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Brown CE, Hibbard JC, Alizadeh D, Blanchard MS, Natri HM, Wang D, Ostberg JR, Aguilar B, Wagner JR, Paul JA, Starr R, Wong RA, Chen W, Shulkin N, Aftabizadeh M, Filippov A, Chaudhry A, Ressler JA, Kilpatrick J, Myers-McNamara P, Chen M, Wang LD, Rockne RC, Georges J, Portnow J, Barish ME, D'Apuzzo M, Banovich NE, Forman SJ, Badie B. Author Correction: Locoregional delivery of IL-13Rα2-targeting CAR-T cells in recurrent high-grade glioma: a phase 1 trial. Nat Med 2024; 30:1501. [PMID: 38514871 DOI: 10.1038/s41591-024-02928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Christine E Brown
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA.
| | - Jonathan C Hibbard
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Darya Alizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - M Suzette Blanchard
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Heini M Natri
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Dongrui Wang
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
- Bone Marrow Transplantation Center, the First Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Julie R Ostberg
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Brenda Aguilar
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jamie R Wagner
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jinny A Paul
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Renate Starr
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Robyn A Wong
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Wuyang Chen
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Noah Shulkin
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Maryam Aftabizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Aleksandr Filippov
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Ammar Chaudhry
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie A Ressler
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie Kilpatrick
- Department of Clinical Research, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Paige Myers-McNamara
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Mike Chen
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Leo D Wang
- Departments of Immuno-Oncology and Pediatrics, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Russell C Rockne
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Joseph Georges
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jana Portnow
- Department of Medical Oncology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Michael E Barish
- Department of Stem Cell Biology & Regenerative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Massimo D'Apuzzo
- Department of Pathology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | | | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Behnam Badie
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
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Brown CE, Hibbard JC, Alizadeh D, Blanchard MS, Natri HM, Wang D, Ostberg JR, Aguilar B, Wagner JR, Paul JA, Starr R, Wong RA, Chen W, Shulkin N, Aftabizadeh M, Filippov A, Chaudhry A, Ressler JA, Kilpatrick J, Myers-McNamara P, Chen M, Wang LD, Rockne RC, Georges J, Portnow J, Barish ME, D'Apuzzo M, Banovich NE, Forman SJ, Badie B. Locoregional delivery of IL-13Rα2-targeting CAR-T cells in recurrent high-grade glioma: a phase 1 trial. Nat Med 2024; 30:1001-1012. [PMID: 38454126 PMCID: PMC11031404 DOI: 10.1038/s41591-024-02875-1] [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: 06/27/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy is an emerging strategy to improve treatment outcomes for recurrent high-grade glioma, a cancer that responds poorly to current therapies. Here we report a completed phase I trial evaluating IL-13Rα2-targeted CAR-T cells in 65 patients with recurrent high-grade glioma, the majority being recurrent glioblastoma (rGBM). Primary objectives were safety and feasibility, maximum tolerated dose/maximum feasible dose and a recommended phase 2 dose plan. Secondary objectives included overall survival, disease response, cytokine dynamics and tumor immune contexture biomarkers. This trial evolved to evaluate three routes of locoregional T cell administration (intratumoral (ICT), intraventricular (ICV) and dual ICT/ICV) and two manufacturing platforms, culminating in arm 5, which utilized dual ICT/ICV delivery and an optimized manufacturing process. Locoregional CAR-T cell administration was feasible and well tolerated, and as there were no dose-limiting toxicities across all arms, a maximum tolerated dose was not determined. Probable treatment-related grade 3+ toxicities were one grade 3 encephalopathy and one grade 3 ataxia. A clinical maximum feasible dose of 200 × 106 CAR-T cells per infusion cycle was achieved for arm 5; however, other arms either did not test or achieve this dose due to manufacturing feasibility. A recommended phase 2 dose will be refined in future studies based on data from this trial. Stable disease or better was achieved in 50% (29/58) of patients, with two partial responses, one complete response and a second complete response after additional CAR-T cycles off protocol. For rGBM, median overall survival for all patients was 7.7 months and for arm 5 was 10.2 months. Central nervous system increases in inflammatory cytokines, including IFNγ, CXCL9 and CXCL10, were associated with CAR-T cell administration and bioactivity. Pretreatment intratumoral CD3 T cell levels were positively associated with survival. These findings demonstrate that locoregional IL-13Rα2-targeted CAR-T therapy is safe with promising clinical activity in a subset of patients. ClinicalTrials.gov Identifier: NCT02208362 .
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Affiliation(s)
- Christine E Brown
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA.
| | - Jonathan C Hibbard
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Darya Alizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - M Suzette Blanchard
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Heini M Natri
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Dongrui Wang
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
- Bone Marrow Transplantation Center, the First Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Julie R Ostberg
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Brenda Aguilar
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jamie R Wagner
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jinny A Paul
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Renate Starr
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Robyn A Wong
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Wuyang Chen
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Noah Shulkin
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Maryam Aftabizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Aleksandr Filippov
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Ammar Chaudhry
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie A Ressler
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie Kilpatrick
- Department of Clinical Research, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Paige Myers-McNamara
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Mike Chen
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Leo D Wang
- Departments of Immuno-Oncology and Pediatrics, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Russell C Rockne
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Joseph Georges
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jana Portnow
- Department of Medical Oncology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Michael E Barish
- Department of Stem Cell Biology & Regenerative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Massimo D'Apuzzo
- Department of Pathology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | | | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Behnam Badie
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
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Nabors B, Portnow J, Hattangadi-Gluth J, Horbinski C. NCCN CNS tumor guidelines update for 2023. Neuro Oncol 2023; 25:2114-2116. [PMID: 37706665 PMCID: PMC10708932 DOI: 10.1093/neuonc/noad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Burt Nabors
- Department of Neurology, Division of Neuro-oncology; Departments of Neurology and Neurosurgery, O’Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jana Portnow
- Department of Medical Oncology and Research Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Craig Horbinski
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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4
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Miller JJ, Gonzalez Castro LN, McBrayer S, Weller M, Cloughesy T, Portnow J, Andronesi O, Barnholtz-Sloan JS, Baumert BG, Berger MS, Bi WL, Bindra R, Cahill DP, Chang SM, Costello JF, Horbinski C, Huang RY, Jenkins RB, Ligon KL, Mellinghoff IK, Nabors LB, Platten M, Reardon DA, Shi DD, Schiff D, Wick W, Yan H, von Deimling A, van den Bent M, Kaelin WG, Wen PY. Isocitrate dehydrogenase (IDH) mutant gliomas: A Society for Neuro-Oncology (SNO) consensus review on diagnosis, management, and future directions. Neuro Oncol 2023; 25:4-25. [PMID: 36239925 PMCID: PMC9825337 DOI: 10.1093/neuonc/noac207] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [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] [Indexed: 01/12/2023] Open
Abstract
Isocitrate dehydrogenase (IDH) mutant gliomas are the most common adult, malignant primary brain tumors diagnosed in patients younger than 50, constituting an important cause of morbidity and mortality. In recent years, there has been significant progress in understanding the molecular pathogenesis and biology of these tumors, sparking multiple efforts to improve their diagnosis and treatment. In this consensus review from the Society for Neuro-Oncology (SNO), the current diagnosis and management of IDH-mutant gliomas will be discussed. In addition, novel therapies, such as targeted molecular therapies and immunotherapies, will be reviewed. Current challenges and future directions for research will be discussed.
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Affiliation(s)
- Julie J Miller
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - L Nicolas Gonzalez Castro
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Samuel McBrayer
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | | | - Jana Portnow
- Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ovidiu Andronesi
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jill S Barnholtz-Sloan
- Informatics and Data Science (IDS), Center for Biomedical Informatics and Information Technology (CBIIT), Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, USA
| | - Brigitta G Baumert
- Cantonal Hospital Graubunden, Institute of Radiation-Oncology, Chur, Switzerland
| | - Mitchell S Berger
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Wenya Linda Bi
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ranjit Bindra
- Department of Therapeutic Radiology, Brain Tumor Center, Yale School of Medicine, New Haven, CT, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan M Chang
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Joseph F Costello
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Craig Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Northwestern Medicine Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raymond Y Huang
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert B Jenkins
- Individualized Medicine Research, Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, Minnesota 55901, USA
| | - Keith L Ligon
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ingo K Mellinghoff
- Department of Neurology, Evnin Family Chair in Neuro-Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - L Burt Nabors
- Department of Neurology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Platten
- CCU Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - David A Reardon
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Diana D Shi
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Wolfgang Wick
- Neuro-Oncology at the German Cancer Research Center (DKFZ), Program Chair of Neuro-Oncology at the National Center for Tumor Diseases (NCT), and Neurology and Chairman at the Neurology Clinic in Heidelberg, Heidelberg, Germany
| | - Hai Yan
- Genetron Health Inc, Gaithersburg, Maryland 20879, USA
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, and, Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), and, DKTK, INF 224, 69120 Heidelberg, Germany
| | - Martin van den Bent
- Brain Tumour Centre, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - William G Kaelin
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
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5
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Horbinski C, Nabors LB, Portnow J, Baehring J, Bhatia A, Bloch O, Brem S, Butowski N, Cannon DM, Chao S, Chheda MG, Fabiano AJ, Forsyth P, Gigilio P, Hattangadi-Gluth J, Holdhoff M, Junck L, Kaley T, Merrell R, Mrugala MM, Nagpal S, Nedzi LA, Nevel K, Nghiemphu PL, Parney I, Patel TR, Peters K, Puduvalli VK, Rockhill J, Rusthoven C, Shonka N, Swinnen LJ, Weiss S, Wen PY, Willmarth NE, Bergman MA, Darlow S. NCCN Guidelines® Insights: Central Nervous System Cancers, Version 2.2022. J Natl Compr Canc Netw 2023; 21:12-20. [PMID: 36634606 DOI: 10.6004/jnccn.2023.0002] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of the following adult CNS cancers: glioma (WHO grade 1, WHO grade 2-3 oligodendroglioma [1p19q codeleted, IDH-mutant], WHO grade 2-4 IDH-mutant astrocytoma, WHO grade 4 glioblastoma), intracranial and spinal ependymomas, medulloblastoma, limited and extensive brain metastases, leptomeningeal metastases, non-AIDS-related primary CNS lymphomas, metastatic spine tumors, meningiomas, and primary spinal cord tumors. The information contained in the algorithms and principles of management sections in the NCCN Guidelines for CNS Cancers are designed to help clinicians navigate through the complex management of patients with CNS tumors. Several important principles guide surgical management and treatment with radiotherapy and systemic therapy for adults with brain tumors. The NCCN CNS Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's most recent recommendations regarding molecular profiling of gliomas.
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Affiliation(s)
- Craig Horbinski
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | - Steven Brem
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Samuel Chao
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Milan G Chheda
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Pierre Gigilio
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | - Lucien A Nedzi
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Kathryn Nevel
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | | | | | | | - Vinay K Puduvalli
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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6
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Liau LM, Ashkan K, Brem S, Campian JL, Trusheim JE, Iwamoto FM, Tran DD, Ansstas G, Cobbs CS, Heth JA, Salacz ME, D’Andre S, Aiken RD, Moshel YA, Nam JY, Pillainayagam CP, Wagner SA, Walter KA, Chaudhary R, Goldlust SA, Lee IY, Bota DA, Elinzano H, Grewal J, Lillehei K, Mikkelsen T, Walbert T, Abram S, Brenner AJ, Ewend MG, Khagi S, Lovick DS, Portnow J, Kim L, Loudon WG, Martinez NL, Thompson RC, Avigan DE, Fink KL, Geoffroy FJ, Giglio P, Gligich O, Krex D, Lindhorst SM, Lutzky J, Meisel HJ, Nadji-Ohl M, Sanchin L, Sloan A, Taylor LP, Wu JK, Dunbar EM, Etame AB, Kesari S, Mathieu D, Piccioni DE, Baskin DS, Lacroix M, May SA, New PZ, Pluard TJ, Toms SA, Tse V, Peak S, Villano JL, Battiste JD, Mulholland PJ, Pearlman ML, Petrecca K, Schulder M, Prins RM, Boynton AL, Bosch ML. Association of Autologous Tumor Lysate-Loaded Dendritic Cell Vaccination With Extension of Survival Among Patients With Newly Diagnosed and Recurrent Glioblastoma: A Phase 3 Prospective Externally Controlled Cohort Trial. JAMA Oncol 2023; 9:112-121. [PMID: 36394838 PMCID: PMC9673026 DOI: 10.1001/jamaoncol.2022.5370] [Citation(s) in RCA: 123] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/27/2022] [Indexed: 11/19/2022]
Abstract
Importance Glioblastoma is the most lethal primary brain cancer. Clinical outcomes for glioblastoma remain poor, and new treatments are needed. Objective To investigate whether adding autologous tumor lysate-loaded dendritic cell vaccine (DCVax-L) to standard of care (SOC) extends survival among patients with glioblastoma. Design, Setting, and Participants This phase 3, prospective, externally controlled nonrandomized trial compared overall survival (OS) in patients with newly diagnosed glioblastoma (nGBM) and recurrent glioblastoma (rGBM) treated with DCVax-L plus SOC vs contemporaneous matched external control patients treated with SOC. This international, multicenter trial was conducted at 94 sites in 4 countries from August 2007 to November 2015. Data analysis was conducted from October 2020 to September 2021. Interventions The active treatment was DCVax-L plus SOC temozolomide. The nGBM external control patients received SOC temozolomide and placebo; the rGBM external controls received approved rGBM therapies. Main Outcomes and Measures The primary and secondary end points compared overall survival (OS) in nGBM and rGBM, respectively, with contemporaneous matched external control populations from the control groups of other formal randomized clinical trials. Results A total of 331 patients were enrolled in the trial, with 232 randomized to the DCVax-L group and 99 to the placebo group. Median OS (mOS) for the 232 patients with nGBM receiving DCVax-L was 19.3 (95% CI, 17.5-21.3) months from randomization (22.4 months from surgery) vs 16.5 (95% CI, 16.0-17.5) months from randomization in control patients (HR = 0.80; 98% CI, 0.00-0.94; P = .002). Survival at 48 months from randomization was 15.7% vs 9.9%, and at 60 months, it was 13.0% vs 5.7%. For 64 patients with rGBM receiving DCVax-L, mOS was 13.2 (95% CI, 9.7-16.8) months from relapse vs 7.8 (95% CI, 7.2-8.2) months among control patients (HR, 0.58; 98% CI, 0.00-0.76; P < .001). Survival at 24 and 30 months after recurrence was 20.7% vs 9.6% and 11.1% vs 5.1%, respectively. Survival was improved in patients with nGBM with methylated MGMT receiving DCVax-L compared with external control patients (HR, 0.74; 98% CI, 0.55-1.00; P = .03). Conclusions and Relevance In this study, adding DCVax-L to SOC resulted in clinically meaningful and statistically significant extension of survival for patients with both nGBM and rGBM compared with contemporaneous, matched external controls who received SOC alone. Trial Registration ClinicalTrials.gov Identifier: NCT00045968.
