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Le Rhun E, Lebrun Frenay C, Devos P, Darlix A, Lorgis V, Ahle G, Boone M, Taillandier L, Curtit E, Gras L, Bourg V, Ramirez C, Reyns N, Weller M, Simon N. P01.034 Prospective evaluation of alternative therapies in glioma patients in France. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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URSU R, Thomas L, Psimaras D, Chinot O, Le Rhun E, Ricard D, Charissoux M, Cuzzubbo S, Sejalon F, Quillien V, Hoang-Xuan K, Ducray F, Portal J, Levy-Piedbois C, Vicaut E, Carpentier A. OS2.4 Angiotensin II Receptor Blockers, steroids and radiotherapy in glioblastoma - A randomized multicenter trial (ASTER Trial). An ANOCEF Study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Le Rhun E, von Achenbach C, Lohmann B, Silginer M, Schneider H, Meetze K, Szabo E, Weller M. P04.11 Profound sensitivity of glioblastoma cells to apoptosis induction by TG02, a novel oral multi-cyclin-dependent kinase inhibitor. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leroy HA, Delmaire C, Le Rhun E, Drumez E, Lejeune JP, Reyns N. High-field intraoperative MRI in glioma surgery: A prospective study with volumetric analysis of extent of resection and functional outcome. Neurochirurgie 2018; 64:155-160. [PMID: 29754739 DOI: 10.1016/j.neuchi.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/14/2018] [Accepted: 02/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND High-field intraoperative MRI (IoMRI) is a useful tool to improve the extent of glioma resection (EOR). OBJECTIVE To compare the interest of 1.5T IoMRI in glioma surgery between enhancing and non-enhancing tumors, based on volumetric analysis. METHODS A prospective single-center study included consecutive adult patients undergoing glioma surgery with IoMRI. Volumetric evaluation was based on FLAIR hypersignal after gadolinium injection in non-enhancing tumors and T1 hypersignal after gadolinium injection in enhancing tumors. Endpoints comprised: residual tumor volume (RTV), EOR, workflow and clinical outcome on Karnofsky performance score (KPS). RESULTS Fifty-three surgeries were performed from July 2014 to January 2016. Thirty-four patients underwent one IoMRI, and 19 two IoMRIs. In non-enhancing tumors, intraoperative RTV on 1st IoMRI T2/FLAIR was higher than in enhancing tumors on T1 sequences (7.25cm3 vs. 0.74cm3, respectively; P=0.008), whereas the RTV on 2nd IoMRIs and final RTV were no longer significantly different. After IoMRI, 72% of patients underwent additional resection. In non-enhancing tumors, EOR increased from 77.3% on 1st IoMRI to 97.4% on last MRI (P<0.001). Taking all tumors together, final RTV values were: median=0cm3, mean=3.9cm3. Mean final EOR was 94%. In 25% of patients, KPS was reduced during early postoperative course; at 3 and 6 months postoperatively, median KPS was 90. CONCLUSION Intraoperative MRI guidance significantly enhanced the extent of glioma resection, especially for non- or minimally enhancing tumors, while preserving patient autonomy.
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Tallet AV, Dhermain F, Le Rhun E, Noël G, Kirova YM. Combined irradiation and targeted therapy or immune checkpoint blockade in brain metastases: toxicities and efficacy. Ann Oncol 2018; 28:2962-2976. [PMID: 29045524 DOI: 10.1093/annonc/mdx408] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Targeted therapies (TT) and immune checkpoint inhibitors (ICI) are currently modifying the landscape of metastatic cancer management and are increasingly used over the course of many cancers treatment. They allow long-term survival with controlled extra-cerebral disease, contributing to the increasing incidence of brain metastases (BMs). Radiation therapy remains the cornerstone of BMs treatment (either whole brain irradiation or stereotactic radiosurgery), and investigating the safety profile of radiation therapy combined with TT or ICI is of high interest. Discontinuing an efficient systemic therapy, when BMs irradiation is considered, might allow systemic disease progression and, on the other hand, the mechanisms of action of these two therapeutic modalities might lead to unexpected toxicities and/or greater efficacy, when combined. Patients and methods We carried out a systematic literature review focusing on the safety profile and the efficacy of BMs radiation therapy combined with targeted agents or ICI, emphasizing on the role (if any) of the sequence of combination scheme (drug given before, during, and/or after radiation therapy). Results Whereas no relevant toxicity has been noticed with most of these drugs, the concomitant use of some other drugs with brain irradiation requires caution. Conclusion Most of available studies appear to advocate for TT or ICI combination with radiation therapy, without altering the clinical safety profiles, allowing the maintenance of systemic treatments when stereotactic radiation therapy is considered. Cognitive functions, health-related quality of life and radiation necrosis risk remain to be assessed. The results of prospective studies are awaited in order to complete and validate the above discussed retrospective data.
