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Roth P, Weiss T, Puca E, Silginer M, Hemmerle T, Pazahr S, Bink A, Neri D, Weller M. Targeting glioblastoma with novel immunocytokines. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2558 Background: There is an urgent need for novel treatment options for patients with glioblastoma, the most frequent malignant primary brain tumor. In contrast to other types of cancer, immunotherapeutic approaches have so far not been successful against glioblastoma. Converting the glioma microenvironment from a "cold" and immunosuppressive status into a more "hot" and immunopermissive phenotype may allow for clinically meaningful anti-tumor immune responses. Methods: We explored the activity of novel immunocytokines based on the L19 antibody, specific to a tumor-associated epitope of extracellular fibronectin, for the targeted delivery of three pro-inflammatory cytokines (IL-2, IL-12, TNF) to the microenvironment of gliomas. Following an extensive preclinical assessment in 2 orthotopic immunocompetent mouse glioma models, we used a fully-human L19-hTNF fusion protein to treat human patients with recurrent glioblastoma. Results: Intravenous administration of L19-mIL12 or L19-mTNF prolonged survival and cured a proportion of tumor-bearing mice while no effect was seen with L19-IL2. When L19-mIL12 or L19-mTNF were administered to glioma-bearing RAG−/− mice, no therapeutic activity was observed which suggests adaptive immunity as an underlying mechanism. On a mechanistic level, both immunocytokines induced the infiltration of the tumor site with lymphocytes and promoted the expression of pro-inflammatory cytokines in the tumor microenvironment. In addition, L19-mTNF induced tumor necrosis. Based on these preclinical findings, we initiated a phase I/II clinical trial with a fully-human L19-hTNF fusion protein for patients with isocitrate dehydrogenase (IDH1R132H) wildtype WHO Grade III or IV glioma at first relapse (NCT03779230). Treatment was safe and well tolerated in the first three glioblastoma patients. Administration of L19-hTNF resulted in reduced regional blood perfusion in the tumor region and was associated with more necrotic areas within the tumor as well as an increased number of tumor-infiltrating CD4 and CD8 T cells. Conclusions: The data obtained with the comprehensive preclinical characterization and subsequent clinical translation form the basis for future studies with immunocytokines as novel treatment option for patients with malignant brain tumors. Clinical trial information: NCT03779230 .
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Affiliation(s)
| | | | - Emanuele Puca
- Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland
| | - Manuela Silginer
- University Hospital and University of Zurich, Clinical Neuroscience Center and Department of Neurology, Zurich, Switzerland
| | | | | | - Andrea Bink
- University Hospital Zurich, Zurich, Switzerland
| | - Dario Neri
- Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland
| | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zürich, University Hospital and University of Zürich, Zürich, Switzerland
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Weller M, Terksikh E, Silginer M, Krieg C, Roth P, Becher B, Wirsching HG. Association of peripheral blood CD4+ T-cell depletion under temozolomide with inferior survival of patients with IDH wildtype glioblastoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2548 Background: Standard first line chemoirradiation with temozolomide is associated with distinctive peripheral blood immune cell profiles in IDH wildtype glioblastoma. Whether such profiles at recurrence are associated with survival has not been studied in detail. Methods: Peripheral blood mononuclear cells of 21 healthy donors and of 91 patients with IDH wildtype glioblastoma were analyzed by flow cytometry at 1st recurrence. Patients received either (i) standard chemoirradiation with temozolomide (TMZ) followed by dose-intensified TMZ at first recurrence within the phase II trial DIRECTOR (N = 52) or (ii) hypofractionated radiotherapy with or without bevacizumab (N = 39) followed by investigators’ choice within the phase II trial ARTE. Patients were classified based on unsupervised analyses of PBMC profiles at 1st recurrence. Associations with survival were explored in multivariate Cox models controlling for established prognostic and predictive factors. Results: At 1st recurrence, two patient clusters were identified in the DIRECTOR cohort which differed in CD4+ T-cell fractions, but not with respect to CD8+ T-cells, CD4+;CD25+;FoxP3+ regulatory T-cells, B-cells or monocytes. The composition of CD4+, CD8+ or regulatory T-cell fractions was similar in both clusters. All control samples clustered with the CD4high cluster. Patients in both clusters did not differ by established prognostic factors, including age, O6-methylguanine-DNA-methyl-transferase ( MGMT) gene promoter methylation, tumor volume, Karfnosky performance score or steroid use. Progression-free survival was similar (CD4high vs CD4low 2.1 vs 2.4 months, p = 0.19), whereas post-recurrence overall survival was longer among the CD4high cluster (12.7 vs 8.7 months, p = 0.004). At 2nd recurrence after dose-intensified TMZ re-challenge, monocyte fractions increased, whereas memory CD4+ T-cell fractions decreased. Higher memory CD4+ fractions were associated with longer overall survival at 2nd recurrence (p = 0.004). The reported associations were retained in multivariate Cox models controlling for established prognostic factors. In the ARTE cohort, CD4+ T cell fractions at 1st recurrence did not differ compared to diagnosis (p = 0.91) and there were no associations with bevacizumab (p = 0.28) or survival (p = 0.74), supporting that the effects observed in the DIRECTOR cohort were driven by TMZ. Conclusions: We conclude that TMZ-associated memory CD4+ T-cell depletion may have deteriorating effects on the survival of glioblastoma patients.
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Affiliation(s)
- Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zürich, University Hospital and University of Zürich, Zürich, Switzerland
| | - Ekaterina Terksikh
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Manuela Silginer
- University Hospital and University of Zurich, Clinical Neuroscience Center and Department of Neurology, Zurich, Switzerland
| | - Carsten Krieg
- Medical University of South Carolina, Charleston, SC
| | | | - Burkhard Becher
- Institute of Experimental Immunology, University of Zürich, Zürich, Switzerland
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Wirsching HG, Roelcke U, Weller J, Hundsberger T, Hottinger AF, Von Moos RAF, Caparrotti F, Conen KL, Remonda L, Roth P, Ochsenbein A, Tabatabai G, Weller M. The imaging substudy of the randomized ARTE trial: MRI and 18FET PET associations with overall survival benefit from bevacizumab in elderly patients with newly diagnosed IDH wildtype glioblastoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2520 Background: Bevacizumab failed to demonstrate overall survival benefit despite markedly prolonged progression-free survival in glioblastoma patients. Reasons for this divergence may include suboptimal patient selection and delayed diagnosis of progression on MRI scans under bevacizumab. Imaging analyses of retrospective and uncontrolled clinical trial cohorts suggest MRI diffusion mapping as a predictor of benefit from bevacizumab. Moreover, amino acid PET has been proposed by the RANO working group for the differentiation of tumor versus edema or gliosis based on proof-of-principle studies demonstrating earlier detection of progression with PET compared to MRI. Methods: ARTE (NCT01443676) was a 2:1 randomized, multi-center, open-label trial of hypofractionated radiotherapy in combination with intravenous bevacizumab every 2 weeks (BEV/RT) versus RT alone in patients with newly diagnosed glioblastoma aged 65 years or older. Patients with histologically and molecularly confirmed IDH wildtype glioblastoma aged 65 years or older were analyzed. MRI was available from 67 and serial 18FET PET from 30 patients in this post hoc analysis. 18FET PET intensity ratios and herein reported MRI parameters including tumor volumetric analyses and ADC were analyzed blinded for outcome and study arm. Results: Demographic, clinical and molecular parameters were balanced between treatment arms. Overall survival benefit from bevacizumab was observed for larger contrast-enhancing tumor volumes (hazard ratio [HR] per cm3 0.94, 95% CI 0.89-0.99, p = 0.032) and higher ADC (HR 0.18, 95% CI 0.05-0.66, p = 0.025) on pre-treatment MRI. Response in the BEV/RT arm by the standard MRI-based RANO criteria was associated with overall survival by trend (HR 0.56, 95% CI 0.30-1.10, time-dependent p = 0.094). In a multivariate model controlling for established risk factors, 18FET tumor-to-brain uptake ratios (TBR) of non-contrast-enhancing tumor portions predicted inferior overall survival specifically in the BEV/RT arm (HR [per 0.1 18FET TBR] 1.50, 95% CI 1.05-2.13, time-dependent p = 0.025). Controlling for 18FET TBR at first follow-up identified benefit from BEV/RT by trend (HR 0.41, 95% CI 0.16-1.07, p = 0.069). Conclusions: Large contrast-enhancing tumor mass and high ADC identify patients with overall survival benefit from bevacizumab. Under bevacizumab, non-contrast enhancing tumor portions can be adequately monitored by amino acid PET.
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Affiliation(s)
| | - Ulrich Roelcke
- Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland
| | - Jonathan Weller
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Thomas Hundsberger
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | | | - Francesca Caparrotti
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Katrin Lisa Conen
- Department of Family Medicine McMaster University, Hamilton, ON, Canada
| | - Luca Remonda
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | | | | | | | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zürich, University Hospital and University of Zürich, Zürich, Switzerland
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Hertler C, Eisele G, Gramatzki D, Seystahl K, Wolpert F, Roth P, Weller M. End-of-life care for glioma patients; the caregivers' perspective. J Neurooncol 2020; 147:663-669. [PMID: 32232622 DOI: 10.1007/s11060-020-03471-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Gliomas are primary brain tumors with a life-limiting course of disease, and the last weeks of life are often characterized by neurological deficits that affect communication and personality. End-of-life treatment in this patient group therefore requires specific approaches. To date, little data is available on patients' and caregivers' needs and experiences in the last phase of the disease. METHODS In this observational study, relatives of patients treated at the University Hospital Zurich, Switzerland and deceased 2015-2017 due to glioma progression were contacted to complete a structured questionnaire assessing caregivers experience within the last weeks of the disease. RESULTS The survey was sent to 120 relatives of deceased patients with a glioma (WHO grades II-IV) (median patient age: 62 years; 73.8% male). Forty-three questionnaires were returned (37.7%). Approximately half of the patients were taken care of at home in the last 4 weeks of the disease, mainly with the assistance of in-home nursing care, of which eventually 14 patients (63.6%) died at home. While caregivers reported high satisfaction with medical and nursing care, psychological support was rated average to poor on a 10-point scale. Free comment fields were used widely, revealing open questions and needs of the relatives. CONCLUSIONS This study illustrates the need for a more patient-centered end-of-life care including higher psychological support mechanisms, and a higher inclusion and consideration of relatives and caregivers into the care focus. Earlier discussion of end-of-life preferences could prevent hospitalizations in the last phase of life and could improve patients' and caregivers' quality of life.
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Affiliation(s)
- Caroline Hertler
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland. .,Department of Radiation Oncology and Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Günter Eisele
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Dorothee Gramatzki
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Katharina Seystahl
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Fabian Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Betts JW, Roth P, Pattrick CA, Southam HM, La Ragione RM, Poole RK, Schatzschneider U. Antibacterial activity of Mn(I) and Re(I) tricarbonyl complexes conjugated to a bile acid carrier molecule. Metallomics 2020; 12:1563-1575. [PMID: 32856674 DOI: 10.1039/d0mt00142b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A bifunctional cholic acid-bis(2-pyridylmethyl)amine (bpa) ligand featuring an amide linker was coordinated to a manganese(i) or rhenium(i) tricarbonyl moiety to give [M(bpacholamide)(CO)3] with M = Mn, Re in good yield and very high purity. Strong antibacterial activity was observed against four strains of methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus, with minimum inhibitory concentrations (MICs) in the range of 2-3.5 μM. No difference in response was observed for the MSSA vs. MRSA strains. Activity was also independent of the nature of the metal center, as the Mn and Re complexes showed essentially identical MIC values. In contrast to some other metal carbonyl complexes, the activity seems to be unrelated to the release of carbon monoxide, as photoactivation of the Mn complex reduced the potency by a factor of 2-8. Both metal complexes were non-toxic in Galleria mellonella larvae at concentrations of up to 100× the MIC value. In vivo testing in Galleria larvae infected with MRSA/MSSA demonstrated a significant increase in overall survival rates from 46% in the control to 88% in the group treated with the metal complexes. ICP-MS analysis showed that the Mn and Re cholamide complexes are efficiently internalized by E. coli cells and do not interfere with membrane integrity, as evident from a lack of release of intracellular ATP. An increased sensitivity was observed in acrB, acrD, and mdt mutants that are defective in multidrug exporters, indicating that the compounds have an intracellular mechanism of action. Furthermore, E. coli mntP mutants defective in the gene encoding an Mn exporter were more sensitive than the wildtype, while inactivation of the regulator that controls expression of the Mn uptake proteins MntP and MntH slightly increased sensitivity to the compound. Single knockout mutants defective in genes linked to bile salt and oxidative stress response (dinF, yiaH, sodA, katE, and soxS) did not show increased sensitivity relative to the wild type. Overall, neither the cholic acid moiety nor the metal-carbonyl fragment alone appear to be responsible for the biological activity observed and thus the search for the primary intracellular target continues.