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Affiliation(s)
- Linda M. Liau
- Department of Neurosurgery, University of California, Los Angeles
| | | | - Steven Brem
- Department of Neurosurgery, Penn Brain Tumor Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jian L. Campian
- Division of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John E. Trusheim
- Givens Brain Tumor Center, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Fabio M. Iwamoto
- Columbia University Irving Medical Center, New York, New York
- New York-Presbyterian Hospital, New York, New York
| | - David D. Tran
- Preston A. Wells, Jr. Center for Brain Tumor Therapy, Division of Neuro-Oncology, Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville
| | - George Ansstas
- Department of Neurological Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Charles S. Cobbs
- Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Medical Center, Seattle, Washington
| | - Jason A. Heth
- Taubman Medical Center, University of Michigan, Ann Arbor
| | - Michael E. Salacz
- Neuro-Oncology Program, Rutgers Cancer Institute of New Jersey, New Brunswick
| | | | - Robert D. Aiken
- Glasser Brain Tumor Center, Atlantic Healthcare, Summit, New Jersey
| | - Yaron A. Moshel
- Glasser Brain Tumor Center, Atlantic Healthcare, Summit, New Jersey
| | - Joo Y. Nam
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois
| | | | | | | | | | - Samuel A. Goldlust
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ian Y. Lee
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Daniela A. Bota
- Department of Neurology and Chao Family Comprehensive Cancer Center, University of California, Irvine
| | | | - Jai Grewal
- Long Island Brain Tumor Center at NSPC, Lake Success, New York
| | - Kevin Lillehei
- Department of Neurosurgery, University of Colorado Health Sciences Center, Boulder
| | - Tom Mikkelsen
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Tobias Walbert
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Steven Abram
- Ascension St Thomas Brain and Spine Tumor Center, Howell Allen Clinic, Nashville, Tennessee
| | | | - Matthew G. Ewend
- Department of Neurosurgery, UNC School of Medicine and UNC Health, Chapel Hill, North Carolina
| | - Simon Khagi
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - Jana Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California
| | - Lyndon Kim
- Division of Neuro-Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Nina L. Martinez
- Jefferson Hospital for Neurosciences, Jefferson University, Philadelphia, Pennsylvania
| | - Reid C. Thompson
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David E. Avigan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Cambridge, Massachusetts
| | - Karen L. Fink
- Baylor Scott & White Neuro-Oncology Associates, Dallas, Texas
| | | | - Pierre Giglio
- Medical University of South Carolina Neurosciences, Charleston
| | - Oleg Gligich
- Mount Sinai Medical Center, Miami Beach, Florida
| | | | - Scott M. Lindhorst
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Jose Lutzky
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | | | - Minou Nadji-Ohl
- Neurochirurgie Katharinenhospital, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Germany
| | | | - Andrew Sloan
- Seidman Cancer Center, University Hospitals–Cleveland Medical Center, Cleveland, Ohio
| | - Lynne P. Taylor
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Julian K. Wu
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Erin M. Dunbar
- Piedmont Physicians Neuro-Oncology, Piedmont Brain Tumor Center, Atlanta, Georgia
| | | | - Santosh Kesari
- Pacific Neurosciences Institute and Saint John’s Cancer Institute, Santa Monica, California
| | - David Mathieu
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - David S. Baskin
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Michel Lacroix
- Geisinger Neuroscience Institute, Danville, Pennsylvania
| | | | | | | | - Steven A. Toms
- Departments of Neurosurgery and Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Victor Tse
- Kaiser Permanente, Redwood City, California
| | - Scott Peak
- Kaiser Permanente, Redwood City, California
| | - John L. Villano
- University of Kentucky Markey Cancer Center, Department of Medicine, Neurosurgery, and Neurology, University of Kentucky, Lexington
| | | | | | | | - Kevin Petrecca
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York
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7
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Liau LM, Ashkan K, Brem S, Campian J, Trusheim J, Iwamoto F, Tran D, Anstass G, Cobbs C, Heth J, Salacz M, D'Andre S, Aiken R, Moshel Y, Nam J, Pillainayagam C, Wagner S, Walter K, Chaudary R, Goldlust S, Lee I, Bota D, Elinzano H, Grewal J, Lillehei K, Mikkelsen T, Walbert T, Abram S, Brenner A, Ewend M, Khagi S, Lovick D, Portnow J, Kim L, Loudon W, Martinez N, Thompson R, Avigan D, Fink K, Geoffroy F, Giglio P, Gligich O, Krex D, Lindhorst SM, Lutzky J, Meisel HJ, Nadji-Ohl M, Sanchin L, Sloan A, Bosch M. CTIM-27. AUTOLOGOUS TUMOR LYSATE-LOADED DENDRITIC CELL VACCINATION IMPROVES SURVIVAL IN PATIENTS WITH NEWLY DIAGNOSED AND RECURRENT GLIOBLASTOMA: SURVIVAL RESULTS FROM A PHASE 3 TRIAL. Neuro Oncol 2022. [PMCID: PMC9660964 DOI: 10.1093/neuonc/noac209.259] [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
Standard of care (SOC) and patient survival in glioblastoma have changed little in the past 17 years. We evaluated in a phase 3 trial whether adding an autologous tumor lysate-loaded dendritic cell vaccine (murcidencel) to SOC extends survival. Patients and
METHODS
Newly diagnosed glioblastoma patients were randomized 2:1 to either murcidencel or placebo. Under a crossover design, all patients could receive murcidencel following tumor recurrence. All parties remained blinded regarding treatments before recurrence. Patients thus received murcidencel at new diagnosis (nGBM) or at recurrence (rGBM) following crossover from placebo. The primary and secondary endpoints compare overall survival (OS) with contemporaneous, matched external controls. Four sets of analyses were conducted to ensure rigorous matching of the controls, reduce biases, and confirm the robustness of the results.
RESULTS
331 patients were enrolled. With the crossover, 89% received murcidencel. Median OS (mOS) for nGBM patients (n = 232) was 19.3 months from randomization (22.4 months from surgery) with murcidencel vs. 16.5 months from randomization in the controls (HR = 0.80, p = 0.002). Survival at 48 months from randomization was 15.7% vs. 9.9%, and at 60 months was 13% vs. 5.7%. For rGBM (n = 64), mOS was 13.2 months from relapse vs. 7.8 months in the controls (HR = 0.58, p < 0.001). Survival at 24 months post-recurrence was 20.7% vs. 9.6%, and at 30 months post-recurrence was 11.1% vs 5.1%. In nGBM patients with methylated MGMT (n = 90), mOS was 30.2 months from randomization (33 months from surgery) with murcidencel vs. 21.3 months from randomization in the controls (HR = 0.74, p = 0.027). The treatment was well tolerated, with only 5 serious adverse events deemed at least possibly related to the vaccine.
CONCLUSION
Clinically meaningful and statistically significant survival extension was seen in both nGBM and rGBM patients treated with murcidencel and SOC compared with contemporaneous, matched external controls who received SOC alone.
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Affiliation(s)
- Linda M Liau
- University of California, Los Angeles , Los Angeles , USA
| | | | - Steven Brem
- University of Pennsylvania , Philadelphia, PA , USA
| | - Jian Campian
- Mayo Clinic, Department of Oncology , Rochester, MN , USA
| | | | - Fabio Iwamoto
- Division of Neuro-Oncology, New York-Presbyterian/Columbia University Medical Center , New York, NY , USA
| | - David Tran
- University of Florida , Gainesville, FL , USA
| | | | | | - Jason Heth
- University of Michigan , Ann Arbor, MI , USA
| | | | | | | | | | | | | | | | | | | | | | - Ian Lee
- Henry Ford Health , Detroit, MI , USA
| | - Daniela Bota
- University of California Irvine , Irvine, CA , USA
| | | | - Jai Grewal
- Mount Sinai South Nassau Hospital, Oceanside, NY , Oceanside, NY , USA
| | | | | | | | | | | | | | | | | | | | - Lyndon Kim
- Mount Sinai Hospital , New York, NY , USA
| | | | | | | | - David Avigan
- Beth Israel Deaconess Medical Center , Cambridge, MA , USA
| | - Karen Fink
- Baylor University Medical Center , Dallas, TX , USA
| | | | - Pierre Giglio
- Ohio State University Comprehensive Cancer Center , Columbus, OH , USA
| | - Oleg Gligich
- Mount Sinai Medical Center , Miami Beach, FL , USA
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden , Dresden , Germany
| | | | | | | | - Minou Nadji-Ohl
- Klinikum der Landeshauptstadt Stuttgart , Stuttgart , Germany
| | | | - Andrew Sloan
- Department of Pathology and Department of Neurosurgery, Case Western Reserve University and University Hospitals Cleveland Medical Center; Seidman Cancer Center and Case Comprehensive Cancer Center , Cleveland , USA
| | - Marnix Bosch
- Northwest Biotherapeutics, Inc , Bethesda, MD , USA
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8
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Reardon DA, Brem S, Desai AS, Bagley SJ, Kurz SC, De La Fuente MI, Nagpal S, Welch MR, Hormigo A, Forsyth PAJ, Mandel JJ, Khagi S, Aiken R, Walbert T, Lieberman FS, Portnow J, Battiste J, Gillespie E, Lowy I, Skolnik J. Intramuscular (IM) INO-5401 + INO-9012 with electroporation (EP) in combination with cemiplimab (REGN2810) in newly diagnosed glioblastoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2004 Background: Novel T cell-enabling therapies plus checkpoint inhibition may improve OS in GBM. INO-5401 (synthetic DNA plasmid encoding hTERT, WT-1, PSMA) plus INO-9012 (synthetic DNA plasmid encoding IL-12), with cemiplimab (PD-1 inhibitor), was given to patients with newly diagnosed GBM with MRD to evaluate tolerability, efficacy, and immunogenicity. Median OS and immunogenicity at 18 months (OS18) are reported. Methods: This is a phase I/II, single arm, two cohort (A: unmethylated MGMT and B: methylated MGMT) study. Primary endpoint is safety; efficacy and immunogenicity are secondary. Nine mg INO-5401 plus 1 mg INO-9012 (4 doses Q3W, then Q9W) was given IM with EP in combination with cemiplimab (350 mg IV Q3W). Hypofractionated RT (40 Gy over 3 weeks) with TMZ was given to all patients, followed by maintenance (Cohort B only), which was a novel therapeutic approach. Immunogenicity was assessed by quantifying INO-5401-specific peripheral cellular immune responses via IFN-g ELISpot and flow cytometry. Intra-tumoral gene expression was analyzed by RNA-Seq of FFPE GBM tissue. Differences in gene expression were analyzed using the Wilcoxon rank sum test. Results: Fifty-two subjects were enrolled: 32 in Cohort A; 20 in Cohort B (35% women; median age 60 years [range 19-78 years]). The adverse event profile was consistent with known single-agent (INO-5401, INO-9012, EP or cemiplimab) events; most events were ≤Grade 2 and no related events were Grade ≥4. Median OS durations in Cohorts A and B were 17.9 months (95% CI 14.5-19.8) and 32.5 months (95% CI 18.4-not reached), respectively. Flow cytometry revealed activated, antigen specific CD4+CD69+PD1+ and CD8+CD69+PD1+ T cells, the latter with lytic potential as defined by presence of perforin and granzyme A. Both subsets exhibited HR < 1.0 and p < 0.05 when accounting for a 0.1% T cell frequency change, translating to a 23% and 28% reduced risk of death, respectively. Gene expression levels in pre-treatment tissues were similar between alive and deceased groups for INO-5401 antigens and immune cell markers; however, the alive group displayed significantly reduced expression of genes associated with anti-apoptosis, pro-proliferation, and immune response suppression. Post-treatment tumor tissue displayed altered gene expression for immune-related markers versus pre-treatment tissue, including markers of T cell infiltration, activation, and lytic potential. Conclusions: INO-5401 + INO-9012 has an acceptable risk/benefit profile and elicits robust immune responses that correlate with enhanced survival when administered with cemiplimab and RT/TMZ to newly diagnosed GBM patients. Pre-treatment gene expression signatures in MGMT-unmethylated patients were statistically associated with OS18. Overall, INO-5401 elicits antigen-specific T cells that can infiltrate GBM tumors. Clinical trial information: NCT03491683.
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Affiliation(s)
- David A. Reardon
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Steven Brem
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | - Simon Khagi
- University of North Carolina, Chapel Hill, NC
| | - Robert Aiken
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tobias Walbert
- Henry Ford Cancer Institute, Henry Ford University, Detroit, MI
| | | | | | - James Battiste
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Israel Lowy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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9
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Mohile NA, Messersmith H, Gatson NTN, Hottinger AF, Lassman AB, Morton J, Ney D, Nghiemphu PL, Olar A, Olson J, Perry J, Portnow J, Schiff D, Shannon A, Shih HA, Strowd R, van den Bent M, Ziu M, Blakeley J. Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab279] [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
Purpose
To provide guidance to clinicians regarding therapy for diffuse astrocytic and oligodendroglial tumors in adults.
Methods
ASCO and the Society for Neuro-Oncology convened an Expert Panel and conducted a systematic review of the literature.
Results
Fifty-nine randomized trials focusing on therapeutic management were identified.
