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Shaffer C, Tang N, Hao Y, Fink K, Snipes G, Mickey B, Berens M. Abstract 1601: Potentiation of arsenic trioxide in glioblastoma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1601] [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: 04/07/2023]
Abstract
Abstract
Glioblastoma (GBM) is the most prevalent type of malignant tumor within the central nervous system. Possessing a five-year survival rate of 6.8%, new therapeutic options are a necessity in order to increase patient quality of life and survival outcomes. Arsenic trioxide (ATO) is an FDA approved drug for the treatment of relapsed or refractory acute promyelocytic leukemia. Clinical trials of ATO in combination with radiation and temozolomide show therapeutic effects in a modest subset of glioblastoma patients. ATO resistance in GBM cell lines is associated with MNK1-eIF4E upregulation. Additionally, diminished response to ATO is linked to resistance to oxidative stress via increased glutathione levels and NrF2 pathway expression. We sought to target each of these proposed mechanisms of resistance in order to develop a suite of compounds for use in combination therapies, with the goal of sensitizing GBM models to ATO. Six GBM PDX models were dosed with ATO at varying concentrations and monitored for the IC50 value of treatment. The cell lines exhibited a 20-fold difference in sensitivity, indicative of an underlying innate resistance to ATO. We performed drug dose response studies of patient-derived glioma cells treated with ATO in combination with the nutraceutical compounds Chrysin and Silibinin. Combination treatments using Chrysin and Silibinin showed potentiation of the cytotoxic effects of ATO. Confirmation of the mechanism for induced sensitivity to ATO will be explored by measuring shifts in glutathione content and susceptibility to oxidative stress in response to treatment using nutraceutical compounds. In addition, drug dosing with combination therapies utilizing the MAPK interacting serine/threonine kinase 1 (MNK1) inhibitors eFT-508 and EFT-206 also show synergistic effects in GBM cell lines. The eIF4E phosphorylation response to treatment of both ATO alone ATO MNK1i combination therapies will be monitored and analyzed for potential translational effects. Each of these compounds were selected based on safe use determined in clinical trials (MNK1 inhibitors) or over-the-counter availability (nutraceuticals). All four companion approaches show low pharmacological liabilities in crossing the blood brain barrier. Future studies involving these compounds will consist of testing these suggested combination therapies in vivo by observing their effectiveness in orthotopic, GBM tumor bearing mice. Identification and development of sensitization targets for ATO will allow for greater effectiveness of treatment and a greater potency of the drug in combating resistance which arises in response to treatment. Discovery of a predictive molecular signature of synergy from ATO and other targeted agents may pave the way for a successful clinical trial of these combinations in an identifiable subpopulation of GBM patients.
Citation Format: Charles Shaffer, Nanyun Tang, Yue Hao, Karen Fink, George Snipes, Bruce Mickey, Michael Berens. Potentiation of arsenic trioxide in glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1601.
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Affiliation(s)
- Charles Shaffer
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
| | - Nanyun Tang
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
| | - Yue Hao
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
| | - Karen Fink
- 2Baylor Scott & White Research Institute, Dallas, TX
| | - George Snipes
- 2Baylor Scott & White Research Institute, Dallas, TX
| | - Bruce Mickey
- 2Baylor Scott & White Research Institute, Dallas, TX
| | - Michael Berens
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
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Peereboom D, Lindsay R, Badruddoja M, Nabors LB, Kumthekar P, Lieberman F, Tran D, Phuphanich S, Schiff D, Sherman J, Butowski N, Dunbar E, Fink K, Iwamoto F, Moertel C, Schulder M, Walbert T, Habboubi N, Grzegorzewski K, Brooks C, Reardon DA. CTIM-29. PHASE 2 STUDY OF A NOVEL IMMUNOTHERAPY SL-701 IN ADULTS WITH RECURRENT GBM: IDENTIFICATION OF TREATMENT-INDUCED CD8+CD107A+ CD57+ PD-1- MEMORY T-CELLS THAT ARE ASSOCIATED WITH INCREASED SURVIVAL. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Recurrent glioblastoma (GBM) is an aggressive disease with poor survival and limited treatment options. SL-701 is a novel immunotherapy comprised of synthetic peptides designed to elicit an anti-tumor immune response against GBM antigens IL-13Rα2, ephrinA2, and survivin. Here we describe an 18-color flow cytometry analysis from stage 2 of a Ph2 clinical trial of SL-701+poly-ICLC+bevacizumab (NCT02078648), in which 12-month overall survival (OS) was 50%. Of the 27 patients in stage 2, 24 (89%) developed heterogeneous T-cell responses against 1, 2, or 3 of the SL-701 CD8 peptides. Magnitude and kinetics of peptide responses were variable among these patients with no clear relationship to OS. Therefore, a phenotypic analysis of the T-cell response in all 27 patients was conducted using terraFlow, a unique data analysis approach utilizing machine learning to identify T-cell phenotypes associated with clinical response from all possible combinations of markers. In total, 10,184 unique SL-701 induced phenotypes were measured, including 223 phenotypes (P < 0.05) and 16 core phenotypes that uniquely represent differences between patients with OS above or below 12 months (P < 0.05). 50% of the core phenotypes were CD8+ CD57+ CD107a+ PD-1- SL-701-specific T-cells, which are highly-differentiated memory T-cells primed for cytotoxicity. The frequency of the CD57+ core phenotypes (8%-18%) was enhanced 1.6- to 2.3-fold in patients with an OS > 12 months (P < 0.05). Similarly, 2 core phenotypes identified cytotoxic CD4+ and CD8+ T cells, which were enhanced 1.9- and 2.5-fold in patients with an OS >12 months. The final 6 core phenotypes identified activated CD4+ CD154+ SL-701-specific T-cells (5%-19%) that were enhanced 0.3- to 0.5-fold in patients with an OS < 12 months (P < 0.05), suggesting helper T-cell responses in the absence of cytotoxic T-cell responses are associated with an OS < 12 months. Deep sequencing of SL-701-specific T-cells using whole transcriptome-based molecular cytometry is planned.
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Affiliation(s)
| | | | | | - L Burt Nabors
- University of Alabama Cancer Center , Birmingham, AL , USA
| | | | | | - David Tran
- University of Florida , Gainesville, FL , USA
| | | | - David Schiff
- University of Virginia , Charlottesville, VA , USA
| | | | - Nicholas Butowski
- Department of Neurological Surgery, University of California San Francisco , San Francisco, CA , USA
| | - Erin Dunbar
- Piedmont Brain Tumor Center, Piedmont Atlanta Hospital , Atlanta, GA , USA
| | - Karen Fink
- Baylor University Medical Center , Dallas, TX , USA
| | - Fabio Iwamoto
- Division of Neuro-Oncology, New York-Presbyterian/Columbia University Medical Center , New York, NY , USA
| | | | - Michael Schulder
- Zucker School of Medicine at Hofstra/Northwell , Hampstead, NY , USA
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Liau LM, Ashkan K, Brem S, Campian J, Trusheim J, Iwamoto F, Tran D, Anstass G, Cobbs C, Heth J, Salacz M, D'Andre S, Aiken R, Moshel Y, Nam J, Pillainayagam C, Wagner S, Walter K, Chaudary R, Goldlust S, Lee I, Bota D, Elinzano H, Grewal J, Lillehei K, Mikkelsen T, Walbert T, Abram S, Brenner A, Ewend M, Khagi S, Lovick D, Portnow J, Kim L, Loudon W, Martinez N, Thompson R, Avigan D, Fink K, Geoffroy F, Giglio P, Gligich O, Krex D, Lindhorst SM, Lutzky J, Meisel HJ, Nadji-Ohl M, Sanchin L, Sloan A, Bosch M. CTIM-27. AUTOLOGOUS TUMOR LYSATE-LOADED DENDRITIC CELL VACCINATION IMPROVES SURVIVAL IN PATIENTS WITH NEWLY DIAGNOSED AND RECURRENT GLIOBLASTOMA: SURVIVAL RESULTS FROM A PHASE 3 TRIAL. Neuro Oncol 2022. [PMCID: PMC9660964 DOI: 10.1093/neuonc/noac209.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Standard of care (SOC) and patient survival in glioblastoma have changed little in the past 17 years. We evaluated in a phase 3 trial whether adding an autologous tumor lysate-loaded dendritic cell vaccine (murcidencel) to SOC extends survival. Patients and
METHODS
Newly diagnosed glioblastoma patients were randomized 2:1 to either murcidencel or placebo. Under a crossover design, all patients could receive murcidencel following tumor recurrence. All parties remained blinded regarding treatments before recurrence. Patients thus received murcidencel at new diagnosis (nGBM) or at recurrence (rGBM) following crossover from placebo. The primary and secondary endpoints compare overall survival (OS) with contemporaneous, matched external controls. Four sets of analyses were conducted to ensure rigorous matching of the controls, reduce biases, and confirm the robustness of the results.