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Affiliation(s)
- Jono W Betts
- Department of Pathology and Infectious Diseases, School of Veterinary Medicine, University of Surrey, Guildford, UK
| | - Patrick Roth
- Institut für Anorganische Chemie, Julius-Maximilians-Universität Würzburg, Am Hubland, D-97074 Würzburg, Germany.
| | - Calum A Pattrick
- Department of Molecular Biology and Biotechnology, The University of Sheffield, UK
| | - Hannah M Southam
- Department of Molecular Biology and Biotechnology, The University of Sheffield, UK
| | - Roberto M La Ragione
- Department of Pathology and Infectious Diseases, School of Veterinary Medicine, University of Surrey, Guildford, UK
| | - Robert K Poole
- Department of Molecular Biology and Biotechnology, The University of Sheffield, UK
| | - Ulrich Schatzschneider
- Institut für Anorganische Chemie, Julius-Maximilians-Universität Würzburg, Am Hubland, D-97074 Würzburg, Germany.
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Grieshaber P, Oswald I, Albert M, Sodah A, Roth P, Diegeler A, Sedding D, Franke U, Böning A. Staged Complete Hybrid Revascularization in Patients with Multivessel Disease and Acute Myocardial Infarction—A Prospective Angiographic and Clinical Study. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705398] [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: 10/24/2022]
Affiliation(s)
| | | | | | - A. Sodah
- Bad Neustadt an der Saale, Germany
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Wirsching HG, Tabatabai G, Roelcke U, Hottinger AF, Jörger F, Schmid A, Plasswilm L, Schrimpf D, Mancao C, Capper D, Conen K, Hundsberger T, Caparrotti F, von Moos R, Riklin C, Felsberg J, Roth P, Jones DTW, Pfister S, Rushing EJ, Abrey L, Reifenberger G, Held L, von Deimling A, Ochsenbein A, Weller M. Bevacizumab plus hypofractionated radiotherapy versus radiotherapy alone in elderly patients with glioblastoma: the randomized, open-label, phase II ARTE trial. Ann Oncol 2019; 29:1423-1430. [PMID: 29648580 DOI: 10.1093/annonc/mdy120] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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
Background The addition of bevacizumab to temozolomide-based chemoradiotherapy (TMZ/RT → TMZ) did not prolong overall survival (OS) in patients with newly diagnosed glioblastoma in phase III trials. Elderly and frail patients are underrepresented in clinical trials, but early reports suggested preferential benefit in this population. Patients and methods ARTE was a 2 : 1 randomized, multi-center, open-label, non-comparative phase II trial of hypofractionated RT (40 Gy in 15 fractions) with bevacizumab (10 mg/kg×14 days) (arm A, N = 50) or without bevacizumab (arm B, N = 25) in patients with newly diagnosed glioblastoma aged ≥65 years. The primary objective was to obtain evidence for prolongation of median OS by the addition of bevacizumab to RT. Response was assessed by RANO criteria. Quality of life (QoL) was monitored by the EORTC QLQ-C30/BN20 modules. Exploratory studies included molecular subtyping by 450k whole methylome and gene expression analyses. Results Median PFS was longer in arm A than in arm B (7.6 and 4.8 months, P = 0.003), but OS was similar (12.1 and 12.2 months, P = 0.77). Clinical deterioration was delayed and more patients came off steroids in arm A. Prolonged PFS in arm A was confined to tumors with the receptor tyrosine kinase (RTK) I methylation subtype (HR 0.25, P = 0.014) and proneural gene expression (HR 0.29, P = 0.025). In a Cox model of OS controlling for established prognostic factors, associations with more favorable outcome were identified for age <70 years (HR 0.52, P = 0.018) and Karnofsky performance score 90%-100% (HR 0.51, P = 0.026). Including molecular subtypes into that model identified an association of the RTK II gene methylation subtype with inferior OS (HR 1.73, P = 0.076). Conclusion Efficacy outcomes and exploratory analyses of ARTE do not support the hypothesis that the addition of bevacizumab to RT generally prolongs survival in elderly glioblastoma patients. Molecular biomarkers may identify patients with preferential benefit from bevacizumab. Clinical trial registration number NCT01443676.
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Affiliation(s)
- H-G Wirsching
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - G Tabatabai
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - U Roelcke
- Department of Neurology, Brain Tumor Center Aarau, Cantonal Hospital Aarau, Aarau, Switzerland
| | - A F Hottinger
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland; Department of Medical Oncology, University Hospital Lausanne, Lausanne, Switzerland
| | - F Jörger
- Department of Clinical Trials Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Schmid
- Department of Medical Oncology, University Hospital Bern, Bern, Switzerland
| | - L Plasswilm
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - D Schrimpf
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Mancao
- Genentech, Oncology Biomarker Development, Basel, Switzerland
| | - D Capper
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Conen
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - T Hundsberger
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - F Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - R von Moos
- Department of Medical Oncology, Cantonal Hospital Chur, Chur, Switzerland
| | - C Riklin
- Department of Medical Oncology, Cantonal Hospital Lucerne, Lucerne Switzerland
| | - J Felsberg
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - P Roth
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - D T W Jones
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - S Pfister
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - E J Rushing
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - L Abrey
- F. Hoffmann-La Roche, Pharma Division, Product Development Oncology, Basel, Switzerland
| | - G Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Cancer Research Center, Essen/Düsseldorf, Germany
| | - L Held
- Biostatistics Department, University of Zurich, Zurich, Switzerland
| | - A von Deimling
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Ochsenbein
- Department of Medical Oncology, University Hospital Bern, Bern, Switzerland
| | - M Weller
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
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Gramatzki D, Roth P, Le Rhun E, Rushing E, Rohrmann S, Stahel R, Weller M. EPID-10. VENOUS THROMBOEMBOLIC EVENTS IN GLIOBLASTOMA PATIENTS: AN EPIDEMIOLOGICAL VIEW. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Venous thromboembolic events (VTE) are a common complication in cancer patients. Anticoagulant use is the appropriate treatment for acute VTE in cancer, although assumed to be associated with increased risk for bleeding. The population-based relationship of VTE and anticoagulant therapy to survival in glioblastoma patients remains unclear.
METHODS
Frequency, risk factors, treatment and complications of VTE were assessed in a glioblastoma cohort in the Canton of Zurich, Switzerland (2010 to 2014). Survival data were retrospectively analyzed using the log rank test.
RESULTS
248 glioblastoma patients with known isocitrate dehydrogenase (IDH) wildtype status were identified in a 5-year time-frame. Median overall survival (OS) was 12.8 months (95% CI 11.0–14.6), with a median follow up of 60.7 months (95% CI 51.4–70.0). VTE were diagnosed in 35 patients (14.4%; 5 out of 248 patients with no follow-up data on VTE). Median time from diagnosis to VTE was 2.23 months (95% CI 0.6–3.9); 3 patients (8.6%) had a history of VTE. Most patients were on steroids at time of diagnosis of VTE (68.6%), and a Karnofsky Performance Score of less than 70% was documented in 21 patients (60%). Most patients with VTE (88.6%) received therapeutic anticoagulation. Complications, resulting in the cessation of therapeutic anticoagulation, occurred in 11 patients (35.5%), mainly (9 patients, 81.8%) due to intracranial hemorrhage. OS did not differ between patients diagnosed with VTE and those without VTE (p=0.103). Tumor progression was the major cause of death (91.3%); 1.4% of patients died from VTE; 1.9% of the patients suffered unexpected sudden death.
CONCLUSION
Although VTE were identified in 14.4% of glioblastoma patients, VTE were not the major reason for death. These data do not support the implementation of primary thromboprophylaxis in glioblastoma patients. Prospective clinical trials are needed to examine the association of anticoagulant use with survival in glioblastoma patients.
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Affiliation(s)
- Dorothee Gramatzki
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Emilie Le Rhun
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Elisabeth Rushing
- Department of Neuropathology, University Hospital Zurich, Zurich, Tajikistan
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Rolf Stahel
- Comprehensive Cancer Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
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Weiss T, Meister H, Weller M, Sentman C, Roth P. IMMU-17. TARGETING GLIOBLASTOMA WITH DNAM-1-BASED CHIMERIC ANTIGEN RECEPTOR (CAR) T CELLS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.510] [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
BACKGROUND
Genetically engineered T cells that express a chimeric antigen receptor (CAR) have shown powerful anti-tumor activity in extracranial malignancies. This concept is now also being explored against glioblastoma. However, many single target antigens used for CAR cell therapy are non-homogeneously expressed. We assessed the therapeutic potential of CAR T cells targeting 2 antigens which are homogeneously expressed by glioma cells which reduces the probability of tumor immune escape due to antigen loss.
METHODS
We analyzed the expression of CD112 and CD155, which are ligands to the activating immune cell receptor DNAX Accessory Molecule-1 (DNAM-1), in a panel of mouse and human glioma cell lines as well as in human glioblastoma samples and generated glioma cells with a CD112 or CD155 knock-out. To exploit the specific binding properties of DNAM-1, we generated first or second-generation CAR T cells that use DNAM-1 as an antigen-binding domain and investigated their anti-tumor activity in vitro and in vivo using syngeneic orthotopic mouse glioma models.
RESULTS
CD112 and CD155 are homogeneously expressed in mouse and human glioma cell lines as well as human glioblastoma tissue specimens. CRISPR/Cas9-mediated knock-out of CD112 or CD155 affected the migration of glioma cells, but had no impact on the proliferation or susceptibility to irradiation or temozolomide. DNAM-1-based CAR T cells exerted high cytolytic activity and secretion of various effector cytokines in vitro. Upon intravenous administration, DNAM-1-based CAR T cells did not exert significant toxicity, homed to the tumor site in the brain and prolonged the survival of orthotopic glioma-bearing mice with durable anti-tumor responses in a fraction of mice.
CONCLUSION
CD112 and CD155 represent attractive targets for glioma immunotherapy using genetically engineered immune cells. Based on the data obtained from our preclincal assessment of DNAM-1-based CAR T cells, this immunotherapeutic strategy might also be explored in human glioma patients.
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Affiliation(s)
| | | | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
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Lassman A, Sepúlveda-Sánchez J, Cloughesy T, Gil-Gil J, Puduvalli V, Raizer J, De Vos F, Wen P, Butowski N, Clement P, Groves M, Belda-Iniesta C, Steward K, Rowsey S, Ye Y, Roth P. ACTR-33. INFIGRATINIB (BGJ398) IN PATIENTS WITH RECURRENT GLIOMAS WITH FIBROBLAST GROWTH FACTOR RECEPTOR (FGFR) ALTERATIONS: A MULTICENTER PHASE II STUDY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
FGFR mutations and translocations occur in approximately 10% of glioblastomas (GBMs). FGFR3-TACC3 fusion is predictive of response to FGFR tyrosine kinase inhibitors pre-clinically and clinically. Infigratinib (BGJ398) is a selective small-molecule pan-FGFR kinase inhibitor with anti-tumor activity in several solid tumors with FGFR genetic alterations.
METHODS
Open-label phase II trial of adults with recurrent high-grade gliomas following failure of initial therapy (NCT01975701). Tumors harbored FGFR1-TACC1 or FGFR3-TACC3 fusions, activating mutations in FGFR1, 2 or 3, or FGFR1, 2, 3, or 4 amplification. Oral infigratinib was administered 125 mg d1–21 q28d. Prophylaxis for hyperphosphatemia was recommended. Primary endpoint: 6-month progression-free survival (6mPFS) rate by RANO (locally assessed); goal of >40%.
RESULTS
As of Sep 2017, 26 patients (16 men, 10 women; median age 55 years, range 20–76 years; 50% with ≥ 2 prior regimens) were treated; 24 (92.3%) discontinued for disease progression (n=21) or other reasons (n=3). All had FGFR1 or FGFR3 gene alterations; 4 had >1 gene alteration. Estimated 6mPFS rate was 16% (95% CI 5.0–32.5%); median PFS was 1.7 months (95% CI 1.1–2.8 months); median OS was 6.7 months (95% CI 4.2–11.7 months); ORR was 7.7% (95% CI 1.0–25.1%). Best overall response was: partial response 7.7% (FGFR1 mutation n=1; FGFR3 amplification n=1); stable disease 26.9%; progressive disease 50.0%; missing/unknown 15.3%. Most common (>15%) all-grade treatment-related adverse events (AEs) were hyperphosphatemia, fatigue, diarrhea, hyperlipasemia, and stomatitis. There were no grade 4 treatment-related AEs. Eleven patients (42.3%) had treatment-related AEs requiring dose interruptions/reductions (most commonly hyperphosphatemia).
CONCLUSIONS
Infigratinib induced partial response or stable disease in approximately one-third of patients with recurrent GBM and/or other glioma subtypes harboring FGFR alterations. Most AEs were reversible and manageable. Further potential combinations are being explored in patients with proven FGFR-TACC fusion genes; analysis of biomarker data is ongoing.