Recommendations
Adults with newly diagnosed oligodendroglioma, isocitrate dehydrogenase (IDH)–mutant, 1p19q codeleted CNS WHO grade 2 and 3 should be offered radiation therapy (RT) and procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ) is a reasonable alternative for patients who may not tolerate PCV, but no high-level evidence supports upfront TMZ in this setting. People with newly diagnosed astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 2 should be offered RT with adjuvant chemotherapy (TMZ or PCV). People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 should be offered RT and adjuvant TMZ. People with astrocytoma, IDH-mutant, CNS WHO grade 4 may follow recommendations for either astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 or glioblastoma, IDH-wildtype, CNS WHO grade 4. Concurrent TMZ and RT should be offered to patients with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 followed by 6 months of adjuvant TMZ. Alternating electric field therapy, approved by the US Food and Drug Administration, should be considered for these patients. Bevacizumab is not recommended. In situations in which the benefits of 6-week RT plus TMZ may not outweigh the harms, hypofractionated RT plus TMZ is reasonable. In patients age ≥ 60 to ≥ 70 years, with poor performance status or for whom toxicity or prognosis are concerns, best supportive care alone, RT alone (for MGMTpromoter unmethylated tumors), or TMZ alone (for MGMT promoter methylated tumors) are reasonable treatment options. Additional information is available at www.asco.org/neurooncology-guidelines.
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Affiliation(s)
- Nimish A Mohile
- Department of Neurology and Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Na Tosha N Gatson
- Banner MD Anderson Cancer Center, Phoenix, AZ, USA
- Geisinger Neuroscience Institute, Danville, PA, USA
| | - Andreas F Hottinger
- Department of Clinical Neurosciences and Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Jordan Morton
- University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Douglas Ney
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Jeffery Olson
- Emory University, Atlanta, GA, USA
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - James Perry
- City of Hope National Medical Center, Duarte, CA, USA
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA, USA
| | - David Schiff
- University of Virginia Medical Center, Charlottesville, VA, USA
| | | | | | - Roy Strowd
- Wake Forest Baptist Health Medical Center, Winston-Salem, NC, USA
| | - Martin van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mateo Ziu
- INOVA Neurosciences and Inova Schar Cancer Institute, Falls Church, VA, USA
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10
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Batalla-Covello J, Ngai HW, Flores L, McDonald M, Hyde C, Gonzaga J, Hammad M, Gutova M, Portnow J, Synold T, Curiel DT, Lesniak MS, Aboody KS, Mooney R. Multiple Treatment Cycles of Neural Stem Cell Delivered Oncolytic Adenovirus for the Treatment of Glioblastoma. Cancers (Basel) 2021; 13:6320. [PMID: 34944938 PMCID: PMC8699772 DOI: 10.3390/cancers13246320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Tumor tropic neural stem cells (NSCs) can improve the anti-tumor efficacy of oncovirotherapy agents by protecting them from rapid clearance by the immune system and delivering them to multiple distant tumor sites. We recently completed a first-in-human trial assessing the safety of a single intracerebral dose of NSC-delivered CRAd-Survivin-pk7 (NSC.CRAd-S-pk7) combined with radiation and chemotherapy in newly diagnosed high-grade glioma patients. The maximum feasible dose was determined to be 150 million NSC.CRAd-Sp-k7 (1.875 × 1011 viral particles). Higher doses were not assessed due to volume limitations for intracerebral administration and the inability to further concentrate the study agent. It is possible that therapeutic efficacy could be maximized by administering even higher doses. Here, we report IND-enabling studies in which an improvement in treatment efficacy is achieved in immunocompetent mice by administering multiple treatment cycles intracerebrally. The results imply that pre-existing immunity does not preclude therapeutic benefits attainable by administering multiple rounds of an oncolytic adenovirus directly into the brain.
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Affiliation(s)
- Jennifer Batalla-Covello
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Hoi Wa Ngai
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Linda Flores
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Marisa McDonald
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Caitlyn Hyde
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Joanna Gonzaga
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Mohamed Hammad
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Margarita Gutova
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Jana Portnow
- Department of Medical Oncology, City of Hope, Duarte, CA 91010, USA;
| | - Tim Synold
- Department of Cancer Biology, City of Hope, Duarte, CA 91010, USA;
| | - David T. Curiel
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Maciej S. Lesniak
- Department of Neurological Surgery, Northwestern University, Chicago, IL 60611, USA;
| | - Karen S. Aboody
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Rachael Mooney
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
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11
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Mohile NA, Messersmith H, Gatson NT, Hottinger AF, Lassman A, Morton J, Ney D, Nghiemphu PL, Olar A, Olson J, Perry J, Portnow J, Schiff D, Shannon A, Shih HA, Strowd R, van den Bent M, Ziu M, Blakeley J. Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline. J Clin Oncol 2021; 40:403-426. [PMID: 34898238 DOI: 10.1200/jco.21.02036] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To provide guidance to clinicians regarding therapy for diffuse astrocytic and oligodendroglial tumors in adults. METHODS ASCO and the Society for Neuro-Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS Fifty-nine randomized trials focusing on therapeutic management were identified. RECOMMENDATIONS Adults with newly diagnosed oligodendroglioma, isocitrate dehydrogenase (IDH)-mutant, 1p19q codeleted CNS WHO grade 2 and 3 should be offered radiation therapy (RT) and procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ) is a reasonable alternative for patients who may not tolerate PCV, but no high-level evidence supports upfront TMZ in this setting. People with newly diagnosed astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 2 should be offered RT with adjuvant chemotherapy (TMZ or PCV). People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 should be offered RT and adjuvant TMZ. People with astrocytoma, IDH-mutant, CNS WHO grade 4 may follow recommendations for either astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 or glioblastoma, IDH-wildtype, CNS WHO grade 4. Concurrent TMZ and RT should be offered to patients with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 followed by 6 months of adjuvant TMZ. Alternating electric field therapy, approved by the US Food and Drug Administration, should be considered for these patients. Bevacizumab is not recommended. In situations in which the benefits of 6-week RT plus TMZ may not outweigh the harms, hypofractionated RT plus TMZ is reasonable. In patients age ≥ 60 to ≥ 70 years, with poor performance status or for whom toxicity or prognosis are concerns, best supportive care alone, RT alone (for MGMT promoter unmethylated tumors), or TMZ alone (for MGMT promoter methylated tumors) are reasonable treatment options. Additional information is available at www.asco.org/neurooncology-guidelines.
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Affiliation(s)
- Nimish A Mohile
- Department of Neurology and Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Na Tosha Gatson
- Banner MD Anderson Cancer Center, Phoenix, AZ.,Geisinger Neuroscience Institute. Danville, PA
| | - Andreas F Hottinger
- Departments of Clinical Neurosciences and Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Jordan Morton
- University of Oklahoma Health Sciences, Oklahoma City, OK
| | - Douglas Ney
- University of Colorado School of Medicine, Aurora, CO
| | | | | | | | - James Perry
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA
| | - David Schiff
- University of Virginia Medical Center, Charlottesville, VA
| | | | | | - Roy Strowd
- Wake Forest Baptist Health Medical Center, Winston-Salem, NC
| | - Martin van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mateo Ziu
- INOVA Neurosciences and Inova Schar Cancer Institute, Falls Church, VA
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12
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Brown C, Blanchard MS, Aftabizadeh M, Hibbard J, Dodia R, Lingaraju CR, Starr R, D'Apuzzo M, Forman SJ, Portnow J, Ressler JA, Stiller T, Barva B, Kilpatrick J, McNamara P, Wagner JR, Wang D, Barish M, Badie B. CTIM-29. CLINICAL EVALUATION OF CHLOROTOXIN-DIRECTED CAR T CELLS FOR PATIENTS WITH RECURRENT GLIOBLASTOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Chlorotoxin (CLTX), a peptide component of scorpion venom, exhibits selective and broad binding to glioblastoma (GBM) and other tumors with minimal activity against non-malignant cells. We have developed a novel CAR that utilizes CLTX as the tumor targeting domain. Preclinical studies established that CLTX-CAR T cells target GBM through recognition of a receptor complex incorporating membrane-bound matrix metalloprotease-2 (MMP-2). Here, we report initial clinical findings for our phase I trial evaluating safety and bioactivity of CLTX-CAR T cells in patients with MMP2+ recurrent GBM (NCT04214392). Weekly infusions of CLTX-CAR T cells are delivered locoregionally, either directly into the tumor cavity (ICT; Arm 1), or in combination with intracerebroventricular (ICV) delivery (dual ICT/ICV; Arm 2). At this interim analysis, four participants have received at least three cycles of CLTX-CAR T cells ICT (Arm 1; 3-8 cycles) at dose level 1 (DL1; 4M, 20M, 20M CAR T cells per cycle). None of the participants experienced dose limiting toxicity (DLT) during the DLT evaluation period of 28-days, although one participant experienced a serious adverse event of grade 3 cerebral edema, possibly attributed to CAR T cells. Overall, Arm 1-DL1 was well-tolerated, and the next patient cohort will be treated on Arm 2-DL1 (dual ICT/ICV; 8M, 40M, 40M CAR T cells per cycle), as per protocol design. Disease response was assessed by RANO, overall survival, and time to progression; three of four participants achieved a best response of stable disease. Liquid biopsy detected persistent CAR T cells in the tumor cavity throughout treatment, suggesting that the therapeutic cells are not immunogenic. Ongoing studies are evaluating biomarkers of response and resistance, including CAR T cell activation and inflammatory cytokines. This clinical study provides first-in-human evidence for the safety and feasibility of CLTX-CAR T cells as a new class of toxin-based CARs for treatment of GBM.
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Affiliation(s)
| | | | | | | | - Ramsinh Dodia
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - Renate Starr
- City of Hope National Medical Center, Duarte, CA, USA
| | | | | | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA, USA
| | | | | | | | | | | | | | | | - Michael Barish
- City of Hope Beckman Research Institute, Duarte, CA, USA
| | - Behnam Badie
- City of Hope National Medical Center, Duarte, CA, USA
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Bota D, Butowski N, Piccioni D, De la Fuente M, Mao Y, Li WB, Trusheim J, Fink K, Campian J, Lobbous M, Portnow J, Zhu JJ, Pearlman M, Rudnick J, Lesser G, Drappatz J, Vaillant B, Sun SL, Luo W. CTNI-08. DB102-01 ENGAGE STUDY: A BIOMARKER-GUIDED, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTI-CENTER PHASE 3 CLINICAL TRIAL OF DB102 IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (GBM). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.233] [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
Precision medicine is vital for treating many cancers. Lack of valid biomarkers might contribute to the failure of drug therapy for GBM. The Denovo Genomic Marker 1 (DGM1), a novel pharmacogenomic biomarker, has been discovered by a genome-wide screen of patients treated with DB102 (enzastaurin) in a trial for lymphoma. Similarly, retrospective analyses showed that DB102 significantly improved outcomes in the biomarker positive GBM patients treated with DB102, regardless of MGMT promoter methylation status. The ENGAGE Study (DB102-01, NCT03776071) is a global Phase 3 clinical trial to confirm clinical benefits in patients with newly diagnosed GBM who are DGM1 biomarker positive. This is a prospective, randomized, double-blind, placebo-controlled, multi-center study. A total of 318 patients with newly diagnosed GBM will be enrolled. After screening, patients will be randomized to receive radiation therapy (RT) and temozolomide (TMZ) plus either DB102 or a matched placebo for 6 weeks in the Concurrent Phase, followed by DB102 or placebo for approximately 5 weeks in the Single-Agent Phase and then TMZ plus DB102 or placebo in the Adjuvant Phase (up to 12 cycles). Thereafter DB102 or placebo may be continued as a single agent for up to 2 years. The primary endpoint is overall survival (OS). The secondary endpoints include progression free survival (PFS), objective response rate (ORR) and drug safety. By April 2021, the safety-run-in part was completed. The study is now open for enrollment in the US and soon in Canada and China.
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Affiliation(s)
- Daniela Bota
- Daniela Bota, University of California Irvine, Irvine, CA, USA
| | | | - David Piccioni
- University of California San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Macarena De la Fuente
- Sylvester Comprehensive Cancer Center, University of Miami Hospital and Clinics, Miami, FL, USA
| | - Ying Mao
- Shanghai Fudan University, Shanghai, China (People's Republic)
| | - Wen-Bin Li
- Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (People's Republic)
| | - John Trusheim
- John Nasseff Neuroscience Institute, Minneapolis, MN, USA
| | - Karen Fink
- Baylor Scott & White, Sammons Cancer Center, Dallas, TX, USA
| | | | - Mina Lobbous
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA, USA
| | - Jay-Jiguang Zhu
- Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | - Glen Lesser
- Wake Forest Baptist Health - Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jan Drappatz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian Vaillant
- Austin Cancer Center – Park St. David’s, Austin, TX, USA
| | | | - Wen Luo
- Denovo Biopharma LLC, San Diego, CA, USA
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14
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Yuan Y, Lee J, Yost SE, Frankel PH, Ruel C, Egelston CA, Guo W, Padam S, Tang A, Martinez N, Schmolze D, Presant C, Ebrahimi B, Yeon C, Sedrak M, Patel N, Portnow J, Lee P, Mortimer J. Phase I/II trial of palbociclib, pembrolizumab and letrozole in patients with hormone receptor-positive metastatic breast cancer. Eur J Cancer 2021; 154:11-20. [PMID: 34217908 PMCID: PMC8691850 DOI: 10.1016/j.ejca.2021.05.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND CDK4/6 inhibitors modulate immune response in breast cancer. This phase I/II trial was designed to test the safety and efficacy of palbociclib, pembrolizumab and letrozole in women with hormone receptor positive (HR+) human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (MBC). PATIENTS AND METHODS Women with stage IV HR+ HER2- MBC were enrolled and treated with palbociclib, pembrolizumab and letrozole. Primary end-points were safety, tolerability and efficacy. RESULTS Between November 2016 and July 2020, 23 patients were enrolled with 20 evaluable for response, including 4 patients in cohort 1 and 16 patients in cohort 2. Cohort 1 median age was 48 years (33-70) and cohort 2 median age was 55 (37-75). Cohort 1 closed early due to limited accrual. Grade III-IV adverse events were neutropenia (83%), leucopaenia (65%), thrombocytopenia (17%) and elevated liver enzymes (17%). In cohort 1, 50% achieved a partial response (PR) and 50% had stable disease (SD). In cohort 2, 31% achieved complete response (CR), 25% had PR and 31% had SD by Response Evaluation Criteria in Solid Tumours version 1.1. Median progression-free survival was 25.2 months (95% confidence interval [CI] 5.3, not reached) and median overall survival was 36.9 months (95% CI 36.9, not reached) in cohort 2 with a median follow-up of 24.8 months (95% CI 17.1, not reached). A correlative immune biomarker analysis was published separately. CONCLUSION The combination of palbociclib, pembrolizumab and letrozole is well tolerated, and a complete response rate of 31% was identified in HR+ MBC patients who received this combination as front-line therapy. Confirmatory trials are required to better understand the immune-priming effects of CDK4/6 inhibitors.