RESULTS
331 patients were enrolled. With the crossover, 89% received murcidencel. Median OS (mOS) for nGBM patients (n = 232) was 19.3 months from randomization (22.4 months from surgery) with murcidencel vs. 16.5 months from randomization in the controls (HR = 0.80, p = 0.002). Survival at 48 months from randomization was 15.7% vs. 9.9%, and at 60 months was 13% vs. 5.7%. For rGBM (n = 64), mOS was 13.2 months from relapse vs. 7.8 months in the controls (HR = 0.58, p < 0.001). Survival at 24 months post-recurrence was 20.7% vs. 9.6%, and at 30 months post-recurrence was 11.1% vs 5.1%. In nGBM patients with methylated MGMT (n = 90), mOS was 30.2 months from randomization (33 months from surgery) with murcidencel vs. 21.3 months from randomization in the controls (HR = 0.74, p = 0.027). The treatment was well tolerated, with only 5 serious adverse events deemed at least possibly related to the vaccine.
CONCLUSION
Clinically meaningful and statistically significant survival extension was seen in both nGBM and rGBM patients treated with murcidencel and SOC compared with contemporaneous, matched external controls who received SOC alone.
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Affiliation(s)
- Linda M Liau
- University of California, Los Angeles , Los Angeles , USA
| | | | - Steven Brem
- University of Pennsylvania , Philadelphia, PA , USA
| | - Jian Campian
- Mayo Clinic, Department of Oncology , Rochester, MN , USA
| | | | - Fabio Iwamoto
- Division of Neuro-Oncology, New York-Presbyterian/Columbia University Medical Center , New York, NY , USA
| | - David Tran
- University of Florida , Gainesville, FL , USA
| | | | | | - Jason Heth
- University of Michigan , Ann Arbor, MI , USA
| | | | | | | | | | | | | | | | | | | | | | - Ian Lee
- Henry Ford Health , Detroit, MI , USA
| | - Daniela Bota
- University of California Irvine , Irvine, CA , USA
| | | | - Jai Grewal
- Mount Sinai South Nassau Hospital, Oceanside, NY , Oceanside, NY , USA
| | | | | | | | | | | | | | | | | | | | - Lyndon Kim
- Mount Sinai Hospital , New York, NY , USA
| | | | | | | | - David Avigan
- Beth Israel Deaconess Medical Center , Cambridge, MA , USA
| | - Karen Fink
- Baylor University Medical Center , Dallas, TX , USA
| | | | - Pierre Giglio
- Ohio State University Comprehensive Cancer Center , Columbus, OH , USA
| | - Oleg Gligich
- Mount Sinai Medical Center , Miami Beach, FL , USA
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden , Dresden , Germany
| | | | | | | | - Minou Nadji-Ohl
- Klinikum der Landeshauptstadt Stuttgart , Stuttgart , Germany
| | | | - Andrew Sloan
- Department of Pathology and Department of Neurosurgery, Case Western Reserve University and University Hospitals Cleveland Medical Center; Seidman Cancer Center and Case Comprehensive Cancer Center , Cleveland , USA
| | - Marnix Bosch
- Northwest Biotherapeutics, Inc , Bethesda, MD , USA
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Donovan L, Won M, Cairncross JG, Iwamoto F, Buckner J, Fink K, Bahary JP, Hartford A, Souhami L, Nguyen T, Cescon T, Mishra M, Barani I, Pu A, Roa W, Huang J, Polley M, Mehta M. NCOG-12. COGNITIVE FUNCTION (CF) & QUALITY OF LIFE (QOL) IN PATIENTS TREATED WITH PROCARBAZINE, CCNU, & VINCRISTINE (PCV) + RADIOTHERAPY (RT) VS. RT FOR ANAPLASTIC OLIGODENDROGLIOMA (AO) ON NRG RTOG TRIAL 9402. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.603] [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
PCV+RT substantially prolongs survival in AO patients, but long-term CF and QOL implications are unclear. We compared CF and QOL by treatment arm in RTOG 9402 participants and evaluated the impact that baseline characteristics had on CF, QOL, and survival.
METHODS
CF and QOL were evaluated using the Mini Mental State Exam (MMSE) and Brain-Quality of Life (B-QOL) scale at baseline and annually. Scores were analyzed between treatment arms at each time point for patients with ≥ 10 years of follow-up data. Shared parameter models evaluated MMSE and B-QOL scores and survival for all patients.
RESULTS
42/148 (28.4%) participants in PCV+RT and 20/143 (14%) in RT alone arms survived ≥ 10 years. 35/42 and 39/42 (PCV+RT) and 18/20 and 17/20 (RT) participants completed baseline B-QOL and MMSE assessments, respectively. B-QOL scores did not differ between treatment groups at any time-point. Among 16 patients (10 PCV+RT, 6 RT) who completed year 10 MMSE evaluations, mean MMSE score at 10 years was higher in the RT arm (29.83 [95% CI 22.1, 30.0] vs. 26.50 [95% CI 29.4, 30.0], P= 0.04). Change in MMSE and B-QOL scores from baseline did not differ significantly between treatment groups at any time. In shared parameter models including all patients with baseline assessments, MMSE and B-QOL scores decreased over time (MMSE P= 0.0189, B-QOL P= 0.0005), but this did not differ by treatment group (MMSE P= 0.5727, B-QOL P= 0.3592). Younger age and higher KPS predicted better scores (MMSE P < 0.0001, P = 0.0002; B-QOL P = 0.0043, P = 0.0007). PCV+RT predicted better survival in both models.
CONCLUSIONS
PCV+RT improves survival in AO. Shared parameter models show decrease in MMSE and B-QOL over time. However, relative to RT alone, the addition of PCV did not impact change in CF and QOL over time.
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Affiliation(s)
- Laura Donovan
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | | | - Fabio Iwamoto
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Karen Fink
- Baylor Scott & White, Sammons Cancer Center, Dallas, TX, USA
| | - Jean-Paul Bahary
- Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Alan Hartford
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Luis Souhami
- McGill University Health Centre, Montreal, QC, Canada
| | - Timothy Nguyen
- London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - Terrence Cescon
- McGlinn Cancer Institute, Reading Hospital, West Reading, PA, USA
| | - Mark Mishra
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Igor Barani
- Barrow Neurological Institute, Phoenix, AZ, USA
| | - Anthony Pu
- Sutter Medical Center, Sacramento, CA, USA
| | - Wilson Roa
- University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - Jiayi Huang
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Mei Polley
- University of Chicago, and NRG Oncology, Philadelphia, PA, USA
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Peereboom D, Lindsay R, Badruddoja M, Nabors LB, Kumthekar P, Lieberman F, Tran D, Phuphanich S, Schiff D, Sherman J, Butowski N, Dunbar E, Fink K, Iwamoto F, Moertel C, Schulder M, Walbert T, Habboubi N, Grzegorzewski K, Brooks C, Reardon D. CTIM-11. PHASE 2 STUDY OF SL-701, A NOVEL IMMUNOTHERAPY, IN ADULTS WITH RECURRENT GBM: A HIGH PARAMETER FLOW CYTOMETRY ANALYSIS OF CD8+ T CELLS AND POTENTIAL IMPLICATIONS FOR PATIENT ENRICHMENT STRATEGIES. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.203] [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
Treatment of glioblastoma (GBM) remains a critical challenge and unmet medical need due to limited treatment options. SL-701 is a novel immunotherapy comprised of synthetic peptides designed to elicit a target-specific anti-tumor immune response against the GBM antigens IL-13Rα2, ephrinA2, and survivin. A multicenter, 2-stage, phase 2 clinical trial (NCT02078648) that evaluated the safety and efficacy of SL-701 in 74 adults with recurrent GBM was previously reported. This report describes preliminary data to suggest a correlation of immunocompetence to clinical outcome. In stage 2 (SL-701 + bevacizumab + poly-ICLC) the overall survival at 12 months was 50%. Two of 28 patients enrolled in stage 2 achieved CR (duration of response: 7.8 and 8.8 months) and 2 achieved PR (duration of response: 7.9 and 8.8 months). In a preliminary analysis to assess CD8+ T-cell responses, long-term survivors were comprised largely of subjects with an SL-701-induced target-specific CD8+ T-cell response, indicating a potential correlation of immunocompetence to clinical outcome. By week 24, SL-701-induced target-specific CD8+ T cells expressing IFNg were detected in 8 of 27 patients (30%) who had sufficient samples, with co-expression of PD-1, TIM3, and LAG3 detected in 4 patients. To further understand the T-cell response to SL-701, deep sequencing of target-specific CD8+ T cells using whole transcriptome-based molecular cytometry and high parameter (25+ color) flow cytometry is currently underway and updated data will be reported.