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Affiliation(s)
- Andrew Lassman
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Juan Gil-Gil
- Hospital Durans I Reynals. ICO, Hospitalet. Barcelona, Spain
| | | | | | - Filip De Vos
- University Medical Center Utrecht, Cancer Center, Department of Medical Oncology, Utrecht, Netherlands
| | - Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Morris Groves
- Texas Oncology Austin Brain Tumor Center, Austin, TX, USA
| | | | | | | | - Yining Ye
- QED Therapeutics, San Francisco, CA, USA
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111
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Roth P, Wong GKL, Frosz MH, Ahmed G, Russell PSJ. Full-field characterization of helical Bloch modes guided in twisted coreless photonic crystal fiber. Opt Lett 2019; 44:5049-5052. [PMID: 31613260 DOI: 10.1364/ol.44.005049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
It was recently reported that a photonic crystal fiber (PCF) with no structural core guides light if a permanent chiral twist is introduced by spinning the fiber preform during the draw. The intriguing guidance mechanism behind this novel effect has many remarkable features; for example, it intrinsically supports circularly polarized helical Bloch modes (HBMs) that carry multiple optical vortices, making twisted PCFs of interest in fields such as optical micro-manipulation, imaging, quantum optics, and optical communications. Here we report for the first time, to the best of our knowledge, that a twisted coreless PCF supports not just one but a family of guided HBMs, each member of which has a unique transverse field distribution and harmonic spectrum. By making detailed interferometric measurements of the near-field phase and amplitude distributions of HBMs, and expanding them as a series of Bessel beams, we are able to extract the amplitude of each azimuthal and radial HBM harmonic. Good agreement is found with the numerical solutions of Maxwell's equations. The results shed light on the properties of this curious new optical phenomenon.
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112
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Beauchamp G, Lauber P, Allen J, Boateng N, Shaak S, Roth P, Laubach L, Crowley L, Burmeister D, Greenberg M. 309 Overcoming Brick and Mortar: Feasibility of Implementation of a Medication for Addiction Treatment and Linkage to Treatment Program by Leveraging Community Partnerships. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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113
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Lareida A, Terziev R, Grossenbacher B, Andratschke N, Roth P, Rohrmann S, Stahel R, Guckenberger M, Le Rhun E, Weller M, Wolpert F. Underweight and weight loss are predictors of poor outcome in patients with brain metastasis. J Neurooncol 2019; 145:339-347. [PMID: 31571112 DOI: 10.1007/s11060-019-03300-1] [Citation(s) in RCA: 5] [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] [Received: 08/06/2019] [Accepted: 09/23/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Overweight may be associated with favorable outcome whereas tumor cachexia may be associated with worse outcome in patients with metastatic cancer. Here we evaluate the association of abnormal body mass index and weight change with outcome in patients with brain metastasis. METHODS Patients with a diagnosis of brain metastasis treated at the University Hospital Zurich (n = 703) were assessed for associations of body mass index, weight change, comorbidities and survival. RESULTS Compared with patients with normal body mass index of 18.5-24.9 kg/m2 and a median overall survival of 9 months (95% confidence interval 7.5-10.5), overall survival was inferior in patients with body mass index < 18.5 kg/m2 (overall survival 6 months, 95% confidence interval 1.6-10.3, p = 0.04), but superior in patients with body mass index > 25 kg/m2 (overall survival 13 months, 95% confidence interval 11.0-15.0; p = 0.033). We report a median relative weight loss of 5% within the first 6 months of diagnosis of brain metastasis (95% confidence interval 3.3-6.5), and reduction exceeding the median was associated with an unfavorable outcome (weight loss < 5% 22.0 months, 95% confidence interval 19.2-24.8; weight loss > 5% 14.0 months, 95% confidence interval 11.9-16.). CONCLUSION High body mass index is associated with better, and underweight with worse outcome in patients with brain metastasis. Conversely, weight loss above median may predict poor outcome. Future studies need to address whether vigorous treatment of tumor cachexia, e.g. by specific nutrition management, might improve outcome of patients with brain metastasis. In contrast, regimens associated with weight loss such as ketogenic diet may be detrimental.
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Affiliation(s)
- Anna Lareida
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Bettina Grossenbacher
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Sabine Rohrmann
- Cancer Registry for the Canton of Zurich, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Rolf Stahel
- Department of Oncology, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Emilie Le Rhun
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
- Neuro-Oncology, Department of Neurosurgery, CHU Lille, 59000, Lille, France
- Neurology, Breast Cancer Department, Oscar Lambret Center, 59000, Lille, France
- Inserm, U-1192, University of Lille, 59000, Lille, France
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Fabian Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
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114
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Zhu Y, Weiss T, Zhang Q, Sun R, Wang B, Yi X, Wu Z, Gao H, Cai X, Ruan G, Zhu T, Xu C, Lou S, Yu X, Gillet L, Blattmann P, Saba K, Fankhauser CD, Schmid MB, Rutishauser D, Ljubicic J, Christiansen A, Fritz C, Rupp NJ, Poyet C, Rushing E, Weller M, Roth P, Haralambieva E, Hofer S, Chen C, Jochum W, Gao X, Teng X, Chen L, Zhong Q, Wild PJ, Aebersold R, Guo T. High-throughput proteomic analysis of FFPE tissue samples facilitates tumor stratification. Mol Oncol 2019; 13:2305-2328. [PMID: 31495056 PMCID: PMC6822243 DOI: 10.1002/1878-0261.12570] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/09/2019] [Accepted: 09/03/2019] [Indexed: 11/06/2022] Open
Abstract
Formalin‐fixed, paraffin‐embedded (FFPE), biobanked tissue samples offer an invaluable resource for clinical and biomarker research. Here, we developed a pressure cycling technology (PCT)‐SWATH mass spectrometry workflow to analyze FFPE tissue proteomes and applied it to the stratification of prostate cancer (PCa) and diffuse large B‐cell lymphoma (DLBCL) samples. We show that the proteome patterns of FFPE PCa tissue samples and their analogous fresh‐frozen (FF) counterparts have a high degree of similarity and we confirmed multiple proteins consistently regulated in PCa tissues in an independent sample cohort. We further demonstrate temporal stability of proteome patterns from FFPE samples that were stored between 1 and 15 years in a biobank and show a high degree of the proteome pattern similarity between two types of histological regions in small FFPE samples, that is, punched tissue biopsies and thin tissue sections of micrometer thickness, despite the existence of a certain degree of biological variations. Applying the method to two independent DLBCL cohorts, we identified myeloperoxidase, a peroxidase enzyme, as a novel prognostic marker. In summary, this study presents a robust proteomic method to analyze bulk and biopsy FFPE tissues and reports the first systematic comparison of proteome maps generated from FFPE and FF samples. Our data demonstrate the practicality and superiority of FFPE over FF samples for proteome in biomarker discovery. Promising biomarker candidates for PCa and DLBCL have been discovered.
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Affiliation(s)
- Yi Zhu
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China.,Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology and Brain Tumor Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Qiushi Zhang
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Rui Sun
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Bo Wang
- Department of Pathology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao Yi
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Zhicheng Wu
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Huanhuan Gao
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Xue Cai
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Guan Ruan
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Tiansheng Zhu
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Chao Xu
- College of Mathematics and Informatics, Digital Fujian Institute of Big Data Security Technology, Fujian Normal University, Fuzhou, China
| | - Sai Lou
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Xiaoyan Yu
- Department of Pathology, The Second Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Ludovic Gillet
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Switzerland
| | - Peter Blattmann
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Switzerland
| | - Karim Saba
- Department of Urology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Michael B Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Switzerland
| | - Dorothea Rutishauser
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Jelena Ljubicic
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Ailsa Christiansen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Christine Fritz
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Cedric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Switzerland
| | - Elisabeth Rushing
- Department of Neuropathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Eugenia Haralambieva
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland
| | - Silvia Hofer
- Division of Medical Oncology, Lucerne Cantonal Hospital and Cancer Center, Switzerland
| | | | - Wolfram Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, Switzerland
| | - Xiaofei Gao
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Xiaodong Teng
- Department of Pathology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Lirong Chen
- Department of Pathology, The Second Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Zhong
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland.,Children's Medical Research Institute, University of Sydney, Australia
| | - Peter J Wild
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Switzerland.,Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ruedi Aebersold
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Switzerland.,Faculty of Science, University of Zurich, Switzerland
| | - Tiannan Guo
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China.,Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Switzerland
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115
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Papachristodoulou A, Silginer M, Weller M, Schneider H, Hasenbach K, Janicot M, Roth P. Therapeutic Targeting of TGFβ Ligands in Glioblastoma Using Novel Antisense Oligonucleotides Reduces the Growth of Experimental Gliomas. Clin Cancer Res 2019; 25:7189-7201. [PMID: 31530630 DOI: 10.1158/1078-0432.ccr-17-3024] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 07/26/2019] [Accepted: 09/13/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Transforming growth factor (TGF)-β is expressed at high levels by glioma cells and contributes to the malignant phenotype of glioblastoma. However, its therapeutic targeting remains challenging. Here, we examined an alternative therapeutic approach of TGFβ inhibition using two novel phosphorothioate-locked nucleic acid (LNA)-modified antisense oligonucleotide gapmers, ISTH1047 and ISTH0047, which specifically target TGFβ1 and TGFβ2. EXPERIMENTAL DESIGN We characterized the effects of ISTH1047 and ISTH0047 on TGFβ1/2 expression, downstream signaling and growth of human LN-308, LN-229, and ZH-161 cells as well as murine SMA-560 glioma cells in vitro. Furthermore, we assessed their target inhibition and effects on survival in orthotopic xenogeneic and syngeneic rodent glioma models in vivo. RESULTS Both antisense oligonucleotides specifically silenced their corresponding target and abrogated SMAD2 phosphorylation in several glioma cell lines. Moreover, inhibition of TGFβ1 or TGFβ2 expression by ISTH1047 or ISTH0047 reduced the migration and invasiveness of LN-308 and SMA-560 glioma cells. Systemic antisense oligonucleotide administration to glioma-bearing mice suppressed TGFβ1 or TGFβ2 mRNA expression as well as the expression of the downstream target PAI-1 in orthotopic gliomas. Glioma-bearing mice had significantly prolonged survival upon systemic treatment with ISTH1047 or ISTH0047, which was associated with a reduction of intratumoral SMAD2 phosphorylation and, in a fully immunocompetent model, with increased immune cell infiltration. CONCLUSIONS Targeting TGFβ expression with the novel LNA antisense oligonucleotides ISTH1047 or ISTH0047 results in strong antiglioma activity in vitro and in vivo, which may represent a promising approach to be examined in human patients with glioma.
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Affiliation(s)
- Alexandros Papachristodoulou
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Manuela Silginer
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Hannah Schneider
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Patrick Roth
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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116
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Yang J, Roth P, Durbin TD, Shafer MM, Hemming J, Antkiewicz DS, Asa-Awuku A, Karavalakis G. Emissions from a flex fuel GDI vehicle operating on ethanol fuels show marked contrasts in chemical, physical and toxicological characteristics as a function of ethanol content. Sci Total Environ 2019; 683:749-761. [PMID: 31150895 DOI: 10.1016/j.scitotenv.2019.05.279] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/19/2019] [Indexed: 06/09/2023]
Abstract
This study assessed the gaseous and particulate emissions, as well as the toxicological properties of particulate matter (PM) from a flex fuel vehicle equipped with a wall-guided gasoline direct injection engine over triplicates cold-start and hot-start LA92 cycles. The vehicle was operated on a Tier 3 E10 fuel, an E10 fuel with higher levels of aromatics than the Tier 3 E10, an E30, and an E78 blend. Total hydrocarbon (THC), non-methane hydrocarbon (NMHC), carbon monoxide (CO), particulate emissions, and gaseous toxics (of benzene, toluene, ethylbenzene, xylenes (BTEX), and 1,3-butadiene) reduced for E30 and E78 blends compared to both E10 fuels. Formaldehyde and acetaldehyde emissions substantially increased with the higher ethanol blends. The high aromatic E10 fuel increased the emissions of THC, NMHC, particulates, and BTEX compared to the Tier 3 E10 fuel and the higher ethanol blends, as well as showed higher concentrations of accumulation mode particles. The GDI PM did not exhibit any measurable mutagenicity at the PM concentrations tested. Cytotoxicity varied only within a small range and concentrations of PM, eliciting a cytotoxic response similar to those by ambient aerosol. The outcomes of our two measures of PM oxidative potential (macrophage ROS and DTT) were significantly correlated, with the E78 blend exhibiting the least oxidative potential and the E30 the greatest. Gene expression analysis at both the mRNA and protein level indicates that there is the potential for GDI PM emissions to contribute to inflammation and etiology of disease such as asthma, and in contrast to the ROS and DTT outcomes, the E78 fuel PM exhibited the greatest potential to elicit pro-inflammatory cytokine (TNFα) production. Overall, the trends in toxicity emission rates (activity/mi) across the ethanol blends was driven primarily by PM mass emission rate contrasts and only secondarily by the differences in intrinsic toxicity of the PM.
