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Noll KR, Bradshaw M, Sheppard D, Wefel JS. Perioperative Neurocognitive Function in Glioma Surgery. Curr Oncol Rep 2024; 26:466-476. [PMID: 38573439 DOI: 10.1007/s11912-024-01522-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW This review provides a concise overview of the recent literature regarding preoperative and postoperative neurocognitive functioning (NCF) in patients with glioma. Brief discussion also covers contemporary intraoperative brain mapping work, with a focus on potential influence of mapping upon NCF outcomes following awake surgery. RECENT FINDINGS Most patients with glioma exhibit preoperative NCF impairment, with severity varying by germ line and tumoral genetics, tumor grade, and lesion location, among other characteristics. Literature regarding postoperative NCF changes is mixed, though numerous studies indicate a majority of patients exhibit immediate and short-term worsening. This is often followed by recovery over several months; however, a substantial portion of patients harbor persisting declines. Decline appears related to surgically-induced structural and functional brain alterations, both local and distal to the tumor and resection cavity. Importantly, NCF decline may be mitigated to some extent by intraoperative brain mapping, including mapping of both language-mediated and nonverbal functions. Research regarding perioperative NCF in patients with glioma has flourished over recent years. While this has increased our understanding of contributors to NCF and risk of decline associated with surgical intervention, more work is needed to better preserve NCF throughout the disease course.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA.
| | - Mariana Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - David Sheppard
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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2
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Cowan BA, Olivier K, Tombal B, Wefel JS. Correction to: Treatment-Related Cognitive Impairment in Patients with Prostate Cancer: Patients' Real-World Insights for Optimizing Outcomes. Adv Ther 2024; 41:1770-1773. [PMID: 38378976 PMCID: PMC10960746 DOI: 10.1007/s12325-023-02778-6] [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: 02/22/2024]
Affiliation(s)
| | - Kara Olivier
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Bertrand Tombal
- Division of Urology at the Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Jeffrey S Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Cowan BA, Olivier K, Tombal B, Wefel JS. Treatment-Related Cognitive Impairment in Patients with Prostate Cancer: Patients' Real-World Insights for Optimizing Outcomes. Adv Ther 2024; 41:476-491. [PMID: 37979089 PMCID: PMC10838823 DOI: 10.1007/s12325-023-02721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
Cognitive impairment (CI) is an issue that needs to be at the forefront of unmet healthcare needs in patients with prostate cancer (PCa) as it can negatively impact quality of life during long-term care. CI in patients with prostate cancer is thought to be influenced by treatment, androgen deprivation therapy (ADT), and novel androgen receptor (AR) pathway inhibitors in particular; however, current understanding is limited on how treatment affects cognition. Additionally, the experience of patients with CI who are receiving PCa treatment is not well understood or represented in clinical literature, which is a barrier to optimal patient outcomes in managing prostate cancer treatment-related cognitive impairment (PCa-TRCI). To help understand the patient journey and elucidate management gaps in PCa-TRCI, an international roundtable of healthcare provider and patient panelists was convened. The panelists focused on four key topic areas: (1) the patient experience when afflicted with, or at risk of, PCa-TRCI, (2) the physical, emotional, and social impact of CI on patients' quality of life (QoL), (3) the challenges that patients with PCa-TRCI face, and their impact on clinical decision-making, and (4) ways in which managing PCa-TRCI should evolve to improve patient outcomes. The purpose of the roundtable was to include patients in a direct discussion with healthcare providers (HCPs) regarding the patient journey and highlight real-world evidence of areas where patient outcomes could be improved in the absence of clinical evidence. The resulting discussion highlighted important healthcare gaps for patients with, and at risk of, PCa-TRCI and offered potential solutions as a roadmap to effective medicine.
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Affiliation(s)
| | - Kara Olivier
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Bertrand Tombal
- Division of Urology at the Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Jeffrey S Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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4
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Noll KR, Asman P, Tasnim I, Hall M, Connelly K, Swamy C, Ene C, Tummala S, Grasu RM, Liu HL, Kumar VA, Muir M, Prinsloo S, Michener H, Wefel JS, Ince NF, Prabhu SS. Intraoperative language mapping guided by real-time visualization of gamma band modulation electrocorticograms: Case report and proof of concept. Neurooncol Pract 2024; 11:92-100. [PMID: 38222047 PMCID: PMC10785572 DOI: 10.1093/nop/npad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Electrocorticography (ECoG) language mapping is often performed extraoperatively, frequently involves offline processing, and relationships with direct cortical stimulation (DCS) remain variable. We sought to determine the feasibility and preliminary utility of an intraoperative language mapping approach guided by real-time visualization of electrocorticograms. Methods A patient with astrocytoma underwent awake craniotomy with intraoperative language mapping, utilizing a dual iPad stimulus presentation system coupled to a real-time neural signal processing platform capable of both ECoG recording and delivery of DCS. Gamma band modulations in response to 4 language tasks at each electrode were visualized in real-time. Next, DCS was conducted for each neighboring electrode pair during language tasks. Results All language tasks resulted in strongest heat map activation at an electrode pair in the anterior to mid superior temporal gyrus. Consistent speech arrest during DCS was observed for Object and Action naming tasks at these same electrodes, indicating good correspondence with ECoG heat map recordings. This region corresponded well with posterior language representation via preoperative functional MRI. Conclusions Intraoperative real-time visualization of language task-based ECoG gamma band modulation is feasible and may help identify targets for DCS. If validated, this may improve the efficiency and accuracy of intraoperative language mapping.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priscella Asman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Israt Tasnim
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Matthew Hall
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Katherine Connelly
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chandra Swamy
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roxana M Grasu
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hayley Michener
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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5
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Catalino MP, Noll KR, Wefel JS, Michener H, Prinsloo S, Tummala S, Prabhu S. Decoding the clinical effects of low-grade glioma-induced cortical excitability. J Neurosurg 2024; 140:18-26. [PMID: 37439490 DOI: 10.3171/2023.5.jns23747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Patients with low-grade glioma (LGG) in eloquent regions often present with seizures, and findings on detailed neuropsychological testing are often abnormal. This study evaluated the association between cortical excitability, seizures, and cognitive function in patients with LGG. METHODS LGG patients who underwent transcranial magnetic stimulation (TMS) from January 2021 to December 2022 were studied. Cortical excitability was measured using the resting motor thresholds (RMTs) of the upper and lower extremities. Early postoperative seizures served as the seizure endpoint. Neuropsychological assessment was completed prior to surgery contemporaneous with the TMS studies. RESULTS A total of 31 patients were analyzed for seizure outcome. Median (interquartile range [IQR]) upper-extremity RMT was 39% (34%-46%) of maximum stimulator output, and the median (IQR) lower-extremity RMT was 69% (51%-79%). Lower-extremity RMT was higher in patients with early postoperative seizures, especially in those with motor region tumors (p = 0.02); however, RMT was not associated with seizures at presentation or long-term seizure control. A total of 26 patients completed neuropsychological assessment. There were significant negative correlations between upper-extremity RMT and psychomotor processing speed (Wechsler Adult Intelligence Scale-Fourth Edition [WAIS-IV] Processing Speed Index r = -0.42, p = 0.031; WAIS-IV Coding r = -0.41, p = 0.036; WAIS-IV Symbol Search r = -0.39, p = 0.048), executive function (Trail Making Test Part B r = -0.41, p = 0.036), and hand dexterity (Grooved Pegboard Test r = -0.50, p = 0.047). CONCLUSIONS RMT was positively correlated with early postoperative seizure risk and negatively correlated with psychomotor processing speed, executive function, and hand dexterity. These findings support the theory of local and regional resting oscillatory network dysfunction from a glioma-brain network.
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Affiliation(s)
| | | | | | - Hayley Michener
- 4Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah Prinsloo
- Departments of1Neurosurgery
- 4Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Wefel JS, Deshmukh S, Brown PD, Grosshans DR, Sulman EP, Cerhan JH, Mehta MP, Khuntia D, Shi W, Mishra MV, Suh JH, Laack NN, Chen Y, Curtis AA, Laba JM, Elsayed A, Thakrar A, Pugh SL, Bruner DW. Impact of Apolipoprotein E Genotype on Neurocognitive Function in Patients With Brain Metastases: An Analysis of NRG Oncology's RTOG 0614. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)08238-X. [PMID: 38101486 DOI: 10.1016/j.ijrobp.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Whole-brain radiation therapy (WBRT) is a common treatment for brain metastases and is frequently associated with decline in neurocognitive functioning (NCF). The e4 allele of the apolipoprotein E (APOE) gene is associated with increased risk of Alzheimer disease and NCF decline associated with a variety of neurologic diseases and insults. APOE carrier status has not been evaluated as a risk factor for onset time or extent of NCF impairment in patients with brain metastases treated with WBRT. METHODS AND MATERIALS NRG/Radiation Therapy Oncology Group 0614 treated adult patients with brain metastases with 37.5 Gy of WBRT (+/- memantine), performed longitudinal NCF testing, and included an optional blood draw for APOE analysis. NCF test results were compared at baseline and over time with mixed-effects models. A cause-specific Cox model for time to NCF failure was performed to assess the effects of treatment arm and APOE carrier status. RESULTS APOE results were available for 45% of patients (n = 227/508). NCF did not differ by APOE e4 carrier status at baseline. Mixed-effects modeling showed that APOE e4 carriers had worse memory after WBRT compared with APOE e4 noncarriers (Hopkins Verbal Learning Test-Revised total recall [least square mean difference, 0.63; P = .0074], delayed recognition [least square mean difference, 0.75; P = .023]). However, APOE e4 carrier status was not associated with time to NCF failure (hazard ratio, 0.86; 95% CI, 0.60-1.23; P = .40). Memantine delayed the time to NCF failure, regardless of carrier status (hazard ratio, 0.72; 95% CI, 0.52-1.01; P = .054). CONCLUSIONS APOE e4 carriers with brain metastases exhibited greater decline in learning and memory, executive function, and the Clinical Trial Battery Composite score after treatment with WBRT (+/- memantine), without acceleration of onset of difference in time to NCF failure.
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Affiliation(s)
- Jeffrey S Wefel
- University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Snehal Deshmukh
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | | | | | - Erik P Sulman
- Laura and Isaac Perlmutter Cancer Center, New York University Langone, New York, New York
| | | | - Minesh P Mehta
- Baptist Hospital of Miami and Florida International University, Miami, Florida
| | | | - Wenyin Shi
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mark V Mishra
- University of Maryland Medical Systems, Baltimore, Maryland
| | - John H Suh
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Amarinthia Amy Curtis
- Spartanburg Medical Center, Accruals for Upstate Carolina NCORP-Gibbs Regional Cancer Center, Spartanburg, South Carolina
| | - Joanna M Laba
- London Regional Cancer Program, Accruals for University of Western Ontario, London, Ontario, Canada
| | - Ahmed Elsayed
- Toledo Community Hospital Oncology Program CCOP, Toledo, Ohio
| | - Anu Thakrar
- John H. Stroger Jr Hospital of Cook County MBCCOP, Chicago, Illinois
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
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7
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Gondi V, Deshmukh S, Brown PD, Wefel JS, Armstrong TS, Tome WA, Gilbert MR, Konski A, Robinson CG, Bovi JA, Benzinger TLS, Roberge D, Kundapur V, Kaufman I, Shah S, Usuki KY, Baschnagel AM, Mehta MP, Kachnic LA. Sustained Preservation of Cognition and Prevention of Patient-Reported Symptoms With Hippocampal Avoidance During Whole-Brain Radiation Therapy for Brain Metastases: Final Results of NRG Oncology CC001. Int J Radiat Oncol Biol Phys 2023; 117:571-580. [PMID: 37150264 PMCID: PMC11070071 DOI: 10.1016/j.ijrobp.2023.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/18/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Initial report of NRG Oncology CC001, a phase 3 trial of whole-brain radiation therapy plus memantine (WBRT + memantine) with or without hippocampal avoidance (HA), demonstrated neuroprotective effects of HA with a median follow-up of fewer than 8 months. Herein, we report the final results with complete cognition, patient-reported outcomes, and longer-term follow-up exceeding 1 year. METHODS AND MATERIALS Adult patients with brain metastases were randomized to HA-WBRT + memantine or WBRT + memantine. The primary endpoint was time to cognitive function failure, defined as decline using the reliable change index on the Hopkins Verbal Learning Test-Revised (HVLT-R), Controlled Oral Word Association, or the Trail Making Tests (TMT) A and B. Patient-reported symptom burden was assessed using the MD Anderson Symptom Inventory with Brain Tumor Module and EQ-5D-5L. RESULTS Between July 2015 and March 2018, 518 patients were randomized. The median follow-up for living patients was 12.1 months. The addition of HA to WBRT + memantine prevented cognitive failure (adjusted hazard ratio, 0.74, P = .016) and was associated with less deterioration in TMT-B at 4 months (P = .012) and HVLT-R recognition at 4 (P = .055) and 6 months (P = .011). Longitudinal modeling of imputed data showed better preservation of all HVLT-R domains (P < .005). Patients who received HA-WBRT + Memantine reported less symptom burden at 6 (P < .001 using imputed data) and 12 months (P = .026 using complete-case data; P < .001 using imputed data), less symptom interference at 6 (P = .003 using complete-case data; P = .0016 using imputed data) and 12 months (P = .0027 using complete-case data; P = .0014 using imputed data), and fewer cognitive symptoms over time (P = .043 using imputed data). Treatment arms did not differ significantly in overall survival, intracranial progression-free survival, or toxicity. CONCLUSIONS With median follow-up exceeding 1 year, HA during WBRT + memantine for brain metastases leads to sustained preservation of cognitive function and continued prevention of patient-reported neurologic symptoms, symptom interference, and cognitive symptoms with no difference in survival or toxicity.
