
|
Wen P, Reardon D, Phuphanich S, Aiken R, Landolfi J, Curry W, Zhu JJ, Glantz M, Peereboom D, Markert J, Larocca R, O'Rourke D, Fink K, Kim L, Gruber M, Lesser G, Pan E, Kesari S, Yu J. AT-60 * A RANDOMIZED DOUBLE BLIND PLACEBO-CONTROLLED PHASE 2 TRIAL OF DENDRITIC CELL (DC) VACCINE ICT-107 FOLLOWING STANDARD TREATMENT IN NEWLY DIAGNOSED PATIENTS WITH GBM. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Strowd R, Russell G, Harmon M, Carter A, Chan M, Tatter S, Laxton A, High K, Lesser G. SM-07 * A PILOT STUDY OF HIGH-DOSE INFLUENZA VACCINE IMMUNOGENICITY IN PATIENTS WITH PRIMARY CENTRAL NERVOUS SYSTEM MALIGNANCY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou277.6] [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
|
37
|
Lesser G, Harmon M, Khan I, Whitlow C, Brown W. BI-18 * CELLULAR MICROPARTICLES AS BLOOD-BORNE ENDOTHELIAL BIOMARKERS IN PATIENTS WITH MALIGNANT GLIOMAS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou239.18] [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
|
38
|
Lawrence J, Griffin L, Rapp S, Messino MJ, Balcueva EP, Curtis AE, Groteluschen DL, Samuel TA, Lesser G, Case D, Shaw EG. Quality of life and cognitive dysfunction in breast cancer survivors on a feasibility study of donepezil versus placebo. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9516] [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)
- Julia Lawrence
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Leah Griffin
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Steve Rapp
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Doug Case
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Edward G. Shaw
- Wake Forest University, School of Medicine, Winston-Salem, NC
| |
Collapse
|
39
|
Mirlohi S, Duncan SE, Harmon M, Case D, Lesser G, Dietrich AM. Analysis of salivary fluid and chemosensory functions in patients treated for primary malignant brain tumors. Clin Oral Investig 2014; 19:127-37. [PMID: 24595687 PMCID: PMC4156565 DOI: 10.1007/s00784-014-1211-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Received: 07/17/2013] [Accepted: 02/05/2014] [Indexed: 12/05/2022]
Abstract
Objectives The frequency and causes of chemosensory (taste and smell) disorders in cancer patients remain under-reported. This study examined the impact of cancer therapy on taste/smell functions and salivary constituents in brain tumor patients. Materials and methods Twenty-two newly diagnosed patients with primary malignant gliomas underwent 6 weeks of combined modality treatment (CMD) with radiation and temozolomide followed by six monthly cycles of temozolomide. Chemosensory functions were assessed at 0, 3, 6, 10, 18, and 30 weeks with paired samples of saliva collected before and after an oral rinse with ferrous-spiked water. Iron (Fe)-induced oxidative stress was measured by salivary lipid oxidation (SLO); salivary proteins, electrolytes, and metals were determined. Parallel salivary analyses were performed on 22 healthy subjects. Results Chemosensory complaints of cancer patients increased significantly during treatment (p = 0.04) except at 30 weeks. Fe-induced SLO increased at 10 and 18 weeks. When compared with healthy subjects, SLO, total protein, Na, K, Cu, P, S, and Mg levels, as averaged across all times, were significantly higher (p < 0.05), whereas salivary Zn, Fe, and oral pH levels were significantly lower in cancer patients (p < 0.05). Neither time nor treatment had a significant impact on these salivary parameters in cancer patients. Conclusions Impact of CMT treatment on chemosensory functions can range from minimal to moderate impairment. Analysis of SLO, metals, and total protein do not provide for reliable measures of chemosensory dysfunctions over time. Clinical relevance Taste and smell functions are relevant in health and diseases; study of salivary constituents may provide clues on the causes of their dysfunctions.
Collapse
Affiliation(s)
- Susan Mirlohi
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
| | | | | | | | | | | |
Collapse
|
40
|