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Affiliation(s)
- Jiacheng Yang
- Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA; Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), Riverside, CA 92507, USA
| | - Patrick Roth
- Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA; Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), Riverside, CA 92507, USA
| | - Thomas D Durbin
- Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA; Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), Riverside, CA 92507, USA
| | - Martin M Shafer
- Department of Civil and Environmental Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, WI, USA
| | - Jocelyn Hemming
- Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, WI, USA
| | - Dagmara S Antkiewicz
- Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, WI, USA
| | - Akua Asa-Awuku
- Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA; Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), Riverside, CA 92507, USA; Department of Chemical and Biomolecular Engineering, A. James Clark School of Engineering, University of Maryland, College Park, MD 20742, USA
| | - Georgios Karavalakis
- Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA; Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), Riverside, CA 92507, USA.
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117
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Taphoorn MJB, Dirven L, Kanner AA, Lavy-Shahaf G, Weinberg U, Taillibert S, Toms SA, Honnorat J, Chen TC, Sroubek J, David C, Idbaih A, Easaw JC, Kim CY, Bruna J, Hottinger AF, Kew Y, Roth P, Desai R, Villano JL, Kirson ED, Ram Z, Stupp R. Influence of Treatment With Tumor-Treating Fields on Health-Related Quality of Life of Patients With Newly Diagnosed Glioblastoma: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2019; 4:495-504. [PMID: 29392280 DOI: 10.1001/jamaoncol.2017.5082] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Tumor-treating fields (TTFields) therapy improves both progression-free and overall survival in patients with glioblastoma. There is a need to assess the influence of TTFields on patients' health-related quality of life (HRQoL). Objective To examine the association of TTFields therapy with progression-free survival and HRQoL among patients with glioblastoma. Design, Setting, and Participants This secondary analysis of EF-14, a phase 3 randomized clinical trial, compares TTFields and temozolomide or temozolomide alone in 695 patients with glioblastoma after completion of radiochemotherapy. Patients with glioblastoma were randomized 2:1 to combined treatment with TTFields and temozolomide or temozolomide alone. The study was conducted from July 2009 until November 2014, and patients were followed up through December 2016. Interventions Temozolomide, 150 to 200 mg/m2/d, was given for 5 days during each 28-day cycle. TTFields were delivered continuously via 4 transducer arrays placed on the shaved scalp of patients and were connected to a portable medical device. Main Outcomes and Measures Primary study end point was progression-free survival; HRQoL was a predefined secondary end point, measured with questionnaires at baseline and every 3 months thereafter. Mean changes from baseline scores were evaluated, as well as scores over time. Deterioration-free survival and time to deterioration were assessed for each of 9 preselected scales and items. Results Of the 695 patients in the study, 639 (91.9%) completed the baseline HRQoL questionnaire. Of these patients, 437 (68.4%) were men; mean (SD) age, 54.8 (11.5) years. Health-related quality of life did not differ significantly between treatment arms except for itchy skin. Deterioration-free survival was significantly longer with TTFields for global health (4.8 vs 3.3 months; P < .01); physical (5.1 vs 3.7 months; P < .01) and emotional functioning (5.3 vs 3.9 months; P < .01); pain (5.6 vs 3.6 months; P < .01); and leg weakness (5.6 vs 3.9 months; P < .01), likely related to improved progression-free survival. Time to deterioration, reflecting the influence of treatment, did not differ significantly except for itchy skin (TTFields worse; 8.2 vs 14.4 months; P < .001) and pain (TTFields improved; 13.4 vs 12.1 months; P < .01). Role, social, and physical functioning were not affected by TTFields. Conclusions and Relevance The addition of TTFields to standard treatment with temozolomide for patients with glioblastoma results in improved survival without a negative influence on HRQoL except for more itchy skin, an expected consequence from the transducer arrays. Trial Registration clinicaltrials.gov Identifier: NCT00916409.
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Affiliation(s)
- Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew A Kanner
- Department of Neurosurgery, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Uri Weinberg
- Research and Development, Novocure, Haifa, Switzerland
| | - Sophie Taillibert
- Department of Neurology 2, Salpêtrière University Hospital, Assistance Public Hôpitaux de Paris, L'Université Pierre et Marie Curie University, Paris VI University, Paris, France
| | - Steven A Toms
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jerome Honnorat
- Department of Neuro-oncology, Hospices Civils de Lyon, University Claude Bernard Lyon, Lyon, France
| | - Thomas C Chen
- Department of Neurosurgery, University of Southern California, Los Angeles
| | - Jan Sroubek
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Carlos David
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts
| | - Ahmed Idbaih
- Department of Neurology 2, Salpêtrière University Hospital, Assistance Public Hôpitaux de Paris, L'Université Pierre et Marie Curie University, Paris VI University, Paris, France
| | - Jacob C Easaw
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, California
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, Korea
| | - Jordi Bruna
- Department of Neurology, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Andreas F Hottinger
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvonne Kew
- Clinical Neuro-Oncology Research Program, Department of Internal Medicine, Methodist Hospital, Houston, Texas
| | - Patrick Roth
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Rajiv Desai
- Neurosurgery and Spine Association, Maine Medical Center, Scarborough, Maine
| | - John L Villano
- Clinical Neuro-Oncology Research Program, Department of Internal Medicine, University of Kentucky Medical Center, Lexington
| | | | - Zvi Ram
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roger Stupp
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Northwestern Brain Tumor Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Le Rhun E, Preusser M, Roth P, Reardon DA, van den Bent M, Wen P, Reifenberger G, Weller M. Molecular targeted therapy of glioblastoma. Cancer Treat Rev 2019; 80:101896. [PMID: 31541850 DOI: 10.1016/j.ctrv.2019.101896] [Citation(s) in RCA: 325] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 09/09/2019] [Indexed: 01/30/2023]
Abstract
Glioblastomas are intrinsic brain tumors thought to originate from neuroglial stem or progenitor cells. More than 90% of glioblastomas are isocitrate dehydrogenase (IDH)-wildtype tumors. Incidence increases with age, males are more often affected. Beyond rare instances of genetic predisposition and irradiation exposure, there are no known glioblastoma risk factors. Surgery as safely feasible followed by involved-field radiotherapy plus concomitant and maintenance temozolomide chemotherapy define the standard of care since 2005. Except for prolonged progression-free, but not overall survival afforded by the vascular endothelial growth factor antibody, bevacizumab, no pharmacological intervention has been demonstrated to alter the course of disease. Specifically, targeting cellular pathways frequently altered in glioblastoma, such as the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR), the p53 and the retinoblastoma (RB) pathways, or epidermal growth factor receptor (EGFR) gene amplification or mutation, have failed to improve outcome, likely because of redundant compensatory mechanisms, insufficient target coverage related in part to the blood brain barrier, or poor tolerability and safety. Yet, uncommon glioblastoma subsets may exhibit specific vulnerabilities amenable to targeted interventions, including, but not limited to: high tumor mutational burden, BRAF mutation, neurotrophic tryrosine receptor kinase (NTRK) or fibroblast growth factor receptor (FGFR) gene fusions, and MET gene amplification or fusions. There is increasing interest in targeting not only the tumor cells, but also the microenvironment, including blood vessels, the monocyte/macrophage/microglia compartment, or T cells. Improved clinical trial designs using pharmacodynamic endpoints in enriched patient populations will be required to develop better treatments for glioblastoma.
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Affiliation(s)
- Emilie Le Rhun
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland; Neuro-oncology, Department of Neurosurgery, University Hospital, Lille, France
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, and Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Patrick Roth
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - David A Reardon
- Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA, USA
| | - Martin van den Bent
- Brain Tumor Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, Netherlands
| | - Patrick Wen
- Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA, USA
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Medical Faculty, Düsseldorf, and German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Germany
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland.
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Lassman AB, Sepúlveda-Sánchez JM, Cloughesy T, Gil-Gil JM, Puduvalli VK, Raizer J, De Vos FY, Wen PY, Butowski N, Clement P, Groves MD, Belda-Iniesta C, Steward K, Moran S, Ye Y, Roth P. OS10.6 Infigratinib (BGJ398) in patients with recurrent gliomas with fibroblast growth factor receptor (FGFR) alterations: a multicenter phase II study. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
FGFR mutations and translocations occur in approximately 10% of glioblastomas (GBMs). FGFR3-TACC3 fusion has been reported as predictive of response to FGFR tyrosine kinase inhibitor therapy both pre-clinically and clinically. Infigratinib (BGJ398) is a selective small-molecule pan-FGFR kinase inhibitor that has demonstrated anti-tumor activity in several solid tumors with FGFR genetic alterations. Therefore, we conducted a phase II trial to test the efficacy of infigratinib in FGFR-altered recurrent GBM (NCT01975701).
METHODS
This open-label trial accrued adults with recurrent high-grade gliomas following failure of initial therapy that harbored FGFR1-TACC1 or FGFR3-TACC3 fusions; activating mutations in FGFR1, 2 or 3; or FGFR1, 2, 3, or 4 amplification. Oral infigratinib was administered 125 mg on days 1–21 every 28 days. Prophylaxis for hyperphosphatemia, a common toxicity, was recommended. The primary endpoint was the 6-month progression-free survival (6mPFS) rate by RANO (locally assessed, estimated by K-M method), with a goal of >40%.
RESULTS
As of the Sep 2017 data cut-off, 26 patients (16 men, 10 women; median age 55 years, range 20–76 years; 50% with ≥2 prior regimens) were treated, and 24 (92.3%) discontinued for disease progression (n=21) or other reasons (n=3). All patients had FGFR1 or FGFR3 gene alterations, and 4 had >1 gene alteration. The estimated 6mPFS rate was 16% (95% CI 5.0–32.5%); median PFS was 1.7 months (95% CI 1.1–2.8 months); median OS was 6.7 months (95% CI 4.2–11.7 months); ORR was 7.7% (95% CI 1.0–25.1%). The best overall response was: partial response 7.7% (FGFR1 mutation n=1; FGFR3 amplification n=1); stable disease 26.9%; progressive disease 50.0%; missing/unknown 15.3%. The most common (>15%) all-grade treatment-related adverse events (AEs) were hyperphosphatemia, fatigue, diarrhea, hyperlipasemia, and stomatitis. There were no grade 4 treatment-related AEs. Eleven patients (42.3%) had treatment-related AEs requiring dose interruptions or reductions (most commonly hyperphosphatemia).
CONCLUSIONS
Infigratinib induced partial response or stable disease in approximately one-third of patients with recurrent GBM and/or other glioma subtypes harboring FGFR alterations. Most AEs were reversible and manageable. Further potential combinations are being explored in patients with proven FGFR-TACC fusion genes and analysis of biomarker data is ongoing.
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Affiliation(s)
- A B Lassman
- Columbia University Irving Medical Center, New York, NY, United States
| | | | - T Cloughesy
- University of California at Los Angeles, Los Angeles, CA, United States
| | - J M Gil-Gil
- Hospital Durans I Reynals. ICO, Hospitalet. Barcelona, Spain
| | - V K Puduvalli
- The Ohio State University, Columbus, OH, United States
| | - J Raizer
- Northwestern University, Evanston, IL, United States
| | - F Y De Vos
- University Medical Center Utrecht Cancer Center, Utrecht University, Utrecht, Netherlands
| | - P Y Wen
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - N Butowski
- University of California San Francisco, San Francisco, CA, United States
| | - P Clement
- UZ Leuven Campus Gasthuisberg, Leuven, Belgium
| | - M D Groves
- Texas Oncology, Austin, TX, United States
| | | | - K Steward
- QED Therapeutics, San Francisco, CA, United States
| | - S Moran
- QED Therapeutics, San Francisco, CA, United States
| | - Y Ye
- QED Therapeutics, San Francisco, CA, United States
| | - P Roth
- University Hospital Zurich, Zurich, Switzerland
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120
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Weiss T, Puca E, Weller M, Neri D, Roth P. P12.08 Immunocytokines are a novel immunotherapeutic approach against glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma is the most common malignant primary brain tumor in adults with an urgent need for novel treatment options. The administration of pro-inflammatory cytokines could be a potent immunotherapeutic approach to shift the balance between tumor-associated immunosuppression and immune activation. However, the systemic administration of therapeutically active doses of pro-inflammatory cytokines is not feasible due to toxic side effects and there is a need for strategies that enable a targeted delivery of pro-inflammatory cytokines to the tumor site.
METHODS
We investigated different antibody-cytokine fusion products that enable a targeted delivery of interleukin (IL)-2, IL-12 or tumor necrosis factor (TNF)-α to the tumor site by binding to a tumor-specific epitope of fibronectin. We investigated the expression of this tumor-specific epitope ex vivo in tumor-bearing mouse brains and human glioblastoma samples. Subsequently, we assessed the anti-tumor activity of IL-2, IL-12 or TNF-α fused to an antibody targeting this tumor-specific epitope in orthotopic syngeneic mouse glioma models.