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Affiliation(s)
- Vinai Gondi
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Proton Center, Department of Radiation Oncology, Warrenville, Illinois.
| | - Snehal Deshmukh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Paul D Brown
- Mayo Clinic, Department of Radiation Oncology, Rochester, Minnesota
| | - Jeffrey S Wefel
- University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, Houston, Texas
| | - Terri S Armstrong
- National Cancer Institute Center for Cancer Research, Bethesda, Maryland
| | - Wolfgang A Tome
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mark R Gilbert
- University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, Houston, Texas
| | - Andre Konski
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Joseph A Bovi
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Isaac Kaufman
- Wayne State University/Karmanos Cancer Institute, Detroit, Michigan
| | - Sunjay Shah
- Delaware/Christiana Care National Cancer Institute Community Oncology Research Program, Wilmington, Delaware
| | | | | | | | - Lisa A Kachnic
- Columbia University, Vagelos Colleg of Physicians and Surgeons, New York, New York
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8
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Altan M, Wang Y, Song J, Welsh J, Tang C, Guha-Thakurta N, Blumenschein GR, Carter BW, Wefel JS, Ghia AJ, Yeboa DN, McAleer MF, Chung C, Woodhouse KD, McGovern SL, Wang C, Kim BYS, Weinberg JS, Briere TM, Elamin YY, Lee X, Cascone T, Negrao MV, Skoulidis F, Ferrarotto R, Heymach JV, Li J. Nivolumab and ipilimumab with concurrent stereotactic radiosurgery for intracranial metastases from non-small cell lung cancer: analysis of the safety cohort for non-randomized, open-label, phase I/II trial. J Immunother Cancer 2023; 11:e006871. [PMID: 37402581 PMCID: PMC10335483 DOI: 10.1136/jitc-2023-006871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Up to 20% of patients with non-small cell lung cancer (NSCLC) develop brain metastasis (BM), for which the current standard of care is radiation therapy with or without surgery. There are no prospective data on the safety of stereotactic radiosurgery (SRS) concurrent with immune checkpoint inhibitor therapy for BM. This is the safety cohort of the phase I/II investigator-initiated trial of SRS with nivolumab and ipilimumab for patients with BM from NSCLC. PATIENTS AND METHODS This single-institution study included patients with NSCLC with active BM amenable to SRS. Brain SRS and systemic therapy with nivolumab and ipilimumab were delivered concurrently (within 7 days). The endpoints were safety and 4-month intracranial progression-free survival (PFS). RESULTS Thirteen patients were enrolled in the safety cohort, 10 of whom were evaluable for dose-limiting toxicities (DLTs). Median follow-up was 23 months (range 9.7-24.3 months). The median interval between systemic therapy and radiation therapy was 3 days. Only one patient had a DLT; hence, predefined stopping criteria were not met. In addition to the patient with DLT, three patients had treatment-related grade ≥3 adverse events, including elevated liver function tests, fatigue, nausea, adrenal insufficiency, and myocarditis. One patient had a confirmed influenza infection 7 months after initiation of protocol treatment (outside the DLT assessment window), leading to pneumonia and subsequent death from hemophagocytic lymphohistiocytosis. The estimated 4-month intracranial PFS rate was 70.7%. CONCLUSION Concurrent brain SRS with nivolumab/ipilimumab was safe for patients with active NSCLC BM. Preliminary analyses of treatment efficacy were encouraging for intracranial treatment response.
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Affiliation(s)
- Mehmet Altan
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yan Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nandita Guha-Thakurta
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George R Blumenschein
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brett W Carter
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristina D Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chenyang Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina M Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yasir Y Elamin
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiuning Lee
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina Cascone
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marcelo V Negrao
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ferdinandos Skoulidis
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John V Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Holdhoff M, Nicholas MK, Peterson RA, Maraka S, Liu LC, Fischer JH, Wefel JS, Fan TM, Vannorsdall T, Russell M, Iacoboni M, Tarasow TM, Hergenrother PJ, Dudek AZ, Danciu OC. Phase I dose-escalation study of procaspase-activating compound-1 in combination with temozolomide in patients with recurrent high-grade astrocytomas. Neurooncol Adv 2023; 5:vdad087. [PMID: 37554223 PMCID: PMC10406430 DOI: 10.1093/noajnl/vdad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Procaspase-3 (PC-3) is overexpressed in various tumor types, including gliomas. Targeted PC-3 activation combined with chemotherapy is a novel strategy for treating patients with high-grade gliomas, with promising preclinical activity. This study aimed to define safety and tolerability of procaspase-activating compound-1 (PAC-1) in combination with temozolomide (TMZ) for patients with recurrent high-grade astrocytomas. METHODS A modified-Fibonacci dose-escalation 3 + 3 design was used. PAC-1 was administered at increasing dose levels (DL; DL1 = 375 mg) on days 1-21, in combination with TMZ 150 mg/m2/5 days, per 28-day cycle. Dose-limiting toxicity was assessed during the first 2 cycles. Neurocognitive function (NCF) testing was conducted throughout the study. RESULTS Eighteen patients were enrolled (13 GBM, IDH-wild type; 2 astrocytoma, IDH-mutant, grade 3; 3 astrocytoma, IDH-mutant, grade 4). Dose escalation was discontinued after DL3 (ie, PAC-1, 625 mg) due to lack of additional funding. Grade 3 toxicity was observed in 1 patient at DL1 (elevated liver transaminases) and 1 at DL 2 (headache). Two partial responses were observed at DL1 in patients with GBM, O6-methylguanine-DNA methyltransferase (MGMT) promoter methylated. Two patients had stable disease, and 11 experienced progression. NCF testing did not show a clear relationship between PAC-1 dose, treatment duration, and declines in NCF. CONCLUSIONS Combination of PAC-1 and TMZ was well tolerated up to 625 mg orally daily and TMZ orally 150 mg/m2/5 days per 28-day cycle. The maximum tolerated dose was not reached. Further dose escalation of PAC-1 in combination with TMZ is advised before conducting a formal prospective efficacy study in this patient population.
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Affiliation(s)
- Matthias Holdhoff
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - M Kelly Nicholas
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Richard A Peterson
- HealthPartners Institute, Regions Cancer Care Center, St. Paul, Minnesota, USA
| | - Stefania Maraka
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Li C Liu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - James H Fischer
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Timothy M Fan
- Vanquish Oncology, Inc., Champaign, Illinois, USA
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
- Cancer Center at Illinois, Urbana-Champaign, Illinois, USA
| | - Tracy Vannorsdall
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meredith Russell
- Clinical Trials Office, University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michaella Iacoboni
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Theodore M Tarasow
- Vanquish Oncology, Inc., Champaign, Illinois, USA
- Institute for Genomic Biology, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Paul J Hergenrother
- Vanquish Oncology, Inc., Champaign, Illinois, USA
- Cancer Center at Illinois, Urbana-Champaign, Illinois, USA
- Institute for Genomic Biology, University of Illinois, Urbana-Champaign, Illinois, USA
- Department of Chemistry, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Arkadiusz Z Dudek
- HealthPartners Institute, Regions Cancer Care Center, St. Paul, Minnesota, USA
- Vanquish Oncology, Inc., Champaign, Illinois, USA
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Oana C Danciu
- Clinical Trials Office, University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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10
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Gregory TA, Mastall M, Lin H, Hess KR, Yuan Y, Martin-Bejarano Garcia M, Fuller GN, Alfaro KD, Gule-Monroe MK, Huse JT, Khatua S, Rao G, Sandberg DI, Wefel JS, Yeboa DN, Paulino AC, McGovern SL, Zaky W, Mahajan A, Suki D, Weathers SP, Harrison RA, de Groot JF, Puduvalli VK, Penas-Prado M, Majd NK. Characterization of recurrence patterns and outcomes of medulloblastoma in adults: The University of Texas MD Anderson Cancer Center experience. Neurooncol Adv 2023; 5:vdad032. [PMID: 37114244 PMCID: PMC10129387 DOI: 10.1093/noajnl/vdad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Background Medulloblastoma in adults is rare and treatment decisions are largely driven from pediatric literature. We sought to characterize recurrent medulloblastoma in adults. Methods From a single-institution dataset of 200 adult patients diagnosed with medulloblastoma during 1978-2017, those with recurrence were analyzed for clinical features, treatment, and outcome. Results Of the 200 patients, 82 (41%) with median age of 29 years (18-59) had recurrence after a median follow-up time of 8.4 years (95% CI = 7.1, 10.3). Of these, 30 (37%) were standard-risk, 31 (38%) were high-risk, and 21 (26%) had unknown-risk diseases at the time of initial diagnosis. Forty-eight (58%) presented with recurrence outside the posterior fossa, of whom 35 (43%) had distant recurrence only. Median Progression-free survival (PFS) and OS from initial surgery were 33.5 and 62.4 months, respectively. Neither PFS nor OS from initial diagnosis differed between the standard-risk and high-risk groups in those who experience recurrence (P = .505 and .463, respectively). Median OS from first recurrence was 20.3 months, also with no difference between the standard-risk and high-risk groups (P = .518). Recurrences were treated with combinations of re-resection (20 patients; 25%), systemic chemotherapy (61 patients; 76%), radiation (29 patients; 36%), stem cell transplant (6 patients; 8%), and intrathecal chemotherapy (4 patients; 5%). Patients who received radiation at recurrence had better OS (32.9 months) than those who did not (19.2 months) (P = .034). Conclusions Recurrent medulloblastoma in adults has a poor prognosis irrespective of initial risk stratification. Recurrence commonly arises outside the posterior fossa years after initial diagnosis.
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Affiliation(s)
- Timothy A Gregory
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maximilian Mastall
- Department of Neurology, Clinical Neuroscience and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Gregory N Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristin D Alfaro
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria K Gule-Monroe
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason T Huse
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Soumen Khatua
- Department of Pediatric Neuro-Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ganesh Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - David I Sandberg
- Department of Pediatric Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuropsychology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wafik Zaky
- Department of Pediatric Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dima Suki
- Department of Pediatric Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rebecca A Harrison
- Department of Neuro-Oncology, BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - John F de Groot
- Brain Tumor Center, UCSF Medical Center, San Francisco, California, USA
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marta Penas-Prado
- Marta Penas-Prado, MD, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, 12NCI/NOB, NIGH, Bloch Bldg. 82, Room 213, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA ()
| | - Nazanin K Majd
- Corresponding Authors: Nazanin Majd, MD, PhD, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX, 77030, USA ()
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11
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Guran E, Hu J, Wefel JS, Chung C, Cata JP. Perioperative considerations in patients with chemotherapy-induced cognitive impairment: a narrative review. Br J Anaesth 2022; 129:909-922. [PMID: 36270848 DOI: 10.1016/j.bja.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022] Open
Abstract
Patients with cancer may suffer from a decline in their cognitive function after various cancer therapies, including surgery, radiation, and chemotherapy, and in some cases, this decline in cognitive function persists even years after completion of treatment. Chemobrain or chemotherapy-induced cognitive impairment, a well-established clinical syndrome, has become an increasing concern as the number of successfully treated cancer patients has increased significantly. Chemotherapy-induced cognitive impairment can originate from direct neurotoxicity, neuroinflammation, and oxidative stress, resulting in alterations in grey matter volume, white matter integrity, and brain connectivity. Surgery has been associated with exacerbating the inflammatory response associated with chemotherapy and predisposes patients to develop postoperative cognitive dysfunction. As the proportion of patients living longer after these therapies increases, the magnitude of impact and growing concern of post-treatment cognitive dysfunction in these patients has also come to the fore. We review the clinical presentation, potential mechanisms, predisposing factors, diagnostic methods, neuropsychological testing, and imaging findings of chemotherapy-induced cognitive impairment and its intersection with postoperative cognitive dysfunction.
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Affiliation(s)
- Ekin Guran
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, Turkey; Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Jian Hu
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA; Department of Anaesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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12
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Beer TM, Shore N, Morgans A, Winters‐Stone K, Wefel JS, George DJ. Functional impact of androgen‐targeted therapy on patients with castration‐resistant prostate cancer. BJUI Compass 2022; 3:424-433. [PMID: 36267196 PMCID: PMC9579880 DOI: 10.1002/bco2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/25/2022] [Accepted: 06/12/2022] [Indexed: 12/05/2022] Open
Abstract
Context Second‐generation androgen receptor inhibitors (ARIs) extend metastasis‐free survival, prolong overall survival, and delay symptoms when added to androgen deprivation therapy for the treatment of castration‐sensitive or castration‐resistant prostate cancer (CRPC). However, ARIs may adversely impact physical and cognitive function, thereby decreasing quality of life and prognosis. Objective To evaluate the evidence regarding the potential effects of ARIs on physical and cognitive function and to contextualize how drug‐related adverse effects may influence treatment decisions in CRPC. Evidence acquisition We performed a literature search using MEDLINE from January 1998 to June 2020 using terms relating to prostate cancer, androgen deprivation, and physical and cognitive function. We selected 61 publications for analysis. Evidence synthesis Treatment‐induced deterioration in physical and cognitive function may impair the independence and well‐being of patients with CRPC. Patient‐reported outcomes from clinical trials of ARIs provide quantitative evidence of their impact on these domains, which appears to vary between ARIs, reflecting the different adverse event profiles of these agents. Thus, the risk of physical or cognitive dysfunction may be managed or mitigated by appropriate selection of treatment options. Studies in patients with CRPC have assessed the cognitive effects of ARIs with validated instruments, whereas quantitative analysis of the impact on physical function has been limited. Conclusion Several validated instruments utilized for the assessment of physical and cognitive function in clinical studies have been adapted for clinical practice; however, consensus on the standardization of these assessments is required. Future clinical studies employing validated tools may generate data on the impact of ARIs and guide treatment decisions for patients with CRPC. Patient summary We review the hormonal therapies used to treat men with prostate cancer and the effects they have on physical and cognitive function. We discuss how to measure these effects and how this may assist when choosing treatment.