Ambady P, Holdhoff M, Ferrigno C, Grossman S, Anderson MD, Liu D, Conrad C, Penas-Prado M, Gilbert MR, Yung AWK, de Groot J, Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi JI, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M, Apok V, Mills S, Soh C, Karabatsou K, Arimappamagan A, Arya S, Majaid M, Somanna S, Santosh V, Schaff L, Armentano F, Harrison C, Lassman A, McKhann G, Iwamoto F, Armstrong T, Yuan Y, Liu D, Acquaye A, Vera-Bolanos E, Diefes K, Heathcock L, Cahill D, Gilbert M, Aldape K, Arrillaga-Romany I, Ruddy K, Greenberg S, Nayak L, Avgeropoulos N, Avgeropoulos G, Riggs G, Reilly C, Banerji N, Bruns P, Hoag M, Gilliland K, Trusheim J, Bekaert L, Borha A, Emery E, Busson A, Guillamo JS, Bell M, Harrison C, Armentano F, Lassman A, Connolly ES, Khandji A, Iwamoto F, Blakeley J, Ye X, Bergner A, Dombi E, Zalewski C, Follmer K, Halpin C, Fayad L, Jacobs M, Baldwin A, Langmead S, Whitcomb T, Jennings D, Widemann B, Plotkin S, Brandes AA, Mason W, Pichler J, Nowak AK, Gil M, Saran F, Revil C, Lutiger B, Carpentier AF, Milojkovic-Kerklaan B, Aftimos P, Altintas S, Jager A, Gladdines W, Lonnqvist F, Soetekouw P, van Linde M, Awada A, Schellens J, Brandsma D, Brenner A, Sun J, Floyd J, Hart C, Eng C, Fichtel L, Gruslova A, Lodi A, Tiziani S, Bridge CA, Baldock A, Kumthekar P, Dilfer P, Johnston SK, Jacobs J, Corwin D, Guyman L, Rockne R, Sonabend A, Cloney M, Canoll P, Swanson KR, Bromberg J, Schouten H, Schaafsma R, Baars J, Brandsma D, Lugtenburg P, van Montfort C, van den Bent M, Doorduijn J, Spalding A, LaRocca R, Haninger D, Saaraswat T, Coombs L, Rai S, Burton E, Burzynski G, Burzynski S, Janicki T, Marszalek A, Burzynski S, Janicki T, Burzynski G, Marszalek A, Cachia D, Smith T, Cardona AF, Mayor LC, Jimenez E, Hakim F, Yepes C, Bermudez S, Useche N, Asencio JL, Mejia JA, Vargas C, Otero JM, Carranza H, Ortiz LD, Cardona AF, Ortiz LD, Jimenez E, Hakim F, Yepes C, Useche N, Bermudez S, Asencio JL, Carranza H, Vargas C, Otero JM, Bartels C, Quintero A, Restrepo CE, Gomez S, Bernal-Vaca L, Lema M, Cardona AF, Ortiz LD, Useche N, Bermudez S, Jimenez E, Hakim F, Yepes C, Mejia JA, Bernal-Vaca L, Restrepo CE, Gomez S, Quintero A, Bartels C, Carranza H, Vargas C, Otero JM, Carlo M, Omuro A, Grommes C, Kris M, Nolan C, Pentsova E, Pietanza M, Kaley T, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, Artoni A, Carrabba G, Bertani G, Cogiamanian F, Ardolino G, Zarino B, Locatelli M, Caroli M, Rampini P, Chamberlain M, Raizer J, Soffetti R, Ruda R, Brandsma D, Boogerd W, Taillibert S, Le Rhun E, Jaeckle K, van den Bent M, Wen P, Chamberlain M, Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Hilton M, Kerloeguen Y, Guijarro A, Cloughsey T, Choi JH, Hong YK, Conrad C, Yung WKA, deGroot J, Gilbert M, Loghin M, Penas-Prado M, Tremont I, Silberman S, Picker D, Costa R, Lycette J, Gancher S, Cullen J, Winer E, Hochberg F, Sachs G, Jeyapalan S, Dahiya S, Stevens G, Peereboom D, Ahluwalia M, Daras M, Hsu M, Kaley T, Panageas K, Curry R, Avila E, Fuente MDL, Omuro A, DeAngelis L, Desjardins A, Sampson J, Peters K, Ranjan T, Vlahovic G, Threatt S, Herndon J, Boulton S, Lally-Goss D, McSherry F, Friedman A, Friedman H, Bigner D, Gromeier M, Prust M, Kalpathy-Cramer J, Poloskova P, Jafari-Khouzani K, Gerstner E, Dietrich J, Fabi A, Villani V, Vaccaro V, Vidiri A, Giannarelli D, Piludu F, Anelli V, Carapella C, Cognetti F, Pace A, Flowers A, Flowers A, Killory B, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Garciarena P, Anderson MD, Hamilton J, Schellingerhout D, Fuller GN, Sawaya R, Gilbert MR, Gilbert M, Pugh S, Won M, Blumenthal D, Vogelbaum M, Aldape K, Colman H, Chakravarti A, Jeraj R, Dignam J, Armstrong T, Wefel J, Brown P, Jaeckle K, Schiff D, Brachman D, Werner-Wasik M, Tremont-Lukats I, Sulman E, Mehta M, Gill B, Yun J, Goldstein H, Malone H, Pisapia D, Sonabend AM, Mckhann GK, Sisti MB, Sims P, Canoll P, Bruce JN, Girvan A, Carter G, Li L, Kaltenboeck A, Chawla A, Ivanova J, Koh M, Stevens J, Lahn M, Gore M, Hariharan S, Porta C, Bjarnason G, Bracarda S, Hawkins R, Oudard S, Zhang K, Fly K, Matczak E, Szczylik C, Grossman R, Ram Z, Hamza M, O'Brien B, Mandel J, DeGroot J, Han S, Molinaro A, Berger M, Prados M, Chang S, Clarke J, Butowski N, Hashimoto N, Chiba Y, Tsuboi A, Kinoshita M, Hirayama R, Kagawa N, Oka Y, Oji Y, Sugiyama H, Yoshimine T, Hawkins-Daarud A, Jackson PR, Swanson KR, Sarmiento JM, Ly D, Jutla J, Ortega A, Carico C, Dickinson H, Phuphanich S, Rudnick J, Patil C, Hu J, Iglseder S, Nowosielski M, Nevinny-Stickel M, Stockhammer G, Jain R, Poisson L, Scarpace L, Mikkelsen T, Kirby J, Freymann J, Hwang S, Gutman D, Jaffe C, Brat D, Flanders A, Janicki T, Burzynski S, Burzynski G, Marszalek A, Jiang C, Wang H, Jo J, Williams B, Smolkin M, Wintermark M, Shaffrey M, Schiff D, Juratli T, Soucek S, Kirsch M, Schackert G, Kakkar A, Kumar S, Bhagat