RESULTS
The tumor-specfic extra domain B of fibronectin is expressed in murine glioma models and human glioblastoma samples. A fluorochrome-labeled antibody targeting this tumor-specific epitope accumulated at the tumor site in the brain in vivo upon systemic administration. IL-2, IL-12, or TNF-α fused to this antibody conferred a survival benefit in orthotopic tumor-bearing mice and cured a fraction of tumor-bearing mice. Mechanistically, antibody-fused TNF-α induced tumor necrosis and increased the activation of tumor-infiltrating natural killer (NK) cells, whereas antibody-fused IL-12 mainly boosted an anti-tumor immune response mediated by NK cells and T cells.
CONCLUSION
We demonstrate the expression of a tumor-specific epitope of fibronectin in glioblastoma and exploit this for the targeted delivery of IL-2, IL-12 or TNF-α to the tumor site. Our preclinical assessments indicate potent anti-tumor activity in orthotopic, syngneic glioma mouse models and reveal the mode of action for the different immunocytokines. Based on these findings, we initiated a phase I/II clinical trial in patients with recurrent glioma to investigate the targeted delivery of TNF-α (ClinicalTrials.gov identifier NCT03779230).
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Affiliation(s)
- T Weiss
- University Hospital Zurich, Zurich, Switzerland
| | - E Puca
- Swiss Federal Institute of Technology (ETH Zürich), Zurich, Switzerland
| | - M Weller
- University Hospital Zurich, Zurich, Switzerland
| | - D Neri
- Swiss Federal Institute of Technology (ETH Zürich), Zurich, Switzerland
| | - P Roth
- University Hospital Zurich, Zurich, Switzerland
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Roth P, Reijneveld J, Gorlia T, Dhermain F, De Vos F, Vanlancker M, O’Callaghan C, Le Rhun E, van den Bent M, Mason W, Weller M. P14.124 EORTC 1709/CCTG CE.8: A phase III trial of marizomib in combination with standard temozolomide-based radiochemotherapy versus standard temozolomide-based radiochemotherapy alone in patients with newly diagnosed glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The standard of care for patients with newly diagnosed glioblastoma includes maximal debulking surgery followed by radiotherapy (RT), and concomitant as well as maintenance therapy with the alkylating agent, temozolomide (TMZ). However, the prognosis remains poor and novel treatment strategies are urgently needed. Targeting the proteasome has been considered a promising anti-cancer approach for several years. Marizomib is a novel, irreversible and pan-proteasome inhibitor, which crosses the blood-brain barrier and has been assessed in phase I trials in patients with newly diagnosed or recurrent glioblastoma.
MATERIAL AND METHODS
EORTC 1709/CCTG CE.8 is a randomized, controlled, open label phase III superiority trial. Patients with histologically confirmed newly diagnosed glioblastoma and a performance status >70 are eligible. Patients are randomized in a 1:1 ratio to receive standard of care (TMZ/RT→TMZ) alone or TMZ/RT→TMZ plus marizomib. The study aims at enrolling 750 patients. Stratification factors include study site, age, performance status and extent of resection. The primary objective of this trial is to compare overall survival in patients receiving marizomib in addition to standard of care with those receiving standard treatment only. The testing strategy specifies the determination of this objective in the intent-to-treat population as well as the subgroup of patients with MGMT-unmethylated tumors. Secondary endpoints include progression-free survival, safety, neurocognitive function and quality of life. A translational research program has been set up. The study will be activated at approximately 50 EORTC sites across Europe, 25 sites in Canada and additional sites in the US. Patient recruitment started in June 2018 and as of April 29, 2019, a total of 164 patients have been randomized. An update on the enrolment status will be provided at the EANO meeting. ClinicalTrials.gov Identifier: NCT03345095
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Affiliation(s)
- P Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - F Dhermain
- Institut Gustave Roussy, Villejuif, France
| | - F De Vos
- University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | | | | | - E Le Rhun
- University Hospital Lille, Lille, France
| | | | - W Mason
- Princess Margaret Hospital, Toronto, ON, Canada
| | - M Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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122
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Weiss T, Meister H, Weller M, Sentman C, Roth P. PL2.1 Exploiting the DNAM-1 system for chimeric antigen receptor (CAR) T cell therapy of glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Cancer immunotherapy with genetically engineered T cells that express a chimeric antigen receptor (CAR) has led to impressive responses in extracranial malignancies and is also explored against glioblastoma. However, CAR T cell strategies that are currently being explored against glioblastoma target single tumor antigens, which are non-homogeneously expressed and are prone to antigen escape. Furthermore, the immunosuppressive brain tumor microenvironment hampers anti-tumor efficacy.
METHODS
By immunohistochemistry and flow cytometry, we investigated the expression of CD155 and CD112, which are ligands to the activating immune cell receptor DNAX accessory molecule-1 (DNAM-1), in human and mouse glioma cell lines as well as in human glioblastoma samples. To understand their functional role, we generated CD155 or CD112 knock-out glioma cell lines using CRISPR/Cas9 and studied proliferation, sensitivity to irradiation or temozolomide as well as migration. To exploit the promiscuous binding features of DNAM-1, we generated different first or second-generation CAR T cells that use DNAM-1 as a tumor-binding domain. Subsequently, we investigated their anti-tumor activity in vitro in co-culture assays and in vivo in syngeneic orthotopic murine glioma models.
RESULTS
CD155 and CD112 are homogenously expressed in human and mouse glioma cell lines and human glioblastoma tissues. Knock-out of these ligands affected the migration of tumor cells, but did not affect proliferation or sensitivity to irradition or temozolomide. DNAM-1-based CAR T cells demonstrated high cytolytic activity and effector cytokine secretion in vitro. In vivo, DNAM-1 based CAR T cells reached to the tumor site in the brain upon intravenous administration, prolonged survival of orthotopic glioma-bearing mice and led to a durable anti-tumor response in a fraction of mice. The treatment was tolerated without toxicities.
CONCLUSION
We elucidated the tumor-intrinisic role of CD155 and CD112 and provide the first systematical preclincal assessment of DNAM-1 CAR T cells against glioma. These findings provide a rationale to test this immunotherapeutic strategy also in human glioma patients.
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Affiliation(s)
- T Weiss
- University Hospital Zurich, Zurich, Switzerland
| | - H Meister
- University Hospital Zurich, Zurich, Switzerland
| | - M Weller
- University Hospital Zurich, Zurich, Switzerland
| | - C Sentman
- Geisel School of Medicine, Hanover, NH, United States
| | - P Roth
- University Hospital Zurich, Zurich, Switzerland
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123
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Gramatzki D, Felsberg J, Bähr O, Hentschel B, Westphal M, Schackert G, Tonn JC, Herrlinger U, Löffler M, Pietsch T, Steinbach J, Reifenberger G, Roth P, Weller M. OS2.2 Chemotherapy for spinal gliomas in adults. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.022] [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
BACKGROUND
Chemotherapy is a treatment option in patients diagnosed with anaplastic gliomas or glioblastomas of the spinal cord, or with recurrent lower graded WHO spinal gliomas that are no longer amenable to local treatment. The low incidence of spinal cord gliomas, particularly in adults, limits the ability to perform clinical trials. The role of chemotherapy in these tumors has remained unclear.
MATERIAL AND METHODS
We performed a retrospective study of 22 patients diagnosed with spinal gliomas who were treated with chemotherapy at any time during the disease course. Benefit from chemotherapy was estimated by applying Response assessment in neuro-oncology criteria. Data on radiotherapy, as well as the number of neurosurgical interventions were taken into consideration.
RESULTS
Most patients were diagnosed with astrocytoma WHO grade I-IV (N=14), the remaining patients were diagnosed with ependymoma (N=8). Median follow-up from start of chemotherapy was 92 months (95% CI, 72.6–111.4). The O6-methylguanyl-DNA-methyltransferase(MGMT)promoter methylation status was available in tumors of 12 patients: 9 tumors (75%) had an unmethylated MGMTpromoter. More than 50% of the patients had more than one neurosurgical intervention. After prior surgery 10 patients in the first-line setting had chemotherapy combined with radiotherapy, while 3 patients received chemotherapy only. The remaining 9 patients had initially received radiation therapy and chemotherapy was given at time of recurrence. In patients diagnosed with astrocytoma mainly temozolomide (TMZ) was applied (N=10), while one patient received CCNU and three patients had combination chemotherapy. Patients diagnosed with ependymoma had hydroxyurea (N=1), CCNU (N=1), TMZ (N=3) or combination chemotherapy (N=3). In the group of patients who had chemotherapy combined with radiation, response rates were as follows: anaplastic astrocytoma 3 stable diseases (SD), glioblastoma 1 complete response (CR) and 1 SD, and anaplastic ependymoma 1 SD. After chemotherapy in the group of patients previously irradiated, the following response rates were observed: 1 SD in pilocytic astrocytoma, 1 SD in diffuse astrocytoma, 3 SD in myxopapillary ependymoma, and 2 SD and 1 partial response (PR) in anaplastic ependymoma. All other patients experienced progressive disease. There was no indication for a favorable prognostic role ofMGMTpromoter methylation.
CONCLUSION
Spinal cord gliomas represent a heterogeneous group of tumors. Survival outcomes in response to chemotherapy in adult spinal glioma patients vary substantially, but individual patients appear to derive benefit from chemotherapy.
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Affiliation(s)
- D Gramatzki
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - J Felsberg
- Department of Neuropathology, Heinrich-Heine-University, Düsseldorf, Germany
| | - O Bähr
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | - B Hentschel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - M Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Schackert
- Department of Neurosurgery, Technical University Dresden, Dresden, Germany
| | - J C Tonn
- Department of Neurosurgery, Ludwig Maximilian University Munich, Munich, Germany
| | - U Herrlinger
- Division of Clinical Neurooncology, University Hospital Bonn, Bonn, Germany
| | - M Löffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - T Pietsch
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - J Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | - G Reifenberger
- Department of Neuropathology, Heinrich-Heine-University, Düsseldorf, Germany
| | - P Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - M Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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Wolpert F, Grossenbacher B, Lareida A, Roth P, Neidert MC, Andratschke N, Le Rhun E, Weller M. P14.25 Venous thromboembolic events in patients with brain metastases: the PICOS score. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Venous thromboembolic events are significant complications in patients and possibly associated with an unfavorable outcome. Thrombosis risk is poorly defined for patients with brain metastasis, and available risk calculation scores are not validated for these patients.
MATERIAL AND METHODS
We identified 811 patients with brain metastasis followed at our institution and screened electronic charts retrospectively for the occurrence of venous thromboembolic events, along with candidate risk factors. Risk factors were tested in uni- and multivariate analyses and finally integrated in a score model for risk prediction.
RESULTS
Venous thromboembolic events were documented in 97 of 811 patients (12.0%). Primary tumors with high thrombogenicity (p=0.02, odds ratio 1.7, 95% CI 1.1–2.8), dexamethasone (p=0.011, odds ratio 2.27, 95% CI 1.5–4.5), chemotherapy (p=0.005, odds ratio 3.4, 95% CI 1.6–7.5), BMI > 35 kg/m2 (p=0.002, odds ratio 3.4, 95% CI 1.6–7.5) and immobilization (p=0.003, odds ratio 2.4, 95% CI 1.3–4.3) were confirmed as independent predictors of VTE. We derived a score model for venous thromboembolic event prediction, the PICOS (thrombogenic Primary, Immobilization, Chemotherapy, Obesity, Steroids) score (0–7 points). Receiver Operating Characteristic Curve Analysis demonstrated its prognostic accuracy (AUC=0.71, 95% CI 0.64–0.77), and its predictive capability was superior to that of other scores proposed for the evaluation of venous thromboembolic event risk such as the Khorana (AUC=0.51) or CONKO (AUC=0.52) scores.
CONCLUSION
We report a rate of venous thrombotic events of 12.0% in our cohort of 811 patients with brain metastasis. We define a risk model for prediction in of venous thrombotic events in patients with BM, the PICOS score. It may become a valuable tool for the identification of brain metastasis patients at high risk for venous thromboembolic events and be helpful for guidance of clinicians towards decision whether to start thrombosis prophylaxis. Further, the PICOS score might be used for stratification in controlled studies.
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Affiliation(s)
- F Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - B Grossenbacher
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Lareida
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - P Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - M C Neidert
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - E Le Rhun
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
- Neuro-Oncology, Department of Neurosurgery, University Hospital Lille, Salengro Hospital, Rue Emile Laine, Lille, France
| | - M Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Wirsching H, Morel C, Roth P, Weller M. OS7.6 Socioeconomic burden and associations with quality of life in meningioma patients. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Socioeconomics affect the outcome of neurological patients, but the socioeconomic burden of brain tumors has not been studied in detail.
PATIENTS AND METHODS
This survey study in a clinically well-annotated cohort of meningioma patients was designed to explore socioeconomic status parameters at diagnosis and one year thereafter. The survey comprised level of education, profession, employment status, subjective work ability, monthly income and the EPICES social deprivation score. Quality of life (QoL) and symptom burden were queried utilizing the EORTC-QLQ-C30/BN20 and MDASI-BT. A multivariate binary regression model was applied to explore associations of socioeconomics with QoL.