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Affiliation(s)
- Tomasz M. Beer
- Oregon Health and Science University Knight Cancer Institute Portland Oregon USA
| | - Neal Shore
- Carolina Urologic Research Center Myrtle Beach South Carolina USA
| | | | - Kerri Winters‐Stone
- Oregon Health and Science University Knight Cancer Institute Portland Oregon USA
| | - Jeffrey S. Wefel
- The University of Texas MD Anderson Cancer Center Houston Texas USA
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13
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Lassman AB, Pugh SL, Wang TJC, Aldape K, Gan HK, Preusser M, Vogelbaum MA, Sulman EP, Won M, Zhang P, Moazami G, Macsai MS, Gilbert MR, Bain EE, Blot V, Ansell PJ, Samanta S, Kundu MG, Armstrong TS, Wefel JS, Seidel C, de Vos FY, Hsu S, Cardona AF, Lombardi G, Bentsion D, Peterson RA, Gedye C, Bourg V, Wick A, Curran WJ, Mehta MP. Depatuxizumab mafodotin in EGFR-amplified newly diagnosed glioblastoma: A phase III randomized clinical trial. Neuro Oncol 2022; 25:339-350. [PMID: 35849035 PMCID: PMC9925712 DOI: 10.1093/neuonc/noac173] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Approximately 50% of newly diagnosed glioblastomas (GBMs) harbor epidermal growth factor receptor gene amplification (EGFR-amp). Preclinical and early-phase clinical data suggested efficacy of depatuxizumab mafodotin (depatux-m), an antibody-drug conjugate comprised of a monoclonal antibody that binds activated EGFR (overexpressed wild-type and EGFRvIII-mutant) linked to a microtubule-inhibitor toxin in EGFR-amp GBMs. METHODS In this phase III trial, adults with centrally confirmed, EGFR-amp newly diagnosed GBM were randomized 1:1 to radiotherapy, temozolomide, and depatux-m/placebo. Corneal epitheliopathy was treated with a combination of protocol-specified prophylactic and supportive measures. There was 85% power to detect a hazard ratio (HR) ≤0.75 for overall survival (OS) at a 2.5% 1-sided significance level (ie traditional two-sided p ≤ 0.05) by log-rank testing. RESULTS There were 639 randomized patients (median age 60, range 22-84; 62% men). Prespecified interim analysis found no improvement in OS for depatux-m over placebo (median 18.9 vs. 18.7 months, HR 1.02, 95% CI 0.82-1.26, 1-sided p = 0.63). Progression-free survival was longer for depatux-m than placebo (median 8.0 vs. 6.3 months; HR 0.84, 95% confidence interval [CI] 0.70-1.01, p = 0.029), particularly among those with EGFRvIII-mutant (median 8.3 vs. 5.9 months, HR 0.72, 95% CI 0.56-0.93, 1-sided p = 0.002) or MGMT unmethylated (HR 0.77, 95% CI 0.61-0.97; 1-sided p = 0.012) tumors but without an OS improvement. Corneal epitheliopathy occurred in 94% of depatux-m-treated patients (61% grade 3-4), causing 12% to discontinue. CONCLUSIONS Interim analysis demonstrated no OS benefit for depatux-m in treating EGFR-amp newly diagnosed GBM. No new important safety risks were identified.
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Affiliation(s)
- Andrew B Lassman
- Corresponding Author: Andrew B. Lassman, MD, Division of Neuro-Oncology, Department of Neurology, Vagelos College of Physicians and Surgeons, Herbert Irving Comprehensive Cancer Center, Columbia University, and New York-Presbyterian Hospital, 710 West 168th Street, New York, NY, USA. ()
| | - Stephanie L Pugh
- RTOG Foundation Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | - Tony J C Wang
- Department of Radiation Oncology (in Neurological Surgery), Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, USA,Herbert Irving Comprehensive Cancer Center, New York, New York, USA
| | - Kenneth Aldape
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Hui K Gan
- Cancer Therapies and Biology Group, Centre of Research Excellence in Brain Tumours, Olivia Newton-John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, Melbourne, Australia,La Trobe University School of Cancer Medicine, Heidelberg, Victoria, Australia,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Erik P Sulman
- Department of Radiation Oncology, New York University, Grossman School of Medicine, New York, New York, USA,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Minhee Won
- RTOG Foundation Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | | | - Golnaz Moazami
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, USA
| | - Marian S Macsai
- NorthShore University HealthSystem, Department of Ophthalmology, University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | | | | | | | | | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Filip Y de Vos
- University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Sigmund Hsu
- Department of Neurosurgery, University of Texas Health Sciences Center, McGovern School of Medicine, Houston, Texas, USA
| | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research-FICMAC/Clinical and Translational Oncology Group, Brain Tumor Section, Bogotá, Colombia
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | | | - Craig Gedye
- Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Véronique Bourg
- Department of Neurology, Côte d’Azur University, Nice, France
| | - Antje Wick
- Heidelberg University Medical Center, Heidelberg, Germany
| | | | - Minesh P Mehta
- Miami Cancer Institute, Baptist Hospital, Miami, Florida, USA
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14
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Lehrer EJ, Jones BM, Dickstein DR, Green S, Germano IM, Palmer JD, Laack N, Brown PD, Gondi V, Wefel JS, Sheehan JP, Trifiletti DM. The Cognitive Effects of Radiotherapy for Brain Metastases. Front Oncol 2022; 12:893264. [PMID: 35847842 PMCID: PMC9279690 DOI: 10.3389/fonc.2022.893264] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022] Open
Abstract
Brain metastases are the most common intracranial neoplasm and are seen in upwards of 10-30% of patients with cancer. For decades, whole brain radiation therapy (WBRT) was the mainstay of treatment in these patients. While WBRT is associated with excellent rates of intracranial tumor control, studies have demonstrated a lack of survival benefit, and WBRT is associated with higher rates of cognitive deterioration and detrimental effects on quality of life. In recent years, strategies to mitigate this risk, such as the incorporation of memantine and hippocampal avoidance have been employed with improved results. Furthermore, stereotactic radiosurgery (SRS) has emerged as an appealing treatment option over the last decade in the management of brain metastases and is associated with superior cognitive preservation and quality of life when compared to WBRT. This review article evaluates the pathogenesis and impact of cranial irradiation on cognition in patients with brain metastases, as well as current and future risk mitigation techniques.
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Affiliation(s)
- Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brianna M. Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sheryl Green
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Isabelle M. Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joshua D. Palmer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nadia Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Paul D. Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Vinai Gondi
- Department of Radiation Oncology, Northwestern Medicine Cancer Center Warrenville and Proton Center, Warrenville, IL, United States
| | - Jeffrey S. Wefel
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, United States
| | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Daniel M. Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
- *Correspondence: Daniel M. Trifiletti,
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15
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Pollack A, Karrison TG, Balogh AG, Gomella LG, Low DA, Bruner DW, Wefel JS, Martin AG, Michalski JM, Angyalfi SJ, Lukka H, Faria SL, Rodrigues GB, Beauchemin MC, Lee RJ, Seaward SA, Allen AM, Monitto DC, Seiferheld W, Sartor O, Feng F, Sandler HM. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial. Lancet 2022; 399:1886-1901. [PMID: 35569466 PMCID: PMC9819649 DOI: 10.1016/s0140-6736(21)01790-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND In men with a detectable prostate-specific antigen (PSA) level after prostatectomy for prostate cancer, salvage prostate bed radiotherapy (PBRT) results in about 70% of patients being free of progression at 5 years. A three-group randomised trial was designed to determine whether incremental gains in patient outcomes can be achieved by adding either 4-6 months of short-term androgen deprivation therapy (ADT) to PBRT, or both short-term ADT and pelvic lymph node radiotherapy (PLNRT) to PBRT. METHODS The international, multicentre, randomised, controlled SPPORT trial was done at 283 radiation oncology cancer treatment centres in the USA, Canada, and Israel. Eligible patients (aged ≥18 years) were those who after prostatectomy for adenocarcinoma of the prostate had a persistently detectable or an initially undetectable and rising PSA of between 0·1 and 2·0 ng/mL. Patients with and without lymphadenectomy (N0/Nx) were eligible if there was no clinical or pathological evidence of lymph node involvement. Other eligibility criteria included pT2 or pT3 disease, prostatectomy Gleason score of 9 or less, and a Zubrod performance status of 0-1. Eligible patients were randomly assigned to receive PBRT alone at a dose of 64·8-70·2 Gy at 1·8 Gy per fraction daily (group 1), PBRT plus short-term ADT (group 2), or PLNRT (45 Gy at 1·8 Gy per fraction, and then a volume reduction made to the planning target volume for the remaining 19·8-25 ·2 Gy) plus PBRT plus short-term ADT (group 3). The primary endpoint was freedom from progression, in which progression was defined as biochemical failure according to the Phoenix definition (PSA ≥2 ng/mL over the nadir PSA), clinical failure (local, regional, or distant), or death from any cause. A planned interim analysis of 1191 patents with minimum potential follow-up time of 5 years applied a Haybittle-Peto boundary of p<0·001 (one sided) for comparison of 5-year freedom from progression rates between the treatment groups. This trial is registered with ClinicalTrials.gov, NCT00567580. The primary objectives of the trial have been completed, although long-term follow-up is continuing. FINDINGS Between March 31, 2008, and March 30, 2015, 1792 eligible patients were enrolled and randomly assigned to the three treatment groups (592 to group 1 [PBRT alone], 602 to group 2 [PBRT plus short-term ADT], and 598 to group 3 [PLNRT plus PBRT plus short-term ADT]). 76 patients subsequently found to be ineligible were excluded from the analyses; thus, the evaluable patient population comprised 1716 patients. At the interim analysis (n=1191 patients; data cutoff May 23, 2018), the Haybittle-Peto boundary for 5-year freedom from progression was exceeded when group 1 was compared with group 3 (difference 17·9%, SE 2·9%; p<0·0001). The difference between groups 2 and 3 did not exceed the boundary (p=0·0063). With additional follow-up beyond the interim analysis (the final planned analysis; data cutoff May 26, 2021), at a median follow-up among survivors of 8·2 years (IQR 6·6-9·4), the 5-year freedom from progression rates in all 1716 eligible patients were 70·9% (95% CI 67·0-74·9) in group 1, 81·3% (78·0-84·6) in group 2, and 87·4% (84·7-90·2) in group 3. Per protocol criteria, freedom from progression in group 3 was superior to groups 1 and 2. Acute (≤3 months after radiotherapy) grade 2 or worse adverse events were significantly more common in group 3 (246 [44%] of 563 patients) than in group 2 (201 [36%] of 563; p=0·0034), which, in turn, were more common than in group 1 (98 [18%] of 547; p<0·0001). Similar findings were observed for grade 3 or worse adverse events. However, late toxicity (>3 months after radiotherapy) did not differ significantly between the groups, apart from more late grade 2 or worse blood or bone marrow events in group 3 versus group 2 (one-sided p=0·0060) attributable to the addition of PLNRT in this group. INTERPRETATION The results of this randomised trial establish the benefit of adding short-term ADT to PBRT to prevent progression in prostate cancer. To our knowledge, these are the first such findings to show that extending salvage radiotherapy to treat the pelvic lymph nodes when combined with short-term ADT results in meaningful reductions in progression after prostatectomy in patients with prostate cancer. FUNDING National Cancer Institute.
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Affiliation(s)
- Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
| | - Theodore G Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA; NRG Oncology, Philadelphia, PA, USA
| | | | - Leonard G Gomella
- Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel A Low
- Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, and Winship Cancer Institute at Emory University, Atlanta, GA, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andre-Guy Martin
- CHU de Quebec-Université Laval (L'Hotel-Dieu de Quebec), Quebec, QC, Canada
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Steve J Angyalfi
- Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Himanshu Lukka
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | | | - George B Rodrigues
- Department of Oncology, London Regional Cancer Program, Western University, London, ON, Canada
| | - Marie-Claude Beauchemin
- Department of Radiation Oncology, CHUM-Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - R Jeffrey Lee
- Intermountain Medical Center, Salt Lake City, UT, USA
| | | | - Aaron M Allen
- Davidoff Center, Rabin Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Drew C Monitto
- Spartanburg Regional Medical Center, Spartanburg, SC, USA
| | | | - Oliver Sartor
- Department of Medicine, Tulane University, New Orleans, LA, USA
| | - Felix Feng
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA , USA
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Wefel JS, Woods SP. Measuring Everyday Functioning in Brain Tumor Patients: The Long Rows Yet to Hoe. Neurooncol Pract 2022; 9:253-254. [PMID: 35859540 PMCID: PMC9290877 DOI: 10.1093/nop/npac037] [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)
- Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven P Woods
- Department of Psychology, The University of Houston, Houston, Texas
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17
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Chung C, Brown PD, Wefel JS. OUP accepted manuscript. Neuro Oncol 2022; 24:851. [PMID: 35460425 PMCID: PMC9071287 DOI: 10.1093/neuonc/noac028] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- Caroline Chung
- Corresponding Author: Caroline Chung, MD, MSc, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA ()
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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18
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Wefel JS, Zhou R, Sulman EP, Boehling NS, Armstrong GN, Tsavachidis S, Liang FW, Etzel CJ, Kahalley LS, Small BJ, Scheurer ME, Bondy ML, Liu Y. Genetic modulation of longitudinal change in neurocognitive function among adult glioma patients. J Neurooncol 2021; 156:185-193. [PMID: 34817796 DOI: 10.1007/s11060-021-03905-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Impaired neurocognitive function (NCF) is extremely common in patients with higher grade primary brain tumor. We previously reported evidence of genetic variants associated with NCF in glioma patients prior to treatment. However, little is known about the effect of genetic variants on NCF decline after adjuvant therapy. METHODS Patients (N = 102) completed longitudinal NCF assessments that included measures of verbal memory, processing speed, and executive function. Testing was conducted in the postoperative period with an average follow up interval of 1.3 years. We examined polymorphisms in 580 genes related to five pathways (inflammation, DNA repair, metabolism, cognitive, and telomerase). RESULTS Five polymorphisms were associated with longitudinal changes in processing speed and 14 polymorphisms with executive function. Change in processing speed was strongly associated with MCPH1 rs17631450 (P = 2.2 × 10-7) and CCDC26 rs7005206 (P = 9.3 × 10-7) in the telomerase pathway; while change in executive function was more strongly associated with FANCF rs1514084 (P = 2.9 × 10-6) in the DNA repair pathway and DAOA rs12428572 (P = 2.4 × 10-5) in the cognitive pathway. Joint effect analysis found significant genetic-dosage effects for longitudinal changes in processing speed (Ptrend = 1.5 × 10-10) and executive function (Ptrend = 2.1 × 10-11). In multivariable analyses, predictors of NCF decline included progressive disease, lower baseline NCF performance, and more at-risk genetic variants, after adjusting for age, sex, education, tumor location, histology, and disease progression. CONCLUSION Our longitudinal analyses revealed that polymorphisms in telomerase, DNA repair, and cognitive pathways are independent predictors of decline in NCF in glioma patients.