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Affiliation(s)
- Y. Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA,Corresponding author: Dr. Yuan Yuan, Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA 91010 USA, Phone: 626-256-4673, Fax: 626-301-8233,
| | - J. Lee
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - S. E. Yost
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - P. H. Frankel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - C. Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - C. A. Egelston
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - W. Guo
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - S. Padam
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - A. Tang
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - N. Martinez
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - D. Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - C. Presant
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - B. Ebrahimi
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - C. Yeon
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - M. Sedrak
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - N. Patel
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - J. Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - P. Lee
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - J. Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
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15
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Fares J, Ahmed AU, Ulasov IV, Sonabend AM, Miska J, Lee-Chang C, Balyasnikova IV, Chandler JP, Portnow J, Tate MC, Kumthekar P, Lukas RV, Grimm SA, Adams AK, Hébert CD, Strong TV, Amidei C, Arrieta VA, Zannikou M, Horbinski C, Zhang H, Burdett KB, Curiel DT, Sachdev S, Aboody KS, Stupp R, Lesniak MS. Neural stem cell delivery of an oncolytic adenovirus in newly diagnosed malignant glioma: a first-in-human, phase 1, dose-escalation trial. Lancet Oncol 2021; 22:1103-1114. [PMID: 34214495 DOI: 10.1016/s1470-2045(21)00245-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Malignant glioma is the most common and lethal primary brain tumour, with dismal survival rates and no effective treatment. We examined the safety and activity of NSC-CRAd-S-pk7, an engineered oncolytic adenovirus delivered by neural stem cells (NSCs), in patients with newly diagnosed high-grade glioma. METHODS This was a first-in-human, open-label, phase 1, dose-escalation trial done to determine the maximal tolerated dose of NSC-CRAd-S-pk7, following a 3 + 3 design. Patients with newly diagnosed, histologically confirmed, high-grade gliomas (WHO grade III or IV) were recruited. After neurosurgical resection, NSC-CRAd-S-pk7 was injected into the walls of the resection cavity. The first patient cohort received a dose starting at 6·25 × 1010 viral particles administered by 5·00 × 107 NSCs, the second cohort a dose of 1·25 × 1011 viral particles administered by 1·00 × 108 NSCs, and the third cohort a dose of 1·875 × 1011 viral particles administered by 1·50 × 108 NSCs. No further dose escalation was planned. Within 10-14 days, treatment with temozolomide and radiotherapy was initiated. Primary endpoints were safety and toxicity profile and the maximum tolerated dose for a future phase 2 trial. All analyses were done in all patients who were included in the trial and received the study treatment and were not excluded from the study. Recruitment is complete and the trial is finished. The trial is registered with ClinicalTrials.gov, NCT03072134. FINDINGS Between April 24, 2017, and Nov 13, 2019, 12 patients with newly diagnosed, malignant gliomas were recruited and included in the safety analysis. Histopathological evaluation identified 11 (92%) of 12 patients with glioblastoma and one (8%) of 12 patients with anaplastic astrocytoma. The median follow-up was 18 months (IQR 14-22). One patient receiving 1·50 × 108 NSCs loading 1·875 × 1011 viral particles developed viral meningitis (grade 3) due to the inadvertent injection of NSC-CRAd-S-pk7 into the lateral ventricle. Otherwise, treatment was safe as no formal dose-limiting toxicity was reached, so 1·50 × 108 NSCs loading 1·875 × 1011 viral particles was recommended as a phase 2 trial dose. There were no treatment-related deaths. The median progression-free survival was 9·1 months (95% CI 8·5-not reached) and median overall survival was 18·4 months (15·7-not reached). INTERPRETATION NSC-CRAd-S-pk7 treatment was feasible and safe. Our immunological and histopathological findings support continued investigation of NSC-CRAd-S-pk7 in a phase 2/3 clinical trial. FUNDING US National Institutes of Health.
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Affiliation(s)
- Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Atique U Ahmed
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ilya V Ulasov
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adam M Sonabend
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason Miska
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Catalina Lee-Chang
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Irina V Balyasnikova
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James P Chandler
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jana Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Matthew C Tate
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Priya Kumthekar
- Department of Neurology, Division of Neuro-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rimas V Lukas
- Department of Neurology, Division of Neuro-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sean A Grimm
- Department of Neurology, Division of Neuro-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ann K Adams
- Office of the Vice-President for Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Christina Amidei
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Victor A Arrieta
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Markella Zannikou
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Craig Horbinski
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Pathology, Division of Neuropathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hui Zhang
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kirsten Bell Burdett
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David T Curiel
- Department of Radiation Oncology, Washington University School of Medicine in Saint Louis, MO, USA
| | - Sean Sachdev
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen S Aboody
- Department of Developmental & Stem Cell Biology, Division of Neurosurgery, City of Hope, Duarte, CA
| | - Roger Stupp
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Maciej S Lesniak
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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16
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Badie B, Barish ME, Chaudhry A, D'Apuzzo M, Forman SJ, Portnow J, Wang S(S, Ressler JA, Simpson J, Kilpatrick J, McNamara P, Wagner J, Blanchard S, Wang D, Brown C. A phase 1 study to evaluate chimeric antigen receptor (CAR) T cells incorporating a chlorotoxin tumor-targeting domain for patients with MMP2+ Recurrent or progressive glioblastoma (NCT04214392). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps2662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2662 Background: Glioblastoma (GBM) is the most common and most aggressive primary brain tumor. Around 294,900 new cases are diagnosed globally with 241,000 deaths each year. The 5-year survival is only 5%. Median overall survival from first recurrence is only 5-8 months. There is no established standard of care for recurrent GBM. City of Hope (COH) has developed and optimized a CAR T cell therapy utilizing the chlorotoxin peptide (CLTX) as the CAR’s tumor recognition domain against GBM. CLTX-CAR T cells specifically and broadly target GBM through recognition of a receptor complex including membrane-bound matrix metalloprotease 2 (MMP-2). CLTX-CAR T cells do not exhibit off-tumor recognition of normal human or murine cells and tissues in preclinical models. In in vitro studies, COH evaluated patient-derived brain tumor (PBT) cell lines for CLTX binding and expression of IL13Rα2, HER2 and EGFR, three targets of CAR T cell trials for GBMs. Strong CLTX binding to tumor cells was observed in of the majority of primary GBM lines, independent of these other antigens. In preclinical studies using in vivo mouse models, a single intratumoral (ICT) injection of CLTX-CAR T cells (1×106 CAR+ T cells) exhibited robust anti-tumor activity against ffLuc+ PBT106 tumors orthotopically-engrafted in NSG mice. Overall, when compared to mice treated with mock-transduced Tn/mem (no CAR) T cells, the CLTX(EQ)28ζ/CD19t+ T cells reduced tumor burden and significantly increased survival. Taken together, these preclinical findings support the potential safety and efficacy of CLTX-CAR T cells, and provide the rationale for clinical testing of this therapy. As cellular heterogeneity intrinsic to GBM likely contributes to resistance to therapy and limited response rates, CLTX-CAR T cells may provide greater tumor eradication in a higher proportion of patients with GBM. Methods: This study is a phase 1, single center, safety and maximum tolerated dose (MTD) finding study of CLTX-CAR T cells for subjects with MMP2+ recurrent or progressive GBM. A safety lead-in of 3−6 participants receiving CLTX-CAR T cells by ICT delivery will be completed first. Subsequently, subjects would receive cells administered through both ICT and intraventricular (ICV catheters) (i.e. dual delivery) in two dose schedules. Subjects will be evaluated for safety and tolerability, and may continue to receive treatment until disease progression. Time to progression, overall survival, and disease response by Response Assessment in Neuro-Oncology (RANO) criteria, will be evaluated and descriptively compared to historical data. The study is actively enrolling patients. Clinical trial information: NCT04214392.
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Affiliation(s)
- Behnam Badie
- City of Hope National Medical Center, Duarte, CA
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Portnow J, Wang D, Blanchard MS, Tran V, Alizadeh D, Starr R, Dodia R, Chiu V, Brito A, Kilpatrick J, McNamara P, Forman SJ, Badie B, Synold TW, Brown CE. Systemic Anti-PD-1 Immunotherapy Results in PD-1 Blockade on T Cells in the Cerebrospinal Fluid. JAMA Oncol 2020; 6:1947-1951. [PMID: 33030521 PMCID: PMC7545351 DOI: 10.1001/jamaoncol.2020.4508] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Question Are systemically administered programmed cell death 1–blocking antibodies able to penetrate and maintain bioactivity in the central nervous system? Findings In this case series study of 10 adult patients with high-grade gliomas, intravenous administration of pembrolizumab yielded cerebrospinal fluid (CSF) concentrations that were approximately 1% of that in serum but were sufficient for blocking programmed cell death 1 on T cells in the CSF. Meaning Systemically administered immune checkpoint blockade is able to reinvigorate T cells within the CSF compartment, supporting its bioavailability for treatment of tumors in the central nervous system and its use in combination with locoregionally delivered cellular therapies. Importance Little is known about the penetration and bioactivity of systemically administered programmed cell death 1 (PD-1) antibodies in the central nervous system. Such information is critical for advancing checkpoint antibody therapies for treatment of brain tumors. Objective To evaluate pembrolizumab concentrations and PD-1 blockade on T cells in the cerebrospinal fluid (CSF) after intravenous administration. Design, Setting, and Participants Cerebrospinal fluid and blood samples were collected from 10 adult patients with high-grade gliomas who were participating in clinical trials of intracranially administered chimeric antigen receptor (CAR) T cells and intravenous pembrolizumab at City of Hope in Duarte, California, from 2017 through 2019. Neuropharmacokinetic and immunologic correlative studies were performed on CSF and serum samples. Interventions or Exposures Pembrolizumab, 200 mg, was given intravenously every 3 weeks with a median of 2 cycles (range, 1-8). CAR T cells were administered intracranially every 1 to 4 weeks. Cerebrospinal fluid and blood samples were collected on the day of CAR T-cell administration and then 24 hours later for a total of 100 paired samples. Main Outcomes and Measures Pembrolizumab concentrations were measured by enzyme-linked immunosorbent assay, PD-1 blocking on T cells by flow cytometry, and results of PD-1 blockade on CAR T-cell function by in vitro tumor rechallenge assays. Results Of the 10 patients included in this study, the mean (SD) age was 45.7 (11.0) years, and 6 (60%) were women. Steady-state pembrolizumab concentrations in the CSF were achieved by 24 hours after initial intravenous administration, with a mean CSF:serum ratio of 0.009 (95% CI, 0.004-0.014). The CSF concentrations of pembrolizumab effectively blocked PD-1 on both endogenous T cells and intracranially administered CAR T cells in the CSF, with flow cytometric detection of surface PD-1 on the T cells decreasing from a mean (SD) of 39.3% (20.2%) before pembrolizumab to a mean (SD) of 3.8% (5.8%) 24 hours after pembrolizumab infusion. Steady-state concentrations in the CSF were maintained throughout the 21-day cycle of pembrolizumab, as was the PD-1 blocking effect, evidenced by no increase in detectable surface PD-1 on T cells in the CSF during that time period. Incubation of PD-1–expressing T cells with CSF samples from patients treated with pembrolizumab also resulted in PD-1 blockade. Conclusions and Relevance Results of this study demonstrate steady-state concentrations of pembrolizumab in CSF after intravenous administration as well as CSF concentrations that are sufficient for blocking PD-1 on endogenous and adoptively transferred T cells. This provides mechanistic insight regarding the ability of systemically administered PD-1 blocking antibodies to modulate T-cell activity in the brain.
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Affiliation(s)
- Jana Portnow
- Department of Medical Oncology and Therapeutics Research, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Dongrui Wang
- Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratories, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - M Suzette Blanchard
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Vivi Tran
- Department of Cancer Biology, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Darya Alizadeh
- Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratories, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Renate Starr
- Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratories, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Ramsinh Dodia
- Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratories, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Vivian Chiu
- Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratories, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Alfonso Brito
- Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratories, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Julie Kilpatrick
- Department of Clinical Research, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Paige McNamara
- Division of Neurosurgery, Department of Surgery, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratories, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Behnam Badie
- Division of Neurosurgery, Department of Surgery, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Timothy W Synold
- Department of Cancer Biology, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
| | - Christine E Brown
- Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratories, City of Hope Beckman Research Institute and Comprehensive Cancer Center, Duarte, California
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18
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Reardon DA, Brem S, Desai AS, Bagley SJ, Kurz SC, De La Fuente MI, Nagpal S, Welch MR, Hormigo A, Forsyth P, Mandell J, Khagi S, Aiken R, Walbert T, Lieberman F, Portnow J, Batiste J, Carroll N, Sylvester A, Campbell P, Lowy I, Dolgoter A, Boyer J, Kraynyak K, Morrow MP, McMullan T, Weiner DB, Skolnik J. LTBK-01. INO-5401 AND INO-9012 DELIVERED INTRAMUSCULARLY (IM) WITH ELECTROPORATION (EP) IN COMBINATION WITH CEMIPLIMAB (REGN2810) IN NEWLY DIAGNOSED GLIOBLASTOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.988] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Novel T cell-enabling therapies, in combination with checkpoint inhibition, may improve OS in GBM. INO-5401 (synthetic DNA plasmids encoding hTERT, WT-1, PSMA) plus INO-9012 (synthetic DNA plasmid encoding IL-12), and the PD-1 immune checkpoint inhibitor cemiplimab, is given to patients with newly diagnosed GBM to evaluate tolerability, efficacy and immunogenicity.
METHODS
Phase I/II, single arm, 2 cohort study (A: MGMT unmethylated, B: MGMT methylated). Primary endpoint is safety; efficacy and immunogenicity are secondary. Nine mg INO-5401 plus 1 mg INO-9012 (every 3 weeks x 4 doses, then Q9W) is given IM with EP by CELLECTRA® 2000 with cemiplimab (350 mg IV Q3W). RT is given as 40 Gy over 3 weeks. TMZ is given with radiation (all patients), and adjuvantly (Cohort B only).