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Affiliation(s)
| | | | | | - L Burt Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Priya Kumthekar
- Northwestern Medicine; Feinberg School of Medicine, Chicago, IL, USA
| | | | - David Tran
- McKnight Brain Institute of the University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | - Jonathan Sherman
- Rockefeller Neuroscience Institute, West VIrginia University, Martinsburg, WV, USA
| | | | - Erin Dunbar
- Piedmont Brain Tumor Center, Atlanta, GA, USA
| | - Karen Fink
- Baylor Scott & White, Sammons Cancer Center, Dallas, TX, USA
| | | | | | - Michael Schulder
- Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Peng S, Lee M, Tang N, Ahluwalia M, Fonkem E, Fink K, Raizer J, Walker C, Dhruv H, Berens M. RTID-08. MACHINE LEARNING TO UNCOVER SIGNATURES OF VULNERABILITY IN GLIOBLASTOMA UMBRELLA SIGNATURE TRIAL (GUST). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.770] [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
Glioblastoma is characterized by intra- and inter-tumoral heterogeneity. A glioblastoma umbrella signature trial (GUST) posits multiple investigational treatment arms based on corresponding biomarker signatures. A contingency of an efficient umbrella trial is a suite of orthogonal signatures to classify patients into the likely-most-beneficial arm. Assigning optimal thresholds of vulnerability signatures to classify patients as “most-likely responders” for each specific treatment arm is a crucial task. We utilized semi-supervised machine learning, Entropy-Regularized Logistic Regression, to predict vulnerability classification. By applying semi-supervised algorithms to the TCGA GBM cohort, we were able to transform the samples with the highest certainty of predicted response into a self-labeled dataset and thus augment the training data. In this case, we developed a predictive model with a larger sample size and potential better performance. Our GUST design currently includes four treatment arms for GBM patients: Arsenic Trioxide, Methoxyamine, Selinexor and Pevonedistat. Each treatment arm manifests its own signature developed by the customized machine learning pipelines based on selected gene mutation status and whole transcriptome data. In order to increase the robustness and scalability, we also developed a multi-class/label classification ensemble model that’s capable of predicting a probability of “fitness” of each novel therapeutic agent for each patient. Such a multi-class model would also enable us to rank each arm and provide sequential treatment planning. By expansion to four independent treatment arms within a single umbrella trial, a “mock” stratification of TCGA GBM patients labeled 56% of all cases into at least one “high likelihood of response” arm. Predicted vulnerability using genomic data from preclinical PDX models correctly placed 4 out of 6 models into the “responder” group. Our utilization of multiple vulnerability signatures in a GUST trial demonstrates how a precision medicine model can support an efficient clinical trial for heterogeneous diseases such as GBM.
Surgical Therapies
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Affiliation(s)
- Sen Peng
- The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Matthew Lee
- The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Nanyun Tang
- The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | | | | | - Karen Fink
- Baylor Scott & White, Sammons Cancer Center, Dallas, TX, USA
| | | | | | - Harshil Dhruv
- The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Michael Berens
- The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
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Bota D, Butowski N, Piccioni D, De la Fuente M, Mao Y, Li WB, Trusheim J, Fink K, Campian J, Lobbous M, Portnow J, Zhu JJ, Pearlman M, Rudnick J, Lesser G, Drappatz J, Vaillant B, Sun SL, Luo W. CTNI-08. DB102-01 ENGAGE STUDY: A BIOMARKER-GUIDED, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTI-CENTER PHASE 3 CLINICAL TRIAL OF DB102 IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (GBM). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Precision medicine is vital for treating many cancers. Lack of valid biomarkers might contribute to the failure of drug therapy for GBM. The Denovo Genomic Marker 1 (DGM1), a novel pharmacogenomic biomarker, has been discovered by a genome-wide screen of patients treated with DB102 (enzastaurin) in a trial for lymphoma. Similarly, retrospective analyses showed that DB102 significantly improved outcomes in the biomarker positive GBM patients treated with DB102, regardless of MGMT promoter methylation status. The ENGAGE Study (DB102-01, NCT03776071) is a global Phase 3 clinical trial to confirm clinical benefits in patients with newly diagnosed GBM who are DGM1 biomarker positive. This is a prospective, randomized, double-blind, placebo-controlled, multi-center study. A total of 318 patients with newly diagnosed GBM will be enrolled. After screening, patients will be randomized to receive radiation therapy (RT) and temozolomide (TMZ) plus either DB102 or a matched placebo for 6 weeks in the Concurrent Phase, followed by DB102 or placebo for approximately 5 weeks in the Single-Agent Phase and then TMZ plus DB102 or placebo in the Adjuvant Phase (up to 12 cycles). Thereafter DB102 or placebo may be continued as a single agent for up to 2 years. The primary endpoint is overall survival (OS). The secondary endpoints include progression free survival (PFS), objective response rate (ORR) and drug safety. By April 2021, the safety-run-in part was completed. The study is now open for enrollment in the US and soon in Canada and China.
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Affiliation(s)
- Daniela Bota
- Daniela Bota, University of California Irvine, Irvine, CA, USA
| | | | - David Piccioni
- University of California San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Macarena De la Fuente
- Sylvester Comprehensive Cancer Center, University of Miami Hospital and Clinics, Miami, FL, USA
| | - Ying Mao
- Shanghai Fudan University, Shanghai, China (People's Republic)
| | - Wen-Bin Li
- Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (People's Republic)
| | - John Trusheim
- John Nasseff Neuroscience Institute, Minneapolis, MN, USA
| | - Karen Fink
- Baylor Scott & White, Sammons Cancer Center, Dallas, TX, USA
| | | | - Mina Lobbous
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA, USA
| | - Jay-Jiguang Zhu
- Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | - Glen Lesser
- Wake Forest Baptist Health - Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jan Drappatz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian Vaillant
- Austin Cancer Center – Park St. David’s, Austin, TX, USA
| | | | - Wen Luo
- Denovo Biopharma LLC, San Diego, CA, USA
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Peng S, Lee M, Tang N, Ahluwalia M, Fonkem E, Fink K, Raizer J, Walker C, Dhruv H, Berens M. CLRM-01. MACHINE LEARNING TO UNCOVER SIGNATURES OF VULNERABILITY IN GLIOBLASTOMA UMBRELLA SIGNATURE TRIAL (GUST). Neurooncol Adv 2021. [PMCID: PMC8453809 DOI: 10.1093/noajnl/vdab112.000] [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: 12/01/2022] Open
Abstract
Glioblastoma is characterized by intra- and inter-tumoral heterogeneity. A glioblastoma umbrella signature trial (GUST) posits multiple investigational treatment arms based on corresponding biomarker signatures. A contingency of an efficient umbrella trial is a suite of orthogonal signatures to classify patients into the likely-most-beneficial arm. Assigning optimal thresholds of vulnerability signatures to classify patients as “most-likely responders” for each specific treatment arm is a crucial task. We utilized semi-supervised machine learning, Entropy-Regularized Logistic Regression, to predict vulnerability classification. By applying semi-supervised algorithms to the TCGA GBM cohort, we were able to transform the samples with the highest certainty of predicted response into a self-labeled dataset and thus augment the training data. In this case, we developed a predictive model with a larger sample size and potential better performance. Our GUST design currently includes four treatment arms for GBM patients: Arsenic Trioxide, Methoxyamine, Selinexor and Pevonedistat. Each treatment arm manifests its own signature developed by the customized machine learning pipelines based on selected gene mutation status and whole transcriptome data. In order to increase the robustness and scalability, we also developed a multi-class/label classification ensemble model that’s capable of predicting a probability of “fitness” of each novel therapeutic agent for each patient. Such a multi-class model would also enable us to rank each arm and provide sequential treatment planning. By expansion to four independent treatment arms within a single umbrella trial, a “mock” stratification of TCGA GBM patients labeled 56% of all cases into at least one “high likelihood of response” arm. Predicted vulnerability using genomic data from preclinical PDX models correctly placed 4 out of 6 models into the “responder” group. Our utilization of multiple vulnerability signatures in a GUST trial demonstrates how a precision medicine model can support an efficient clinical trial for heterogeneous diseases such as GBM.