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Affiliation(s)
- Jeffrey S Wefel
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA.
| | - Renke Zhou
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Mailstop BCM305, Houston, TX, 77030, USA
| | - Erik P Sulman
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - Nicholas S Boehling
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - Georgina N Armstrong
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Mailstop BCM305, Houston, TX, 77030, USA
| | - Spiridon Tsavachidis
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Mailstop BCM305, Houston, TX, 77030, USA
| | - Fu-Wen Liang
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Carol J Etzel
- Biostatistics, Corrona, LLC, Southborough, MA, 01772, USA
| | - Lisa S Kahalley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, 4202 E Fowler Avenue, Tampa, FL, 33620, USA
| | - Michael E Scheurer
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Mailstop BCM305, Houston, TX, 77030, USA
| | - Melissa L Bondy
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Mailstop BCM305, Houston, TX, 77030, USA.
| | - Yanhong Liu
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, Mailstop BCM305, Houston, TX, 77030, USA.
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Chung C, Brown PD, Wefel JS. Short reply to "Proton therapy for newly diagnosed glioblastoma: more room for investigation" by R. Press et al. Neuro Oncol 2021; 23:1982. [PMID: 34453547 DOI: 10.1093/neuonc/noab193] [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: 11/13/2022] Open
Affiliation(s)
- Caroline Chung
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Jeffrey S Wefel
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
Neurocognitive function (NCF) deficits are common in patients with brain metastases, occurring in up to 90% of cases. NCF deficits may be caused by tumor-related factors and/or treatment for the metastasis, including surgery, radiation therapy, chemotherapy, and immunotherapy. In recent years, strategies to prevent negative impact of treatments and ameliorate cognitive deficits for patients with brain tumors have gained momentum. In this review, we report on research that has established the efficacy of preventative and rehabilitative therapies for NCF deficits in patients with brain metastases. Surgical strategies include the use of laser interstitial thermal therapy and intraoperative mapping. Radiotherapy approaches include focal treatments such as stereotactic radiosurgery and tailored approaches such as hippocampal avoidant whole-brain radiotherapy (WBRT). Pharmacologic options include use of the neuroprotectant memantine to reduce cognitive decline induced by WBRT and incorporation of medications traditionally used for attention and memory problems. Integration of neuropsychology into the care of patients with brain metastases helps characterize cognitive patterns, educate patients and families regarding their management, and guide rehabilitative therapies. These and other strategies will become even more important for long-term survivors of brain metastases as treatment options improve.
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Affiliation(s)
- Michael W Parsons
- Pappas Center for Neuro-Oncology, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine B Peters
- Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Scott R Floyd
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Paul Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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21
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Noll K, King AL, Dirven L, Armstrong TS, Taphoorn MJB, Wefel JS. Neurocognition and Health-Related Quality of Life Among Patients with Brain Tumors. Hematol Oncol Clin North Am 2021; 36:269-282. [PMID: 34711455 DOI: 10.1016/j.hoc.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Patients with brain tumors experience great symptom burden across various domains of functioning, with associated decreases in health-related quality of life and general well-being. Impaired neurocognitive functioning is among the primary concerns of these patients. Unfortunately, most patients will experience such impairment at some point in the disease. However, impaired neurocognitive functioning, symptom burden, and well-being vary according numerous patient-, tumor-, and treatment-related factors. Recent work has furthered our understanding of these contributors to patient functioning and health-related quality of life and also points to various potential targets for prevention and intervention strategies, though more efficacious treatments remain needed.
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Affiliation(s)
- Kyle Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA
| | - Amanda L King
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Road, Building 82, Room 214, Bethesda, MD 20892, USA
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands; Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, the Netherlands
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 82, Room 201, Bethesda, MD 20892, USA
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands; Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, the Netherlands
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA.
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22
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Brown PD, Chung C, Liu DD, McAvoy S, Grosshans D, Al Feghali K, Mahajan A, Li J, McGovern SL, McAleer MF, Ghia AJ, Sulman EP, Penas-Prado M, de Groot JF, Heimberger AB, Wang J, Armstrong TS, Gilbert MR, Guha-Thakurta N, Wefel JS. A prospective phase II randomized trial of proton radiotherapy vs intensity-modulated radiotherapy for patients with newly diagnosed glioblastoma. Neuro Oncol 2021; 23:1337-1347. [PMID: 33647972 DOI: 10.1093/neuonc/noab040] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To determine if proton radiotherapy (PT), compared to intensity-modulated radiotherapy (IMRT), delayed time to cognitive failure in patients with newly diagnosed glioblastoma (GBM). METHODS Eligible patients were randomized unblinded to PT vs IMRT. The primary endpoint was time to cognitive failure. Secondary endpoints included overall survival (OS), intracranial progression-free survival (PFS), toxicity, and patient-reported outcomes (PROs). RESULTS A total of 90 patients were enrolled and 67 were evaluable with median follow-up of 48.7 months (range 7.1-66.7). There was no significant difference in time to cognitive failure between treatment arms (HR, 0.88; 95% CI, 0.45-1.75; P = .74). PT was associated with a lower rate of fatigue (24% vs 58%, P = .05), but otherwise, there were no significant differences in PROs at 6 months. There was no difference in PFS (HR, 0.74; 95% CI, 0.44-1.23; P = .24) or OS (HR, 0.86; 95% CI, 0.49-1.50; P = .60). However, PT significantly reduced the radiation dose for nearly all structures analyzed. The average number of grade 2 or higher toxicities was significantly higher in patients who received IMRT (mean 1.15, range 0-6) compared to PT (mean 0.35, range 0-3; P = .02). CONCLUSIONS In this signal-seeking phase II trial, PT was not associated with a delay in time to cognitive failure but did reduce toxicity and patient-reported fatigue. Larger randomized trials are needed to determine the potential of PT such as dose escalation for GBM and cognitive preservation in patients with lower-grade gliomas with a longer survival time.
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Affiliation(s)
- Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah McAvoy
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - David Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Karine Al Feghali
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary-Fran McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York, USA
| | - Marta Penas-Prado
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy B Heimberger
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Terri S Armstrong
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nandita Guha-Thakurta
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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23
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Wefel JS, Armstrong TS, Pugh SL, Gilbert MR, Wendland MM, Brachman DG, Roof KS, Brown PD, Crocker IR, Robins HI, Hunter G, Won M, Mehta MP. Neurocognitive, symptom, and health-related quality of life outcomes of a randomized trial of bevacizumab for newly diagnosed glioblastoma (NRG/RTOG 0825). Neuro Oncol 2021; 23:1125-1138. [PMID: 33515019 DOI: 10.1093/neuonc/noab011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Results of NRG Oncology RTOG 0825 reported adding bevacizumab to standard chemoradiation did not significantly improve survival endpoints and resulted in greater decline in neurocognitive function (NCF) and patient-reported outcomes (PRO) over time in bevacizumab-treated patients. The present report provides additional results of patient-centered outcomes over time and their prognostic association with survival endpoints. METHODS NCF tests, MD Anderson Symptom Inventory - Brain Tumor Module (MDASI-BT), and European Organization for Research and Treatment of Cancer (EORTC) quality of life (QOL) questionnaire with brain cancer module (QLQ-C30/BN20) were completed in a subset of progression-free patients at baseline and longitudinally. The prognostic value of baseline and early changes in NCF and PROs and differences between treatments from baseline to follow-up assessments were evaluated. RESULTS A total of 508 randomized patients participated. Baseline/early changes in NCF and PROs were prognostic for OS and PFS. No between-arm differences in time to deterioration were found. At week 6, patients treated with bevacizumab evidenced greater improvement on NCF tests of executive function and the MDASI-BT Cognitive Function scale, but simultaneously reported greater decline on the EORTC Cognitive Function Scale. At later time points (weeks 22, 34, and 46), patients treated with bevacizumab had greater worsening on NCF tests as well as PRO measures of cognitive, communication, social function, motor symptoms, general symptoms, and interference. CONCLUSION The collection of patient-centered clinical outcome assessments in this phase III trial revealed greater deterioration in NCF, symptoms, and QOL in patients treated with bevacizumab. Baseline and early change in NCF and PROs were prognostic for survival endpoints.
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Affiliation(s)
- Jeffrey S Wefel
- Department of Neuro-Oncology and Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, University of Texas Health Science Center, Houston, Texas, USA
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Merideth M Wendland
- Radiation Oncology, USON-Willamette Valley Cancer Institute, Eugene, Oregon, USA
| | - David G Brachman
- Department of Radiation Oncology, Arizona Oncology Services Foundation, Phoenix, Arizona, USA
| | - Kevin S Roof
- Department of Radiation Oncology, Southeast Cancer Control Consortium, CCOP, Winston-Salem, North Carolina, USA
| | - Paul D Brown
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ian R Crocker
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - H Ian Robins
- Departments of Medicine and Human Oncology, University of Wisconsin Hospital, Madison, Wisconsin, USA
| | - Grant Hunter
- Department of Radiation Oncology, Intermountain Medical Center, Murray, Utah, USA
| | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
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24
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Majd NK, Mastall M, Lin H, Dibaj SS, Hess KR, Yuan Y, Garcia MMB, Fuller GN, Alfaro KD, Gule-Monroe MK, Huse JT, Khatua S, Rao G, Sandberg DI, Wefel JS, Yeboa DN, Paulino AC, McGovern SL, Zaky W, Mahajan A, Suki D, Weathers SP, Harriso RA, De Groo JF, Puduvalli VK, Penas-Prado M. Clinical characterization of adult medulloblastoma and the effect of first-line therapies on outcome; The MD Anderson Cancer Center experience. Neurooncol Adv 2021; 3:vdab079. [PMID: 34377987 PMCID: PMC8350154 DOI: 10.1093/noajnl/vdab079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Adult medulloblastoma (MB) is rare, and management guidelines are largely based on pediatric clinical trials and retrospective series. Limited data exist with respect to clinical characteristics, prognostic factors, and outcomes based on first-line treatments. Methods Two hundred adults with MB seen at a single institution from January 1978 to April 2017 were identified and followed for a median of 8.4 y (7.1, 10.3). Results Patient’s median age at diagnosis was 29 y (18, 63). One hundred eleven (55.5%) were standard-risk, 59 (29.5%) were high-risk, and 30 (15.0%) were indeterminate. Most received post-operative radiation (RT) (184 [92.0%]), and 105 (52.5%) received first-line chemotherapy. Median overall survival (OS) was 8.8 y (7.2, 12.2) and median progression-free survival (PFS) was 6.6 y (4.9, 11.2). High-risk patients had inferior OS (Hazard ratio [HR] = 2.5 [1.5, 4.2], P = .0006) and PFS (HR = 2.3 [1.3, 3.9], P = .002) compared to standard-risk patients. Age, sex, and metastatic disease were not associated with survival. After adjusting for risk status, those who received RT plus adjuvant chemotherapy had superior PFS compared to RT plus neoadjuvant chemotherapy [HR = 0.46 (0.22, 0.95), P = .0357]. Within a subgroup for whom detailed clinical data were available, those who received RT plus adjuvant chemotherapy had improved PFS compared to RT only [HR = 0.24 (0.074–0.76), P = .016]. The substitution of cisplatin for carboplatin and the elimination of vincristine did not negatively affect outcomes. Conclusion This is the largest single-institution retrospective study of adult MB to our knowledge and identifies standard-risk status, first-line RT and adjuvant chemotherapy as factors associated with improved outcomes.
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Affiliation(s)
- Nazanin K Majd
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maximilan Mastall
- Department of Neurology, Clinical Neuroscience Center and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyede Shiva Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Gregory N Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristin D Alfaro
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria K Gule-Monroe
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason T Huse
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Soumen Khatua
- Department of Pediatric Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ganesh Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - David I Sandberg
- Department of Pediatric Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuropsychology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wafik Zaky
- Department of Pediatric Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anita Mahajan
- Department of Radiation-Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dima Suki
- Department of Pediatric Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rebecca A Harriso
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John F De Groo
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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25
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De Witt Hamer PC, Klein M, Hervey-Jumper SL, Wefel JS, Berger MS. In Reply: Functional Outcomes and Health-Related Quality of Life Following Glioma Surgery. Neurosurgery 2021; 89:E189. [PMID: 34131734 PMCID: PMC8364820 DOI: 10.1093/neuros/nyab218] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Philip C De Witt Hamer
- Cancer Center Amsterdam Department of Neurosurgery Amsterdam UMC Vrije Universiteit Amsterdam, The Netherlands
| | - Martin Klein
- Department of Medical Psychology Amsterdam UMC Vrije Universiteit Amsterdam, The Netherlands
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery University of California, San Francisco San Francisco, California, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology The University of Texas MD Anderson Cancer Center Houston, Texas, USA.,Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston, Texas, USA
| | - Mitchel S Berger
- Department of Neurological Surgery University of California, San Francisco San Francisco, California, USA
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26
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Quirarte JA, Kumar VA, Liu HL, Noll KR, Wefel JS, Lang FF. Language supplementary motor area syndrome correlated with dynamic changes in perioperative task-based functional MRI activations: case report. J Neurosurg 2021; 134:1738-1742. [DOI: 10.3171/2020.4.jns193250] [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] [Received: 01/24/2020] [Accepted: 04/03/2020] [Indexed: 11/06/2022]
Abstract
Supplementary motor area (SMA) syndrome is well known; however, the mechanism underlying recovery from language SMA syndrome is unclear. Herein the authors report the case of a right-handed woman with speech aphasia following resection of an oligodendroglioma located in the anterior aspect of the left superior frontal gyrus. The patient exhibited language SMA syndrome, and functional MRI (fMRI) findings 12 days postoperatively demonstrated a complete shift of blood oxygen level–dependent (BOLD) activation to the contralateral right language SMA/pre-SMA as well as coequal activation and an increased volume of activation in the left Broca’s area and the right Broca’s homolog. The authors provide, to the best of their knowledge, the first description of dynamic changes in task-based hemispheric language BOLD fMRI activations across the preoperative, immediate postoperative, and more distant postoperative settings associated with the development and subsequent complete resolution of the clinical language SMA syndrome.