RESULTS
Fifty-two subjects enrolled: 32 in Cohort A; 20 in Cohort B. 35% women; median age 60 years (19–78 years). The adverse event profile is consistent with single-agent (INO-5401, INO-9012, EP and cemiplimab) reported events. OS at 12 months was 84.4% (Cohort A) and 85% (Cohort B). OS at 18 months in Cohort A is 50% (95% CI 31.9 - 68.1); median OS is 17.9 months (14.5 - NR); Cohort B OS18 and median OS will be presented. Tumor gene transcripts at diagnosis confirmed expression of INO-5401 antigens. Peripheral immune responses following INO-5401 revealed antigen-specific T cell responses by Interferon gamma ELISpot and flow cytometry, including cytokine production and expansion of antigen specific CD8+T cells with lytic potential.
CONCLUSIONS
INO-5401 + INO-9012, a novel DNA plasmid immunotherapy, demonstrates acceptable risk/benefit and generates robust systemic immune responses to encoded tumor antigens when administered with cemiplimab and RT/TMZ in newly diagnosed GBM patients. Overall survival is encouraging. Clinical trial information: NCT03491683.
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Affiliation(s)
- David A Reardon
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Steven Brem
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | - Adilia Hormigo
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Simon Khagi
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | - James Batiste
- Sarah Cannon Research Institute, Chattanooga, TN, USA
| | | | | | | | - Israel Lowy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Jean Boyer
- Inovio Pharmaceuticals, Plymouth Meeting, PA, USA
| | | | | | | | - David B Weiner
- Inovio Pharmaceuticals, Plymouth Meeting, PA, USA
- The Wistar Institute, Philadelphia, PA, USA
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Nabors LB, Portnow J, Ahluwalia M, Baehring J, Brem H, Brem S, Butowski N, Campian JL, Clark SW, Fabiano AJ, Forsyth P, Hattangadi-Gluth J, Holdhoff M, Horbinski C, Junck L, Kaley T, Kumthekar P, Loeffler JS, Mrugala MM, Nagpal S, Pandey M, Parney I, Peters K, Puduvalli VK, Robins I, Rockhill J, Rusthoven C, Shonka N, Shrieve DC, Swinnen LJ, Weiss S, Wen PY, Willmarth NE, Bergman MA, Darlow SD. Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:1537-1570. [PMID: 33152694 DOI: 10.6004/jnccn.2020.0052] [Citation(s) in RCA: 210] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of adult CNS cancers ranging from noninvasive and surgically curable pilocytic astrocytomas to metastatic brain disease. The involvement of an interdisciplinary team, including neurosurgeons, radiation therapists, oncologists, neurologists, and neuroradiologists, is a key factor in the appropriate management of CNS cancers. Integrated histopathologic and molecular characterization of brain tumors such as gliomas should be standard practice. This article describes NCCN Guidelines recommendations for WHO grade I, II, III, and IV gliomas. Treatment of brain metastases, the most common intracranial tumors in adults, is also described.
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Affiliation(s)
| | | | - Manmeet Ahluwalia
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Henry Brem
- 5The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Steven Brem
- 6Abramson Cancer Center at the University of Pennsylvania
| | | | - Jian L Campian
- 8Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | - Craig Horbinski
- 13Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Larry Junck
- 14University of Michigan Rogel Cancer Center
| | | | - Priya Kumthekar
- 13Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Manjari Pandey
- 19St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Vinay K Puduvalli
- 21The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Ian Robins
- 22University of Wisconsin Carbone Cancer Center
| | - Jason Rockhill
- 23Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Lode J Swinnen
- 5The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Portnow J, Badie B, Suzette Blanchard M, Kilpatrick J, Tirughana R, Metz M, Mi S, Tran V, Ressler J, D'Apuzzo M, Aboody KS, Synold TW. Feasibility of intracerebrally administering multiple doses of genetically modified neural stem cells to locally produce chemotherapy in glioma patients. Cancer Gene Ther 2020; 28:294-306. [PMID: 32895489 PMCID: PMC8843788 DOI: 10.1038/s41417-020-00219-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/04/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Neural stem cells (NSCs) are tumor tropic and can be genetically modified to produce anti-cancer therapies locally in the brain. In a prior first-in-human study we demonstrated that a single dose of intracerebrally administered allogeneic NSCs, which were retrovirally transduced to express cytosine deaminase (CD), tracked to glioma sites and converted oral 5-fluorocytosine (5-FC) to 5-fluorouracil (5-FU). The next step in the clinical development of this NSC-based anti-cancer strategy was to assess the feasibility of administering multiple intracerebral doses of CD-expressing NSCs (CD-NSCs) in patients with recurrent high grade gliomas. CD-NSCs were given every 2 weeks using an indwelling brain catheter, followed each time by a 7-day course of oral 5-FC (and leucovorin in the final patient cohort). Fifteen evaluable patients received a median of 4 (range 2–10) intracerebral CD-NSC doses; doses were escalated from 50 x 106 to 150 x 106 CD-NSCs. Neuropharmacokinetic data confirmed that CD-NSCs continuously produced 5-FU in the brain during the course of 5-FC. There were no clinical signs of immunogenicity, and only three patients developed anti-NSC antibodies. Our results suggest intracerebral administration of serial doses of CD-NSCs is safe and feasible and identified a recommended dose for phase II testing of 150 x 106 CD-NSCs.
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Affiliation(s)
- Jana Portnow
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA.
| | - Behnam Badie
- Department of Surgery, Division of Neurosurgery, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA
| | - M Suzette Blanchard
- Department of Computational and Quantitative Medicine, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Julie Kilpatrick
- Department of Clinical Research, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA
| | - Revathiswari Tirughana
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA.,Office of IND Development and Regulatory Affairs, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Marianne Metz
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Shu Mi
- Department of Cancer Biology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Vivi Tran
- Department of Cancer Biology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Julie Ressler
- Department of Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA
| | - Massimo D'Apuzzo
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA
| | - Karen S Aboody
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Timothy W Synold
- Department of Cancer Biology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
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21
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Wang D, Portnow J, Tran V, Chiu V, Brito A, Alizadeh D, Starr R, Kilpatrick J, McNamara P, Forman SJ, Badie B, Synold TW, Brown CE. Abstract A52: Systemic anti-PD-1 immunotherapy results in PD-1 blockade on T cells in the cerebrospinal fluid. Cancer Immunol Res 2020. [DOI: 10.1158/2326-6074.tumimm19-a52] [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: 11/16/2022]
Abstract
Abstract
Immune checkpoint inhibitors have shown promising clinical efficacy in many types of cancers, including some with metastasis into the central neural system (CNS). However, little is known about the CNS penetration of immune checkpoint inhibitors and their bioactivity on the locoregional T cells. Here, we analyzed the CNS and systemic concentration of pembrolizumab (Pembro) in high-grade glioma patients, who were concurrently treated with intravenously administered Pembro and locoregionally delivered chimeric antigen receptor (CAR) T cells. A total of 99 paired cerebrospinal fluid (CSF) and serum samples were collected from 10 patients during multicycle treatment of CAR T cell and Pembro. We discovered that after the first Pembro infusion, CSF antibody concentrations were increased slower than serum concentrations. However, CSF antibody concentrations reached steady-state 24 hours after Pembro infusion and were maintained stable over the 21-day infusion cycles. Although average CSF Pembro concentrations (3.2nM) were only 1% of serum levels (329nM), we observed effective PD-1 blockade on the T cells in CSF samples of all analyzed patients. The blocking effect was found on both endogenous T cells and locoregionally administered CAR T cells. Further, PD-1 on CD3/CD28 beads-activated T cells was completely blocked after incubation with cell-depleted CSF samples, suggesting the bioactivity of Pembro that penetrated into the CSF. Using a dose-titration assay, we also confirmed that CSF Pembro concentrations were sufficient to ameliorate the cytotoxic activity of CAR T cells against repetitive tumor challenges. Together, for the first time, we showed the dynamic Pembro levels in the CSF throughout multiple treatment cycles and confirmed that systemically administered immune checkpoint inhibitors can penetrate into the CNS and elicit blocking effect on T cells. Our findings add strength to the rationale for combining immune checkpoint inhibitors with locoregionally delivered CAR T cells and other types of immunotherapy for the treatment of brain tumors.
Citation Format: Dongrui Wang, Jana Portnow, Vivi Tran, Vivian Chiu, Alfonso Brito, Darya Alizadeh, Renate Starr, Julie Kilpatrick, Paige McNamara, Stephen J. Forman, Behnam Badie, Timothy W. Synold, Christine E. Brown. Systemic anti-PD-1 immunotherapy results in PD-1 blockade on T cells in the cerebrospinal fluid [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2019 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(3 Suppl):Abstract nr A52.
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Yuan Y, Yost SE, Lee JS, Egelston C, Frankel PH, Ruel C, Padam S, Tang A, Martinez N, Portnow J, Yeon C, Presant C, Rajurkar S, Sedrak M, Patel N, Lee P, Mortimer J. Abstract P3-11-04: A phase II study of pembrolizumab, letrozole and palbociclib in patients with metastatic estrogen receptor positive breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-11-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The combination of CDK4/6 inhibitor and aromatase inhibitor is the current standard of care therapy for patients with estrogen receptor positive (ER+) metastatic breast cancer (MBC). Single agent immune check point inhibitor (ICI) pembrolizumab has a response rate of 12% in selected patients (PD-L1+), and preclinical studies demonstrated immune-modulatory effect of CDK4/6 inhibitors. The combination of CDK 4/6 inhibitors and ICI might turn “immune-cold” breast cancer tumors into “immune-hot” tumors. This study was designed to evaluate the safety and efficacy of adding pembrolizumab to letrozole and palbociclib in patients with ER+ MBC.
Methods: This is an open-label single arm study enrolling patients with biopsy proven ER+ MBC with measurable disease by RECIST1.1, ECOG performance status 0-1. Patient received letrozole (2.5mg po daily), palbociclib (125mg po daily 3 weeks on, 1 week off), and pembrolizumab (200mg iv q3wks). Two cohorts were included: cohort 1 for patients who were previously on letrozole and palbociclib for > 6 months and had pembrolizumab added on C1D1, and cohort 2 for patients who had all 3 drugs started on C1D1. Premenopausal patients received ovarian suppression prior to C1D1. The primary objective was to determine the safety and tolerability of the combination. The secondary objectives were RR, PFS, and OS. For both cohorts, a three-at-risk design (modified rolling design) was used for safety-lead to ensure the triplet was well-tolerated. This design permitted only 3 patients to be a risk for DLT at any one time during the “safety lead-in” and permitted continuing accrual if ≤1 DLT occurred in the first 6 patients. Secondary consideration was response (cohort 2 only), with an a priori requirement of at least 9 responses to warrant further evaluation. Baseline tumor specimen, peripheral blood plasma, and PBMCs were collected for immune correlative analysis.
Results: A total of 20 patients were accrued to this trial (4 in cohort 1, 16 in cohort 2), with 19 eligible for response assessment because one patient was determined to be TNBC upon repeat of biopsy. Median age was 49 years, with 40% Hispanic, and 60% non-Hispanic. There were 2 DLTs (1 biopsy site infection and delay in treatment that was possibly related to treatment in cohort 1, and 1 pneumonitis in cohort 2). 9/20 patients (45%) had dose delay and 9/20 patients (45%) had dose reduction, with the most common cause being neutropenia. Gr 4 AEs included neutropenia (n=4), WBC (n=3), LFT (n=1), and bowel perforation (n=1). Grade 3 AEs included neutropenia (n=11), WBC (n=9), LFT (n=3), PLT (n=2), and pneumonitis, pruritus, anemia, biopsy site infection (n=1 each). Other immune-related toxicities of Grade 2 included: hypothyroidism, colitis, LFTs, and dermatitis (n≤2 each). Responses were CR 1/19 (5.3%), PR 8/19 (42.1%), SD 6/19 (31.6%) and PD 4/19 (21.1%). Median follow up was 13.7 (95% CI 6.4-16.9) months and median PFS was not reached. No association of baseline tumor PD-L1 (22C3) and clinical response were observed (data available on 13 patients). PBMC flow from the first 9 patients (5 PR, 4 SD) showed lower percentage of naïve CD8+ T cells (CD8+CD45RA+ CD27+), and higher level of non-naïve KLRG1+CD8+ T cell (CD8+CD45RA− CD27− KLRG1+) were associated with clinical response (p<0.05).
Conclusion: The combination of letrozole, palbociclib, and pembrolizumab is well tolerated in patients with ER+ MBC.
Citation Format: Yuan Yuan, Susan E Yost, Jin Sun Lee, Colt Egelston, Paul H Frankel, Christopher Ruel, Simran Padam, Aileen Tang, Norma Martinez, Jana Portnow, Christina Yeon, Cary Presant, Swapnil Rajurkar, Mina Sedrak, Niki Patel, Peter Lee, Joanne Mortimer. A phase II study of pembrolizumab, letrozole and palbociclib in patients with metastatic estrogen receptor positive breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-11-04.
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23
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Lee JS, Yost SE, Blanchard S, Schmolze D, Yin HH, Pillai R, Robinson K, Tang A, Martinez N, Portnow J, Wen W, Yim JH, Brauer HA, Ren Y, Luu T, Mortimer J, Yuan Y. Phase I clinical trial of the combination of eribulin and everolimus in patients with metastatic triple-negative breast cancer. Breast Cancer Res 2019; 21:119. [PMID: 31703728 PMCID: PMC6839083 DOI: 10.1186/s13058-019-1202-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Alteration of the PI3K/AKT/mTOR pathway is a common genomic abnormality detected in triple-negative breast cancer (TNBC). Everolimus acts synergistically with eribulin in TNBC cell lines and xenograft models. This phase I trial was designed to test the safety and tolerability of combining eribulin and everolimus in patients with metastatic TNBC. METHODS The primary objective of this study was to evaluate the safety and toxicities of the combination. Patients with metastatic TNBC who had up to four lines of prior chemotherapies were enrolled. The combination of eribulin and everolimus was tested using three dosing levels: A1 (everolimus 5 mg daily; eribulin 1.4 mg/m2 days 1 and 8 every 3 weeks), A2 (everolimus 7.5 mg daily; eribulin 1.4 mg/m2, days 1 and 8 every 3 weeks), and B1 (everolimus 5 mg daily; eribulin 1.1 mg/m2 days 1 and 8 every 3 weeks). RESULTS Twenty-seven patients with median age 55 years were enrolled. Among 8 evaluable patients who received dose level A1, 4 had dose-limiting toxicities (DLTs). Among 3 evaluable patients treated with dose level A2, 2 had DLTs. Among 12 evaluable patients who received dose level B1, 4 had DLTs. The DLTs were neutropenia, stomatitis, and hyperglycemia. Over the study period, 59% had a ≥ grade 3 toxicity, 44% had ≥ grade 3 hematologic toxicities, and 22% had grade 4 hematologic toxicities. The most common hematological toxicities were neutropenia, leukopenia, and lymphopenia. Thirty-three percent had grade 3 non-hematologic toxicities. The most common non-hematological toxicities were stomatitis, hyperglycemia, and fatigue. The median number of cycles completed was 4 (range 0-8). Among 25 eligible patients, 9 patients (36%) achieved the best response as partial response, 9 (36%) had stable disease, and 7 (28%) had progression. The median time to progression was 2.6 months (95% CI [2.1, 4.0]), and median overall survival (OS) was 8.3 months (95% CI [5.5, undefined]). CONCLUSION Eribulin 1.1 mg/m2 days 1 and 8 every 3 weeks with everolimus 5 mg daily was defined as the highest dose with acceptable toxicity (RP2D). The combination is safe, and efficacy is modest. A post hoc analysis showed that participants that used dexamethasone mouthwash stayed on treatment for one additional cycle. TRIAL REGISTRATION ClinicalTrials.gov, NCT02120469. Registered 18 April 2014.