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Affiliation(s)
- Sen Peng
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Matthew Lee
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Nanyun Tang
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | | | | | | | | | | | - Harshil Dhruv
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Michael Berens
- The Translational Genomics Research Institute, Phoenix, AZ, USA
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Lee ME, Tang N, Ahluwalia M, Fonkem E, Fink K, Dhurv H, Dhurv H, Berens ME, Peng S. Abstract 180: Identifying signatures of vulnerability through machine learning in an umbrella trial for glioblastoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Glioblastoma is characterized by intra- and inter-tumoral heterogeneity. An umbrella trial tests multiple investigational treatment arms depending on corresponding biomarker signatures. A contingency of an efficient umbrella trial is a suite of preferably orthogonal molecular biomarkers to classify patients into the likely-most-beneficial arm. Assigning thresholds of molecular signatures to classify a patient as a “most-likely responder” for one specific treatment arm is a crucial task. Gene Set Variation Analysis (GSVA) of specimens from a GBM clinical trial of methoxyamine associated differential enrichment in DNA repair pathways activities with patient response. However, the large number of DNA-repair related pathways confound confident “high” enrichment of responder, as well as obscuring to what degree each feature contributes to the likelihood of a patient's response. Here, we utilized semi-supervised machine learning, Entropy-Regularized Logistic Regression (ERLR) to predict vulnerability classification. By first training all available data using semi-supervised algorithms we transformed unclassified TCGA GBM samples with highest certainty of predicted response into a self-labeled dataset. In this case, we developed a predictive model which has a larger sample size and potential better performance. Our umbrella trial design currently includes three treatment arms for GBM patients: arsenic trioxide, methoxyamine, and pevonedistat. Each treatment arm manifests its own signature developed by the above (or similar) machine learning pipeline based on selected gene mutation status and whole transcriptome data. In order to increase the robustness and scalability (with future more treatment arms), we also developed a multi-label classification ensemble model that's capable of predicting a probability of “fitness” of each novel therapeutic agent for each patient. By expansion to three, independent treatment arms within a single umbrella trial, a “mock” stratification of TCGA GBM patients labeled 56% of all cases into at least one “high likelihood of response” arm. Predicted vulnerability using genomic data from preclinical PDX models placed 4 out of 6 models into a “high likelihood of response” regimen. Our utilization of multiple vulnerability signatures in an umbrella trial demonstrates how a precision medicine model can support an efficient clinical trial for heterogeneous diseases such as GBM.
Citation Format: Matthew Eric Lee, Nanyun Tang, Manmeet Ahluwalia, Ekokobe Fonkem, Karen Fink, Harshil Dhurv, Harshil Dhurv, Michael E. Berens, Sen Peng. Identifying signatures of vulnerability through machine learning in an umbrella trial for glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 180.
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Affiliation(s)
| | - Nanyun Tang
- 1The Translational Genomics Research Institute, Phoenix, AZ
| | | | | | - Karen Fink
- 4Baylor Scott & White Health, Dallas, TX
| | - Harshil Dhurv
- 1The Translational Genomics Research Institute, Phoenix, AZ
| | - Harshil Dhurv
- 1The Translational Genomics Research Institute, Phoenix, AZ
| | | | - Sen Peng
- 1The Translational Genomics Research Institute, Phoenix, AZ
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Puduvalli VK, Wu J, Yuan Y, Armstrong TS, Vera E, Wu J, Xu J, Giglio P, Colman H, Walbert T, Raizer J, Groves MD, Tran D, Iwamoto F, Avgeropoulos N, Paleologos N, Fink K, Peereboom D, Chamberlain M, Merrell R, Penas Prado M, Yung WKA, Gilbert MR. A Bayesian adaptive randomized phase II multicenter trial of bevacizumab with or without vorinostat in adults with recurrent glioblastoma. Neuro Oncol 2021; 22:1505-1515. [PMID: 32166308 DOI: 10.1093/neuonc/noaa062] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Bevacizumab has promising activity against recurrent glioblastoma (GBM). However, acquired resistance to this agent results in tumor recurrence. We hypothesized that vorinostat, a histone deacetylase (HDAC) inhibitor with anti-angiogenic effects, would prevent acquired resistance to bevacizumab. METHODS This multicenter phase II trial used a Bayesian adaptive design to randomize patients with recurrent GBM to bevacizumab alone or bevacizumab plus vorinostat with the primary endpoint of progression-free survival (PFS) and secondary endpoints of overall survival (OS) and clinical outcomes assessment (MD Anderson Symptom Inventory Brain Tumor module [MDASI-BT]). Eligible patients were adults (≥18 y) with histologically confirmed GBM recurrent after prior radiation therapy, with adequate organ function, KPS ≥60, and no prior bevacizumab or HDAC inhibitors. RESULTS Ninety patients (bevacizumab + vorinostat: 49, bevacizumab: 41) were enrolled, of whom 74 were evaluable for PFS (bevacizumab + vorinostat: 44, bevacizumab: 30). Median PFS (3.7 vs 3.9 mo, P = 0.94, hazard ratio [HR] 0.63 [95% CI: 0.38, 1.06, P = 0.08]), median OS (7.8 vs 9.3 mo, P = 0.64, HR 0.93 [95% CI: 0.5, 1.6, P = 0.79]) and clinical benefit were similar between the 2 arms. Toxicity (grade ≥3) in 85 evaluable patients included hypertension (n = 37), neurological changes (n = 2), anorexia (n = 2), infections (n = 9), wound dehiscence (n = 2), deep vein thrombosis/pulmonary embolism (n = 2), and colonic perforation (n = 1). CONCLUSIONS Bevacizumab combined with vorinostat did not yield improvement in PFS or OS or clinical benefit compared with bevacizumab alone or a clinical benefit in adults with recurrent GBM. This trial is the first to test a Bayesian adaptive design with adaptive randomization and Bayesian continuous monitoring in patients with primary brain tumor and demonstrates the feasibility of using complex Bayesian adaptive design in a multicenter setting.
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Affiliation(s)
- Vinay K Puduvalli
- Division of Neuro-Oncoology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Jing Wu
- Neuro-Oncology Branch, National Institute of Health, Bethesda, Maryland
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center (MDACC), Houston, Texas
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Institute of Health, Bethesda, Maryland
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Institute of Health, Bethesda, Maryland
| | - Jimin Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center (MDACC), Houston, Texas
| | - Jihong Xu
- Division of Neuro-Oncoology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Pierre Giglio
- Division of Neuro-Oncoology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Howard Colman
- Department of Neurosurgery, Huntsman Cancer Center, University of Utah, Salt Lake City, Utah
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey Raizer
- Department of Neurology, Northwestern University, Chicago, Illinois
| | | | - David Tran
- Department of Medicine, Washington University, St Louis, Missouri
| | - Fabio Iwamoto
- Division of Neurooncology, Columbia University, New York, New York
| | | | | | - Karen Fink
- Baylor University Medical Center, Dallas, Texas
| | | | - Marc Chamberlain
- Department of Neurology, University of Washington, Seattle, Washington
| | - Ryan Merrell
- Department of Neurology, North Shore University Health System, Evanston, Illinois
| | - Marta Penas Prado
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - W K Alfred Yung
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Institute of Health, Bethesda, Maryland
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Lee M, Tang N, Ahluwalia M, Fonkem E, Fink K, Dhruv H, Berens M, Peng S. BIOM-24. IDENTIFYING VULNERABILITY SIGNATURES THROUGH MACHINE LEARNING IN AN UMBRELLA TRIAL FOR GLIOBLASTOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.024] [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: 11/15/2022] Open
Abstract
Abstract
Glioblastoma is characterized by intra- and inter-tumoral heterogeneity. An umbrella trial tests multiple treatment arms depending on corresponding biomarker signatures. A contingency of an umbrella trial is a suite of preferably orthogonal molecular biomarkers to classify patients into the likely-most-beneficial arm. Assigning thresholds of molecular signatures to classify a patient as a “most-likely responder” for one specific treatment arm is a crucial task. Gene Set Variation Analysis (GSVA) of specimens from a GBM clinical trial of methoxyamine associated differential enrichment in DNA repair pathways activities with patient response. The 44 DNA-repair related pathways confound confident “high” enrichment of responder, as well as obscuring to what degree each feature contributes to the likelihood of a patient’s response. Here, we utilized semi-supervised machine learning, Entropy-Regularized Logistic Regression (ERLR) to predict classification. By first training all available data using semi-supervised algorithms we transformed unclassified TCGA GBM samples with highest certainty of predicted response into a self-labeled dataset. In this case, we developed the predictive model which has a larger sample size and potential better performance. Our umbrella trial design currently includes three treatment arms for GBM patients: arsenic trioxide, methoxyamine, and pevonedistat. Each treatment arm manifests its own signature developed by the above (or similar) machine learning pipeline based on selected gene mutation status and whole transcriptome data. By expansion to three, independent treatment arms within a single umbrella trial, a “mock” stratification of TCGA GBM patients binned 56% of all cases into a “high likelihood of response“ arm. Predicted vulnerability using genomic data from preclinical PDX models placed 4 out of 6 models into a “high likelihood of response” regimen. Our utilization of multiple vulnerability signatures in an umbrella trial demonstrates how a precision medicine model can support an efficient clinical trial for heterogeneous diseases such as GBM.