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Affiliation(s)
| | | | - Ho-Ling Liu
- Imaging Physics, University of Texas MD Anderson Cancer Center; and
| | - Kyle R. Noll
- Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S. Wefel
- Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
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27
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Al Feghali KA, Randall JW, Liu DD, Wefel JS, Brown PD, Grosshans DR, McAvoy SA, Farhat MA, Li J, McGovern SL, McAleer MF, Ghia AJ, Paulino AC, Sulman EP, Penas-Prado M, Wang J, de Groot J, Heimberger AB, Armstrong TS, Gilbert MR, Mahajan A, Guha-Thakurta N, Chung C. Phase II trial of proton therapy versus photon IMRT for GBM: secondary analysis comparison of progression-free survival between RANO versus clinical assessment. Neurooncol Adv 2021; 3:vdab073. [PMID: 34337411 PMCID: PMC8320688 DOI: 10.1093/noajnl/vdab073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background This secondary image analysis of a randomized trial of proton radiotherapy (PT) versus photon intensity-modulated radiotherapy (IMRT) compares tumor progression based on clinical radiological assessment versus Response Assessment in Neuro-Oncology (RANO). Methods Eligible patients were enrolled in the randomized trial and had MR imaging at baseline and follow-up beyond 12 weeks from completion of radiotherapy. “Clinical progression” was based on a clinical radiology report of progression and/or change in treatment for progression. Results Of 90 enrolled patients, 66 were evaluable. Median clinical progression-free survival (PFS) was 10.8 (range: 9.4–14.7) months; 10.8 months IMRT versus 11.2 months PT (P = .14). Median RANO-PFS was 8.2 (range: 6.9, 12): 8.9 months IMRT versus 6.6 months PT (P = .24). RANO-PFS was significantly shorter than clinical PFS overall (P = .001) and for both the IMRT (P = .01) and PT (P = .04) groups. There were 31 (46.3%) discrepant cases of which 17 had RANO progression more than a month prior to clinical progression, and 14 had progression by RANO but not clinical criteria. Conclusions Based on this secondary analysis of a trial of PT versus IMRT for glioblastoma, while no difference in PFS was noted relative to treatment technique, RANO criteria identified progression more often and earlier than clinical assessment. This highlights the disconnect between measures of tumor response in clinical trials versus clinical practice. With growing efforts to utilize real-world data and personalized treatment with timely adaptation, there is a growing need to improve the consistency of determining tumor progression within clinical trials and clinical practice.
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Affiliation(s)
- Karine A Al Feghali
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - James W Randall
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA.,Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Grosshans
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah A McAvoy
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Maguy A Farhat
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary F McAleer
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Langone, New York, New York, USA
| | - Marta Penas-Prado
- Department of Neuro-Oncology, National Institutes of Health, Bethesda, Maryland, USA
| | - Jihong Wang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - John de Groot
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy B Heimberger
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Terri S Armstrong
- Department of Neuro-Oncology, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Department of Neuro-Oncology, National Institutes of Health, Bethesda, Maryland, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
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De Witt Hamer PC, Klein M, Hervey-Jumper SL, Wefel JS, Berger MS. Functional Outcomes and Health-Related Quality of Life Following Glioma Surgery. Neurosurgery 2021; 88:720-732. [PMID: 33517431 PMCID: PMC7955971 DOI: 10.1093/neuros/nyaa365] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/25/2020] [Indexed: 12/19/2022] Open
Abstract
Functional outcome following glioma surgery is defined as how the patient functions or feels. Functional outcome is a coprimary end point of surgery in patients with diffuse glioma, together with oncological outcome. In this review, we structure the functional outcome measurements following glioma surgery as reported in the last 5 yr. We review various perspectives on functional outcome of glioma surgery with available measures, and offer suggestions for their use. From the recent neurosurgical literature, 160 publications were retrieved fulfilling the selection criteria. In these publications, neurological outcomes were reported most often, followed by activities of daily living, seizure outcomes, neurocognitive outcomes, and health-related quality of life or well-being. In more than a quarter of these publications functional outcome was not reported. A minimum essential consensus set of functional outcome measurements would benefit comparison across neurosurgical reports. The consensus set should be based on a combination of clinician- and patient-reported outcomes, assessed at a predefined time before and after surgery. The selected measurements should have psychometric properties supporting the intended use including validity-related evidence, reliability, and sensitivity to detect meaningful change with minimal burden to ensure compliance. We circulate a short survey as a start towards reporting guidelines. Many questions remain to better understand, report, and improve functional outcome following glioma surgery.
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Affiliation(s)
- Philip C De Witt Hamer
- Correspondence: Philip C. De Witt Hamer, MD, PhD, Amsterdam UMC, Vrije Universiteit, Department of Neurosurgery, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands.
| | - Martin Klein
- Amsterdam UMC, Vrije Universiteit, Department of Medical Psychology, Neuroscience Campus, Amsterdam, Netherlands
| | - Shawn L Hervey-Jumper
- University of California San Francisco, Department of Neurological Surgery, San Francisco, California
| | - Jeffrey S Wefel
- University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology and Department of Radiation Oncology, Houston, Texas
| | - Mitchel S Berger
- University of California San Francisco, Department of Neurological Surgery, San Francisco, California
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29
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Jaeckle KA, Ballman KV, van den Bent M, Giannini C, Galanis E, Brown PD, Jenkins RB, Cairncross JG, Wick W, Weller M, Aldape KD, Dixon JG, Anderson SK, Cerhan JH, Wefel JS, Klein M, Grossman SA, Schiff D, Raizer JJ, Dhermain F, Nordstrom DG, Flynn PJ, Vogelbaum MA. CODEL: phase III study of RT, RT + TMZ, or TMZ for newly diagnosed 1p/19q codeleted oligodendroglioma. Analysis from the initial study design. Neuro Oncol 2021; 23:457-467. [PMID: 32678879 DOI: 10.1093/neuonc/noaa168] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We report the analysis involving patients treated on the initial CODEL design. METHODS Adults (>18) with newly diagnosed 1p/19q World Health Organization (WHO) grade III oligodendroglioma were randomized to radiotherapy (RT; 5940 centigray ) alone (arm A); RT with concomitant and adjuvant temozolomide (TMZ) (arm B); or TMZ alone (arm C). Primary endpoint was overall survival (OS), arm A versus B. Secondary comparisons were performed for OS and progression-free survival (PFS), comparing pooled RT arms versus TMZ-alone arm. RESULTS Thirty-six patients were randomized equally. At median follow-up of 7.5 years, 83.3% (10/12) TMZ-alone patients progressed, versus 37.5% (9/24) on the RT arms. PFS was significantly shorter in TMZ-alone patients compared with RT patients (hazard ratio [HR] = 3.12; 95% CI: 1.26, 7.69; P = 0.014). Death from disease progression occurred in 3/12 (25%) of TMZ-alone patients and 4/24 (16.7%) on the RT arms. OS did not statistically differ between arms (comparison underpowered). After adjustment for isocitrate dehydrogenase (IDH) status (mutated/wildtype) in a Cox regression model utilizing IDH and RT treatment status as covariables (arm C vs pooled arms A + B), PFS remained shorter for patients not receiving RT (HR = 3.33; 95% CI: 1.31, 8.45; P = 0.011), but not OS ((HR = 2.78; 95% CI: 0.58, 13.22, P = 0.20). Grade 3+ adverse events occurred in 25%, 42%, and 33% of patients (arms A, B, and C). There were no differences between arms in neurocognitive decline comparing baseline to 3 months. CONCLUSIONS TMZ-alone patients experienced significantly shorter PFS than patients treated on the RT arms. The ongoing CODEL trial has been redesigned to compare RT + PCV versus RT + TMZ.
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Affiliation(s)
- Kurt A Jaeckle
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Karla V Ballman
- Alliance Statistics and Data Center, Weill Cornell Medicine, New York, New York, USA
| | - Martin van den Bent
- Brain Tumor Center, Erasmus MC Cancer Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Caterina Giannini
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Evanthia Galanis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert B Jenkins
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - J Gregory Cairncross
- Department of Clinical Neurosciences, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Wolfgang Wick
- Neurologische Klinik, University of Heidelberg, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kenneth D Aldape
- Department of Neuropathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jesse G Dixon
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota, USA
| | - S Keith Anderson
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Jane H Cerhan
- Departments of Psychiatry and Psychology, Houston, Texas, USA
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Martin Klein
- Department of Medical Psychology, VU University Medical Center, Amsterdam, Netherlands
| | - Stuart A Grossman
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - David Schiff
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Jeffrey J Raizer
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Frederick Dhermain
- Department of Radiation Therapy, Gustave Roussy Cancer Institute, Villejuif, France
| | | | - Patrick J Flynn
- Medical Oncology, Minnesota Oncology, Northfield, Minnesota, USA
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30
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Mrugala MM, Ostrom QT, Pressley SM, Taylor JW, Thomas AA, Wefel JS, Coven SL, Acquaye AA, Haynes C, Agnihotri S, Lim M, Peters KB, Sulman EP, Salcido JT, Butowski NA, Hervey-Jumper S, Mansouri A, Oliver KR, Porter AB, Nassiri F, Schiff D, Dunbar EM, Hegi ME, Armstrong TS, van den Bent MJ, Chang SM, Zadeh G, Chheda MG. The state of neuro-oncology during the COVID-19 pandemic: a worldwide assessment. Neurooncol Adv 2021; 3:vdab035. [PMID: 34007966 PMCID: PMC7928618 DOI: 10.1093/noajnl/vdab035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background It remains unknown how the COVID-19 pandemic has changed neuro-oncology clinical practice, training, and research efforts. Methods We performed an international survey of practitioners, scientists, and trainees from 21 neuro-oncology organizations across 6 continents, April 24-May 17, 2020. We assessed clinical practice and research environments, institutional preparedness and support, and perceived impact on patients. Results Of 582 respondents, 258 (45%) were US-based and 314 (55%) international. Ninety-four percent of participants reported changes in their clinical practice. Ninety-five percent of respondents converted at least some practice to telemedicine. Ten percent of practitioners felt the need to see patients in person, specifically because of billing concerns and pressure from their institutions. Sixty-seven percent of practitioners suspended enrollment for at least one clinical trial, including 62% suspending phase III trial enrollments. More than 50% believed neuro-oncology patients were at increased risk for COVID-19. Seventy-one percent of clinicians feared for their own personal safety or that of their families, specifically because of their clinical duties; 20% had inadequate personal protective equipment. While 69% reported increased stress, 44% received no psychosocial support from their institutions. Thirty-seven percent had salary reductions and 63% of researchers temporarily closed their laboratories. However, the pandemic created positive changes in perceived patient satisfaction, communication quality, and technology use to deliver care and mediate interactions with other practitioners. Conclusions The pandemic has changed treatment schedules and limited investigational treatment options. Institutional lack of support created clinician and researcher anxiety. Communication with patients was satisfactory. We make recommendations to guide clinical and scientific infrastructure moving forward and address the personal challenges of providers and researchers.