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Affiliation(s)
- Jin Sun Lee
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Susan E Yost
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Suzette Blanchard
- Department of Biostatistics, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Hongwei Holly Yin
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Raju Pillai
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Kim Robinson
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Aileen Tang
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Norma Martinez
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Jana Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Wei Wen
- Department of Surgery, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - John H Yim
- Department of Surgery, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | | | - Yuqi Ren
- NanoString Technologies, Inc., Seattle, WA, USA
| | | | - Joanne Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
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Gutova M, Flores L, Adhikarla V, Tsaturyan L, Tirughana R, Aramburo S, Metz M, Gonzaga J, Annala A, Synold TW, Portnow J, Rockne RC, Aboody KS. Quantitative Evaluation of Intraventricular Delivery of Therapeutic Neural Stem Cells to Orthotopic Glioma. Front Oncol 2019; 9:68. [PMID: 30838174 PMCID: PMC6389659 DOI: 10.3389/fonc.2019.00068] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 10/01/2018] [Accepted: 01/25/2019] [Indexed: 01/02/2023] Open
Abstract
Neural stem cells (NSCs) are inherently tumor-tropic, which allows them to migrate through normal tissue and selectively localize to invasive tumor sites in the brain. We have engineered a clonal, immortalized allogeneic NSC line (HB1.F3.CD21; CD-NSCs) that maintains its stem-like properties, a normal karyotype and is HLA Class II negative. It is genetically and functionally stable over time and multiple passages, and has demonstrated safety in phase I glioma trials. These properties enable the production of an "off-the-shelf" therapy that can be readily available for patient treatment. There are multiple factors contributing to stem cell tumor-tropism, and much remains to be elucidated. The route of NSC delivery and the distribution of NSCs at tumor sites are key factors in the development of effective cell-based therapies. Stem cells can be engineered to deliver and/or produce many different therapeutic agents, including prodrug activating enzymes (which locally convert systemically administered prodrugs to active chemotherapeutic agents); oncolytic viruses; tumor-targeted antibodies; therapeutic nanoparticles; and extracellular vesicles that contain therapeutic oligonucleotides. By targeting these therapeutics selectively to tumor foci, we aim to minimize toxicity to normal tissues and maximize therapeutic benefits. In this manuscript, we demonstrate that NSCs administered via intracerebral/ventricular (IVEN) routes can migrate efficiently toward single or multiple tumor foci. IVEN delivery will enable repeat administrations for patients through an Ommaya reservoir, potentially resulting in improved therapeutic outcomes. In our preclinical studies using various glioma lines, we have quantified NSC migration and distribution in mouse brains and have found robust migration of our clinically relevant HB1.F3.CD21 NSC line toward invasive tumor foci, irrespective of their origin. These results establish proof-of-concept and demonstrate the potential of developing a multitude of therapeutic options using modified NSCs.
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Affiliation(s)
- Margarita Gutova
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Linda Flores
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Vikram Adhikarla
- Division of Mathematical Oncology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Lusine Tsaturyan
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Revathiswari Tirughana
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Soraya Aramburo
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Marianne Metz
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Joanna Gonzaga
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Alexander Annala
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Timothy W Synold
- Department of Cancer Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Jana Portnow
- Department of Medical Oncology & Therapeutics, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Russell C Rockne
- Division of Mathematical Oncology, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Karen S Aboody
- Department of Developmental and Stem Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, United States
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Yuan Y, Yost S, Blanchard S, Yin H, Li M, Robinson K, Tang A, Martinez N, Leong L, Somlo G, Tank Patel N, Waisman J, Portnow J, Hurria A, Luu TH, Mortimer J. Abstract P6-18-18: Phase I trial of eribulin and everolimus in patients with metastatic triple negative breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Alteration of PI3K/Akt/mTOR pathway is the most common genomic abnormality detected in triple negative breast cancer (TNBC). Everolimus acts synergistically with eribulin in inducing apoptosis in TNBC cell lines and xenografts in our preclinical study. This phase I trial was designed to test the safety and tolerability of combining eribulin and everolimus in patients (pts) with metastatic TNBC.
Methods: The overall objective of this study was to describe the safety and toxicities of the combination. The secondary objective was to assess activity based on response rate (RR) and progression free survival (PFS). Eligibility criteria included pts with metastatic TNBC, ECOG 0-2, 0-3 lines of prior chemotherapy in metastatic setting, and prior treatment with anthracycline and/or taxane therapy. The study utilized the toxicity equivalence range (TEQR) design with a target equivalence range for dose-limiting toxicities (DLTs) of 0.20-0.35. The recommended phase 2 dose (RP2D) will be the dose closest to the target of 0.25 below 0.51 based on isotonic regression.Three dosing levels of the combinations were tested: level A1 (everolimus 5mg daily; eribulin 1.4 mg/m2 days 1, 8 every 3 weeks), level A2 (everolimus 7.5mg daily; eribulin 1.4 mg/m2, days 1, 8 every 3 weeks), level B1(everolimus 5mg daily; eribulin 1.1 mg/m2 days 1, 8 every 3 weeks). Nanostring RNA analysis and genomic mutation analysis were conducted in 16 pts with available tumor tissue.
Results: A total of 27 pts were enrolled. Median age was 55 years (range 36-76). Two pts were ineligible due to HER2+ on repeat biopsy and were only included in the toxicity analysis. Dose level B1 (everolimus 5mg daily and eribulin 1.1 mg/m2 days 1, 8 every 3 weeks) was determined to be the RP2D doses. The DLTs were neutropenia, stomatitis and hyperglycemia. Across all cycles, 59% (16/27) had a ≥ Gr3 toxicity attributed to treatment at the possible or above level. 44% (12/27) had Gr3 heme-toxicities. The most common toxicities were ≥ Gr3 neutropenia (10 pts), Gr3 lymphopenia (6 pts) and ≥ Gr3 leukopenia (7 pts). 33% (9/27) had Gr3 non-heme toxicities. The most common were Gr3 stomatitis (3 pts), Gr3 hyperglycemia (3 pts) and Gr3 fatigue (5 pts). The median number of cycles completed was 4 (0-8). 68% (17/25) had a dose modification or hold, 14 of 25 (56%) were for eribulin and 15 of 25 (60%) were for everolimus. Of 25 eligible pts, 8 (32%) achieved a best response as partial response, 11 (44%) had stable disease and 6 (24%) had progression. 80% (20/25) experienced progression by RECIST or showed clinical progression, and the median time to progression was 2.7 mo (95% CI (2.2, 4.6)). At the time of this analysis, 16 participants had died, median OS was 6.3 mo (95% CI (5.3, undefined)). Two pts are still being followed on treatment. PI3K-Akt-mTOR pathway genes and mutations profiles were studied.
Conclusion: Eribulin 1.1 mg/m2 days 1, 8 and everolimus 5mg daily was defined as the RP2D. Genomic analysis is currently underway to understand the molecular mechanisms of resistance.
Citation Format: Yuan Y, Yost S, Blanchard S, Yin H, Li M, Robinson K, Tang A, Martinez N, Leong L, Somlo G, Tank Patel N, Waisman J, Portnow J, Hurria A, Luu T-H, Mortimer J. Phase I trial of eribulin and everolimus in patients with metastatic triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-18.
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Affiliation(s)
- Y Yuan
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - S Yost
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - S Blanchard
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - H Yin
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - M Li
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - K Robinson
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - A Tang
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - N Martinez
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - L Leong
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - G Somlo
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - N Tank Patel
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - J Waisman
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - J Portnow
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - A Hurria
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - T-H Luu
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
| | - J Mortimer
- City of Hope National Medical Center, Duarte, CA; OncoGambit, Irvine, CA
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Portnow J, Synold T, Badie B, Blanchard S, Kilpatrick J, Tirughana R, Metz M, Tran V, Aboody K. ACTR-22. A PHASE I STUDY OF CYTOSINE DEAMINASE-EXPRESSING NEURAL STEM CELLS (CD-NSCs) ADMINISTERED INTRACRANIALLY AND IN COMBINATION WITH ORAL 5-FLUOROCYTOSINE (5-FC) AND LEUCOVORIN IN PATIENTS WITH RECURRENT HIGH GRADE GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.056] [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)
| | | | - Behnam Badie
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Suzette Blanchard
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | | | | | | | | | - Karen Aboody
- City of Hope Beckman Research Institute and National Medical Center, Duarte, CA, USA
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Portnow J, Synold T, Tran V, Chiu V, Alizadeh D, Wang D, Brito A, Kilpatrick J, Mcnamara P, Forman S, Badie B, Brown C. ATIM-17. PEMBROLIZUMAB BLOCKS PD-1 ON CAR T CELLS ADMINISTERED INTRAVENTRICULARLY TO GLIOBLASTOMA PATIENTS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.012] [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: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Alfonso Brito
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | | | | | | | - Behnam Badie
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Christine Brown
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
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Sahoo P, Badie B, Brown C, Portnow J, Chaudhry A, Kilpatrick J, Rockne R. NIMG-28. CONVENTIONAL AND ADVANCED IMAGING FINDINGS FOLLOWING INTRACAVITARY DELIVERY OF AUTOLOGOUS CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY IN RECURRENT GLIOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.754] [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: 11/14/2022] Open
Affiliation(s)
| | - Behnam Badie
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Christine Brown
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | | | | | | | - Russell Rockne
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
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Yuan Y, Hou W, Padam S, Frankel P, Sedrak M, Portnow J, Mortimer J, Yeon C, Hurria A, Tang A, Martinez N, Lee P. Peripheral blood mononuclear cell biomarkers predict response to immune checkpoint inhibitor therapy in metastatic breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nabors LB, Portnow J, Ammirati M, Baehring J, Brem H, Butowski N, Fenstermaker RA, Forsyth P, Hattangadi-Gluth J, Holdhoff M, Howard S, Junck L, Kaley T, Kumthekar P, Loeffler JS, Moots PL, Mrugala MM, Nagpal S, Pandey M, Parney I, Peters K, Puduvalli VK, Ragsdale J, Rockhill J, Rogers L, Rusthoven C, Shonka N, Shrieve DC, Sills AK, Swinnen LJ, Tsien C, Weiss S, Wen PY, Willmarth N, Bergman MA, Engh A. NCCN Guidelines Insights: Central Nervous System Cancers, Version 1.2017. J Natl Compr Canc Netw 2018; 15:1331-1345. [PMID: 29118226 DOI: 10.6004/jnccn.2017.0166] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For many years, the diagnosis and classification of gliomas have been based on histology. Although studies including large populations of patients demonstrated the prognostic value of histologic phenotype, variability in outcomes within histologic groups limited the utility of this system. Nonetheless, histology was the only proven and widely accessible tool available at the time, thus it was used for clinical trial entry criteria, and therefore determined the recommended treatment options. Research to identify molecular changes that underlie glioma progression has led to the discovery of molecular features that have greater diagnostic and prognostic value than histology. Analyses of these molecular markers across populations from randomized clinical trials have shown that some of these markers are also predictive of response to specific types of treatment, which has prompted significant changes to the recommended treatment options for grade III (anaplastic) gliomas.