U, Kumar A, Suri A, Singh M, Sharma M, Sarkar C, Suri V, Kaley T, Barani I, Chamberlain M, McDermott M, Raizer J, Rogers L, Schiff D, Vogelbaum M, Weber D, Wen P, Kalita O, Vaverka M, Hrabalek L, Zlevorova M, Trojanec R, Hajduch M, Kneblova M, Ehrmann J, Kanner AA, Wong ET, Villano JL, Ram Z, Khatua S, Fuller G, Dasgupta S, Rytting M, Vats T, Zaky W, Khatua S, Sandberg D, Foresman L, Zaky W, Kieran M, Geoerger B, Casanova M, Chisholm J, Aerts I, Bouffet E, Brandes AA, Leary SES, Sullivan M, Bailey S, Cohen K, Mason W, Kalambakas S, Deshpande P, Tai F, Hurh E, McDonald TJ, Kieran M, Hargrave D, Wen PY, Goldman S, Amakye D, Patton M, Tai F, Moreno L, Kim CY, Kim T, Han JH, Kim YJ, Kim IA, Yun CH, Jung HW, Koekkoek JAF, Reijneveld JC, Dirven L, Postma TJ, Vos MJ, Heimans JJ, Taphoorn MJB, Koeppen S, Hense J, Kong XT, Davidson T, Lai A, Cloughesy T, Nghiemphu PL, Kong DS, Choi YL, Seol HJ, Lee JI, Nam DH, Kool M, Jones DTW, Jager N, Northcott PA, Pugh T, Hovestadt V, Markant S, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schuller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Krel R, Krutoshinskaya Y, Rosiello A, Seidman R, Kowalska A, Kudo T, Hata Y, Maehara T, Kumthekar P, Bridge C, Patel V, Rademaker A, Helenowski I, Mrugala M, Rockhill J, Swanson K, Grimm S, Raizer J, Meletath S, Bennett M, Nestor VA, Fink KL, Lee E, Reardon D, Schiff D, Drappatz J, Muzikansky A, Hammond S, Grimm S, Norden A, Beroukhim R, McCluskey C, Chi A, Batchelor T, Smith K, Gaffey S, Gerard M, Snodgras S, Raizer J, Wen P, Leeper H, Johnson D, Lima J, Porensky E, Cavaliere R, Lin A, Liu J, Evans J, Leuthardt E, Dacey R, Dowling J, Kim A, Zipfel G, Grubb R, Huang J, Robinson C, Simpson J, Linette G, Chicoine M, Tran D, Liubinas SV, D'Abaco GM, Moffat B, Gonzales M, Feleppa F, Nowell CJ, Gorelick A, Drummond KJ, Morokoff AP, O'Brien TJ, Kaye AH, Loghin M, Melhem-Bertrandt A, Penas-Prado M, Zaidi T, Katz R, Lupica K, Stevens G, Ly I, Hamilton S, Rostomily R, Rockhill J, Mrugala M, Mandel J, Yust-Katz S, de Groot J, Yung A, Gilbert M, Burzynski S, Janicki T, Burzynski G, Marszalek A, Pachow D, Kliese N, Kirches E, Mawrin C, McNamara MG, Lwin Z, Jiang H, Chung C, Millar BA, Sahgal A, Laperriere N, Mason WP, Megyesi J, Salehi F, Merker V, Slusarz K, Muzikansky A, Francis S, Plotkin S, Mishima K, Adachi JI, Suzuki T, Uchida E, Yanagawa T, Watanabe Y, Fukuoka K, Yanagisawa T, Wakiya K, Fujimaki T, Nishikawa R, Moiyadi A, Kannan S, Sridhar E, Gupta T, Shetty P, Jalali R, Alshami J, Lecavalier-Barsoum M, Guiot MC, Tampieri D, Kavan P, Muanza T, Nagane M, Kobayashi K, Takayama N, Shiokawa Y, Nakamura H, Makino K, Hideo T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Nambudiri N, Arrilaga I, Dunn I, Folkerth R, Chi S, Reardon D, Nayak L, Omuro A, DeAngelis L, Robins HI, Govindan R, Gadgeel S, Kelly K, Rigas J, Reimers HJ, Peereboom D, Rosenfeld S, Garst J, Ramnath N, Wing P, Zheng M, Urban P, Abrey L, Wen P, Nayak L, DeAngelis LM, Wen PY, Brandes AA, Soffietti R, Peereboom DM, Lin NU, Chamberlain M, Macdonald D, Galanis E, Perry J, Jaeckle K, Mehta M, Stupp R, van den Bent M, Reardon DA, Norden A, Hammond S, Drappatz J, Phuphanich S, Reardon D, Wong E, Plotkin S, Lesser G, Raizer J, Batchelor T, Lee E, Kaley T, Muzikansky A, Doherty L, LaFrankie D, Ruland S, Smith K, Gerard M, McCluskey C, Wen P, Norden A, Schiff D, Ahluwalia M, Lesser G, Nayak L, Lee E, Muzikansky A, Dietrich J, Smith K, Gaffey S, McCluskey C, Ligon K, Reardon D, Wen P, Bush NAO, Kesari S, Scott B, Ohno M, Narita Y, Miyakita Y, Arita H, Matsushita Y, Yoshida A, Fukushima S, Ichimura K, Shibui S, Okamura T, Kaneko S, Omuro A, Chinot O, Taillandier L, Ghesquieres H, Soussain C, Delwail V, Lamy T, Gressin R, Choquet S, Soubeyran P, Maire JP, Benouaich-Amiel A, Lebouvier-Sadot S, Gyan E, Barrie M, del Rio MS, Gonzalez-Aguilar A, Houllier C, Tanguy ML, Hoang-Xuan K, Omuro A, Abrey L, Raizer J, Paleologos N, Forsyth P, DeAngelis L, Kaley T, Louis D, Cairncross JG, Matasar M, Mehta J, Grimm S, Moskowitz C, Sauter C, Opinaldo P, Torcuator R, Ortiz LD, Cardona AF, Hakim F, Jimenez E, Yepes C, Useche N, Bermudez S, Mejia JA, Asencio JL, Carranza H, Vargas C, Otero JM, Lema M, Pace A, Villani V, Fabi A, Carapella CM, Patel A, Allen J, Dicker D, Sheehan J, El-Deiry W, Glantz M, Tsyvkin E, Rauschkolb P, Pentsova E, Lee M, Perez A, Norton J, Uschmann H, Chamczuck A, Khan M, Fratkin J, Rahman R, Hempfling K, Norden A, Reardon DA, Nayak L, Rinne M, Doherty