RESULTS
Completed surveys were obtained from 249 of 410 patients (61%) who were invited to participate. The level of education was an apprenticeship or higher in 214 patients (86%). One year after diagnosis, there was a 20% decline in the fraction of employed patients and a more than twofold increase in unemployment and disability (p<0.001). There was a decrease in monthly income among patients with a baseline income below national average (p=0.008). On multivariate analyses, there was an association of inferior QoL with pre-operative unemployment or retirement (OR 2.43, 95% CI 1.02–5.88), whereas a subjective work ability of >70% was associated with better QoL (OR 0.37, 95% CI 0.15–0.92).
CONCLUSION
Socioeconomics assessments should be incorporated in prospective neuro-oncology clinical trials. A more detailed knowledge of the effects of socioeconomics on patient outcome will aid in identifying patients at risk for deterioration and allow to implement improved preventive and supportive strategies.
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Affiliation(s)
- H Wirsching
- University Hospital and University of Zurich, Zürich, Switzerland
| | - C Morel
- University Hospital and University of Zurich, Zürich, Switzerland
| | - P Roth
- University Hospital and University of Zurich, Zürich, Switzerland
| | - M Weller
- University Hospital and University of Zurich, Zürich, Switzerland
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126
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Kaidar-Person O, Saez J, Andratschke N, de Abrunhosa Branquinho A, Clementel E, Corning C, Hurkmans C, Monti A, Roth P, Verhoeff J, Dhermain F. A Multi-Institutional Estimation of Interobserver Variability in Glioblastoma Delineation in the EORTC-1709-BTG /CCTG CE.8 Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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127
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Monti A, de Abrunhosa Branquinho A, Andratschke N, Clementel E, Corning C, Dhermain F, Hurkmans C, Kaidar-Person O, Roth P, Saez J, Verhoeff J. A Multi-Institutional Estimation of Interobserver Variability in Glioblastoma Treatment Planning in the EORTC-1709-BTG / CCTG CE.8 trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wolpert F, Grossenbacher B, Lareida A, Roth P, Neidert M, Andratschke N, Le Rhun E, Weller M. MLTI-19. VENOUS THROMBOEMBOLIC EVENTS IN PATIENTS WITH BRAIN METASTASES: THE PICOS SCORE. Neurooncol Adv 2019. [PMCID: PMC7213140 DOI: 10.1093/noajnl/vdz014.078] [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: 11/18/2022] Open
Abstract
BACKGROUND: Venous thromboembolic events are significant complications in patients and possibly associated with an unfavorable outcome. Thrombosis risk is poorly defined for patients with brain metastasis, and available risk calculation scores are not validated for these patients. METHODS: We identified 811 patients with brain metastasis followed at our institution and screened electronic charts retrospectively for the occurrence of venous thromboembolic events, along with candidate risk factors. Risk factors were tested in uni- and multivariate analyses and finally integrated in a score model for risk prediction. RESULTS: Venous thromboembolic events were documented in 97 of 811 patients (12.0%). Primary tumors with high thrombogenicity (p=0.02, odds ratio 1.7, 95% CI 1.1–2.8), dexamethasone (p=0.011, odds ratio 2.27, 95% CI 1.5–4.5), chemotherapy (p=0.005, odds ratio 3.4, 95% CI 1.6–7.5), BMI > 35 kg/m2 (p=0.002, odds ratio 3.4, 95% CI 1.6–7.5) and immobilization (p=0.003, odds ratio 2.4, 95% CI 1.3–4.3) were confirmed as independent predictors of VTE. We derived a score model for venous thromboembolic event prediction, the PICOS (thrombogenic Primary, Immobilization, Chemotherapy, Obesity, Steroids) score (0–7 points). Receiver Operating Characteristic Curve Analysis demonstrated its prognostic accuracy (AUC=0.71, 95% CI 0.64–0.77), and its predictive capability was superior to that of other scores proposed for the evaluation of venous thromboembolic event risk such as the Khorana (AUC=0.51) or CONKO (AUC=0.52) scores. CONCLUSIONS: We report a rate of venous thrombotic events of 12.0% in our cohort of 811 patients with brain metastasis. We define a risk model for prediction in of venous thrombotic events in patients with BM, the PICOS score. It may become a valuable tool for the identification of brain metastasis patients at high risk for venous thromboembolic events and be helpful for guidance of clinicians towards decision whether to start thrombosis prophylaxis. Further, the PICOS score might be used for stratification in controlled studies.
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Affiliation(s)
- Fabian Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Bettina Grossenbacher
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Anna Lareida
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marian Neidert
- Department of Neurosurgery, University Hospital Zurich, USA
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emilie Le Rhun
- Neuro-oncology, Department of Neurosurgery, CHU Lille, Haute-Normandie, France
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Weller M, Lareida A, Terziev R, Grossenbacher B, Andratschke N, Roth P, Rohrmann S, Stahel R, Guckenberger M, Le Rhun E, Wolpert F. MLTI-09. UNDERWEIGHT AND WEIGHT LOSS ARE PREDICTORS OF POOR OUTCOME IN PATIENTS WITH BRAIN METASTASIS. Neurooncol Adv 2019. [PMCID: PMC7213465 DOI: 10.1093/noajnl/vdz014.068] [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: 11/17/2022] Open
Abstract
BACKGROUND: Despite increased risk of comorbidities, overweight may be associated with improved outcome in patients with metastatic cancer. Conversely, tumor cachexia has been identified as a negative predictor of outcome in patients with brain metastasis (BM) from lung cancer. Here we evaluate the association of abnormal body mass index (BMI) and weight change with outcome in patients with BM from different primary tumors. METHODS: Patients with a diagnosis of BM diagnosed and treated at the University Hospital Zurich (n=703) were assessed for associations of BMI, weight change, comorbidities and survival. RESULTS: Compared with patients with normal BMI of 18.5–24.9 kg/m2 who experienced a median overall survival (OS) of 9 months (95% confidence interval (CI) 7.5–10.5), OS was inferior in patients with BMI< 18.5 kg/m2 (OS 6 months, 95% CI 1.6–10.3, p=0.04), but superior in patients with BMI >25 kg/m2 (OS 13 months, 95% CI 11.0–15.0; p=0.033). For patients with documented weight course (n=173 of 703), we report a median relative weight loss of 5% within the first 6 months of BM diagnosis (95% CI 3.3–6.5). Reduction above the median was associated with an unfavorable outcome in this subgroup (weight loss ≧5% 22.0 months, 95% CI 19.2–24.8; weight loss < 5% 14.0 months, 95% CI 11.9–16.). CONCLUSIONS: Despite being associated with a worse cardiovascular risk profile, high BMI is associated with preferable and underweight with poor outcome in BM patients. Conversely, weight loss above median may be a predictor of poor outcome. Future studies need to address the question whether vigorous treatment of tumor cachexia, e.g. by specific nutrition management, might improve outcome of BM patients. In contrast, regimens that are associated with weight loss such as ketogenic diet may be detrimental.
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Affiliation(s)
- Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Anna Lareida
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Bettina Grossenbacher
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sabine Rohrmann
- Cancer Registry for the Canton of Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Rolf Stahel
- Department of Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emilie Le Rhun
- Neuro-oncology, Department of Neurosurgery, CHU Lille, Haute-Normandie, France
| | - Fabian Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Roth P, Valavanis A, Weller M. Long-term control and partial remission after initial pseudoprogression of glioblastoma by anti-PD-1 treatment with nivolumab. Neuro Oncol 2019; 19:454-456. [PMID: 28039369 DOI: 10.1093/neuonc/now265] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Patrick Roth
- Department of Neurology and Brain Tumour Centre, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Michael Weller
- Department of Neurology, University Hospital Zurich, Switzerland
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Azmi H, Gibbons M, DeVito MC, Schlesinger M, Kreitner J, Freguletti T, Banovic J, Ferrell D, Horton M, Pierce S, Roth P. The interventional magnetic resonance imaging suite: Experience in the design, development, and implementation in a pre-existing radiology space and review of concepts. Surg Neurol Int 2019; 10:101. [PMID: 31528439 PMCID: PMC6744761 DOI: 10.25259/sni-209-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Intraoperative magnetic resonance imaging (ioMRI) has led to significant advancements in neurosurgery with improved accuracy, assessment of the extent of resection, less invasive surgical alternatives, and real-time confirmation of targeting as well delivery of therapies. The costs associated with developing ioMRI units in the surgical suite have been obstacles to the expansion of their use. More recently, the development of hybrid interventional MRI (iMRI) units has become a viable alternative. The process of designing, developing, and implementing operations for these units requires the careful integration of environmental, technical, and safety elements of both surgical and MR practices. There is a paucity of published literature providing guidance for institutions looking to develop a hybrid iMRI unit, especially with a limited footprint in the radiology department. Methods: The experience of designing, developing, and implementing an iMRI in a preexisting space for neurosurgical procedures at a single institution in light of available options and the literature is described. Results: The development of the unit was accomplished through the engagement of a multidisciplinary team of stakeholders who utilized existing guidelines and recommendations and their own professional experience to address issues including physical layout, equipment selection, operations planning, infection control, and oversight/review, among others. Conclusion: Successful creation of an iMRI program requires multidisciplinary collaboration in integrating surgical and MR practice. The authors’ aim is that the experience described in this article will serve as an example for facilities or neurosurgical departments looking to navigate the same process.
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Affiliation(s)
- Hooman Azmi
- Departments of Neurosurgery, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Mary Gibbons
- Departments of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Michele C DeVito
- Departments of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Mark Schlesinger
- Departments of Anesthesiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Jason Kreitner
- Departments of Operations, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Terri Freguletti
- Departments of Perioperative Services, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Joan Banovic
- Departments of Perioperative Services, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Donald Ferrell
- Departments of Operations, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Michael Horton
- Departments of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Sean Pierce
- Departments of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Patrick Roth
- Departments of Neurosurgery, Hackensack University Medical Center, Hackensack, New Jersey, United States
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Abstract
Glioblastoma is an intrinsic brain tumour thought to arise from neuroglial progenitor cells. Its incidence increases steadily with age. Males are moderately more often affected. Genetic predisposition and exposure to irradiation in childhood are the only established risk factors which, however, account only for a very small proportion of glioblastomas. Surgery as safely feasible not only to allow for tissue diagnosis but also to reduce tumour volume is usually the first therapeutic measure. Radiotherapy delivered to the tumour region with a safety margin has been demonstrated to roughly double survival four decades ago. Temozolomide given during radiotherapy followed by six cycles of maintenance chemotherapy was the first and so far only pharmacological treatment shown to prolong survival. Adding tumour-treating fields during maintenance, temozolomide chemotherapy has been reported to prolong survival. There is little evidence that any intervention at relapse improves outcome, but nitrosourea-based chemotherapy, commonly lomustine, is probably the most agreed on standard of care. Bevacizumab prolongs progression-free survival and probably quality of life in the first line or recurrent setting, but not overall survival, and is therefore not approved in the European Union. Immunotherapy remains experimental. Drugs in advanced clinical development include the programmed death 1 antibody, nivolumab, the antibody drug conjugate depatuxizumab directed to the epidermal growth factor receptor and the proteasome inhibitor marizomib.
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Affiliation(s)
- Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zürich, Zurich, Switzerland.
| | - Emilie Le Rhun
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zürich, Zurich, Switzerland; Neuro-oncology, Department of Neurosurgery, University Hospital, Lille, France
| | - Matthias Preusser
- Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | | | - Patrick Roth
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zürich, Zurich, Switzerland
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Abstract
This study implemented three different methods for presenting scientific graphs to visually impaired people: audition, kinesthetics, or a combination of the two. The results indicate that the combination of both audio and kinesthetic modalities can be a promising representation medium of common scientific graphs for people who are visually impaired.