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Affiliation(s)
- Matthew Lee
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Nanyun Tang
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | | | | | - Karen Fink
- Baylor Scott & White Health, Dallas, TX, USA
| | - Harshil Dhruv
- The Translational Genomics Research Institute, Lehi, UT, USA
| | - Michael Berens
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Sen Peng
- The Translational Genomics Research Institute, Phoenix, AZ, USA
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Peng S, Gu J, Wang X, Rath S, Cardenas J, Schork N, Snipes G, Dhruv H, Fink K, Berens M. Abstract 2007: Development of a clinical assay for predicting glioblastoma (GBM) patients most likely to respond to arsenic trioxide (ATO). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Glioblastoma (GBM) is the most frequently reported primary malignant brain tumor (29.6%). The prognosis for patients who develop GBM is bleak, with average survival after diagnosis of 12-16 months. Although conventional treatment with surgery, irradiation, and temozolomide postpones tumor progression and extends patients survival, these tumors universally recur and unrelentingly result in patient death. Personalized therapies against molecular targets that drive the growth of the bulk of primary tumors have so far been unsuccessful in clinical trials, due to lack of biomarker driven approaches. Thus, there is significant unmet need to begin biomarker driven precision medicine trials for treatment of GBM. Arsenic trioxide (ATO) is an inorganic compound that induces apoptosis via multiple pathways. Arsenic trioxide (TRISENOX®) is approved by the FDA for patients with acute promyelocytic leukemia (APL). Pre-clinical studies in brain tumors suggest that ATO is synergistic with radiation therapy (RT) and may enhance effects of radiation. In an earlier Phase II clinical trial (NCT00275067) using intravenous ATO and temozolomide in combination with radiation therapy for patients with newly diagnosed malignant gliomas, a subset of patients demonstrated notable benefit (Progression free survival (avg. = 638 days) and overall survival (avg. = 967 days)). Comparing RNAseq data from preclinical models and specimen from the Phase II clinical trial, the responder group could be confidently distinguished from the non-responder cohort leading to gene signatures of differential ATO sensitivity. Applying a Relative Expression Ordering (REO) Analysis framework, we pinpointed a probability-based roster of 28 top scoring pairs (TSP) as the classifier by which to identify patients with a higher likelihood to benefit from including ATO in combination with TMZ and radiation. This method is completely independent of platform on which data is collected and can be used for analysis of individual, newly-enrolled, n = 1 patients. We are advancing a protocol using the above gene classifier as enrollment criteria for an Adaptive clinical trial testing an oral formulation of ATO for newly diagnosed IDH1 WT Primary GBM patients; the trial will test whether patients whose tumors with ATO Classifier show 6-month PFS benefit by addition of ATO to Standard-of-Care. The trial will validate and refine the comprehensive biomarker panel that could identify most likely GBM responders to ATO and TMZ treatment in combination with radiation. Supported by a grant from the Baylor Scott & White Foundation.
Citation Format: Sen Peng, Jinghua Gu, Xuan Wang, Sanhita Rath, Jacob Cardenas, Nicholas Schork, George Snipes, Harshil Dhruv, Karen Fink, Michael Berens. Development of a clinical assay for predicting glioblastoma (GBM) patients most likely to respond to arsenic trioxide (ATO) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2007.
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Affiliation(s)
- Sen Peng
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
| | - Jinghua Gu
- 2Baylor Scott White Research Institute, Dallas, TX
| | - Xuan Wang
- 2Baylor Scott White Research Institute, Dallas, TX
| | - Sanhita Rath
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
| | | | - Nicholas Schork
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
| | | | - Harshil Dhruv
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
| | - Karen Fink
- 2Baylor Scott White Research Institute, Dallas, TX
| | - Michael Berens
- 1TGen (The Translational Genomics Research Institute), Phoenix, AZ
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13
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Lee ME, Peng S, Taylor B, Ferdosi S, Dhruv H, Ahluwalia M, Fink K, Berens M. Abstract 857: Discovering molecular biomarkers through machine learning to assign patients to one of multiple arms for most-likely-to-benefit in an umbrella trial for glioblastoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Glioblastoma Multiforme (GBM) is the most common primary brain tumor, characterized by intra- and inter-tumoral heterogeneity and relentless, lethal progression. Molecular data from next-generation sequencing subclassifies the disease into discrete subtypes, setting the stage for biomarker-driven clinical trials. An umbrella trial tests various treatment arms depending on various biomarker signatures that preferentially assign each new patient into a specific treatment arm. A contingency of an umbrella trial is a suite of distinct, orthogonal molecular biomarkers to classify patients into the likely-most-beneficial arm of the different separate treatment arms. Assigning thresholds to molecular signatures in order to classify a patient as a likely-responder within a single treatment arm is a crucial task. For example, in GBM patients treated with methoxyamine (covalently binds to apurinic/apyrimidinic (AP) DNA damage sites), Gene Set Variation Analysis (GSVA) identifies the differential enrichment in several DNA repair pathways of individuals. The 44 DNA-repair related pathways (or features) make it difficult to define “high” enrichment, as well as which, and to what degree, each feature contributes to the likelihood of a patient's response. Here, we utilize two semi-supervised algorithms, the Transductive Support Vector Machine (TSVM) and Entropy-Regularized Logistic Regression (ERLR). By first training these algorithms in a semi-supervised method using both patient as well as TCGA samples we can then transform the output of GSVA on unlabeled TCGA samples into a labeled data set based on those with the highest certainty of their predicted response. By employing semi-supervised algorithms to self-label the response of GBM Cases in TCGA, a predictive model can be developed which has a larger sample number, thereby reducing uncertainty.
Our umbrella trial design currently includes three treatment arms for GBM patients: arsenic trioxide, methoxyamine, and pevonedistat. Each treatment arm contains its own biomarker developed by the above machine learning pipeline based on selected gene mutation status in addition to whole transcriptome data. By conducting a “mock” stratification of GBM patients in TCGA, we identify likely patient responders in a single arm (as low as 9%) to upwards of 45% by expansion to three, independent treatment arms within a single trial. Our utilization of multiple biomarker signatures in an umbrella trial demonstrates how a precision medicine model can be effective in heterogeneous diseases such as GBM.
Citation Format: Matthew E. Lee, Sen Peng, Brett Taylor, Shay Ferdosi, Harshil Dhruv, Manmeet Ahluwalia, Karen Fink, Michael Berens. Discovering molecular biomarkers through machine learning to assign patients to one of multiple arms for most-likely-to-benefit in an umbrella trial for glioblastoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 857.
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Affiliation(s)
- Matthew E. Lee
- 1The Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - Sen Peng
- 1The Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - Brett Taylor
- 1The Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - Shay Ferdosi
- 1The Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - Harshil Dhruv
- 1The Translational Genomics Research Institute (TGen), Phoenix, AZ
| | | | - Karen Fink
- 3Baylor Scott & White Health, Dallas, TX
| | - Michael Berens
- 1The Translational Genomics Research Institute (TGen), Phoenix, AZ
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Lassman A, Won M, Gregory Cairncross J, Shaw E, Ashby L, Souhami L, Laack N, Fink K, Macdonald D, Bahary JP, Hartford A, Whitton A, Werner-Wasik M, Laperriere N, Suh J, Robinson C, Mehta M. ACTR-13. FINAL RESULTS WITH CHEMORADIOTHERAPY FOR ANAPLASTIC OLIGODENDROGLIAL TUMORS FROM NRG ONCOLOGY/RTOG 9402. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.056] [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
Adding intensive-procarbazine, lomustine, and vincristine (iPCV) to radiotherapy (RT) prolonged progression-free (PFS) and overall survival (OS) for patients with 1p19q codeleted anaplastic oligodendroglial tumors (AOTs); some benefit was also observed for IDH-mutant non-codeleted cases (Cairncross et al 2013, 2014, 2016). Now, 25 years after study activation, we updated survival, further assessed IDH as a predictive biomarker, and are exploring the benefit from vincristine.
METHODS
Eligible adults (KPS ≥ 60, adequate end-organ function) were randomized to pre-RT iPCV (4 cycles x 6 weeks each) vs. RT alone, stratified by age (< or ≥ 50), KPS (60–70 or ≥ 80), and level of anaplasia. Histology (anaplastic oligodendroglioma/oligo-astrocytoma required) and biomarkers (IDH and 1p19q, post-hoc) were determined centrally. Survival was estimated by Kaplan-Meier and Hazard Ratios (HRs) by Cox-regression.