L, Ruland S, Rai A, Rifenburg J, LaFrankie D, Wen P, Lee E, Ranjan T, Peters K, Vlahovic G, Friedman H, Desjardins A, Reveles I, Brenner A, Ruda R, Bello L, Castellano A, Bertero L, Bosa C, Trevisan E, Riva M, Donativi M, Falini A, Soffietti R, Saran F, Chinot OL, Henriksson R, Mason W, Wick W, Nishikawa R, Dahr S, Hilton M, Garcia J, Cloughesy T, Sasaki H, Nishiyama Y, Yoshida K, Hirose Y, Schwartz M, Grimm S, Kumthekar P, Fralin S, Rice L, Drawz A, Helenowski I, Rademaker A, Raizer J, Schwartz K, Chang H, Nikolai M, Kurniali P, Olson K, Pernicone J, Sweeley C, Noel M, Sharma M, Gupta R, Suri V, Singh M, Sarkar C, Shibahara I, Sonoda Y, Saito R, Kanamori M, Yamashita Y, Kumabe T, Watanabe M, Suzuki H, Watanabe T, Ishioka C, Tominaga T, Shih K, Chowdhary S, Rosenblatt P, Weir AB, Shepard G, Williams JT, Shastry M, Hainsworth JD, Singer S, Riely GJ, Kris MG, Grommes C, Sanders MWCB, Arik Y, Seute T, Robe PAJT, Leijten FSS, Snijders TJ, Sturla L, Culhane JJ, Donahue J, Jeyapalan S, Suchorska B, Jansen N, Wenter V, Eigenbrod S, Schmid-Tannwald C, Zwergal A, Niyazi M, Bartenstein P, Schnell O, Kreth FW, LaFougere C, Tonn JC, Taillandier L, Wittwer B, Blonski M, Faure G, De Carvalho M, Le Rhun E, Tanaka K, Sasayama T, Nishihara M, Mizukawa K, Kohmura E, Taylor S, Newell K, Graves L, Timmer M, Cramer C, Rohn G, Goldbrunner R, Turner S, Gergel T, Lacroix M, Toms S, Ueki K, Higuchi F, Sakamoto S, Kim P, Salgado MAV, Rueda AG, Urzaiz LL, Villanueva MG, Millan JMS, Cervantes ER, Pampliega RA, de Pedro MDA, Berrocal VR, Mena AC, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Hoekstra O, van Dongen G, Kaspers GJ, Schlamann A, von Bueren AO, Hagel C, Kramm C, Kortmann RD, Muller K, Friedrich C, Muller K, von Hoff K, Kwiecien R, Pietsch T, Warmuth-Metz M, Gerber NU, Hau P, Kuehl J, Kortmann RD, von Bueren AO, Rutkowski S, von Bueren AO, Friedrich C, von Hoff K, Kwiecien R, Muller K, Pietsch T, Warmuth-Metz M, Kuehl J, Kortmann RD, Rutkowski S, Walker J, Tremont I, Armstrong T, Wang H, Jiang C, Wang H, Jiang C, Warren P, Robert S, Lahti A, White D, Reid M, Nabors L, Sontheimer H, Wen P, Yung A, Mellinghoff I, Lamborn K, Ramkissoon S, Cloughesy T, Rinne M, Omuro A, DeAngelis L, Gilbert M, Chi A, Batchelor T, Colman H, Chang S, Nayak L, Massacesi C, DiTomaso E, Prados M, Reardon D, Ligon K, Wong ET, Elzinga G, Chung A, Barron L, Bloom J, Swanson KD, Elzinga G, Chung A, Wong ET, Wu W, Galanis E, Wen P, Das A, Fine H, Cloughesy T, Sargent D, Yoon WS, Yang SH, Chung DS, Jeun SS, Hong YK, Yust-Katz S, Milbourne A, Diane L, Gilbert M, Armstrong T, Zaky W, Weinberg J, Fuller G, Ketonen L, McAleer MF, Ahmed N, Khatua S, Zaky W, Olar A, Stewart J, Sandberg D, Foresman L, Ketonen L, Khatua S. NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2013; 15:iii98-iii135. [PMCID: PMC3823897 DOI: 10.1093/neuonc/not182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
|
41
|
Ahmed I, Biswas A, Krishnamurthy S, Julka P, Rath G, Back M, Huang D, Gzell C, Chen J, Kastelan M, Gaur P, Wheeler H, Badiyan SN, Robinson CG, Simpson JR, Tran DD, Rich KM, Dowling JL, Chicoine MR, Leuthardt EC, Kim AH, Huang J, Michaelsen SR, Christensen IJ, Grunnet K, Stockhausen MT, Broholm H, Kosteljanetz M, Poulsen HS, Tieu M, Lovblom E, Macnamara M, Mason W, Rodin D, Tai E, Ubhi K, Laperriere N, Millar BA, Menard C, Perkins B, Chung C, Clarke J, Molinaro A, Phillips J, Butowski N, Chang S, Perry A, Costello J, DeSilva A, Rabbitt J, Prados M, Cohen AL, Anker C, Shrieve D, Hall B, Salzman K, Jensen R, Colman H, Farber O, Weinberg U, Palti Y, Fisher B, Chen H, Macdonald D, Lesser G, Coons S, Brachman D, Ryu S, Werner-Wasik M, Bahary JP, Chakravarti A, Mehta M, Gupta T, Nair V, Epari S, Godasastri J, Moiyadi A, Shetty P, Juvekar S, Jalali R, Herrlinger U, Schafer N, Steinbach J, Weyerbrock A, Hau P, Goldbrunner R, Kohnen R, Urbach H, Stummer W, Glas M, Houillier C, Ghesquieres H, Chabrot C, Soussain C, Ahle G, Choquet S, Faurie P, Bay JO, Vargaftig J, Gaultier C, Nicolas-Virelizier E, Hoang-Xuan K, Iskanderani O, Izar F, Benouaich-Amiel A, Filleron T, Moyal E, Iweha C, Jain S, Melian E, Sethi A, Albain K, Shafer D, Emami B, Kong XT, Green S, Filka E, Green R, Yong W, Nghiemphu P, Cloughesy T, Lai A, Mallick S, Biswas A, Roy S, Purkait S, Gupta S, Julka PK, Rath GK, Marosi C, Thaler J, Ay C, Kaider A, Reitter EM, Haselbock J, Preusser M, Flechl B, Zielinski C, Pabinger I, Miyatake SI, Furuse M, Miyata T, Yoritsune E, Kawabata