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Le Rhun E, Weller M, Brandsma D, Van den Bent M, de Azambuja E, Henriksson R, Boulanger T, Peters S, Watts C, Wick W, Wesseling P, Rudà R, Preusser M. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours. Ann Oncol 2017; 28:iv84-iv99. [PMID: 28881917 DOI: 10.1093/annonc/mdx221] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
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Wolpert F, Le Rhun E, Berghoff A, Rushing E, Andratschke N, Regli L, Reyns N, Kaufmann P, Preusser M, Weller M. P14.25 18F-fluordesoxyglucose positron emission tomography (FDG-PET/CT) the detection of the primary lesion and staging in brain metastasis (BM) patients with cancer of unknown primary site (CUPS). Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Le Rhun E, Gregoire V, Girard E, Rodrigues I, Baranzelli A, Descarpentries C, Maurage C, Cortot A, Escande F. P14.11 Determination of the EGFR mutations including T790M in the cerebrospinal fluid of patients with leptomeningeal metastasis from EGFR mutant non small cell lung cancer. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gauvain C, Vauleon E, Vinas F, Le Rhun E, Jabot L, Scherpereel A, Chouaid C, Cortot A, Monnet I. Activité intracérébrale et tolérance du nivolumab dans les cancers bronchiques non à petites cellules avec métastases cérébrales. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Remon J, Le Rhun E, Besse B. Leptomeningeal carcinomatosis in non-small cell lung cancer patients: A continuing challenge in the personalized treatment era. Cancer Treat Rev 2016; 53:128-137. [PMID: 28110254 DOI: 10.1016/j.ctrv.2016.12.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/11/2016] [Accepted: 12/20/2016] [Indexed: 01/15/2023]
Abstract
Leptomeningeal metastasis is a fatal manifestation seen in advanced cancer patients. Its incidence is increasing, reaching 3.8% in molecularly unselected non-small cell lung cancer patients and up to 5% and 9% in ALK-rearranged and EGFR-mutant lung cancer patients, respectively. The prognosis remains poor despite systemic treatment, intrathecal chemotherapy, radiation therapy and personalized treatments in molecularly selected patients. However, new therapies with improved cerebral-spinal fluid penetration have been developed for subgroups of molecular selected patients indicating they could be promising therapeutic options for managing leptomeningeal disease. Systemic chemotherapy, which may be combined with intrathecal chemotherapy, remains standard treatment for lung cancer patients with leptomeningeal disease and a good-risk profile. We summarize evidence reported in the literature for managing this complication in lung cancer patients. Based on this, we have selected potential therapeutic strategies that could be used in daily clinical practice.