RESULTS
Overall (n=289), median follow-up was 16.4 years vs. 11.3 years at last report. In codeleted cases, 40% randomized to iPCV remained alive vs. 53% at last report; 5, 10, and 14 year-PFS and -OS rates were 62%, 50%, 41% and 70%, 57%, 46%, respectively; and iPCV unequivocally prolonged PFS (median 9.8 vs. 2.9 years, HR 0.46, 95% CI 0.3–0.7, p< 0.001) and OS (median 13.2 vs. 7.3 years, HR 0.61, 95% CI 0.40–0.94; p=0.02). With IDH mutation but without codeletion (n=66), iPCV prolonged PFS (median 2.8 vs. 1.9 years, HR 0.58, 95% CI 0.34–0.99, p=0.046); OS was longer with a trend for significance (median 5.5 vs. 3.3 years, HR 0.6, 95% CI 0.34–1.03, p=0.06) on this underpowered exploratory post-hoc analysis.
CONCLUSION
For codeleted AOTs, long-term analyses confirmed that pre-RT iPCV produced meaningful and significant prolongations of PFS and OS. With IDH mutation but without codeletion, iPCV significantly prolonged PFS and showed a trend for prolonged OS. The value of vincristine is being assessed. Supported by NCI grants U10CA180868, U10CA180822, U24CA196067, and UG1CA189867.
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Affiliation(s)
- Andrew Lassman
- Columbia University Irving Medical Center, New York, NY, USA
| | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | | | - Edward Shaw
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Lynn Ashby
- Barrow Neurological Institute/Arizona Oncology Services Foundation, Phoenix, AZ, USA
| | | | - Nadia Laack
- Mayo Clinic/Accruals for Rochester Methodist Hospital (NCCTG), Rochester, MN, USA
| | - Karen Fink
- Baylor University Medical Center Accruals for University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Jean-Paul Bahary
- CHUM - Centre Hospitalier de l’Universite de Montreal, Montreal, QC, Canada
| | - Alan Hartford
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Anthony Whitton
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Normand Laperriere
- Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - John Suh
- Cleveland Clinic Foundation, Cleveland, OH, USA
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Khwaja R, Mantilla E, Fink K, Pan E. Adult Primary Peripheral PNET/Ewing's Sarcoma of the Cervical and Thoracic Spine. Anticancer Res 2019; 39:4463-4465. [PMID: 31366545 DOI: 10.21873/anticanres.13619] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 11/10/2022]
Abstract
This case report describes a patient with a rare occurrence of primary spinal intramedullary Ewing's sarcoma (ES) in the cervical and thoracic spine. The older age of disease occurrence, uncommon location in the cervical and thoracic spine, and EWSR1 gene fusion as the basis of diagnosis are unique features of this case. There is no clear protocol for treatment of primary extraskeletal ES of the spine, with controversy between evidence for pursuing surgery versus a combination of radiation and chemotherapy. Our patient was treated with temozolomide chemotherapy for recurrent metastatic disease of primary ES of the spine.
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Affiliation(s)
| | | | - Karen Fink
- Baylor University Medical Center, Dallas, TX, U.S.A
| | - Edward Pan
- UT Southwestern Medical Center, Dallas, TX, U.S.A.
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Busch HJ, Schmid B, Kron J, Fink K, Busche C, Danner T, Veits O, Gottlieb D, Benk C, Trummer G, Meyer-Först S, Kopp S, Schwab W, Wengenmayer T, Biever P. [Freiburg Cardiac Arrest Receiving Team (CART) : Interdisciplinary solution for the acute management of non-traumatic out-of-hospital cardiac arrest]. Med Klin Intensivmed Notfmed 2019; 115:292-299. [PMID: 31363800 DOI: 10.1007/s00063-019-0598-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/18/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Standard procedures and guidelines provide specific instructions for basic and advanced cardiac life support. Recommendations for the admission of patients from preclinical into clinical structures after successful cardiopulmonary resuscitation (CPR) are available, but only a few are detailed. In the presence of ST-elevation myocardial infarction after return of spontaneous circulation (ROSC), coronary angiography must be performed as soon as possible. However, acute management and consecutive diagnostic procedures after hospital admission are up to the doctor on duty, who can rely on standard internal hospital procedures at best. Despite the enormous progress and new findings in intensive care and emergency medicine, intra-hospital mortality, as well as long-term survival, after CPR remains low and depends on a wide variety of influencing factors. To optimize in-hospital acute care of successfully resuscitated patients, an interdisciplinary admission team, a so-called cardiac arrest receiving team (CART), has been implemented at the University Hospital of Freiburg, Germany. The aim of the CART is to provide primary care to resuscitated patients as quickly and in as standardized a manner as possible with predefined diagnostic and therapeutic pathways by a team with special expertise in the field of CPR and post-resuscitation management. Accordingly, clear criteria for procedures and the location of primary care (e.g. emergency room vs. cardiac catheter laboratory), the composition of the CART and concrete treatment measures were defined.
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Affiliation(s)
- H-J Busch
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland.
| | - B Schmid
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - J Kron
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - K Fink
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - C Busche
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - T Danner
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - O Veits
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - D Gottlieb
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - C Benk
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - G Trummer
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - S Meyer-Först
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - S Kopp
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - W Schwab
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - T Wengenmayer
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - P Biever
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
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Wen PY, Reardon DA, Armstrong TS, Phuphanich S, Aiken RD, Landolfi JC, Curry WT, Zhu JJ, Glantz M, Peereboom DM, Markert JM, LaRocca R, O'Rourke DM, Fink K, Kim L, Gruber M, Lesser GJ, Pan E, Kesari S, Muzikansky A, Pinilla C, Santos RG, Yu JS. A Randomized Double-Blind Placebo-Controlled Phase II Trial of Dendritic Cell Vaccine ICT-107 in Newly Diagnosed Patients with Glioblastoma. Clin Cancer Res 2019; 25:5799-5807. [PMID: 31320597 DOI: 10.1158/1078-0432.ccr-19-0261] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/30/2019] [Accepted: 07/11/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the results of the randomized, double-blind, placebo-controlled phase II clinical trial of ICT-107 in patients with newly diagnosed glioblastoma. PATIENTS AND METHODS We conducted a double-blinded randomized phase II trial of ICT-107 in newly diagnosed patients with glioblastoma (GBM) and tested efficacy, safety, quality of life (QoL), and immune response. HLA-A1+ and/or -A2+-resected patients with residual tumor ≤1 cm3 received radiotherapy and concurrent temozolomide. Following completion of radiotherapy, 124 patients, randomized 2:1, received ICT-107 [autologous dendritic cells (DC) pulsed with six synthetic peptide epitopes targeting GBM tumor/stem cell-associated antigens MAGE-1, HER-2, AIM-2, TRP-2, gp100, and IL13Rα2] or matching control (unpulsed DC). Patients received induction ICT-107 or control weekly × 4 followed by 12 months of adjuvant temozolomide. Maintenance vaccinations occurred at 1, 3, and 6 months and every 6 months thereafter. RESULTS ICT-107 was well tolerated, with no difference in adverse events between the treatment and control groups. The primary endpoint, median overall survival (OS), favored ICT-107 by 2.0 months in the intent-to-treat (ITT) population but was not statistically significant. Progression-free survival (PFS) in the ITT population was significantly increased in the ICT-107 cohort by 2.2 months (P = 0.011). The frequency of HLA-A2 primary tumor antigen expression was higher than that for HLA-A1 patients, and HLA-A2 patients had higher immune response (via Elispot). HLA-A2 patients achieved a meaningful therapeutic benefit with ICT-107, in both the MGMT methylated and unmethylated prespecified subgroups, whereas only HLA-A1 methylated patients had an OS benefit. CONCLUSIONS PFS was significantly improved in ICT-107-treated patients with maintenance of QoL. Patients in the HLA-A2 subgroup showed increased ICT-107 activity clinically and immunologically.