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Affiliation(s)
| | - Quinn T Ostrom
- Department of Medicine, Epidemiology & Population Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jennie W Taylor
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Alissa A Thomas
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Scott L Coven
- Division of Pediatric Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alvina A Acquaye
- Neuro-oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chas Haynes
- Society for Neuro-oncology, Houston, Texas, USA
| | - Sameer Agnihotri
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine B Peters
- Departments of Neurology and Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York, USA.,Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Joanne T Salcido
- Pediatric Brain Tumor Foundation, Asheville, North Carolina, USA
| | - Nicholas A Butowski
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA
| | | | - Alyx B Porter
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA.,Departments of Neurologic Surgery and Hematology Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Farshad Nassiri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Schiff
- Departments of Neurology, Neurological Surgery and Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | | | - Monika E Hegi
- Neuroscience Research Center, Lausanne University Hospital and University of Lausanne, Epalinges, Switzerland
| | - Terri S Armstrong
- Neuro-oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Milan G Chheda
- Departments of Medicine and Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
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31
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Noll KR, Chen HS, Wefel JS, Kumar VA, Hou P, Ferguson SD, Rao G, Johnson JM, Schomer DF, Suki D, Prabhu SS, Liu HL. Alterations in Functional Connectomics Associated With Neurocognitive Changes Following Glioma Resection. Neurosurgery 2021; 88:544-551. [PMID: 33080024 PMCID: PMC7884148 DOI: 10.1093/neuros/nyaa453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Decline in neurocognitive functioning (NCF) often occurs following brain tumor resection. Functional connectomics have shown how neurologic insults disrupt cerebral networks underlying NCF, though studies involving patients with brain tumors are lacking. OBJECTIVE To investigate the impact of brain tumor resection upon the connectome and relationships with NCF outcome in the early postoperative period. METHODS A total of 15 right-handed adults with left perisylvian glioma underwent resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological assessment before and after awake tumor resection. Graph theoretical analysis was applied to rs-fMRI connectivity matrices to calculate network properties. Network properties and NCF measures were compared across the pre- to postoperative periods with matched pairs Wilcoxon signed-rank tests. Associations between pre- to postoperative change in network and NCF measures were determined with Spearman rank-order correlations (ρ). RESULTS A majority of the sample showed postoperative decline on 1 or more NCF measures. Significant postoperative NCF decline was found across measures of verbal memory, processing speed, executive functioning, receptive language, and a composite index. Regarding connectomic properties, betweenness centrality and assortativity were significantly smaller postoperatively, and reductions in these measures were associated with better NCF outcomes. Significant inverse associations (ρ = -.51 to -.78, all P < .05) were observed between change in language, executive functioning, and learning and memory, and alterations in segregation, centrality, and resilience network properties. CONCLUSION Decline in NCF was common shortly following resection of glioma involving eloquent brain regions, most frequently in verbal learning/memory and executive functioning. Better postoperative outcomes accompanied reductions in centrality and resilience connectomic measures.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Henry S Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dima Suki
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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32
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Wefel JS, Won M, Lassman A, Stern Y, Wang T, Aldape K, Armstrong T, Vogelbaum M, Sulman E, Moazami G, Macsai M, Gilbert M, Bain E, Blot V, Gan H, Preusser M, Ansell P, Samanta S, Kundu M, Seidel C, de Vos F, Hsu S, Cardona A, Lombardi G, Bentsion D, Peterson R, Gedye C, Lebrun-Frenay C, Wick A, Pugh S, Curran W, Mehta M. CTNI-51. NEUROCOGNITIVE FUNCTION (NCF) OUTCOMES OF RTOG FOUNDATION 3508: A PHASE 3 TRIAL OF ABT-414 WITH CONCURRENT CHEMORADIATION AND ADJUVANT TEMOZOLOMIDE IN PATIENTS WITH EGFR-AMPLIFIED NEWLY DIAGNOSED GBM. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.217] [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
RTOG 3508/AbbVie M13-813/INTELLANCE-1 was a phase 3 trial of depatuximab-mafodotin (depatux-m, formerly ABT-414) that accrued 639 patients with EGFR-amplified newly diagnosed GBM. At the pre-specified interim OS analysis, the futility criteria were met and there was no survival benefit from adding depatux-m to SOC. Pre-specified secondary NCF analyses included time to decline in verbal learning and memory as assessed by the HVLT-R Total Recall based on the reliable change index. Exploratory NCF analyses examined changes in other HVLT-R outcomes over time. As corneal epitheliopathy causing visual impairment is a known toxicity of depatux-m, NCF tests that did not depend on visual acuity were employed. NCF testing occurred at baseline, day 1 of the first cycle of adjuvant depatux-m, every other cycle (i.e., 8 weeks) thereafter, and at progression. Compliance with test completion was 95% at screening and 80%, 70%, 58%, 51%, 47% thereafter through cycle 9. The most common reasons for missing data was site error. Time to HVLT-R Total Recall decline trended worse in the depatux-m arm compared to placebo but the difference was not significant (12 month deterioration: 41.2%, 95% CI: 3.50–47.2 vs 32.4%, 95% CI: 26.6- 38.4, p=0.052). The depatux-m arm, in comparison to the placebo arm, showed greater decline from baseline on the HVLT-R at the following time points: cycle 3 (Total Recall: mean= -1.8, SD=5.7 vs mean= -0.5, SD=5.5, respectively, p=0.046; Delayed Recall: mean= -1.1, SD=3.0 vs. mean= -0.2, SD=2.7, respectively, p=0.01), cycle 7 (Total Recall: mean= -0.6, SD=5.1 vs mean= 1.4, SD=5.0, respectively, p=0.009; Delayed Recall: mean -0.6, SD=3.0 vs. mean= 0.5, SD=2.7, respectively, p=0.01), and cycle 9 (Delayed Recall: mean=-0.4, SD=2.7 vs. mean= 0.8, SD=2.4, respectively, p=0.003). Depatux-m added to concurrent chemoradiation and adjuvant temozolomide was associated with faster time to deterioration and worse episodic learning and memory over time than placebo.
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Affiliation(s)
| | | | - Andrew Lassman
- New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | | | - Tony Wang
- NYP / Columbia University Irving Medical Center, New York, NY, USA
| | - Kenneth Aldape
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | | | | | - Erik Sulman
- Department of Radiation Oncology at NYU Grossman School of Medicine, New York, NY, USA
| | | | | | | | | | | | - Hui Gan
- Olivia Newton-John Cancer Research Institute, Heideleberg, VIC, Australia
| | | | | | | | | | | | - Filip de Vos
- Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Sigmund Hsu
- Memorial Hermann Texas Medical Center, Houston, TX, USA
| | | | | | - Dmitry Bentsion
- Sverdlovsk Regional Oncology Center, Ekaterinburg, Russian Federation
| | - Richard Peterson
- Metro MN Community Oncology Research Consortium, St Louis Park, MN, USA
| | - Craig Gedye
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | | | - Antje Wick
- Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Walter Curran
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
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Wefel JS, DeMora L, Gondi V, Tsien C, Chenevert T, Gilbert M, Omuro A, Cao Y, Srinivasan A, Rogers L, Shi W, Nedzi L, Chan M, Suh J, Battiste J, Mishra M, Shivnani A, Movsas B, Mehta M. CTNI-50. NEUROCOGNITIVE FUNCTION (NCF) OF THE PHOTON COHORT IN NRG-BN001. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.216] [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
NRG BN001 is an ongoing randomized phase II trial of dose-intense (DI-RT) versus standard dose photon-based radiation therapy (SD-RT) with temozolomide (TMZ) for newly diagnosed glioblastoma. We report preliminary results of Group 1, DI-RT delivered with IMRT while SD-RT could be 3DCRT or IMRT. Group 2, DI-RT delivered with proton therapy, continues to accrue. From 10/2014 to 7/2018, 229 patients were eligible and randomized. Differences in overall survival following DI-RT versus SD-RT were not significant. Patients were scheduled to complete NCF testing at baseline, cycle 3 (within 7 days of cycle 4), and cycle 12 (day 22–28 of cycle 12, or 60 weeks from completion of chemoradiation). At baseline, 93–94% of eligible patients completed NCF testing. Compliance for evaluable patients at cycle 3 and cycle 12 was 66–68% and 51–54%, respectively, across the battery of NCF tests. The most common reasons for missing data were patient refusal (cycle 3: 14%, cycle 12: 22–23%) and institutional error (cycle 3: 9–10%, cycle 12: 14–15%). A prespecified secondary endpoint analysis was conducted to evaluate differences in NCF between SD-RT and DI-RT based on the Clinical Trial Battery Composite (CTB COMP), which is the mean of the standardized scores from the NCF test battery (HVLT-R, TMT, COWA). There was no statistically significant between arm difference in change from baseline on the CTB COMP at cycle 3 (DI-RT vs SD-RT mean/SD, 0.0 +/- 1.3 vs -0.3 +/- 1.5, p=0.370, Cohen’s d=0.22) or cycle 12 (DI-RT vs SD-RT mean/SD, 0.2 +/- 1.7 vs 0.2 +/- 1.1, p=0.977, Cohen’s d=0.01). A mixed effects longitudinal model of the CTB COMP yielded a non-significant time by treatment effect interaction (p=0.216). There were no significant differences in change scores between arms on any NCF test at cycles 3 or 12. NCF outcomes were similar for photon-based SD-RT and DI-RT.
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Affiliation(s)
| | | | - Vinai Gondi
- Northwestern Medicine Cancer Center Warrenville, Warrenville, IL, USA
| | - Christina Tsien
- Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | | | | | | | - Yue Cao
- University of Michigan, Ann Arbor, MI, USA
| | | | | | - Wenyin Shi
- Jefferson University Hospital, Philadelphia, PA, USA
| | - Lucien Nedzi
- UT Southwestern/Simmons Cancer Center-Dallas, Dallas, TX, USA
| | - Michael Chan
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - John Suh
- Cleveland Clinic, Cleveland, OH, USA
| | - James Battiste
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Mark Mishra
- University of Maryland / Greenebaum Cancer Center, Baltimore, MD, USA
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Bovi J, Pugh S, Brown P, Gondi V, Wefel JS, Tome WA, Gilbert M, Robinson C, Benzinger TLS, Sabsevitz D, Lee K, Paulson E, Kundapur V, Roberge D, Kaufman I, Shah SA, Usuki KY, Stea BD, Yoon HA, DeMora L, Mehta M, Kachnik L. NCOG-04. PRETREATMENT VOLUME OF MR-DETERMINED WHITE MATTER INJURY (WMI) PREDICTS NEUROCOGNITIVE DECLINE AFTER HIPPOCAMPAL AVOIDANT (HA) WBRT+MEMANTINE FOR BRAIN METASTASES: SECONDARY ANALYSIS OF NRG ONCOLOGYCC001. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.543] [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
PURPOSE
Previous secondary analysis of NRG/RTOG 0933 provided hypothesis-generating data supporting a relationship between larger volumes of MR-determined pre-treatment WMI and developing neurocognitive decline following HA-WBRT. The current study examines the relationship between pre-treatment WMI and neurocognitive function (NCF) following WBRT+memantine +/-HA in a substantially larger cohort.
METHODS
NCF testing was performed at baseline,2,4,6,and 12 months post-WBRT, and included Hopkins Verbal Learning Test–Revised (HVLT-R), Trail Making Test (TMT) Parts A and B, and Controlled Oral Word Association (COWA). Pre-treatment WMI was measured by FLAIR volume corrected for whole brain volume and corrected for the FLAIR volume associated with metastases (FLAIR/(whole brain volume – metastasis FLAIR volume). Pearson correlation coefficients were used to assess association between pre-treatment WMI and change from baseline for each standardized NCF score.
RESULTS
Of 518 randomized patients, 442 (217,WBRT+Memantine; 225,HA-WBRT+Memantine) had WMI data and were included. In the entire cohort, mean FLAIR volume was 9.3cc (0.1-68.2cc), mean metastases FLAIR volume was 61.5cc (0-423.5cc), mean Whole Brain volume was 1336.4cc (949.4-2397.8cc). At 2 months, there were no significant correlations between neurocognitive test change scores and pre-treatment WMI volume. However, at 4 months, both HVLT-R Total Recall and TMT Part B change score and pre-treatment WMI volume were significantly negatively correlated on the HA-WBRT+Memantine arm (ρ=-0.22 p=0.042 and ρ=-0.27, p=0.013). At 12 months, both TMT Part A and TMT Part B change scores and pre-treatment WMI volume were significantly negatively correlated on the HA-WBRT+Memantine arm (ρ=-0.30, p=0.046 and ρ=-0.53, p< 0.001).
CONCLUSIONS
Pre-treatment WMI volume was a significant imaging-biomarker predictor of post-treatment neurocognitive decline at 4-and 12-months following HA-WBRT+Memantine. This suggests patients with greater pre-treatment WMI were more susceptible to neurocognitive decline, specifically when undergoing HA-WBRT, but not following standard WBRT. Dose heterogeneity inherent to HA-WBRT delivery may contribute to these findings and are hypothesis generating.
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Affiliation(s)
- Joseph Bovi
- Dept. Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | | | - Vinai Gondi
- Northwestern Medicine Cancer Center, Warrenville, IL, USA
| | | | | | | | | | | | | | - Karen Lee
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Paulson
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Sunjay A Shah
- Delaware/ Christiana Care NCI Community Oncology Research Program, Wilmington, DE, USA
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Mrugala M, Ostrom Q, Pressley S, Thomas A, Wefel JS, Coven S, Acquaye A, Haynes C, Agnihotri S, Lim M, Peters K, Butowski N, Hervey-Jumper S, Porter A, Oliver K, Dunbar E, Taylor J, Schiff D, Nassiri F, Hegi M, Armstrong T, van den Bent M, Chang S, Zadeh G, Chheda M. COVD-31. THE STATE OF NEURO-ONCOLOGY DURING THE COVID-19 PANDEMIC: A WORLDWIDE ASSESSMENT. Neuro Oncol 2020. [PMCID: PMC7650329 DOI: 10.1093/neuonc/noaa215.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To assess the impact of the pandemic on the field, we performed an international web-based survey of practitioners, scientists, and trainees from 21 neuro-oncology organizations across 6 continents from April 24 through May 17. Of 582 respondents, 258 (45%) were in the US, and 314 (55%) were international. 80.4% were affiliated with academic institutions. 94% respondents reported changes in clinical practice; 95% reported conversion to telemedicine for at least some appointments. However, almost 10% practitioners felt the need to see patients in person specifically because of billing concerns and perceived institutional pressure. Over 50% believed neuro-oncology patients were at increased risk of contracting COVID-19. 67% practitioners suspended enrollment for at least one clinical trial: 53% suspended phase II and 62% suspended phase III trial enrollment. 71% clinicians feared for their or their families’ safety, specifically because of their clinical duties. 20% percent said they did not have enough PPE to work safely; about the same percentage were unhappy with their institutions’ response to the pandemic. 43% believed the pandemic would negatively affect their academic career, and 52% fellowship program directors were worried about losing funding for their training programs. While 69% respondents reported increased stress, 44% were offered no psychosocial support. 37% had their salary reduced. 36% researchers had to temporarily close their laboratories. In contrast, the pandemic created positive changes in perceived patient and family satisfaction, quality of communication, and use of technology to deliver care and interactions with other practitioners. CONCLUSIONS: The pandemic has altered standard treatment schedules and limited investigational treatment options for patients. In some cases, clinicians felt institutional pressure to continue conducting billable in-person visits when telemedicine visits would have sufficed. A lack of institutional support created anxiety among clinicians and researchers. We make specific recommendations to guide clinical and scientific infrastructure moving forward.