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Duhamel M, Le Rhun E, Wisztorski M, Zairi F, Escande F, Maurage C, Fournier I, Reyns N, Salzet M. P06.11 Classification of high-grade glioma using Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry imaging (MALDI MSI): interim results of the GLIOMIC study. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Frappaz D, Meyronnet D, Garin G, Laigle-Donadey F, Le Rhun E, Bonneville-Levard A, Frenel J, Idbaih A, Gourmelon C, Chinot O. P20.01 MEVITEM: A European, randomized, open-label Phase I/II study of vismodegib in combination with temozolomide versus temozolomide alone in adult patients with recurrent or refractory medulloblastoma presenting an activation of the Sonic Hedgehog pathway. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Parrott T, Weller M, Estok TM, Le Rhun E. P08.32 TG02, an oral CDK inhibitor, demonstrates activity in glioma models: EORTC Brain Tumor Group Conducts Phase 1b study (STEAM / EORTC 1608). Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wick W, Stupp R, Gorlia T, Bendszus M, Brandes AA, Voss MJ, Le Rhun E, Clement PM, Golfinopoulos V, van den Bent M. OS5.1 Sequence of bevacizumab and lomustine in patients with first progression of a glioblastoma: phase II EORTC study 26101. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Frappaz D, Sunyach M, Le Rhun E, Blonski M, Laurence V, Bonneville Levard A, Loiseau H, Meyronnet D, Callies A, Laigle Donadey F. P10.01 Adolescent and Young Adults (AYAS) brain tumor national Web conference. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Le Rhun E, Weller M, Soffietti R, Rudà R. P13.04 Practice patterns of diagnosis and management of leptomeningeal metastasis in Europe: results from a web-based survey. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Frappaz D, Sunyach M, Le Rhun E, Le Rhun E, Laigle Donadey F, Bonneville Levard A, Massimino M. P19.01 Is reduced dose craniospinal radiation safe in adult medulloblastoma? Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
INTRODUCTION Meningioma comprise 20-30% of all primary brain tumors. Notwithstanding surgery and radiotherapy, a subset of patients will manifest recurrent meningioma. Systemic therapy is recommended only when further surgery and radiotherapy are not possible. No prospective study with a high level of evidence is available to inform as to recommendations regarding systemic therapy. AREAS COVERED We aim to summarize systemic therapies for recurrent meningioma. Expert commentary: Hydroxurea, temozolomide, irinotecan, the combination of cyclophosphamide/adriamycine/vincristine, interferon-alpha, somatostatin analogs, mifepristone, megestrol acetate, imatinib, erlotinib and gefitinib are considered as having limited efficacy. Potential activity of VEGF (vascular endothelial growth factor) inhibitors such as sunitinib, valatinib, and bevacizumab is suggested in small non-controlled studies and requires validation in randomized trials. The identification of new prognostic markers such as TERT promoter mutations and potential new therapeutic targets, such as KLF4, AKT1, TRAF7, and SMO mutations hopefully facilitate this endeavor.
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Le Rhun E, Dhermain F, Vogin G, Reyns N, Metellus P. Radionecrosis after stereotactic radiotherapy for brain metastases. Expert Rev Neurother 2016; 16:903-14. [DOI: 10.1080/14737175.2016.1184572] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Lévy C, Allouache D, Lacroix J, Dugué AE, Supiot S, Campone M, Mahe M, Kichou S, Leheurteur M, Hanzen C, Dieras V, Kirova Y, Campana F, Le Rhun E, Gras L, Bachelot T, Sunyach MP, Hrab I, Geffrelot J, Gunzer K, Constans JM, Grellard JM, Clarisse B, Paoletti X. REBECA: a phase I study of bevacizumab and whole-brain radiation therapy for the treatment of brain metastasis from solid tumours. Ann Oncol 2015; 26:2359. [PMID: 26504187 DOI: 10.1093/annonc/mdv386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Delmaire C, Savatovsky J, Boulanger T, Dhermain F, Le Rhun E, Météllus P, Gerber S, Carsin-Nicole B, Petyt G. Imagerie des métastases cérébrales. Cancer Radiother 2015; 19:16-9. [DOI: 10.1016/j.canrad.2014.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 11/30/2022]
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Taillibert S, Conforti R, Bonneterre J, Bachelot T, Le Rhun E, Bernard-Marty C. Métastases cérébrales de cancer du sein : traitements systémiques. Cancer Radiother 2015; 19:36-42. [DOI: 10.1016/j.canrad.2014.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
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Sakji-Dupre L, Le Rhun E, Templier C, Desmedt E, Blanchet B, Mortier L. Concentrations du vémurafénib dans le liquide céphalo-rachidien (LCR) et le plasma : à propos de six patients. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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49
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Sakji-Dupre L, Blanchet B, Templier C, Desmet E, Bonneterre J, Mortier L, Le Rhun E. BM-30 * INTRA CEREBROPSINAL FLUID CONCENTRATIONS OF VEMURAFENIB IN MELANOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou240.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zairi F, Le Rhun E, Taillibert S, Boulanger T, Farre I, Bonneterre J, Assaker R, Chamberlain M. BM-37 * COMPLICATIONS RELATED TO THE USE OF A VENTRICULAR DEVICE FOR THE TREATMENT OF LEPTOMENINGEAL METASTASES FROM SOLID TUMORS: A SINGLE CENTER EXPERIENCE ON 112 PATIENTS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou240.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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