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Affiliation(s)
- Patrick Y Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - David A Reardon
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Robert D Aiken
- Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | | | - Jay-Jiguang Zhu
- University of Texas Health Sciences Center at Houston (UTHealth), Houston, Texas
| | - Michael Glantz
- Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | | | | | - Donald M O'Rourke
- Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Fink
- Baylor Scott and White Neuro-Oncology Associates, Dallas, Texas
| | - Lyndon Kim
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Glenn J Lesser
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Edward Pan
- University of Texas, Southwest Medical Center, Dallas, Texas
| | - Santosh Kesari
- John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, California
| | - Alona Muzikansky
- Alona Muzikansky, Massachusetts General Hospital, Boston, Massachusetts
| | - Clemencia Pinilla
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida
| | - Radleigh G Santos
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida
| | - John S Yu
- Cedars-Sinai Medical Center, Los Angeles, California.,Immunocellular Therapeutics, Calabasas, California.,Precision Lifesciences Group, Nashville, TN
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Storm C, Behringer W, Wolfrum S, Michels G, Fink K, Kill C, Arrich J, Leithner C, Ploner C, Busch HJ. [Postcardiac arrest treatment guide]. Med Klin Intensivmed Notfmed 2019; 115:573-584. [PMID: 31197420 DOI: 10.1007/s00063-019-0591-6] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment after cardiac arrest has become more complex and interdisciplinary over the last few years. Thus, the clinically active intensive and emergency care physician not only has to carry out the immediate care and acute diagnostics, but also has to prognosticate the neurological outcome. AIM The different, most important steps are presented by leading experts in the area, taking into account the interdisciplinarity and the currently valid guidelines. MATERIALS AND METHODS Attention was paid to a concise, practice-oriented presentation. RESULTS AND DISCUSSION The practical guide contains all important steps from the acute care to the neurological prognosis generation that are relevant for the clinically active intensive care physician.
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Affiliation(s)
- C Storm
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - W Behringer
- Zentrum für Notfallmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - S Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikum Lübeck, Lübeck, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Köln, Deutschland
| | - K Fink
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg Breisgau, Deutschland
| | - C Kill
- Zentrum für Notfallmedizin, Universitätsklinikum Essen, Essen, Deutschland
| | - J Arrich
- Zentrum für Notfallmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - C Leithner
- Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Ploner
- Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg Breisgau, Deutschland.
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Fink K, Busch HJ. Effect of selenium on early outcomes after cardiopulmonary resuscitation. Med Klin Intensivmed Notfmed 2019; 114:246-251. [DOI: 10.1007/s00063-018-0412-3] [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] [Received: 07/21/2017] [Accepted: 01/04/2018] [Indexed: 11/24/2022]
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20
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Huang J, Chaudhary R, Cohen AL, Fink K, Goldlust S, Boockvar J, Chinnaiyan P, Wan L, Marcus S, Campian JL. A multicenter phase II study of temozolomide plus disulfiram and copper for recurrent temozolomide-resistant glioblastoma. J Neurooncol 2019; 142:537-544. [PMID: 30771200 DOI: 10.1007/s11060-019-03125-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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: 01/15/2019] [Accepted: 02/08/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Preclinical studies have suggested promising activity for the combination of disulfiram and copper (DSF/Cu) against glioblastoma (GBM) including re-sensitization to temozolomide (TMZ). A previous phase I study demonstrated the safety of combining DSF/Cu with adjuvant TMZ for newly diagnosed GBM. This phase II study aimed to estimate the potential effectiveness of DSF/Cu to re-sensitize recurrent GBM to TMZ. METHODS This open-label, single-arm phase II study treated recurrent TMZ-resistant GBM patients with standard monthly TMZ plus concurrent daily DSF 80 mg PO TID and Cu 1.5 mg PO TID. Eligible patients must have progressed after standard chemoradiotherapy and within 3 months of the last dose of TMZ. Known isocitrate dehydrogenase (IDH) mutant or secondary GBMs were excluded. The primary endpoint was objective response rate (ORR), and the secondary endpoints included progression-free survival (PFS), overall survival (OS), clinical benefit (response or stable disease for at least 6 months), and safety. RESULTS From March 2017 to January 2018, 23 recurrent TMZ-resistant GBM patients were enrolled across seven centers, and 21 patients were evaluable for response. The median duration of DSF/Cu was 1.6 cycles (range: 0.1-12.0). The ORR was 0%, but 14% had clinical benefit. Median PFS was 1.7 months, and median OS was 7.1 months. Only one patient (4%) had dose-limiting toxicity (grade three elevated alanine transaminase). CONCLUSIONS Addition of DSF/Cu to TMZ for TMZ-resistant IDH-wild type GBM appears well tolerated but has limited activity for unselected population.
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Affiliation(s)
- Jiayi Huang
- Washington University School of Medicine, St. Louis, MO, USA.
- Department of Radiation Oncology, Center for Advanced Medicine, Washington University School of Medicine, 4921 Parkview Place, Campus Box #8224, St. Louis, MO, 63110, USA.
| | - Rekha Chaudhary
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam L Cohen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Karen Fink
- Baylor University Medical Center, Dallas, TX, USA
| | | | | | | | - Leping Wan
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jian L Campian
- Washington University School of Medicine, St. Louis, MO, USA
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Puduvalli V, Wu J, Yuan Y, Armstrong T, Wu J, Giglio P, Xu J, Colman H, Walbert T, Raizer J, Groves M, Iwamoto F, Tran D, Avgeropoulos N, Paleologos N, Fink K, Peereboom D, Chamberlain M, Merrell R, Penas-Prado M, Yung WKA, Gilbert M. ACTR-13. A BAYESIAN ADAPTIVE RANDOMIZED PHASE II TRIAL OF BEVACIZUMAB VERSUS BEVACIZUMAB PLUS VORINOSTAT IN ADULTS WITH RECURRENT GLIOBLASTOMA FINAL RESULTS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.047] [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)
- Vinay Puduvalli
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Ying Yuan
- UT MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jimin Wu
- UT MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jihong Xu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Howard Colman
- Department of Neurosurgery, Huntsman Cancer Institute and Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | | | | | - Morris Groves
- Texas Oncology Austin Brain Tumor Center, Austin, TX, USA
| | | | - David Tran
- University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | | | | | - W K Alfred Yung
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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Briggs R, Pan E, Sewell J, Fink K, Smitherman A, Conner A, Walsh C, Sughrue M, Villano J, Battiste J. HOUT-06. PATTERN OF LOW FIELD INTENSITY RECURRENCE IN HIGH-GRADE GLIOMAS FOLLOWING TUMOR TREATMENT FIELD THERAPY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.474] [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)
- Robert Briggs
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Edward Pan
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Adam Smitherman
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrew Conner
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Collin Walsh
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael Sughrue
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - John Villano
- University of Kentucky UK HealthCare, Lexington, KY, KY, USA
| | - James Battiste
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Huang J, Chaudhary R, Cohen A, Fink K, Godlust S, Boockvar J, Chinnaiyan P, Marcus S, Campian J. ACTR-19. A MULTICENTER PILOT PHASE II STUDY OF CONTINUING TMZ WITH THE ADDITION OF DISULFIRAM AND COPPER FOR REFRACTORY GLIOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.053] [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)
- Jiayi Huang
- Washington University in St. Louis, St. Louis, MO, USA
| | - Rehka Chaudhary
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam Cohen
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, Salt Lake City, UT, USA
| | | | - Samuel Godlust
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Prakash Chinnaiyan
- Radiation Oncology, Beaumont Health and Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Peereboom D, Nabors LB, Kumthekar P, Badruddoja M, Fink K, Lieberman F, Phuphanich S, Dunbar E, Walbert T, Schiff D, Tran D, Ashby L, Butowski N, Iwamoto F, Lindsay R, Bullington J, Schulder M, Sherman J, Brooks C, Reardon D. ATIM-06. PHASE 2 TRIAL OF SL-701 + BEVACIZUMAB IN PATIENTS WITH PREVIOUSLY TREATED GLIOBLASTOMA (GBM) MEETS PRIMARY ENDPOINT OF OS-12, WITH PRELIMINARY CORRELATION BETWEEN LONG-TERM SURVIVAL AND TARGET-SPECIFIC CD8+ T CELL IMMUNE RESPONSE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - L Burt Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | - Erin Dunbar
- Piedmont Brain Tumor Center, Atlanta, GA, USA
| | | | - David Schiff
- University of Virginia, Charlottesville, VA, USA
| | - David Tran
- University of Florida, Gainesville, FL, USA
| | - Lynn Ashby
- St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Fabio Iwamoto
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
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Peereboom D, Nabors L, Kumthekar P, Badruddoja M, Fink K, Lieberman F, Phuphanich S, Dunbar E, Walbert T, Schiff D, Tran D, Ashby L, Butowski N, Iwamoto F, Lindsay R, Bullington J, Schulder M, Sherman J, Brooks C, Reardon D. Results of phase II trial of SL-701, a novel immunotherapy targeting IL-13Ra2, EphA2, and survivin, in adults with second-line recurrent glioblastoma (GBM). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy273.361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ribar A, Fink K, Li Z, Ptasińska S, Carmichael I, Feketeová L, Denifl S. Stripping off hydrogens in imidazole triggered by the attachment of a single electron. Phys Chem Chem Phys 2018; 19:6406-6415. [PMID: 28198894 DOI: 10.1039/c6cp08773f] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Imidazole [C3H4N2] is ubiquitous in nature as an important biological building block of amino acids, purine nucleobases or antibiotics. In the present study, dissociative electron attachment to imidazole shows low energy shape resonances at 1.52 and 2.29 eV leading to the most abundant dehydrogenated anion [imidazole - H]- through dehydrogenation at the N1 position. All the other anions formed exhibit core excited resonances observed dominantly at similar electron energies of ∼7 and 11 eV, suggesting an initial formation through two temporary negative ion states. Among these anions, multiple dehydrogenation reactions are observed resulting in the loss of 2 up to 4 hydrogens, thus, leading to a complete dehydrogenation of the imidazole molecule, an interesting prototype of complex unimolecular decay induced by the attachment of a single electron. Additionally, the quantum chemical calculations reveal that these multiple dehydrogenation reactions are responsible for the remarkable one electron-induced gas-phase chemistry leading to the opening of the ring. The formation of the observed anions is likely driven by the high positive electron affinity of cyanocarbon molecules supported by quantum chemical calculations. The formation of H- showed additional resonance at about 5 eV and dipolar dissociation above ∼14 eV.