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Affiliation(s)
- Patrick Roth
- Computer Science Department, CUI, University of Geneva, CH-1211 Geneva 4, Switzerland
| | - Hesham Kamel
- The Group for User Interface Research, EECS, University of California at Berkeley, Berkeley, CA 94720
| | | | - Thierry Pun
- Computer Science Department, CUI, University of Geneva, CH-1211 Geneva 4, Switzerland
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Mason WP, Kesari S, Stupp R, Aregawi DG, Piccioni DE, Roth P, Desjardins A, Reich SD, Casadebaig ML, Elias I, Winograd B, Levin N, Bota DA. Full enrollment results from an extended phase I, multicenter, open label study of marizomib (MRZ) with temozolomide (TMZ) and radiotherapy (RT) in newly diagnosed glioblastoma (GBM). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2021 Background: Proteasome inhibition sensitizes glioma cells to TMZ and RT, providing a novel therapeutic strategy for GBM. MRZ, an irreversible, brain-penetrant, pan-proteasome inhibitor with anti-glioma activity was combined with standard TMZ/RT → TMZ in newly diagnosed GBM (NCT02903069), to determine the recommended dose (RD). The primary endpoint of this expanded phase 1 trial was toxicity, with secondary endpoint of OS. Methods: Patients were enrolled in separate cohorts (TMZ/RT+MRZ→TMZ+MRZ, N=15; TMZ/RT→TMZ+MRZ, N=18) in dose-escalation (3+3 design), followed by dose-expansion (N=20) with TMZ/RT+MRZ at RD → TMZ+MRZ at RD. A separate cohort received TMZ/RT→TMZ+MRZ at RD with Tumor Treating Fields (Optune, N=13). MRZ was infused IV (10 min at 0.55, 0.7, 0.8, and 1.0 mg/m2) on Days 1, 8, 15, 29, 36 (42-day TMZ/RT+MRZ cycle) and Days 1, 8, 15 (28-day TMZ+MRZ cycle). Results: 66 patients treated; median age 58 years, 68% male, 50% receiving corticosteroid at baseline, 52% unmethylated MGMT. Dose-limiting toxicities (DLTs) in dose-escalation cohorts: 1 (fatigue) at 0.7 mg/m2 MRZ, 5 (ataxia/diarrhea; ataxia/confusion; myocardial infarction, delirium/ataxia; ataxia/fatigue) in 1.0 mg/m2 cohorts. MRZ demonstrated a steep dose-response with treatment-emergent adverse events (TEAEs)/DLTs predominately CNS AEs (Grade ≥3 TEAEs in 12 of 12 patients at 1.0 mg/m2 vs 22 of 41 patients at ≤0.8 mg/m2); the RD for MRZ was determined to be 0.8 mg/m2. Most common TEAEs (all grades): fatigue, nausea (both 70%), hallucination (54%), vomiting (53%), headache (47%), confusional state (33%), ataxia, constipation, muscular weakness (all 29%). Conclusions: CNS TEAEs were short-lasting, reversible and ameliorated by early dose reductions (29% patients dose-reduced), allowing patients to remain on treatment. For patients receiving MRZ with TMZ/RT→TMZ (N=35), the median OS was 14.8 months (17 deaths, median follow-up 14.3 months), and 7 patients remain active (Cycles 11-23). The MRZ RD + TMZ/Optune combination was tolerated, with 4 of 13 patients treated on this arm remaining active. An international Phase 3 trial (EORTC 1709-BTG/CCTG CE.8, NCT03345095) is ongoing. Clinical trial information: NCT02903069.
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Affiliation(s)
- Warren P. Mason
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Le Rhun E, Devos P, Boulanger T, Smits M, Brandsma D, Ruda R, Furtner J, Hempel JM, Postma T, Roth P, Snijders TJ, Winkler F, Winklhofer S, Castellano A, Hattingen E, Capellades J, Van Den Bent MJ, Wen PY, Bendszus M, Weller M. Validation and revision of the RANO Leptomeningeal Metastasis Group scorecard for response assessment. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13546 Background: The Response Assessment in Neuro-Oncology (RANO) group has proposed a scorecard to evaluate response assessed by magnetic resonance imaging (MRI) during treatment of leptomeningeal metastasis (LM). Methods: To validate the LM-RANO scorecard, cerebrospinal MRI of 22 patients with LM from solid tumors were rated by 10 neuro-oncologists and 9 neuroradiologists at baseline and during follow-up after treatment. The original scorecard and its instructions were sent to the raters. The inter-observer agreement for the evaluation of single items was assessed using the Krippendorff alpha coefficient. The agreement between numerical parameters including scores at baseline and at follow-up after treatment and total scores was determined using the intraclass coefficient of correlation (ICC). Results: Instructions of the scorecard were not clear for the majority of raters. The alpha concordance coefficients obtained for the rating of single items at baseline and at follow-up were low (Krippendorf alpha coefficient < 0.61 for all raters). The best concordances were noted for spinal nodules (0.60). The worst concordances were obtained for brain linear leptomeningeal enhancement and cranial nerve enhancement. The concordance was better among neuroradiologists than among neuro-oncologists. A poor agreement was also noted when evaluating changes between baseline and follow-up and for total scores (ICC < 0.65 for the best score for all raters). Conclusions: Assessing response of LM by MRI remains challenging. The definition of a measurable lesion and the determination of response were the most important challenges. A central review is therefore recommended for clinical trials in LM. Based on this study we propose a new scorecard that will require a similar assessment as conducted here.
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Affiliation(s)
| | | | | | | | - Dieta Brandsma
- Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Roberta Ruda
- Department of Neuro-Oncology, University of Turin and City of Health and Science, Turin, Italy
| | - Julia Furtner
- Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Johann-Martin Hempel
- Department Radiologie, Abteilung für Diagnostische und Interventionelle Neuroradiologie, TüBingen, Germany
| | - Tjeerd Postma
- Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Tom J. Snijders
- University Medical Center Utrecht/Brain Center Rudolf Magnus, Utrecht, Netherlands
| | - Frank Winkler
- Deparment of Neurology, University Hospital Heidelberg and National Center of Tumor Diseases, Heidelberg, Germany
| | - Sebastian Winklhofer
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonella Castellano
- Department of Neuroradiology, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | | | | | | | - Patrick Y. Wen
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA
| | - Martin Bendszus
- National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
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Roth P, Reijneveld JC, Gorlia T, Dhermain F, De Vos FYFL, Vanlancker M, O'Callaghan CJ, Le Rhun E, Van Den Bent MJ, Mason WP, Weller M. EORTC 1709/CCTG CE.8: A phase III trial of marizomib in combination with standard temozolomide-based radiochemotherapy versus standard temozolomide-based radiochemotherapy alone in patients with newly diagnosed glioblastoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps2072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2072 Background: The standard treatment for patients with newly diagnosed glioblastoma comprises maximum safe surgery, radiotherapy (RT), and concomitant and up to six cycles of maintenance temozolomide (TMZ) chemotherapy (TMZ/RT→TMZ). Despite this intense therapy, the prognosis remains poor and there is an urgent need to develop new therapeutic options. Marizomib is a novel, irreversible and brain-penetrant pan-proteasome inhibitor. Following its successful assessment in phase I trials in patients with newly diagnosed as well as recurrent glioblastoma, marizomib is now being investigated in a phase III trial. Methods: EORTC 1709/CCTG CE.8 is a multicenter, randomized, controlled, open label phase III superiority trial. Eligibility criteria include histologically confirmed newly diagnosed glioblastoma and a performance status ≥70. Approximately a total of 750 patients will be enrolled and randomized 1:1. Stratification factors include institution, age, Karnofsky performance status and extent of surgery. The primary objective of this study is to compare overall survival in patients receiving marizomib in addition to standard of care (TMZ/RT→TMZ) with patients receiving standard treatment only. The testing strategy specifies the determination of this objective in both the intent-to-treat population and the subgroup of patients with tumors harboring an unmethylated MGMT promoter. Secondary endpoints include progression-free survival, safety, neurocognitive function and quality of life. The study is accompanied by a translational research program. The study will be opened at 50 EORTC sites in Europe and done as an intergroup collaboration with the Canadian Cancer Trials Group (CCTG) with 25 sites in Canada and additional sites in the US. Patient enrolment started in June 2018 and as of January 29, 2019, a total of 85 patients have been randomized. An update on the enrolment status will be provided at the ASCO conference. Clinical trial information: NCT03345095.
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Affiliation(s)
| | - Jaap C. Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | | | | | | | | | | | | | | | - Warren P. Mason
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
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Roth P, Yang J, Fofie E, Cocker DR, Durbin TD, Brezny R, Geller M, Asa-Awuku A, Karavalakis G. Catalyzed Gasoline Particulate Filters Reduce Secondary Organic Aerosol Production from Gasoline Direct Injection Vehicles. Environ Sci Technol 2019; 53:3037-3047. [PMID: 30794395 DOI: 10.1021/acs.est.8b06418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The effects of photochemical aging on exhaust emissions from two light-duty vehicles with gasoline direct injection (GDI) engines equipped with and without catalyzed gasoline particle filters (GPFs) were investigated using a mobile environmental chamber. Both vehicles with and without the GPFs were exercised over the LA92 drive cycle using a chassis dynamometer. Diluted exhaust emissions from the entire LA92 cycle were introduced to the mobile chamber and subsequently photochemically reacted. It was found that the addition of catalyzed GPFs will significantly reduce tailpipe particulate emissions and also provide benefits in gaseous emissions, including nonmethane hydrocarbons (NMHC). Tailpipe emissions composition showed important changes with the use of GPFs by practically eliminating black carbon and increasing the fractional contribution of organic mass. Production of secondary organic aerosol (SOA) was reduced with GPF addition, but was also dependent on engine design which determined the amount of SOA precursors at the tailpipe. Our findings indicate that SOA production from GDI vehicles will be reduced with the application of catalyzed GPFs through the mitigation of reactive hydrocarbon precursors.
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Affiliation(s)
- Patrick Roth
- University of California , Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT) , 1084 Columbia Avenue , Riverside , California 92507 , United States
- Department of Chemical and Environmental Engineering, Bourns College of Engineering , University of California , Riverside , California 92521 , United States
| | - Jiacheng Yang
- University of California , Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT) , 1084 Columbia Avenue , Riverside , California 92507 , United States
- Department of Chemical and Environmental Engineering, Bourns College of Engineering , University of California , Riverside , California 92521 , United States
| | - Emmanuel Fofie
- University of California , Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT) , 1084 Columbia Avenue , Riverside , California 92507 , United States
- Department of Chemical and Environmental Engineering, Bourns College of Engineering , University of California , Riverside , California 92521 , United States
| | - David R Cocker
- University of California , Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT) , 1084 Columbia Avenue , Riverside , California 92507 , United States
- Department of Chemical and Environmental Engineering, Bourns College of Engineering , University of California , Riverside , California 92521 , United States
| | - Thomas D Durbin
- University of California , Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT) , 1084 Columbia Avenue , Riverside , California 92507 , United States
- Department of Chemical and Environmental Engineering, Bourns College of Engineering , University of California , Riverside , California 92521 , United States
| | - Rasto Brezny
- Manufacturers of Emission Controls Association , 2200 Wilson Boulevard, Suite 310 , Arlington , Virginia 22201 , United States
| | - Michael Geller
- Manufacturers of Emission Controls Association , 2200 Wilson Boulevard, Suite 310 , Arlington , Virginia 22201 , United States
| | - Akua Asa-Awuku
- University of California , Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT) , 1084 Columbia Avenue , Riverside , California 92507 , United States
- Department of Chemical and Environmental Engineering, Bourns College of Engineering , University of California , Riverside , California 92521 , United States
- Department of Chemical and Biomolecular Engineering, A. James Clark School of Engineering , University of Maryland , College Park , Maryland 20742 , United States
| | - Georgios Karavalakis
- University of California , Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT) , 1084 Columbia Avenue , Riverside , California 92507 , United States
- Department of Chemical and Environmental Engineering, Bourns College of Engineering , University of California , Riverside , California 92521 , United States
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Happold C, Stojcheva N, Silginer M, Weiss T, Roth P, Reifenberger G, Weller M. Transcriptional control of O 6 -methylguanine DNA methyltransferase expression and temozolomide resistance in glioblastoma. J Neurochem 2019; 144:780-790. [PMID: 29480969 DOI: 10.1111/jnc.14326] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 06/30/2017] [Revised: 02/05/2018] [Accepted: 02/19/2018] [Indexed: 12/23/2022]
Abstract
O6 -methylguanine DNA methyltransferase (MGMT) promoter methylation is a predictive biomarker for benefit from alkylating chemotherapy, specifically temozolomide (TMZ), in glioblastoma, the most common malignant intrinsic brain tumor. Glioma-initiating cells (GIC) with stem-like properties have been associated with resistance to therapy and progression. We assessed the levels of MGMT mRNA and MGMT protein by real-time PCR and immunoblot and evaluated the impact of MGMT on TMZ sensitivity in clonogenicity assays in GIC sphere cultures (S) or differentiated adherent monolayer cultures (M). Nuclear factor kappa B (NF-κB) signaling was assessed by reporter assay and immunoblot. Compared to M cells, S cells expressed higher levels of MGMT. Differentiation of GIC induced by S-to-M transition resulted in a gradual loss of MGMT expression and increased TMZ sensitivity. This transcriptional regulation of MGMT was restricted to cell lines without MGMT promoter methylation and was not coupled to any specific neurobasal (NB) stem cell medium supplement or loss of cell adhesion. Expression levels of p50/p65 subunits of NF-κB, a transcriptional regulator of MGMT, were increased in S cells. Inhibition of NF-κB by the small molecule inhibitor, BAY 11-7082, or siRNA-mediated gene silencing, reduced MGMT levels. In summary, alkylator resistance of S cells is mainly promoted by over-expression of MGMT which results from increased activity of the NF-κB pathway in this cell culture model of glioma stem-like cells. Read the Editorial Highlight for this article on page 688.