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Affiliation(s)
| | | | | | - Alissa Thomas
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | | | - Scott Coven
- Riley Children’s Health, Indianapolis, IN, USA
| | | | - Chas Haynes
- Society for Neuro-Oncology, Houston, TX, USA
| | | | - Michael Lim
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, United Kingdom
| | | | - Jennie Taylor
- Department of Neurological Surgery, University of California (UCSF), San Francisco, San Francisco, CA, USA
| | - David Schiff
- University of Virginia Health Systems, Emily Couric Clinical Cancer Center, Charlottesville, VA, USA
| | | | - Monika Hegi
- Lausanne University Hospital, Epalinges, Switzerland
| | | | | | - Susan Chang
- University of California San Francisco, San Francisco, CA, USA
| | - Gelareh Zadeh
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Milan Chheda
- Washington University School of Medicine, St Louis, MO, USA
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Cramer C, Page B, Wefel JS, Dressler E, Ip E, Rapp S, Shaw E, Weaver K, Lesser G, Chan M. NCOG-24. WAKE FOREST NCORP RESEARCH BASE FEASIBILITY STUDY OF RAMIPRIL FOR PREVENTING COGNITIVE DECLINE IN GLIOBLASTOMA PATIENTS RECEIVING BRAIN RADIOTHERAPY (WF-1801). Neuro Oncol 2020. [PMCID: PMC7651320 DOI: 10.1093/neuonc/noaa215.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Chronic neuro-inflammation after brain radiotherapy (RT) contributes to radiation-induced cognitive decline (RICD). The renin angiotensin system (RAS) may mediate this inflammatory cascade after RT. Ramipril is an angiotensin-converting enzyme inhibitor used to treat hypertension and has good blood-brain barrier penetration. By blocking RAS activation, ramipril reduces neuro-inflammation and preclinical data show that ramipril administration during RT can prevent RICD. METHODS WF-1801 is an ongoing feasibility study that will enroll a total of 75 patients. Patients ≥ 18 with newly diagnosed and pathologically confirmed GBM who will receive chemoradiation are eligible. All participants take ramipril daily during RT and for 4 months thereafter. Ramipril is titrated from 1.25mg to 5mg daily over 3 weeks. A cognitive battery that includes the Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT), and Controlled Oral Word Association test (COWA) is administered at baseline, end of RT, and 1-month and 4-months post-RT. The co-primary endpoints are retention rate (with retention defined as compliance with > 75% of drug therapy doses) and neurocognitive function at 1-month post-RT. To estimate the effect of ramipril on cognitive function, performance on the cognitive battery will be compared to a historical control (cognitive data from the control arm of RTOG 0825). ApoE genotyping is being performed as a correlative study. RESULTS 31 of a planned 75 participants have been enrolled over 14 months. 20 of 31 (64.5%) are male. 21 (67.7%) are between the age of 40-64. 20 (95.6%) are white and 29 (93.6%) are not Hispanic or Latino. CONCLUSION Despite a pause in accrual due to COVID-19, we are easily meeting planned accrual goals. Community oncology-based clinical trials of interventions to prevent cognitive toxicity appear to be feasible. GBM patients seem eager to enroll in studies seeking to prevent cognitive decline. Supported by NCI grant UG1CA189824.
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Affiliation(s)
| | - Brandi Page
- Johns Hopkins University School of Medicine, Bethesda, MD, USA
| | | | | | - Edward Ip
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steve Rapp
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward Shaw
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael Chan
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Jaeckle K, Ballman K, van den Bent M, Giannini C, Galanis E, Brown P, Jenkins R, Cairncross G, Wick W, Weller M, Aldape K, Dixon J, Anderson SK, Cerhan J, Wefel JS, Klein M, Grossman S, Schiff D, Raizer J, Dhermain F, Nordstrom D, Flynn P, Vogelbaum M. CTNI-29. CODEL: PHASE III TRIAL OF RT ALONE, RT PLUS TMZ, OR TMZ ALONE FOR NEWLY-DIAGNOSED, 1p/19q CODELETED ANAPLASTIC OLIGODENDROGLIOMA. ANALYSIS FROM THE INITIAL STUDY DESIGN. (NCCTG N0577, ALLIANCE). Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.196] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The original 3-arm CODEL design included a radiotherapy (RT)-alone control arm, an RT plus temozolomide (TMZ) arm, and an exploratory TMZ-alone arm. We report the analysis involving patients treated per the initial design.
METHODS
Adults (18+ years) with newly-diagnosed 1p/19q codeleted WHO grade III oligodendroglioma were randomized to RT (5940 cGy) alone (Arm A); RT with concomitant and adjuvant TMZ (Arm B); or TMZ alone (Arm C). Primary endpoint was OS, Arm A vs. B. Secondary comparisons were performed for OS and PFS, comparing pooled RT arms with the TMZ-alone arm.
RESULTS
36 patients were randomized equally to the three arms. At median follow-up of 7.5 years, 83.3% (10/12) TMZ-alone patients had progressed, versus 37.5% (9/24) patients on the RT arms. PFS was shorter in TMZ-alone patients compared to RT-treated patients (HR=3.12; 95% CI: 1.26, 7.69; p=0.014). Death from disease progression occurred in 3/12 (25%) of TMZ-alone patients and 4/24 (16.7%) of RT-treated patients. OS did not statistically differ between arms, although this comparison was underpowered. After adjustment for IDH status (mutated vs. wildtype) in a Cox regression model, with IDH status and RT treatment status as co-variables (Arm C vs pooled A and B), PFS remained shorter for patients not receiving RT (HR= 3.33; 95% CI: 1.31, 8.45; p=0.011), and OS differences remained non-significant ((HR = 2.78; 95% CI 0.58, 13.22, p=0.20). Grade 3+ adverse events occurred in 25%, 42% and 33% patients (Arms A, B and C, respectively). Neurocognitive assessments, comparing baseline and 3 month timepoints, showed no significant differences between arms.
CONCLUSIONS
TMZ-alone treated patients experienced significantly shorter PFS than patients treated on the pooled RT arms, which remained significant when adjusting for IDH status. CODEL has been redesigned to compare the efficacy and toxicity of RT+PCV versus RT+TMZ. Clinicaltrials.gov Identifier: NCT00887146. Support: U10CA180821, U10CA180882, https://acknowledgments.alliancefound.org.
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Affiliation(s)
| | - Karla Ballman
- Weill Medical College of Cornell University, New York, NY, USA
| | - Martin van den Bent
- Erasmus MC Cancer Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | | | - Gregory Cairncross
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada
| | | | - Michael Weller
- UniversitätsSpital Zürich - Klinik für Neurologie, Zurich, Switzerland
| | - Kenneth Aldape
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | | | | | | | | | - Martin Klein
- VU University Medical Center, Amsterdam, Netherlands
| | - Stuart Grossman
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - David Schiff
- University of Virginia, Charlottesville, NC, USA
| | - Jeffrey Raizer
- Northwestern University Medical Center, Chicago, IL, USA
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Wefel JS. Improving access and standard of care for all. Neurooncol Pract 2020; 7:261-262. [PMID: 32537174 DOI: 10.1093/nop/npaa018] [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: 11/13/2022] Open
Affiliation(s)
- Jeffrey S Wefel
- University of Texas M.D. Anderson Cancer Center, Department of Neuro-Oncology, Section of Neuropsychology, Houston, TX
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Ryan C, Wefel JS, Morgans AK. A review of prostate cancer treatment impact on the CNS and cognitive function. Prostate Cancer Prostatic Dis 2020; 23:207-219. [PMID: 31844181 PMCID: PMC7237350 DOI: 10.1038/s41391-019-0195-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is the backbone of systemic therapy for men with prostate cancer (PC); almost one-half of patients receive treatment during their disease course. However, a range of cognitive and other central nervous system (CNS) changes have been associated with ADT. In this review, we discuss extant data describing these complications and the mechanisms through which medications used to deliver ADT may affect them. METHODS We performed a MEDLINE search for appropriate papers published between January 2000 and December 2018. Relevant papers were selected and reviewed; additional publications were identified by manually assessing references from included papers, and recent congress abstracts. RESULTS Of ~230 search outputs, 33 were selected for inclusion. Some studies suggested a clear association between ADT and CNS effects in men with PC, whereas others did not. Accurate assessment is limited by test instrument variability, inadequate sample sizes, short follow-up duration, and limited prospective longitudinal studies. The approved second-generation androgen receptor (AR) inhibitors enzalutamide and apalutamide were associated with some CNS-related adverse events (AEs) in clinical studies, including fatigue (which can interfere with cognitive function). The androgen synthesis inhibitor abiraterone acetate was associated with a low CNS AE profile when compared with enzalutamide. The AR antagonist darolutamide demonstrated a comparable incidence of cognitive disorder in clinical trials to that of ADT alone. CONCLUSIONS Adequately caring for men receiving ADT requires an understanding of the symptoms, incidence and magnitude of cognitive effects, and a feasible approach to cognitive assessment and management in clinical settings. Some CNS effects could relate to blood-brain barrier penetration and direct AR inhibitor activity; drug safety profiles may differ by the degree of blood-brain barrier penetration of particular agents. Ongoing clinical trials seek to define the CNS tolerability of newer AR pathway-targeted therapy options more clearly.
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Affiliation(s)
- Charles Ryan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA.
| | - Jeffrey S Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alicia K Morgans
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Brown PD, Gondi V, Pugh S, Tome WA, Wefel JS, Armstrong TS, Bovi JA, Robinson C, Konski A, Khuntia D, Grosshans D, Benzinger TLS, Bruner D, Gilbert MR, Roberge D, Kundapur V, Devisetty K, Shah S, Usuki K, Anderson BM, Stea B, Yoon H, Li J, Laack NN, Kruser TJ, Chmura SJ, Shi W, Deshmukh S, Mehta MP, Kachnic LA. Hippocampal Avoidance During Whole-Brain Radiotherapy Plus Memantine for Patients With Brain Metastases: Phase III Trial NRG Oncology CC001. J Clin Oncol 2020; 38:1019-1029. [PMID: 32058845 PMCID: PMC7106984 DOI: 10.1200/jco.19.02767] [Citation(s) in RCA: 413] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Radiation dose to the neuroregenerative zone of the hippocampus has been found to be associated with cognitive toxicity. Hippocampal avoidance (HA) using intensity-modulated radiotherapy during whole-brain radiotherapy (WBRT) is hypothesized to preserve cognition. METHODS This phase III trial enrolled adult patients with brain metastases to HA-WBRT plus memantine or WBRT plus memantine. The primary end point was time to cognitive function failure, defined as decline using the reliable change index on at least one of the cognitive tests. Secondary end points included overall survival (OS), intracranial progression-free survival (PFS), toxicity, and patient-reported symptom burden. RESULTS Between July 2015 and March 2018, 518 patients were randomly assigned. Median follow-up for alive patients was 7.9 months. Risk of cognitive failure was significantly lower after HA-WBRT plus memantine versus WBRT plus memantine (adjusted hazard ratio, 0.74; 95% CI, 0.58 to 0.95; P = .02). This difference was attributable to less deterioration in executive function at 4 months (23.3% v 40.4%; P = .01) and learning and memory at 6 months (11.5% v 24.7% [P = .049] and 16.4% v 33.3% [P = .02], respectively). Treatment arms did not differ significantly in OS, intracranial PFS, or toxicity. At 6 months, using all data, patients who received HA-WBRT plus memantine reported less fatigue (P = .04), less difficulty with remembering things (P = .01), and less difficulty with speaking (P = .049) and using imputed data, less interference of neurologic symptoms in daily activities (P = .008) and fewer cognitive symptoms (P = .01). CONCLUSION HA-WBRT plus memantine better preserves cognitive function and patient-reported symptoms, with no difference in intracranial PFS and OS, and should be considered a standard of care for patients with good performance status who plan to receive WBRT for brain metastases with no metastases in the HA region.