S, Kuroiwa T, Muragaki Y, Maruyama T, Iseki H, Akimoto J, Ikuta S, Nitta M, Maebayashi K, Saito T, Okada Y, Kaneko S, Matsumura A, Kuroiwa T, Karasawa K, Nakazato Y, Kayama T, Nabors LB, Fink KL, Mikkelsen T, Grujicic D, Tarnawski R, Nam DH, Mazurkiewicz M, Salacz M, Ashby L, Thurzo L, Zagonel V, Depenni R, Perry JR, Henslee-Downey J, Picard M, Reardon DA, Nambudiri N, Nayak L, LaFrankie D, Wen P, Ney D, Carlson J, Damek D, Blatchford P, Gaspar L, Kavanagh B, Waziri A, Lillehei K, Reddy K, Chen C, Rashed I, Melian E, Sethi A, Barton K, Anderson D, Prabhu V, Rusch R, Belongia M, Maheshwari M, Firat S, Schiff D, Desjardins A, Cloughesy T, Mikkelsen T, Glantz M, Chamberlain M, Reardon DA, Wen P, Shapiro W, Gopal S, Judy K, Patel S, Mahapatra A, Shan J, Gupta D, Shih K, Bacha JA, Brown D, Garner WJ, Steino A, Schwart R, Kanekal S, Li M, Lopez L, Burris HA, Soderberg-Naucler C, Rahbar A, Stragliotto G, Song AJ, Kumar AMS, Murphy ES, Tekautz T, Suh JH, Recinos V, Chao ST, Spoor J, Korami K, Kloezeman J, Balvers R, Dirven C, Lamfers M, Leenstra S, Sumrall A, Haggstrom D, Crimaldi A, Symanowski J, Giglio P, Asher A, Burri S, Sunkersett G, Khatib Z, Prajapati CM, Magalona EE, Mariano M, Sih IM, Torcuator R, Taal W, Oosterkamp H, Walenkamp A, Beerenpoot L, Hanse M, Buter J, Honkoop A, Boerman D, de Vos F, Jansen R, van der Berkmortel F, Brandsma D, Enting R, Kros J, Bromberg J, van Heuvel I, Smits M, van der Holt R, Vernhout R, van den Bent M, Weinberg U, Farber O, Palti Y, Wick W, Suarez C, Rodon J, Desjardins A, Forsyth P, Gueorguieva I, Cleverly A, Burkholder T, Desaiah D, Lahn M, Zach L, Guez D, Last D, Daniels D, Nissim O, Grober Y, Hoffmann C, Nass D, Talianski A, Spiegelmann R, Cohen Z, Mardor Y. MEDICAL RADIATION THERAPIES. Neuro Oncol 2013; 15:iii75-iii84. [PMCID: PMC3823894 DOI: 10.1093/neuonc/not179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
|
42
|
Shaw EG, Case D, Bryant D, Grisell D, Lesser G, Monitto DC, Naughton MJ, Rapp SR, Savona SR, Shah S, Chan MD. Phase II double-blind placebo-controlled study of armodafinil for brain radiation induced fatigue. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9505] [Citation(s) in RCA: 5] [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: 11/20/2022] Open
Abstract
9505 Background: Armodafinil (ARM), the R-enantiomer of modafinil, is FDA approved for narcolepsy, shift work disorder, and treated sleep-apnea, and has also been shown to reduce fatigue/improve cognitive function in cancer patients. This phase II study estimated the efficacy and toxicity of ARM in primary brain tumor (PBT) patients receiving brain radiation therapy (RT) to determine whether a larger phase III study would be warranted. Methods: Eligibility criteria – adult, PBT, total RT dose >45Gy, KPS>60, no severe headaches, and concurrent chemotherapy allowed. Patients were assessed at baseline, end of RT, then 4 weeks after end RT with the Brief Fatigue Inventory (BFI), Epworth Sleep Scale (ESS), FACT, and FACT brain and FACIT fatigue subscales. Patients were randomized to receive ARM 150mg/day during RT and for 4 weeks after RT or placebo (PLAC). Results: 54 patients enrolled between 9/10-12/12; 26 to ARM, 28 to placebo PLAC. Median age 59; 59% female; 95% White; 41% KPS 90-100, 59% KPS 60-80; 74% malignant glioma, 26% low-grade glioma/benign histology. 83% patients had concurrent chemotherapy. For all randomized patients, there were no statistically significant differences in outcome between ARM and PLAC groups at end-RT vs. baseline or 4 weeks post RT vs. baseline. For patients who had more baseline fatigue (fatigue subscale score <median), ARM-treated patients had significantly/suggestively better outcomes at end-RT vs. baseline compared to PLAC-treated patients: less fatigue (BFI p=0.056, fatigue subscale p=0.0295), less sleepiness (ESS p=0.1034), and better QOL (FACT p=0.0001). Incidence of grade 2/3 toxicities was the same between the two treatment groups: 7% anxiety, 7% nausea, 18% headaches, and 20% insomnia. There were no grade 4 or 5 toxicities. Conclusions: In irradiated PBT patients, fatigue, sleepiness, and reduced QOL occurring at the end of brain RT was less with ARM in those patients who were more fatigued at baseline. Toxicity was minimal. These data support conducting a larger phase III study. Analysis of cognitive function data is ongoing. Support - NIH/NCI grant 2U10 CA 81851 and Teva Pharmaceuticals. Clinical trial information: 95709.