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Liau LM, Ashkan K, Tran DD, Campian JL, Trusheim JE, Cobbs CS, Heth JA, Salacz M, Taylor S, D'Andre SD, Iwamoto FM, Dropcho EJ, Moshel YA, Walter KA, Pillainayagam CP, Aiken R, Chaudhary R, Goldlust SA, Bota DA, Duic P, Grewal J, Elinzano H, Toms SA, Lillehei KO, Mikkelsen T, Walbert T, Abram SR, Brenner AJ, Brem S, Ewend MG, Khagi S, Portnow J, Kim LJ, Loudon WG, Thompson RC, Avigan DE, Fink KL, Geoffroy FJ, Lindhorst S, Lutzky J, Sloan AE, Schackert G, Krex D, Meisel HJ, Wu J, Davis RP, Duma C, Etame AB, Mathieu D, Kesari S, Piccioni D, Westphal M, Baskin DS, New PZ, Lacroix M, May SA, Pluard TJ, Tse V, Green RM, Villano JL, Pearlman M, Petrecca K, Schulder M, Taylor LP, Maida AE, Prins RM, Cloughesy TF, Mulholland P, Bosch ML. Correction to: First results on survival from a large Phase 3 clinical trial of an autologous dendritic cell vaccine in newly diagnosed glioblastoma. J Transl Med 2018; 16:179. [PMID: 29958537 PMCID: PMC6026340 DOI: 10.1186/s12967-018-1552-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Linda M Liau
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
| | | | | | | | | | - Charles S Cobbs
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Jason A Heth
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Salacz
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sarah Taylor
- University of Kansas Cancer Center, Kansas City, KS, USA
| | | | | | | | | | - Kevin A Walter
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Robert Aiken
- Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Rekha Chaudhary
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | - Paul Duic
- Winthrop-University Hospital, Mineola, NY, USA
| | | | | | | | | | | | | | | | | | - Steven Brem
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Simon Khagi
- University of North Carolina, Chapel Hill, NC, USA
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA, USA
| | - Lyndon J Kim
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Karen L Fink
- Baylor University Medical Center, Dallas, TX, USA
| | | | | | - Jose Lutzky
- Mount Sinai Comprehensive Cancer Center, Miami, FL, USA
| | - Andrew E Sloan
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gabriele Schackert
- University Hospital Carl-Gustav-Carus of Technical University, Dresden, Germany
| | - Dietmar Krex
- University Hospital Carl-Gustav-Carus of Technical University, Dresden, Germany
| | | | - Julian Wu
- Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Arnold B Etame
- H. Lee Moffit Cancer Center and Research Institute, Tampa, FL, USA
| | - David Mathieu
- CHUSHopital Fleurimont, Sherbrooke University, Sherbrooke, QC, Canada
| | | | | | - Manfred Westphal
- Neurochirurgische Klinik University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | - Victor Tse
- Kaiser Permanente Northern California, Redwood City, CA, USA
| | | | - John L Villano
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Kevin Petrecca
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | | | - Lynne P Taylor
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
| | | | - Robert M Prins
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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Liau LM, Ashkan K, Tran DD, Campian JL, Trusheim JE, Cobbs CS, Heth JA, Salacz M, Taylor S, D'Andre SD, Iwamoto FM, Dropcho EJ, Moshel YA, Walter KA, Pillainayagam CP, Aiken R, Chaudhary R, Goldlust SA, Bota DA, Duic P, Grewal J, Elinzano H, Toms SA, Lillehei KO, Mikkelsen T, Walbert T, Abram SR, Brenner AJ, Brem S, Ewend MG, Khagi S, Portnow J, Kim LJ, Loudon WG, Thompson RC, Avigan DE, Fink KL, Geoffroy FJ, Lindhorst S, Lutzky J, Sloan AE, Schackert G, Krex D, Meisel HJ, Wu J, Davis RP, Duma C, Etame AB, Mathieu D, Kesari S, Piccioni D, Westphal M, Baskin DS, New PZ, Lacroix M, May SA, Pluard TJ, Tse V, Green RM, Villano JL, Pearlman M, Petrecca K, Schulder M, Taylor LP, Maida AE, Prins RM, Cloughesy TF, Mulholland P, Bosch ML. First results on survival from a large Phase 3 clinical trial of an autologous dendritic cell vaccine in newly diagnosed glioblastoma. J Transl Med 2018; 16:142. [PMID: 29843811 PMCID: PMC5975654 DOI: 10.1186/s12967-018-1507-6] [Citation(s) in RCA: 325] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023] Open
Abstract
Background Standard therapy for glioblastoma includes surgery, radiotherapy, and temozolomide. This Phase 3 trial evaluates the addition of an autologous tumor lysate-pulsed dendritic cell vaccine (DCVax®-L) to standard therapy for newly diagnosed glioblastoma. Methods After surgery and chemoradiotherapy, patients were randomized (2:1) to receive temozolomide plus DCVax-L (n = 232) or temozolomide and placebo (n = 99). Following recurrence, all patients were allowed to receive DCVax-L, without unblinding. The primary endpoint was progression free survival (PFS); the secondary endpoint was overall survival (OS). Results For the intent-to-treat (ITT) population (n = 331), median OS (mOS) was 23.1 months from surgery. Because of the cross-over trial design, nearly 90% of the ITT population received DCVax-L. For patients with methylated MGMT (n = 131), mOS was 34.7 months from surgery, with a 3-year survival of 46.4%. As of this analysis, 223 patients are ≥ 30 months past their surgery date; 67 of these (30.0%) have lived ≥ 30 months and have a Kaplan-Meier (KM)-derived mOS of 46.5 months. 182 patients are ≥ 36 months past surgery; 44 of these (24.2%) have lived ≥ 36 months and have a KM-derived mOS of 88.2 months. A population of extended survivors (n = 100) with mOS of 40.5 months, not explained by known prognostic factors, will be analyzed further. Only 2.1% of ITT patients (n = 7) had a grade 3 or 4 adverse event that was deemed at least possibly related to the vaccine. Overall adverse events with DCVax were comparable to standard therapy alone. Conclusions Addition of DCVax-L to standard therapy is feasible and safe in glioblastoma patients, and may extend survival. Trial registration Funded by Northwest Biotherapeutics; Clinicaltrials.gov number: NCT00045968; https://clinicaltrials.gov/ct2/show/NCT00045968?term=NCT00045968&rank=1; initially registered 19 September 2002
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Affiliation(s)
- Linda M Liau
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
| | | | | | | | | | - Charles S Cobbs
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Jason A Heth
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Salacz
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sarah Taylor
- University of Kansas Cancer Center, Kansas City, KS, USA
| | | | | | | | | | - Kevin A Walter
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Robert Aiken
- Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Rekha Chaudhary
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | - Paul Duic
- Winthrop-University Hospital, Mineola, NY, USA
| | | | | | | | | | | | | | | | | | - Steven Brem
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Simon Khagi
- University of North Carolina, Chapel Hill, NC, USA
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA, USA
| | - Lyndon J Kim
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Karen L Fink
- Baylor University Medical Center, Dallas, TX, USA
| | | | | | - Jose Lutzky
- Mount Sinai Comprehensive Cancer Center, Miami, FL, USA
| | - Andrew E Sloan
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gabriele Schackert
- University Hospital Carl-Gustav-Carus of Technical University, Dresden, Germany
| | - Dietmar Krex
- University Hospital Carl-Gustav-Carus of Technical University, Dresden, Germany
| | | | - Julian Wu
- Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Arnold B Etame
- H. Lee Moffit Cancer Center and Research Institute, Tampa, FL, USA
| | - David Mathieu
- CHUS-Hopital Fleurimont, Sherbrooke University, Sherbrooke, QC, Canada
| | | | | | - Manfred Westphal
- Neurochirurgische Klinik University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | - Victor Tse
- Kaiser Permanente Northern California, Redwood City, CA, USA
| | | | - John L Villano
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Kevin Petrecca
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | | | - Lynne P Taylor
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
| | | | - Robert M Prins
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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Ghoda L, Metz M, Tirughana R, Aramburo S, Gilchrist M, Gutova M, Synold T, Barish M, Brown C, D’Apuzzo M, Moats R, Potter P, Blanchard S, Portnow J, Aboody K. STEM-32. PRE-CLINICAL SAFETY AND EFFICACY STUDIES OF NEURAL STEM CELL MEDIATED CARBOXYLESTERASE/IRINOTECAN ENZYME/PRODRUG GENE THERAPY FOR RECURRENT GLIOMA LEADING TO FIRST-IN-HUMAN PHASE I CLINICAL TRIAL. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sahoo P, Aboody K, Gutova M, D’Apuzzo M, Portnow J, Badie B, Frankel P, Annala AJ, Rockne R. NIMG-57. SURVIVAL ANALYSIS OF GLIOBLASTOMA (GBM) PATIENTS RECEIVING NEURAL STEM CELL (NSC)-MEDIATED TREATMENT USING T1-WEIGHTED DYNAMIC CONTRAST ENHANCED (DCE) MRI. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Lesniak MS, Stupp R, Sachdev S, Lukas R, Chandler J, Portnow J, Amidei C, Miska J, Balyasnikova I, Ahmed A, Curiel D, Strong T, LeFever A, Adams A, Giles F, Aboody K. ACTR-36. A PHASE I STUDY OF NEURAL STEM CELLS LOADED WITH AN ONCOLYTIC ADENOVIRUS FOR PATIENTS WITH NEWLY DIAGNOSED MALIGNANT GLIOMA: PRELIMINARY SAFETY AND DATA ANALYSIS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Priceman SJ, Tilakawardane D, Jeang B, Aguilar B, Murad JP, Park AK, Chang WC, Ostberg JR, Neman J, Jandial R, Portnow J, Forman SJ, Brown CE. Regional Delivery of Chimeric Antigen Receptor-Engineered T Cells Effectively Targets HER2 + Breast Cancer Metastasis to the Brain. Clin Cancer Res 2017; 24:95-105. [PMID: 29061641 DOI: 10.1158/1078-0432.ccr-17-2041] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/13/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
Purpose: Metastasis to the brain from breast cancer remains a significant clinical challenge, and may be targeted with CAR-based immunotherapy. CAR design optimization for solid tumors is crucial due to the absence of truly restricted antigen expression and potential safety concerns with "on-target off-tumor" activity. Here, we have optimized HER2-CAR T cells for the treatment of breast to brain metastases, and determined optimal second-generation CAR design and route of administration for xenograft mouse models of breast metastatic brain tumors, including multifocal and leptomeningeal disease.Experimental Design: HER2-CAR constructs containing either CD28 or 4-1BB intracellular costimulatory signaling domains were compared for functional activity in vitro by measuring cytokine production, T-cell proliferation, and tumor killing capacity. We also evaluated HER2-CAR T cells delivered by intravenous, local intratumoral, or regional intraventricular routes of administration using in vivo human xenograft models of breast cancer that have metastasized to the brain.Results: Here, we have shown that HER2-CARs containing the 4-1BB costimulatory domain confer improved tumor targeting with reduced T-cell exhaustion phenotype and enhanced proliferative capacity compared with HER2-CARs containing the CD28 costimulatory domain. Local intracranial delivery of HER2-CARs showed potent in vivo antitumor activity in orthotopic xenograft models. Importantly, we demonstrated robust antitumor efficacy following regional intraventricular delivery of HER2-CAR T cells for the treatment of multifocal brain metastases and leptomeningeal disease.Conclusions: Our study shows the importance of CAR design in defining an optimized CAR T cell, and highlights intraventricular delivery of HER2-CAR T cells for treating multifocal brain metastases. Clin Cancer Res; 24(1); 95-105. ©2017 AACR.
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Affiliation(s)
- Saul J Priceman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - Dileshni Tilakawardane
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - Brook Jeang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - Brenda Aguilar
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - John P Murad
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - Anthony K Park
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - Wen-Chung Chang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - Julie R Ostberg
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - Josh Neman
- Department of Neurosurgery, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - Rahul Jandial
- Division of Neurosurgery, Beckman Research Institute, City of Hope, Duarte, California
| | - Jana Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California. .,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
| | - Christine E Brown
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California. .,T Cell Therapeutics Research Laboratory, City of Hope, Duarte, California
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Brown CE, Alizadeh D, Starr R, Weng L, Wagner JR, Naranjo A, Ostberg JR, Blanchard MS, Kilpatrick J, Simpson J, Kurien A, Priceman SJ, Wang X, Harshbarger TL, D'Apuzzo M, Ressler JA, Jensen MC, Barish ME, Chen M, Portnow J, Forman SJ, Badie B. Regression of Glioblastoma after Chimeric Antigen Receptor T-Cell Therapy. N Engl J Med 2016; 375:2561-9. [PMID: 28029927 PMCID: PMC5390684 DOI: 10.1056/nejmoa1610497] [Citation(s) in RCA: 1160] [Impact Index Per Article: 145.0] [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] [Indexed: 12/11/2022]
Abstract
A patient with recurrent multifocal glioblastoma received chimeric antigen receptor (CAR)-engineered T cells targeting the tumor-associated antigen interleukin-13 receptor alpha 2 (IL13Rα2). Multiple infusions of CAR T cells were administered over 220 days through two intracranial delivery routes - infusions into the resected tumor cavity followed by infusions into the ventricular system. Intracranial infusions of IL13Rα2-targeted CAR T cells were not associated with any toxic effects of grade 3 or higher. After CAR T-cell treatment, regression of all intracranial and spinal tumors was observed, along with corresponding increases in levels of cytokines and immune cells in the cerebrospinal fluid. This clinical response continued for 7.5 months after the initiation of CAR T-cell therapy. (Funded by Gateway for Cancer Research and others; ClinicalTrials.gov number, NCT02208362 .).
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Affiliation(s)
- Christine E Brown
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Darya Alizadeh
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Renate Starr
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Lihong Weng
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Jamie R Wagner
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Araceli Naranjo
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Julie R Ostberg
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - M Suzette Blanchard
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Julie Kilpatrick
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Jennifer Simpson
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Anita Kurien
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Saul J Priceman
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Xiuli Wang
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Todd L Harshbarger
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Massimo D'Apuzzo
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Julie A Ressler
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Michael C Jensen
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Michael E Barish
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Mike Chen
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Jana Portnow
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Stephen J Forman
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
| | - Behnam Badie
- From the Department of Hematology and Hematopoietic Cell Transplantation, T Cell Therapeutics Research Laboratory (C.E.B., D.A., R.S., L.W., J.R.W., A.N., J.R.O., A.K., S.J.P., X.W., S.J.F.), and the Departments of Information Sciences (M.S.B.), Clinical Research (J.K., J.S.), Neurosurgery (T.L.H., M.C., B.B.), Pathology (M.D.), Diagnostic Radiology (J.A.R.), Developmental and Stem Cell Biology (M.E.B.), and Medical Oncology and Therapeutics Research (J.P.), City of Hope Beckman Research Institute and Medical Center, Duarte, CA; and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle (M.C.J.)
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Portnow J, Synold TW, Badie B, Tirughana R, Lacey SF, D'Apuzzo M, Metz MZ, Najbauer J, Bedell V, Vo T, Gutova M, Frankel P, Chen M, Aboody KS. Neural Stem Cell-Based Anticancer Gene Therapy: A First-in-Human Study in Recurrent High-Grade Glioma Patients. Clin Cancer Res 2016; 23:2951-2960. [PMID: 27979915 DOI: 10.1158/1078-0432.ccr-16-1518] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/08/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
Purpose: Human neural stem cells (NSC) are inherently tumor tropic, making them attractive drug delivery vehicles. Toward this goal, we retrovirally transduced an immortalized, clonal NSC line to stably express cytosine deaminase (HB1.F3.CD.C21; CD-NSCs), which converts the prodrug 5-fluorocytosine (5-FC) to 5-fluorouracil (5-FU).Experimental Design: Recurrent high-grade glioma patients underwent intracranial administration of CD-NSCs during tumor resection or biopsy. Four days later, patients began taking oral 5-FC every 6 hours for 7 days. Study treatment was given only once. A standard 3 + 3 dose escalation schema was used to increase doses of CD-NSCs from 1 × 107 to 5 × 107 and 5-FC from 75 to 150 mg/kg/day. Intracerebral microdialysis was performed to measure brain levels of 5-FC and 5-FU. Serial blood samples were obtained to assess systemic drug concentrations as well as to perform immunologic correlative studies.Results: Fifteen patients underwent study treatment. We saw no dose-limiting toxicity (DLT) due to the CD-NSCs. There was 1 DLT (grade 3 transaminitis) possibly related to 5-FC. We did not see development of anti-CD-NSC antibodies and did not detect CD-NSCs or replication-competent retrovirus in the systemic circulation. Intracerebral microdialysis revealed that CD-NSCs produced 5-FU locally in the brain in a 5-FC dose-dependent manner. Autopsy data indicate that CD-NSCs migrated to distant tumor sites and were nontumorigenic.Conclusions: Collectively, our results from this first-in-human study demonstrate initial safety and proof of concept regarding the ability of NSCs to target brain tumors and locally produce chemotherapy. Clin Cancer Res; 23(12); 2951-60. ©2016 AACR.