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Affiliation(s)
- Caroline Happold
- Department of Neurology, Laboratory of Molecular Neuro-Oncology, University Hospital and University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Nina Stojcheva
- Department of Neurology, Laboratory of Molecular Neuro-Oncology, University Hospital and University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Manuela Silginer
- Department of Neurology, Laboratory of Molecular Neuro-Oncology, University Hospital and University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology, Laboratory of Molecular Neuro-Oncology, University Hospital and University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology, Laboratory of Molecular Neuro-Oncology, University Hospital and University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Cancer Consortium (DKTK), Partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Michael Weller
- Department of Neurology, Laboratory of Molecular Neuro-Oncology, University Hospital and University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
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139
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Çavuşoğlu M, Zhang J, Ielacqua GD, Pellegrini G, Signorell RD, Papachristodoulou A, Brambilla D, Roth P, Weller M, Rudin M, Martin E, Leroux JC, Werner B. Closed-loop cavitation control for focused ultrasound-mediated blood-brain barrier opening by long-circulating microbubbles. Phys Med Biol 2019; 64:045012. [PMID: 30577029 DOI: 10.1088/1361-6560/aafaa5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Focused ultrasound (FUS) exposure in the presence of microbubbles (MBs) has been successfully used in the delivery of various sizes of therapeutic molecules across the blood-brain barrier (BBB). While acoustic pressure is correlated with the BBB opening size, real-time control of BBB opening to avoid vascular and neural damage is still a challenge. This arises mainly from the variability of FUS-MB interactions due to the variations of animal-specific metabolic environment and specific experimental setup. In this study, we demonstrate a closed-loop cavitation control framework to induce BBB opening for delivering large therapeutic molecules without causing macro tissue damages. To this end, we performed in mice long-term (5 min) cavitation monitoring facilitated by using long-circulating MBs. Monitoring the long-term temporal kinetics of the MBs under varying level of FUS pressure allowed to identify in situ, animal specific activity regimes forming pressure-dependent activity bands. This enables to determine the boundaries of each activity band (i.e. steady oscillation, transition, inertial cavitation) independent from the physical and physiological dynamics of the experiment. However, such a calibration approach is time consuming and to speed up characterization of the in situ, animal specific FUS-MB dynamics, we tested a novel method called 'pre-calibration' that closely reproduces the results of long-term monitoring but with a much shorter duration. Once the activity bands are determined from the pre-calibration method, an operation band can be selected around the desired cavitation dose. To drive cavitation in the selected operation band, we developed an adaptive, closed-loop controller that updates the acoustic pressure between each sonication based on measured cavitation dose. Finally, we quantitatively assessed the safety of different activity bands and validated the proposed methods and controller framework. The proposed framework serves to optimize the FUS pressure instantly to maintain the targeted cavitation level while improving safety control.
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Affiliation(s)
- Mustafa Çavuşoğlu
- Center for MR-Research, University Children's Hospital Zurich, 8032 Zurich, Switzerland. Institute for Biomedical Engineering, ETH Zurich, 8091 Zurich, Switzerland. Information Technology and Electrical Engineering Department, Swiss Federal Institute of Technology, Institute for Biomedical Engineering, ETH Zurich, ETZ F 64.1, Gloriastrasse 35, 8092, Zurich, Switzerland. Author to whom any correspondence should be addressed
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140
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Yang J, Roth P, Ruehl CR, Shafer MM, Antkiewicz DS, Durbin TD, Cocker D, Asa-Awuku A, Karavalakis G. Physical, chemical, and toxicological characteristics of particulate emissions from current technology gasoline direct injection vehicles. Sci Total Environ 2019; 650:1182-1194. [PMID: 30308806 DOI: 10.1016/j.scitotenv.2018.09.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 09/08/2018] [Indexed: 06/08/2023]
Abstract
We assessed the physical, chemical and toxicological characteristics of particulate emissions from four light-duty gasoline direct injection vehicles when operated over the LA92 driving cycle. Our results showed that particle mass and number emissions increased markedly during accelerations. For three of the four vehicles tested, particulate matter (PM) mass and particle number emissions were markedly higher during cold-start and the first few accelerations following the cold-start period than during the hot running and hot-start segments of the LA92 cycle. For one vehicle (which had the highest emissions overall) the hot-start and cold-start PM emissions were similar. Black carbon emissions were also much higher during the cold-start conditions, indicating severe fuel wetting leading to slow evaporation and pool burning, and subsequent soot formation. Particle number concentrations and black carbon emissions showed large reductions during the urban and hot-start phases of the test cycle. The oxidative potential of PM was quantified with both a chemical and a biological assay, and the gene expression impacts of the PM in a macrophage model with PCR (polymerase chain reaction) and ELISA (enzyme-linked immunosorbent assay) analyses. Inter- and intra-vehicle variability in oxidative potential per milligram of PM emitted was relatively low for both oxidative assays, suggesting that real-world emissions and exposure can be estimated with distance-normalized emission factors. The PCR response from signaling markers for oxidative stress (e.g., NOX1) was greater than from inflammatory, AhR (aryl hydrocarbon receptor), or MAPK (mitogen-activated protein kinase) signaling. Protein production associated with inflammation (tumor necrosis factor alpha-TNFα) and oxidative stress (HMOX-1) were quantified and displayed relatively high inter-vehicle variability, suggesting that these pathways may be activated by different PM components. Correlation of trace metal concentrations and oxidative potential suggests a role for small, insoluble particles in inducing oxidative stress.
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Affiliation(s)
- Jiacheng Yang
- University of California, Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), 1084 Columbia Avenue, Riverside, CA 92507, USA; Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA
| | - Patrick Roth
- University of California, Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), 1084 Columbia Avenue, Riverside, CA 92507, USA; Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA
| | | | - Martin M Shafer
- Department of Civil and Environmental Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, WI, USA
| | - Dagmara S Antkiewicz
- Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas D Durbin
- University of California, Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), 1084 Columbia Avenue, Riverside, CA 92507, USA; Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA
| | - David Cocker
- University of California, Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), 1084 Columbia Avenue, Riverside, CA 92507, USA; Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA
| | - Akua Asa-Awuku
- University of California, Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), 1084 Columbia Avenue, Riverside, CA 92507, USA; Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA
| | - Georgios Karavalakis
- University of California, Bourns College of Engineering, Center for Environmental Research and Technology (CE-CERT), 1084 Columbia Avenue, Riverside, CA 92507, USA; Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, CA 92521, USA.
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141
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Dominik E, Rohrbach S, Grieshaber P, Roth P, Böning A, Niemann B. Why Say Never—Ablation of “Permanent” Atrial Fibrillation? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678771] [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: 10/27/2022]
Affiliation(s)
- E. Dominik
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - S. Rohrbach
- Justus Liebig Universität Giessen, Physiologisches Institut, Giessen, Germany
| | - P. Grieshaber
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - P. Roth
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - A. Böning
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - B. Niemann
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
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142
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Grieshaber P, Kreuder J, Görlach G, Roth P, Niemann B, Reents W, Böning A. Good University Teaching Inspires Medical Students for Cardiothoracic and Vascular Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678903] [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: 10/27/2022]
Affiliation(s)
- P. Grieshaber
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - J. Kreuder
- Justus-Liebig-Universität Giessen, Studiendekanat Fachbereich 11, Giessen, Germany
| | - G. Görlach
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - P. Roth
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - B. Niemann
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - W. Reents
- Herz- und Gefäßklinik Bad Neustadt, Klinik für Kardiochirurgie, Bad Neustadt a.d. Saale, Germany
| | - A. Böning
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
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143
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Wirsching HG, Terksikh E, Silginer M, Krieg C, Tabatabai G, Wick W, Reifenberger G, Roth P, Becher B, Weller M. ACTR-16. PERIPHERAL BLOOD CD4+ MONONUCLEAR CELL FRACTIONS ARE ASSOCIATED WITH OVERALL SURVIVAL AT FIRST RECURRENCE OF IDH-WILDTYPE GLIOBLASTOMA AFTER STANDARD CHEMORADIOTHERAPY: SECONDARY ANALYSES OF THE PHASE II DIRECTOR TRIAL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.050] [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)
| | - Ekaterina Terksikh
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerl
| | | | - Carsten Krieg
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerl
| | - Ghazaleh Tabatabai
- Department of Neurology, University Hospital Zurich, Zurich, Zurich, Switzerl
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Baden-Wurttemberg, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Nordrhein-Westfalen, Germany
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich, Zurich, Zurich, Switzerl
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerl
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerl
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144
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Gramatzki D, Felsberg J, Baehr O, Hentschel B, Westphal M, Schackert G, Tonn JC, Herrlinger U, Steinbach J, Reifenberger G, Roth P, Weller M. RARE-19. CHEMOTHERAPY FOR SPINAL GLIOMAS IN ADULTS: A RETROSPECTIVE STUDY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Jörg Felsberg
- Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Oliver Baehr
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Bettina Hentschel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, University of Bonn Medical Center, Bonn, Germany
| | - Joachim Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerl
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145
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Affiliation(s)
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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146
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Hertler C, Roelcke U, Conen K, Huber F, Weiss T, Hofer S, Heese O, Westphal M, Roth P, Weller M, Eisele G. QOLP-27. USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN GLIOMA PATIENTS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.913] [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 Hertler
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - Ulrich Roelcke
- Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerl
| | - Katrin Conen
- Department of Oncology, University Hospital Basel, Basel, Switzerl
| | - Fabienne Huber
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - Tobias Weiss
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - Silvia Hofer
- Department of Oncology, University Hospital Zurich, Zurich, Switzerl
| | - Oliver Heese
- Department of Neurosurgery, Helios Kliniken, Schwerin, Schwerin, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University of Hamburg, Hamburg, Germany
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerl
| | - Günter Eisele
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
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147
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Roth P, Reijneveld J, Gorlia T, Dhermain F, Vanlancker M, Fournier B, Nuyens S, O’Callaghan C, Le Rhun E, Elias I, van den Bent M, Mason W, Winograd B, Weller M. RBTT-08. EORTC 1709/CCTG CE.8: A PHASE III TRIAL OF MARIZOMIB IN COMBINATION WITH STANDARD TEMOZOLOMIDE-BASED RADIOCHEMOTHERAPY VERSUS STANDARD TEMOZOLOMIDE-BASED RADIOCHEMOTHERAPY ALONE IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.977] [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)
| | | | - Thierry Gorlia
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | | | | | | | | | | | | | | | - Warren Mason
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Benjamin Winograd
- University Hospital Zurich, Zurich, Switzerl
- Celgene, Summit, NJ, USA
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
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148
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Silginer M, Papachristodolou A, Hentschel B, Gramatzki D, Felsberg J, Löffler M, Schackert G, Westphal M, Tonn JC, von Deimling A, Pietsch T, Reifenberger G, Roth P, Weller M. CSIG-27. DIFFERENTIAL ELEVATION OF TERT ACTIVITY AND SENSITIVITY TO TEMOZOLOMIDE BY TYPE OF TERT MUTATION IN MGMT PROMOTER-METHYLATED GLIOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.193] [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)
| | | | - Bettina Hentschel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | | | - Jörg Felsberg
- Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Markus Löffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | | | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Torsten Pietsch
- Institut für Neuropathologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerl
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149
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Eisele G, Roelcke U, Conen K, Huber F, Weiss T, Hofer S, Heese O, Westphal M, Hertler C, Roth P, Weller M. Complementary and alternative medicine use by glioma patients in Switzerland. Neurooncol Pract 2018; 6:237-244. [PMID: 31386047 DOI: 10.1093/nop/npy035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/30/2023] Open
Abstract
Background During the course of disease, most glioma patients learn that there is no cure for their tumor. It is therefore not uncommon for patients or caregivers to seek complementary and alternative medicine (CAM) treatments. Patterns of CAM use vary across the globe, but little is known about the type of, and motivation for, CAM use in most countries. Methods Here we conducted a cross-sectional survey of CAM use in patients harboring gliomas of World Health Organization (WHO) grades II to IV at 3 specialized neuro-oncology centers in Switzerland. Results Of 208 patients who returned the survey, approximately half reported having used or using CAM. CAM use was associated with younger age. Patients suffering from WHO grade II gliomas were less likely to indicate CAM use. The leading motivation for CAM use was to contribute actively to the treatment of the disease. CAM use was commonly not counseled or supervised by a health care professional. Cost and issues of reimbursement were not an important factor in the decision against or for CAM use. Conclusions Physicians caring for glioma patients should be aware of and explore CAM use to better understand patients' attitudes toward their disease, to provide counseling, and to identify potential interactions of CAM with standard treatments for gliomas.
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Affiliation(s)
- Günter Eisele
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Ulrich Roelcke
- Department of Neurology and Brain Tumor Center, Aarau, Switzerland
| | - Katrin Conen
- Department of Oncology, University Hospital Basel, Switzerland and Department of Family Medicine McMaster University, Hamilton, Canada
| | - Fabienne Huber
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Silvia Hofer
- Department of Oncology, University Hospital Zurich, Switzerland
| | - Oliver Heese
- Department of Neurosurgery, Helios Kliniken, Schwerin, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Eppendorf, Hamburg, Germany
| | - Caroline Hertler
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
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150
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Balbi A, Gak A, Kim E, Park T, Quinn J, Colon M, Roth P, Weaver K, Richardson D, Cannon R, Greenberg M. 75 Medical Student Brief Motivational Interviewing for Substance Use in the Emergency Department. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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