Collapse
Affiliation(s)
- Edward G. Shaw
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Doug Case
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | | | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | | | - Stephen R. Rapp
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | | | - Michael D Chan
- Wake Forest University, School of Medicine, Winston Salem, NC
| |
Collapse
|
43
|
Urbanic JJ, Case D, Naughton MJ, Hu JJ, Enevold G, Beech B, Weaver KE, Danhauer S, Rapp S, Sheidler V, Vitolins M, Lesser G, Shaw EG. Minority accrual on a prospective study targeting a diverse U.S. breast cancer population: An analysis of Wake Forest CCOP research base protocol 97609. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6564 Background: Clinical trial accrual rates are lower among minority patients. Wake Forest CCOP RB protocol 97609 designed to accrue 400 non-Hispanic White (NHW) and 600 minority patients to a study evaluating potential genomic single nucleotide polymorphisms as markers for breast radiosensitivty. Methods: Accrual data evaluated from 24 participating CCOPs and numerous CTSU sites. Race / ethnicity self-reported by participants (NHW, non-Hispanic Black, Hispanic/Latino, Asian /Pacific Islander, or American Indian/Alaskan Native) based on ACS reporting criteria. Results: 752 participants accrued in 14.5 mths (11/11-1/13); 402 NHW and 350 minorities. NHW accrual goal reached, 5.9 months (period 1; avg 68.4 participants /month) compared with 54 minority participants (period 1; avg 9.2 participants / month). This 7.4 ratio NHW to minority accrual is higher than expected given incidence. During 8.6 months following closure NHW enrollment (period 2), 296 minority participants accrued (avg 34.3 participants/month). An almost 4-fold increase in minority accrual raises question of accrual disparity. 19 CCOPs open in period 1 and 24 CCOPs in period 2. CTSU contributed both periods, more CTSU sites were added during period 2. Excluding all CTSU sites and five CCOPs open only in period 2, the avg minority accrual:6.8 patients / month period 1 and 10.6 patients / month period 2. The average time of accrual was 4.0 months period 1 and 8.6 months period 2 due to variable opening dates at sites. Taking time into account, the avg minority accrual rate was 0.60 patients / month / site in period 1 and 0.56 patients / site / month in period 2. CCOP minority accrual rates in period 1 vs. 2 increased 11 / 19 sites, decreased 6 / 19, and remained the same in 2 / 19, p = .33. Conclusions: Despite closure of enrollment of NHWs into this study with a specific goal to accrue a large minority population, there was no increase in the rate of minority accrual. The initial appearance of an accrual bias can be attributed to the addition of sites and variable lengths of accrual time at sites. It is unknown whether overall lower minority accrual rate compared to NHWs is participant-, provider-, or population-based. Clinical trial information: NCT01407770.
Collapse
Affiliation(s)
| | - Doug Case
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | - Jennifer J. Hu
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Gina Enevold
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Bettina Beech
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | | | - Steve Rapp
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | - Mara Vitolins
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Edward G. Shaw
- Wake Forest University, School of Medicine, Winston Salem, NC
| |
Collapse
|
44
|
Vincent A, Lesser G, Brown D, Vern-Gross T, Metheny-Barlow L, Lawrence J, Chan M. Prolonged regression of metastatic leptomeningeal breast cancer that has failed conventional therapy: a case report and review of the literature. J Breast Cancer 2013; 16:122-6. [PMID: 23593093 PMCID: PMC3625760 DOI: 10.4048/jbc.2013.16.1.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/08/2013] [Indexed: 11/30/2022] Open
Abstract
Approximately 5% of breast cancer patients develop leptomeningeal metastases over the course of their disease. Though several treatments options are available for these patients, their prognosis is typically considered to be poor. We report a case of leptomeningeal failure after a patient underwent prior radiotherapy, radiosurgery, surgery, chemotherapy, and biologic therapy. This patient experienced a prolonged response after receiving bevacizumab and capecitabine. The literature currently contains several reports regarding the use of systemic therapy to manage leptomeningeal metastases from breast cancer, which we summarize. Finally, we review the relevant effects of the patient's treatment modalities and provide a rationale for the mechanism that led to her prolonged response.
Collapse
Affiliation(s)
- Andrew Vincent
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Strowd RE, Blackwood R, Brown M, Harmon M, Lovato J, Yalcinkaya T, Lesser G. Impact of temozolomide on gonadal function in patients with primary malignant brain tumors. J Oncol Pharm Pract 2013; 19:321-7. [PMID: 23292971 DOI: 10.1177/1078155212469243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cumulative exposure to alkylating agents may produce impaired reproductive function. Temozolomide is an alkylating agent approved for treating malignant gliomas. OBJECTIVE A pilot study was undertaken to investigate the effects of temozolomide on semen integrity in men with newly diagnosed or recurrent malignant gliomas. METHODS Eligible patients had no known fertility problems or impotence. Comprehensive semen analysis and serum sex hormones were obtained at baseline and following 3 and at least 6 months of temozolomide. RESULTS Thirteen men were recruited. Mean age was 42 years (28-58). Three had recurrent and 10 newly diagnosed malignant glioma. Four were unable to ejaculate or were azoospermic at baseline. Four provided samples at baseline and after at least 6 months of temozolomide. Five were unable to complete the study. Two of four patients with paired baseline and 6-month samples received 6 months of standard monthly temozolomide. Two patients received standard radiation and concurrent temozolomide followed by adjuvant temozolomide. At 6 months, three of these four patients demonstrated low sperm motility (two low at baseline); three had abnormally low percent normal forms (one abnormal at baseline); two developed abnormally low sperm density. Sex hormone values were normal in all four patients at all time points. CONCLUSION Changes in semen analysis parameters following 6 months of temozolomide were observed. The small sample size precludes any firm conclusions regarding the importance and duration of these findings and their relation to temozolomide exposure. With validation in a larger study, these results may have important implications for counseling prior to initiation of temozolomide therapy in these patients.