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Affiliation(s)
| | - Vinai Gondi
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Proton Center, Warrenville, IL
| | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Wolfgang A. Tome
- Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY
| | | | | | - Joseph A. Bovi
- Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Deepak Khuntia
- East Bay Radiation Oncology Center, Eden Medical Center, Castro Valley, CA
| | - David Grosshans
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Deborah Bruner
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mark R. Gilbert
- National Cancer Institute Center for Cancer Research, Bethesda, MD
| | - David Roberge
- CHUM-Hôtel-Dieu de Montréal, Montreal, Quebec, Canada
| | | | - Kiran Devisetty
- Wayne State University, Karmanos Cancer Institute, Detroit, MI
| | - Sunjay Shah
- ChristianaCare National Cancer Institute Community Oncology Research Program, Newark, DE
| | | | | | - Baldassarre Stea
- University of Arizona Medical Center-University Campus, Tucson, AZ
| | - Harold Yoon
- Heartland Cancer Research National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Jing Li
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Steven J. Chmura
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Wenyin Shi
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Snehal Deshmukh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | - Lisa A. Kachnic
- Vanderbilt University Medical Center, Ingram Cancer Center, Nashville, TN
| | - for NRG Oncology
- Mayo Clinic, Rochester, MN
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Proton Center, Warrenville, IL
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
- Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY
- The University of Texas MD Anderson Cancer Center, Houston, TX
- National Cancer Institute Center for Cancer Research, Bethesda, MD
- Froedtert & the Medical College of Wisconsin, Milwaukee, WI
- Washington University in St Louis, St Louis, MO
- Chester County Hospital, West Chester, PA
- East Bay Radiation Oncology Center, Eden Medical Center, Castro Valley, CA
- Winship Cancer Institute of Emory University, Atlanta, GA
- CHUM-Hôtel-Dieu de Montréal, Montreal, Quebec, Canada
- Saskatoon Cancer Center, Saskatoon, Saskatchewan, Canada
- Wayne State University, Karmanos Cancer Institute, Detroit, MI
- ChristianaCare National Cancer Institute Community Oncology Research Program, Newark, DE
- University of Rochester, Rochester, NY
- University of Wisconsin Hospitals and Clinics, Madison, WI
- University of Arizona Medical Center-University Campus, Tucson, AZ
- Heartland Cancer Research National Cancer Institute Community Oncology Research Program, Decatur, IL
- Northwestern Memorial Hospital, Chicago, IL
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
- Thomas Jefferson University Hospital, Philadelphia, PA
- Miami Cancer Institute, Miami, FL
- Vanderbilt University Medical Center, Ingram Cancer Center, Nashville, TN
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Kumthekar P, Tang SC, Brenner AJ, Kesari S, Piccioni DE, Anders C, Carrillo J, Chalasani P, Kabos P, Puhalla S, Tkaczuk K, Garcia AA, Ahluwalia MS, Wefel JS, Lakhani N, Ibrahim N. ANG1005, a Brain-Penetrating Peptide–Drug Conjugate, Shows Activity in Patients with Breast Cancer with Leptomeningeal Carcinomatosis and Recurrent Brain Metastases. Clin Cancer Res 2020; 26:2789-2799. [DOI: 10.1158/1078-0432.ccr-19-3258] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 01/17/2020] [Indexed: 11/16/2022]
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Hall WA, Pugh SL, Wefel JS, Armstrong TS, Gilbert MR, Brachman DG, Werner-Wasik M, Wendland MM, Brown PD, Chao ST, Roof KS, Robins HI, Mehta MP, Curran WJ, Movsas B. Influence of Residual Disease Following Surgical Resection in Newly Diagnosed Glioblastoma on Clinical, Neurocognitive, and Patient Reported Outcomes. Neurosurgery 2020; 84:66-76. [PMID: 29618054 DOI: 10.1093/neuros/nyy003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/15/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The influence of subtotal resection (STR) on neurocognitive function (NCF), quality of life, and symptom burden in glioblastoma is unknown. If bevacizumab preferentially benefits patients with STR is unknown. OBJECTIVE To examine these uncertainties. METHODS NCF and patient reported outcomes (PRO) were prospectively collected in NRG Oncology RTOG 0525 and 0825. Changes in NCF and PRO measures from baseline to prespecified times were examined by Wilcoxon test, and mixed effects longitudinal modeling, to assess differences between patients who received STR vs gross-total resection. Changes were also compared among STR patients on 0825 receiving placebo vs bevacizumab to assess for a preferential therapeutic effect. Overall survival between STR and gross-total resection patients was compared using the Kaplan-Meier method. RESULTS A total of 427 patients were eligible with STR present in 37%. At baseline, patients with STR had worse NCF, worse MD Anderson Symptom Inventory Brain Tumor Neurological Factor ratings (P = .004), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (P = .002). Longitudinal multivariate analysis associated STR with worse NCF (Hopkins Verbal Learning Test-Revised Delayed Recognition [P = .048], Trail Making Test Part A [P = .035], and Controlled Oral Word Association [P = .049]). One hundred eighty-three STR patients from 0825 were analyzed (89 bevacizumab, 94 placebo); bevacizumab failed to demonstrate improvement in select NCF or PRO measures. CONCLUSION STR patients had worse NCF and PROs before therapy. During adjuvant therapy, STR patients had worse objective NCF, despite accounting for tumor location. STR did not result in a detriment to OS. The addition of bevacizumab did not preferentially improve PRO or NCF outcomes in STR patients.
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Affiliation(s)
- William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin and Clement J. Zablocki, VA, Medical Center, Milwaukee, Wisconsin
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark R Gilbert
- Center for Cancer Research, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David G Brachman
- Department of Radiation Oncology, University of Arizona, St. Joseph's Hospital Medical Center and Barrow Neurological Institute, Phoenix, Arizona
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Merideth M Wendland
- Department of Radiation Oncology, Willamette Valley Cancer Institute, Eugene, Oregon
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kevin S Roof
- Department of Radiation Oncology, Southeast Cancer Control Consortium, Inc, CCOP, Winston Salem, NC, North Carolina
| | - H Ian Robins
- Departments of Medicine, Human Oncology, and Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Minesh P Mehta
- Miami Cancer Institute, Baptist Health, Kendall, Florida
| | - Walter J Curran
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan
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Zeng Y, Dong J, Huang M, Zhang JE, Zhang X, Xie M, Wefel JS. Nonpharmacological interventions for cancer-related cognitive impairment in adult cancer patients: A network meta-analysis. Int J Nurs Stud 2020; 104:103514. [PMID: 32004776 DOI: 10.1016/j.ijnurstu.2019.103514] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Conventional meta-analyses can only provide direct comparison evidence, and the best options of nonpharmacological interventions for cancer-related cognitive impairment remain largely unknown. OBJECTIVES To evaluate the comparative effects of all known nonpharmacological interventions for cancer-related cognitive impairment, and to rank the best intervention options for adult non- central nervous system cancer patients with cancer-related cognitive impairment. DESIGN Systematic review with a new analytic approach of network meta-analysis. DATA SOURCES Six electronic databases were searched for randomized controlled trials from January 2010 to July 2019. REVIEW METHODS Literature screening, data extraction and quality appraisal was undertaken systematically by two independent reviewers. Quantitative network meta-analysis performed to analyze key study outcomes. The primary outcome was the effectiveness of interventions on subjective cognitive function, and the secondary outcome was the safety of nonpharmacological interventions for cancer-related cognitive impairment. RESULTS There were 29 eligible randomized controlled trials searched, and a total of 10 interventions identified. All 29 randomized controlled trials that were included had no reported significant adverse events, therefore, these 10 nonpharmacological interventions are safe for cancer-related cognitive impairment management. In terms of effectiveness, the pooled overall effects were in favor of these 10 nonpharmacological interventions. The most effective interventions included meditation, cognitive training, cognitive rehabilitation, and exercise interventions, with a mean difference of effective size plus 95% confidence interval 10.26 (1.53, 19.00), 5.02 (1.41, 8.63), 4.88 (0.65, 9.11), and 3.82 (0.52, 7.13), respectively. Other treatment effects did not show statistically significant differences. CONCLUSIONS This network meta-analysis found that meditation interventions, cognitive training, cognitive rehabilitation, and exercise were the most effective interventions for adult non-central nervous system cancer patients to manage cancer-related cognitive impairment. Results of this network meta-analysis contribute evidence-based data to inform medical decision-making.
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Affiliation(s)
- Yingchun Zeng
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Juntao Dong
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiling Huang
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Jun-E Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Xiaoming Zhang
- The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Man Xie
- Jieyang People's Hospital, Jieyang, Guangdong Province, China
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, The University of Texas MD Anderson Cancer Center, TX, US
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Abstract
Abstract
Background
Operating a motor vehicle involves multiple cognitive and sensorimotor faculties. Neurological conditions pose driving risk, but this has not been examined in patients with primary brain tumors.
Methods
Sixty-four patients with primary brain tumors (32 left hemisphere; 69% glioblastoma) completed the Cognitive Behavioral Driver’s Inventory (CBDI). A subset also completed broader cognitive testing. Patient characteristics, CBDI measures, and broader neuropsychological test scores were compared between Passing and Nonpassing groups. Follow-up logistic regression analyses identified patient characteristics and CBDI measures predictive of Pass/Nonpass outcome. Point-biserial correlations determined associations between neuropsychological tests and CBDI outcome.
Results
Sixty-nine percent of patients were classified as passing the CBDI. Nonpassing patients were older and more likely to have WHO grade IV and temporal lobe tumors. Age was the most salient predictor of CBDI performance. CBDI measures of speeded visual search and set-shifting, speeded response inhibition, vigilance and freedom from distractibility, and basic visual scanning speed were predictive of Pass/Nonpass outcome. Neuropsychological tests of memory in particular, but also speeded visual scanning and discrimination, executive function, basic visual attention, visuoconstruction, and manual dexterity (dominant hand), were associated with CBDI outcome.
Conclusions
A sizeable proportion of patients with primary brain tumors appear at risk of driving difficulty, particularly those with higher-grade tumors and of older age. Memory, visual attention, and executive difficulties appear to contribute most to driving safety risk as determined by the CBDI. These results highlight the importance of driving safety screening in this population.
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Affiliation(s)
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Wefel JS, Pugh S, Gondi V, Brown PD, Tome W, Armstrong TS, Bruner D, Bovi J, Robinson C, Khuntia D, Grosshans D, Konski A, Roberge D, Kundapur V, Devisetty K, Shah S, Usuki K, Anderson B, Mehta MP, Kachnic L. NRG Oncology CC001 Neurocognitive Final Analysis: A Phase III Trial of Hippocampal Avoidance (HA) in Addition to Whole-Brain Radiotherapy (WBRT) Plus Memantine to Preserve Neurocognitive Function (NCF) in Patients With Brain Metastases (BM). Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_642] [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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Abstract
Impaired neurocognitive function is an increasingly recognized morbidity in patients who have cancer. Cancer treatments, psychosocial stressors, and the malignancy itself can alter brain function. The mechanisms by which this occurs are under active investigation. Although there is a growing appreciation of its prevalence and causes, there remain limited therapeutic options for the treatment of neurocognitive dysfunction in this population. A persistent scientific and clinical effort to understand its mechanisms and impact is critical to the care of oncology patients.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA.
| | - Jeffrey S Wefel
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA
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Wefel JS. Opportunities to enhance our management, outcomes, and interventions for patients with CNS malignancy. Neurooncol Pract 2019; 6:247-248. [DOI: 10.1093/nop/npz035] [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)
- Jeffrey S Wefel
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas MD Anderson Cancer Center, Houston
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Noll KR, Bradshaw ME, Parsons MW, Dawson EL, Rexer J, Wefel JS. Monitoring of Neurocognitive Function in the Care of Patients with Brain Tumors. Curr Treat Options Neurol 2019; 21:33. [PMID: 31250277 DOI: 10.1007/s11940-019-0573-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW A detailed characterization of the nature of neurocognitive impairment in patients with brain tumors is provided, as well as considerations for clinical practice regarding neuropsychological assessment throughout the disease course. RECENT FINDINGS Neurocognitive impairment is common in patients with brain tumors and may result from the tumor itself, as a consequence of treatment, including surgery, chemotherapy, and radiation, or in association with supportive care medications (e.g., anticonvulsant and pain medications). Serial surveillance of neurocognitive functioning in this population can facilitate medical decision-making and inform recommendations to improve patient daily functioning and quality of life. Neuropsychological assessment is increasingly recognized as a critical component of the multidisciplinary care of patients with brain tumors and has already had practice-changing effects. Further understanding of genetic risk factors for neurocognitive decline along with the development of novel assessment and intervention strategies may further enhance functioning and general well-being in this patient population.
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Affiliation(s)
- Kyle R Noll
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Mariana E Bradshaw
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Michael W Parsons
- Department of Neuro-Oncology, Psychology Assessment Center, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Erica L Dawson
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Jennie Rexer
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Jeffrey S Wefel
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA. .,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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van Lonkhuizen PJC, Klaver KM, Wefel JS, Sitskoorn MM, Schagen SB, Gehring K. Interventions for cognitive problems in adults with brain cancer: A narrative review. Eur J Cancer Care (Engl) 2019; 28:e13088. [PMID: 31090162 PMCID: PMC9285967 DOI: 10.1111/ecc.13088] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Many patients with brain cancer experience cognitive problems. In this narrative review, we comprehensively evaluated empirical studies on various intervention approaches for cognitive problems in these patients. METHODS Intervention studies that reported effects on cognitive functioning (either objectively tested or subjectively reported) in adult patients with primary and/or secondary brain tumours were identified through online searches in PubMed (MEDLINE) and Web of Science up to 13 March 2019. RESULTS Of the 364 identified records, 10 pharmacological (including five randomised placebo-controlled trials), 10 cognitive rehabilitation (including five [pilot] RCTs) and two multiple-group exercise studies matched the inclusion criteria. Seventeen of 22 studies had final sample sizes smaller than 40. Several cognitive rehabilitation studies and some pharmacological approaches (donepezil and memantine) showed (at least partial) benefits for cognitive problems in adults with brain cancer. The effects of other pharmacological and exercise interventions were inconclusive and/or preliminary. CONCLUSION Overall, drawing firm conclusions is complicated due to various methodological shortcomings, including the absence of a (placebo) control group and small sample sizes. Promising effects have been reported for cognitive rehabilitation and some pharmacological approaches. Suggestions for more thorough research with respect to the various approaches are provided.
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Affiliation(s)
- Pearl J C van Lonkhuizen
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands.,Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Kete M Klaver
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Margriet M Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Karin Gehring
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands.,Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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Noll KR, Sullaway CM, Wefel JS. Depressive symptoms and executive function in relation to survival in patients with glioblastoma. J Neurooncol 2019; 142:183-191. [PMID: 30680509 DOI: 10.1007/s11060-018-03081-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/15/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Depression and neurocognitive function, particularly executive functioning (EF), have been associated with overall survival (OS) in patients with glioblastoma (GBM). However, the combined effect of depressive symptoms and impaired EF upon OS has not been reported. METHODS Patients with GBM (N = 102) completed neuropsychological assessment postoperatively, including the Beck Depression Inventory-Second Edition (BDI-II) and the Trail Making Test Part B (TMTB). Median splits were used to determine cut-points denoting elevated depressive symptoms on the BDI-II and impaired EF on TMTB. Patients were stratified into four groups: low depressive symptoms/low EF impairment (- Dep/- Imp; N = 23), high depressive symptoms/low EF impairment (+ Dep/- Imp; N = 28), low depressive symptoms/high EF impairment (- Dep/+Imp; N = 28), and high depressive symptoms/high EF impairment (+ Dep/+Imp; N = 23). The Kaplan-Meier method, log-rank test, and Cox regression were used to examine differences in survival between groups. RESULTS Relative to - Dep/- Imp patients (median OS = 22.8 months), median OS in all other patient groups was shorter (+ Dep/- Imp OS = 16.6; - Dep/+Imp OS = 14.8; +Dep/+Imp OS = 10.8; all p < .05). With the exception of KPS and age, groups did not differ in distribution of clinical and demographic characteristics. Neither KPS nor age modified the independent effect of BDI-II and TMTB on OS in Cox regression models. CONCLUSIONS The presence of depressive symptoms and impaired EF are independently associated with shorter OS in patients with GBM. These results suggest that routine neuropsychological assessment of mood and cognition may help refine prognosis and facilitate initiation of psychological and cognitive interventions, which can improve patient quality of life, and warrants further investigation.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Catherine M Sullaway
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA. .,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA.
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