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Affiliation(s)
- Jana Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California.
| | | | - Behnam Badie
- Division of Neurosurgery, City of Hope, Duarte, California
| | | | - Simon F Lacey
- Clinical Immunobiology Correlative Studies Laboratory, City of Hope, Duarte, California
| | | | - Marianne Z Metz
- Department of Developmental & Stem Cell Biology, City of Hope, Duarte, California
| | - Joseph Najbauer
- Department of Developmental & Stem Cell Biology, City of Hope, Duarte, California
| | | | - Tien Vo
- Department of Developmental & Stem Cell Biology, City of Hope, Duarte, California
| | - Margarita Gutova
- Department of Developmental & Stem Cell Biology, City of Hope, Duarte, California
| | - Paul Frankel
- Division of Biostatistics, City of Hope, Duarte, California
| | - Mike Chen
- Division of Neurosurgery, City of Hope, Duarte, California
| | - Karen S Aboody
- Division of Neurosurgery, City of Hope, Duarte, California.,Department of Developmental & Stem Cell Biology, City of Hope, Duarte, California
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Aghi M, Vogelbaum M, Kalkanis S, Bota D, Carter B, Chen C, Elder B, Engh J, Goldlust S, Kaptain G, Kesari S, Landolfi J, Liau L, Mikkelsen T, Piccioni D, Portnow J, Singer S, Walbert T, Gruber H, Ibañez C, Jolly D, Mitchell L, Ostertag D, Shorr J, Yang L, Das A, Cloughesy T. ATIM-05. COMPLEMENTARY CLINICAL AND ANCILLARY DATA FROM 123 PATIENTS WITH RECURRENT HIGH GRADE GLIOMA FROM THREE PHASE 1 TRIALS OF TOCA 511 AND TOCA FC: UPDATE AND JUSTIFICATION FOR A PHASE 2/3 TRIAL. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Brown C, Alizadeh D, Starr R, Weng L, Wagner J, Naranjo A, Blanchard S, Kilpatrick J, Simpson J, Ressler JA, Jensen M, Portnow J, D’Apuzzo M, Barish M, Forman S, Badie B. ATIM-13. PHASE I STUDY OF CHIMERIC ANTIGEN RECEPTOR-ENGINEERED T CELLS TARGETING IL13Rα2 FOR THE TREATMENT OF GLIOBLASTOMA. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cloughesy T, Aghi M, Bota D, Chen C, Elder J, Kalkanis S, Kaptain G, Kesari S, Landolfi J, Mikkelsen T, Portnow J, Robbins J, Ostertag D, Chu A, Huang T, Vogelbaum M. Prior Radiation in Subjects Who Were Treated With Toca 511 and Toca FC Across 3 Toca 511 Phase 1 Trials. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.758] [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: 11/16/2022]
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Nabors LB, Portnow J, Ammirati M, Baehring J, Brem H, Brown P, Butowski N, Chamberlain MC, Fenstermaker RA, Friedman A, Gilbert MR, Hattangadi-Gluth J, Holdhoff M, Junck L, Kaley T, Lawson R, Loeffler JS, Lovely MP, Moots PL, Mrugala MM, Newton HB, Parney I, Raizer JJ, Recht L, Shonka N, Shrieve DC, Sills AK, Swinnen LJ, Tran D, Tran N, Vrionis FD, Weiss S, Wen PY, McMillian N, Engh AM. Central Nervous System Cancers, Version 1.2015. J Natl Compr Canc Netw 2016; 13:1191-202. [PMID: 26483059 DOI: 10.6004/jnccn.2015.0148] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Central Nervous System (CNS) Cancers provide interdisciplinary recommendations for managing adult CNS cancers. Primary and metastatic brain tumors are a heterogeneous group of neoplasms with varied outcomes and management strategies. These NCCN Guidelines Insights summarize the NCCN CNS Cancers Panel's discussion and highlight notable changes in the 2015 update. This article outlines the data and provides insight into panel decisions regarding adjuvant radiation and chemotherapy treatment options for high-risk newly diagnosed low-grade gliomas and glioblastomas. Additionally, it describes the panel's assessment of new data and the ongoing debate regarding the use of alternating electric field therapy for high-grade gliomas.
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Affiliation(s)
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA
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Cloughesy TF, Aghi MK, Chen C, Elder JB, Kesari S, Kalkanis SN, Kaptain G, Landolfi JC, Mikkelsen T, Portnow J, Robbins JM, Ostertag D, Das A, Chu A, Vogelbaum MA. Encouraging survival with Toca 511 and Toca FC compared to external lomustine control. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Clark Chen
- University of California, San Diego, San Diego, CA
| | | | - Santosh Kesari
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, CA
| | | | | | | | | | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Asha Das
- Genentech, Inc., South San Francisco, CA
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Afkhami M, Sharma V, Cuellar M, D'Apuzzo M, Badie B, Portnow J, Pillai RK, Aoun PA, Telatar M. Detection of MGMT promoter methylation in malignant gliomas. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23131] [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)
| | | | | | | | - Behnam Badie
- City of Hope National Medical Center, Duarte, CA
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA
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Brown CE, Starr R, Weng L, Alizadeh D, Wagner JR, Kilpatrick J, Harshbarger TL, D'Apuzzo M, Ressler JA, Jensen MC, Portnow J, Barish ME, Forman SJ, Badie B. 247. Phase I Study of Second Generation Chimeric Antigen Receptor-Engineered T Cells Targeting IL13Rα2 for the Treatment of Glioblastoma. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)33056-8] [Citation(s) in RCA: 2] [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: 10/20/2022] Open
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Marcinkowski E, Luu T, Yuan Y, Mortimer J, Leong L, Portnow J, Xing Q, Wen W, Yim J. Abstract P6-13-17: The combination of eribulin and everolimus results in enhanced suppression of tumors in mouse models of triple negative breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-13-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION. Triple negative breast cancer (TNBC) is an aggressive form of breast cancer with poor overall and relapse free survival. TNBC does not have targeted or matched therapies. Patients have worse outcomes after chemotherapy than with other subtypes of breast cancer. TNBC accounts for 12-17% of all breast cancers, leaving an unmet need for targeted therapy. Efforts to profile these tumors have revealed several potential targets.
The PI3K/AKT/mTOR pathway is a signal transduction pathway that links growth related hormone receptor interaction to downstream targets such as AKT and mammalian target of rapamycin (mTOR). This pathway targets affect cell proliferation, survival, and apoptosis. Patients with TNBC have high levels of AKT expression and activation of this pathway.
Microtubule-targeting agents have been used in TNBC. Eribulin mesylate is a microtubule-targeting agent with benefits in treating taxane and anthracycline refractory breast cancer via a microtubule targeting anti-mitotic mechanism. It has been approved for the treatment of TNBC in heavily pretreated patients.
Despite targeted therapy, breast cancer cells can grow resistant. Targeting multiple cancer growth pathways has been used in patients that progress on therapy or fail to respond. We hypothesized that targeting both mitotic blockade and PI3K/AKT/mTOR pathway may provide enhanced suppression of TNBC growth in both syngeneic and xenogeneic mouse models.
MATERIALS AND METHODS. MDA-MB-468 is a human TNBC cell line. 4T1 is a highly metastatic mouse TNBC cell line derived from a spontaneously arising Balb/c mammary tumor. 4T1 and MDA-MB-468 tumor cells were injected into the mammary fat pad of female Balb/c and NOD/SCID/IL2Rgamma null (NSG) mice (with matrigel) respectively. After tumors were formed Balb/c mice were treated three times per week with vehicle, eribulin (0.75 mg/kg i.v.), RAD001 (5 mg/kg via oral gavage) or a combination of both. NSG mice were treated three times per week with vehicle, eribulin (0.5 mg/kg i.v.), RAD001 (5 mg/kg by oral gavage), or a combination of both. Tumor volumes and body weights were measured. Student t-test was used to compare the means of two groups and determine the p value (p<0.05 is significant). N=3-8 per group.
Table I. 4T1 mouse breast cancer modelTreatmentTumor Volume (mm3)+/-SEMVehicle511.6+/-56.82Eribulin445.6+/-92.17Everolimus324.9+/-24.55Combination171.4+/-16.07 p valueCombination vs. Vehicle0.0001Combination vs. Eribulin0.01Combination vs. Everolimus0.001
Table II. MDA-MB-468 human breast cancer cells in immune deficient mice.TreatmentTumor Volume (mm3)+/-SEMVehicle966.8+/-69.2Eribulin67.81+/-11.79Everolimus830.6+/-156.3Combination31.37+/-3.37 p valueCombination vs. Eribulin0.041Combination vs. Everolimus0.0076
RESULTS. In the 4T1 syngeneic breast cancer mouse model, the combination of Eribulin and Everolimus resulted in marked suppression of tumor growth which was statistically significant versus vehicle treatment alone, or Eribulin or Everolimus alone (Table I). In the MDA-MB-468 model, the combination of Eribulin and Everolimus demonstrated marked suppression of tumor growth which was statistically significant compared to either agent alone (Table II).
Citation Format: Marcinkowski E, Luu T, Yuan Y, Mortimer J, Leong L, Portnow J, Xing Q, Wen W, Yim J. The combination of eribulin and everolimus results in enhanced suppression of tumors in mouse models of triple negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-13-17.
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Wheeler LA, Manzanera AG, Bell SD, Cavaliere R, McGregor JM, Grecula JC, Newton HB, Lo SS, Badie B, Portnow J, Teh BS, Trask TW, Baskin DS, New PZ, Aguilar LK, Aguilar-Cordova E, Chiocca EA. Phase II multicenter study of gene-mediated cytotoxic immunotherapy as adjuvant to surgical resection for newly diagnosed malignant glioma. Neuro Oncol 2016; 18:1137-45. [PMID: 26843484 DOI: 10.1093/neuonc/now002] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite aggressive standard of care (SOC) treatment, survival of malignant gliomas remains very poor. This Phase II, prospective, matched controlled, multicenter trial was conducted to assess the safety and efficacy of aglatimagene besadenovec (AdV-tk) plus valacyclovir (gene-mediated cytotoxic immunotherapy [GMCI]) in combination with SOC for newly diagnosed malignant glioma patients. METHODS Treatment cohort patients received SOC + GMCI and were enrolled at 4 institutions from 2006 to 2010. The preplanned, matched-control cohort included all concurrent patients meeting protocol criteria and SOC at a fifth institution. AdV-tk was administered at surgery followed by SOC radiation and temozolomide. Subset analyses were preplanned, based on prognostic factors: pathological diagnosis (glioblastoma vs others) and extent of resection. RESULTS Forty-eight patients completed SOC + GMCI, and 134 met control cohort criteria. Median overall survival (OS) was 17.1 months for GMCI + SOC versus 13.5 months for SOC alone (P = .0417). Survival at 1, 2, and 3 years was 67%, 35%, and 19% versus 57%, 22%, and 8%, respectively. The greatest benefit was observed in gross total resection patients: median OS of 25 versus 16.9 months (P = .0492); 1, 2, and 3-year survival of 90%, 53%, and 32% versus 64%, 28% and 6%, respectively. There were no dose-limiting toxicities; fever, fatigue, and headache were the most common GMCI-related symptoms. CONCLUSIONS GMCI can be safely combined with SOC in newly diagnosed malignant gliomas. Survival outcomes were most notably improved in patients with minimal residual disease after gross total resection. These data should help guide future immunotherapy studies and strongly support further evaluation of GMCI for malignant gliomas. CLINICAL TRIAL REGISTRY ClinicalTrials.gov NCT00589875.
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Affiliation(s)
- Lee A Wheeler
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Andrea G Manzanera
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Susan D Bell
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Robert Cavaliere
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - John M McGregor
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - John C Grecula
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Herbert B Newton
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Simon S Lo
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Behnam Badie
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Jana Portnow
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Bin S Teh
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Todd W Trask
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - David S Baskin
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Pamela Z New
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Laura K Aguilar
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - Estuardo Aguilar-Cordova
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
| | - E Antonio Chiocca
- Brigham and Women's Hospital/Harvard Medical School, Massachusetts (L.A.W., E.A.C.); Advantagene, Inc., Auburndale, Massachusetts (A.G.M., L.K.A., E.A.-C.); Ohio State University, Columbus, Ohio (S.D.B., R.C., J.M.M., J.C.G., H.B.N.); University Hospitals Seidman Cancer Center/ Case Western Reserve University, Cleveland, Ohio (S.S.L.); City of Hope, Duarte, California (B.B., J.B.); Houston Methodist Hospital, Houston, Texas (B.S.T., T.W.T., D.S.B., P.Z.N.)
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Chiocca EA, Wheeler L, Manzanera A, Bell S, Cavaliere R, McGregor J, Grecula J, Newton H, Lo S, Badie B, Portnow J, Trask T, New P, Aguilar L, Aguilar-Cordova E, Baskin D. IMCT-02PHASE II MULTICENTER STUDY OF GENE MEDIATED CYTOTOXIC IMMUNOTHERAPY AS ADJUVANT TO SURGICAL RESECTION FOR NEWLY DIAGNOSED MALIGNANT GLIOMA. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov218.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Landolfi J, Cloughesy T, Vogelbaum MA, Kesari S, Piccioni DE, Kalkanis SN, Portnow J, Mikkelsen T, Elder JB, Baskin D, Chu A, Niethammer A, Gruber H, Cobbs C, Foltz G, Kaptain G, Aghi M. DDEL-08OVERALL SAFETY AND EFFICACY IN SUBJECTS WITH RECURRENT HGG TREATED ACROSS 2 TOCAGEN STUDIES - PROGNOSTIC FACTORS ASSOCIATED WITH SURVIVAL. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov212.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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