Collapse
Affiliation(s)
- R E Strowd
- Department of Neurology, Wake Forest School of Medicine, NC, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
Attia A, Rapp SR, Case LD, D'Agostino R, Lesser G, Naughton M, McMullen K, Rosdhal R, Shaw EG. Phase II study of Ginkgo biloba in irradiated brain tumor patients: effect on cognitive function, quality of life, and mood. J Neurooncol 2012; 109:357-63. [PMID: 22700031 PMCID: PMC3752650 DOI: 10.1007/s11060-012-0901-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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: 12/23/2011] [Accepted: 05/28/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Ginkgo biloba has been reported to improve cognitive function in older adults and patients with Alzheimer's disease and multi-infarct dementia. We conducted an open-label phase II study of this botanical product in symptomatic irradiated brain tumor survivors. Eligibility criteria included: life expectancy ≥30 weeks, partial or whole brain radiation ≥6 months before enrollment, no imaging evidence of tumor progression in previous 3 months, or stable or decreasing steroid dose, and no brain tumor treatment planned while on study. The Ginkgo biloba dose was 120 mg/day (40 mg t.i.d.) for 24 weeks followed by a 6-week washout period. Assessments performed at baseline, 12, 24 (end of treatment), and 30 weeks (end of washout) included KPS, Functional Assessment of Cancer Therapy-Brain (FACT-Br), Profile of Mood States, Mini-Mental Status Exam, Trail Making Test Parts A (TMT-A) and B (TMT-B), Digit Span Test, Modified Rey Osterrieth Complex Figure (ROCF), California Verbal Learning Test Part II, and the F-A-S Test. RESULTS Of the 34 patients enrolled on study, 23 (68 %) completed 12 weeks of treatment and 19 (56 %) completed 24 weeks of treatment. There were significant improvements at 24 weeks in: executive function (TMT-B) (p = 0.007), attention/concentration (TMT-A) (p = 0.002), and non-verbal memory (ROCF-immediate/delayed recall) (p = 0.001/0.002), mood (p = 0.002), FACT-Br subscale (p = 0.001), and the FACT physical subscale (p = 0.003). CONCLUSIONS Some improvement in quality of life and cognitive function were noted with Ginkgo biloba. However, treatment with Ginkgo biloba was associated with a high dropout rate.
Collapse
Affiliation(s)
- Albert Attia
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Nabors LB, Mikkelsen T, Hegi ME, Ye X, Batchelor T, Lesser G, Peereboom D, Rosenfeld MR, Olsen J, Brem S, Fisher JD, Grossman SA. A safety run-in and randomized phase 2 study of cilengitide combined with chemoradiation for newly diagnosed glioblastoma (NABTT 0306). Cancer 2012; 118:5601-7. [PMID: 22517399 DOI: 10.1002/cncr.27585] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/08/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cilengitide is a selective integrin inhibitor that is well tolerated and has demonstrated biologic activity in patients with recurrent malignant glioma. The primary objectives of this randomized phase 2 trial were to determine the safety and efficacy of cilengitide when combined with radiation and temozolomide for patients with newly diagnosed glioblastoma multiforme and to select a dose for comparative clinical testing. METHODS In total, 112 patients were accrued. Eighteen patients received standard radiation and temozolomide with cilengitide in a safety run-in phase followed by a randomized phase 2 trial with 94 patients assigned to either a 500 mg dose group or 2000 mg dose group. The trial was designed to estimate overall survival benefit compared with a New Approaches to Brain Tumor Therapy (NABTT) Consortium internal historic control and data from the published European Organization for Research and Treatment of Cancer (EORTC) trial EORTC 26981. RESULTS Cilengitide at all doses studied was well tolerated with radiation and temozolomide. The median survival was 19.7 months for all patients, 17.4 months for the patients in the 500 mg dose group, 20.8 months for patients in the 2000 mg dose group, 30 months for patients who had methylated O6-methylguanine-DNA methyltransferase (MGMT) status, and 17.4 months for patients who had unmethylated MGMT status. For patients aged ≤70 years, the median survival and survival at 24 months was superior to what was observed in the EORTC trial (20.7 months vs 14.6 months and 41% vs 27%, respectively; P = .008). CONCLUSIONS Cilengitide was well tolerated when combined with standard chemoradiation and may improve survival for patients newly diagnosed with glioblastoma multiforme regardless of MGMT methylation status. The authors concluded that, from an efficacy and safety standpoint, future trials of this agent in this population should use the 2000 mg dose.
Collapse
Affiliation(s)
- L Burt Nabors
- Brain Tumor Treatment and Research Program, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
High KP, Case D, Hurd D, Powell B, Lesser G, Falsey AR, Siegel R, Metzner-Sadurski J, Krauss JC, Chinnasami B, Sanders G, Rousey S, Shaw EG. A randomized, controlled trial of Panax quinquefolius extract (CVT-E002) to reduce respiratory infection in patients with chronic lymphocytic leukemia. ACTA ACUST UNITED AC 2012; 10:195-201. [PMID: 22266154 DOI: 10.1016/j.suponc.2011.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/08/2011] [Accepted: 10/14/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) patients are at high risk for acute respiratory illness (ARI). OBJECTIVE We evaluated the safety and efficacy of a proprietary extract of Panax quinquefolius, CVT-E002, in reducing ARI. METHODS This was a double-blind, placebo-controlled, randomized trial of 293 subjects with early-stage, untreated CLL conducted January-March 2009. RESULTS ARI was common, occurring on about 10% of days during the study period. There were no significant differences of the 2 a priori primary end points: ARI days (8.5 ± 17.2 for CVT-E002 vs 6.8 ± 13.3 for placebo) and severe ARI days (2.9 ± 9.5 for CVT-E002 vs 2.6 ± 9.8 for placebo). However, 51% of CVT-E002 vs 56% of placebo recipients experienced at least 1 ARI (difference, -5%; 95% confidence interval [CI], -16% to 7%); more intense ARI occurred in 32% of CVT-E002 vs 39% of placebo recipients (difference, -7%; 95% CI, -18% to 4%), and symptom-specific evaluation showed reduced moderate to severe sore throat (P = .004) and a lower rate of grade ≥3 toxicities (P = .02) in CVT-E002 recipients. Greater seroconversion (4-fold increases in antibody titer) vs 9 common viral pathogens was documented in CVT-E002 recipients (16% vs 7%, P = .04). LIMITATIONS Serologic evaluation of antibody titers was not tied to a specific illness, but covered the entire study period. CONCLUSION CVT-E002 was well tolerated. It did not reduce the number of ARI days or antibiotic use; however, there was a trend toward reduced rates of moderate to severe ARI and significantly less sore throat, suggesting that the increased rate of seroconversion most likely reflects CVT-E002-enhanced antibody responses.
Collapse
Affiliation(s)
- Kevin P High
- Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1042, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Snyder LA, Honea N, Coons SW, Eschbacher J, Smith KA, Spetzler RF, Sanai N, Groves MD, DeGroot J, Tremont I, Forman A, Kang S, Pei BL, Julie W, Schultz D, Yuan Y, Guha N, Hwu WJ, Papadopoulos N, Camphausen K, Yung WA, Ryken T, Johnston SK, Graham C, Grimm S, Colman H, Raizer J, Chamberlain MC, Mrugala MM, Adair JE, Beard BC, Silbergeld DL, Rockhill JK, Kiem HP, Lee EQ, Batchelor TT, Lassman AB, Schiff DS, Kaley TJ, Wong ET, Mikkelsen T, Purow BW, Drappatz J, Norden AD, Beroukhim R, Weiss S, Alexander BM, Sceppa C, Gerard M, Hallisey SD, Bochacki CA, Smith KH, Muzikansky AM, Wen PY, Peereboom DM, Mikkelson T, Sloan AE, Rich JN, Supko JG, Ye X, Brewer C, Lamborn K, Prados M, Grossman SA, Zhu JJ, Recht LD, Colman H, Kesari S, Kim LJ, Balch AH, Pope CC, Brulotte M, Beelen AP, Chamberlain MC, Wong ET, Ram Z, Gutin PH, Stupp R, Marsh J, McDonald K, Wheeler H, Teo C, Martin L, Palmer L, Rodriguez M, Buckland M, Koh ES, Back M, Robinson B, Joseph D, Nowak AK, Saito R, Sonoda Y, Yamashita Y, Kanamori M, Kumabe T, Tominaga T, Rodon J, Tawbi HA, Thomas AL, Amakye DD, Granvil C, Shou Y, Dey J, Buonamici S, Dienstmann R, Mita AC, Dummer R, Hutterer M, Martha N, Sabine E, Thaddaus G, Florian S, Christine M, Stefan O, Richard G, Martin M, Johanna B, Jochen T, Ullrich H, Wolfgang W, Peter V, Gunther S, Field KM, Cher L, Wheeler H, Hovey E, Nowak AK, Simes J, Sawkins K, France T, Brown C, Nicholas MK, Chmura S, Paleologos N, Krouwer H, Malkin M, Junck L, Vick NA, Lukas RV, Jaeckle KA, Anderson SK, Kosel M, Sarkaria J, Brown P, Flynn PJ, Buckner JC, Galanis E, Batchelor T, Grossman S, Brem S, Lesser G, Voloschin A, Nabors LB, Mikkelsen T, Desideri S, Supko J, Peereboom D, Westphal M, Pietsch T, Bach F, Heese O, Vredenburgh JJ, Desjardins A, Reardon DA, Peters KB, Kirkpatrick JP, Herndon JE, Coan AD, Bailey L, Janney D, Lu C, Friedman HS, Desjardins A, Reardon DA, Peters KB, Herndon JE, Gururangan S, Norfleet J, Friedman HS, Vredenburgh JJ, Lassman AB, Kaley TJ, DeAngelis LM, Hormigo A, Mellinghoff IK, Otap DD, Seger J, Doyle LA, Ludwig E, Lacouture ME, Panageas KS, Rezazadeh A, LaRocca RV, Vitaz TW, Villanueva WG, Hodes J, Haysley L, Pertschuk D, Cloughesy TF, Chang SM, Aghi MK, Vogelbaum MA, Liau LM, Shafa B, Jolly DJ, Ibanez CE, Perez OD, Robbins JM, Gruber HE, Maher EA, Stewart C, Hatanpaa K, Raisanen J, Mashimo T, Yang XL, Muralidhara C, Madden C, Ramachandran A, Mickey B, Bachoo R. ONGOING CLINICAL TRIALS. Neuro Oncol 2011; 13:iii85-iii91. [PMCID: PMC3199166 DOI: 10.1093/neuonc/nor154] [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: 11/27/2023] Open
|
50
|
Hobbs J, Fardo DW, Cieply K, Dacic S, Hamilton RL, Horbinski C, Giannini C, Bernardo MC, Menke J, Radford JG, Hallemeier C, Boes CJ, Lewis M, Scheithauer BW, Kim SH, Change WS, Kim JP, Chang JH, Chen ZP, Chen YS, Mihalcik SA, Jentoft M, Giannini C, Scheithauer B, Laack N, Mori K, Fujita S, Tomogane Y, Izumoto S, Arita N, Pollo B, Maderna E, Calatozzolo C, Nunziata R, Silvani A, Eoli M, Salmaggi A, Finocchiaro G, Wesseling P, Boots-Sprenger S, Bleeker F, Sijben A, Rijntjes J, Gijtenbeek A, Jeuken J, Kirsch M, Mackenroth L, Geiger K, Schackert G, Steiner G, Engler J, Robinson A, Gupta N, James CD, Phillips JJ, Cole VR, Kennedy LD, Lesser G. PATHOLOGY. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor155] [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
|