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Affiliation(s)
- A Ribar
- Institut für Ionenphysik und Angewandte Physik and Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens Universität Innsbruck, Technikerstrasse 25, A-6020, Austria. and Department of Plasma Physics, Comenius University, Mlynská dolina F2, 84248 Bratislava, Slovakia
| | - K Fink
- Institut für Ionenphysik und Angewandte Physik and Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens Universität Innsbruck, Technikerstrasse 25, A-6020, Austria.
| | - Z Li
- Radiation Laboratory, University of Notre Dame, Notre Dame, IN 46556, USA and Department of Physics, University of Notre Dame, Notre Dame, IN 46556, USA
| | - S Ptasińska
- Radiation Laboratory, University of Notre Dame, Notre Dame, IN 46556, USA and Department of Physics, University of Notre Dame, Notre Dame, IN 46556, USA
| | - I Carmichael
- Radiation Laboratory, University of Notre Dame, Notre Dame, IN 46556, USA
| | - L Feketeová
- Institut für Ionenphysik und Angewandte Physik and Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens Universität Innsbruck, Technikerstrasse 25, A-6020, Austria. and Université de Lyon, 69003 Lyon, France and CNRS/IN2P3, UMR5822, Institut de Physique Nucléaire de Lyon, 69622 Villeurbanne, France
| | - S Denifl
- Institut für Ionenphysik und Angewandte Physik and Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens Universität Innsbruck, Technikerstrasse 25, A-6020, Austria.
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Stupp R, Taillibert S, Kanner A, Read W, Steinberg DM, Lhermitte B, Toms S, Idbaih A, Ahluwalia MS, Fink K, Di Meco F, Lieberman F, Zhu JJ, Stragliotto G, Tran DD, Brem S, Hottinger AF, Kirson ED, Lavy-Shahaf G, Weinberg U, Kim CY, Paek SH, Nicholas G, Burna J, Hirte H, Weller M, Palti Y, Hegi ME, Ram Z. Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients With Glioblastoma: A Randomized Clinical Trial. JAMA 2017; 318:2306-2316. [PMID: 29260225 PMCID: PMC5820703 DOI: 10.1001/jama.2017.18718] [Citation(s) in RCA: 1369] [Impact Index Per Article: 195.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Tumor-treating fields (TTFields) is an antimitotic treatment modality that interferes with glioblastoma cell division and organelle assembly by delivering low-intensity alternating electric fields to the tumor. OBJECTIVE To investigate whether TTFields improves progression-free and overall survival of patients with glioblastoma, a fatal disease that commonly recurs at the initial tumor site or in the central nervous system. DESIGN, SETTING, AND PARTICIPANTS In this randomized, open-label trial, 695 patients with glioblastoma whose tumor was resected or biopsied and had completed concomitant radiochemotherapy (median time from diagnosis to randomization, 3.8 months) were enrolled at 83 centers (July 2009-2014) and followed up through December 2016. A preliminary report from this trial was published in 2015; this report describes the final analysis. INTERVENTIONS Patients were randomized 2:1 to TTFields plus maintenance temozolomide chemotherapy (n = 466) or temozolomide alone (n = 229). The TTFields, consisting of low-intensity, 200 kHz frequency, alternating electric fields, was delivered (≥ 18 hours/d) via 4 transducer arrays on the shaved scalp and connected to a portable device. Temozolomide was administered to both groups (150-200 mg/m2) for 5 days per 28-day cycle (6-12 cycles). MAIN OUTCOMES AND MEASURES Progression-free survival (tested at α = .046). The secondary end point was overall survival (tested hierarchically at α = .048). Analyses were performed for the intent-to-treat population. Adverse events were compared by group. RESULTS Of the 695 randomized patients (median age, 56 years; IQR, 48-63; 473 men [68%]), 637 (92%) completed the trial. Median progression-free survival from randomization was 6.7 months in the TTFields-temozolomide group and 4.0 months in the temozolomide-alone group (HR, 0.63; 95% CI, 0.52-0.76; P < .001). Median overall survival was 20.9 months in the TTFields-temozolomide group vs 16.0 months in the temozolomide-alone group (HR, 0.63; 95% CI, 0.53-0.76; P < .001). Systemic adverse event frequency was 48% in the TTFields-temozolomide group and 44% in the temozolomide-alone group. Mild to moderate skin toxicity underneath the transducer arrays occurred in 52% of patients who received TTFields-temozolomide vs no patients who received temozolomide alone. CONCLUSIONS AND RELEVANCE In the final analysis of this randomized clinical trial of patients with glioblastoma who had received standard radiochemotherapy, the addition of TTFields to maintenance temozolomide chemotherapy vs maintenance temozolomide alone, resulted in statistically significant improvement in progression-free survival and overall survival. These results are consistent with the previous interim analysis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00916409.
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Affiliation(s)
- Roger Stupp
- Lou and Jean MalnatiBrain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sophie Taillibert
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | | | - William Read
- University of California, San Diego
- Emory University, Atlanta, Georgia
| | | | - Benoit Lhermitte
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Steven Toms
- Geisinger Health System, Danville, Pennsylvania
| | - Ahmed Idbaih
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | | | - Karen Fink
- Baylor University Medical Center, Houston, Texas
| | | | - Frank Lieberman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jay-Jiguang Zhu
- University of Texas Health Sciences Center at Houston
- Tufts Medical Center, Boston, Massachusetts
| | | | - David D. Tran
- Washington University Barnes-Jewish Hospital, St Louis, Missouri
| | - Steven Brem
- Moffitt Cancer Center, Tampa, Florida
- University of Pennsylvania, Philadelphia
| | - Andreas F. Hottinger
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Chae-Yong Kim
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, Korea
| | | | - Garth Nicholas
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jordi Burna
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Hal Hirte
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Michael Weller
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Monika E. Hegi
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Zvi Ram
- Tel Aviv Medical Center, Tel Aviv, Israel
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Xiu J, Piccioni D, Juarez T, Pingle SC, Hu J, Rudnick J, Fink K, Spetzler DB, Maney T, Ghazalpour A, Bender R, Gatalica Z, Reddy S, Sanai N, Idbaih A, Glantz M, Kesari S. Multi-platform molecular profiling of a large cohort of glioblastomas reveals potential therapeutic strategies. Oncotarget 2017; 7:21556-69. [PMID: 26933808 PMCID: PMC5008305 DOI: 10.18632/oncotarget.7722] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/28/2016] [Indexed: 01/22/2023] Open
Abstract
Glioblastomas (GBM) are the most aggressive and prevalent form of gliomas with abysmal prognosis and limited treatment options. We analyzed clinically relevant molecular aberrations suggestive of response to therapies in 1035 GBM tumors. Our analysis revealed mutations in 39 genes of 48 tested. IHC revealed expression of PD-L1 in 19% and PD-1 in 46%. MGMT-methylation was seen in 43%, EGFRvIII in 19% and 1p19q co-deletion in 2%. TP53 mutation was associated with concurrent mutations, while IDH1 mutation was associated with MGMT-methylation and TP53 mutation and was mutually exclusive of EGFRvIII mutation. Distinct biomarker profiles were seen in GBM compared with WHO grade III astrocytoma, suggesting different biology and potentially different treatment approaches. Analysis of 17 metachronous paired tumors showed frequent biomarker changes, including MGMT-methylation and EGFR aberrations, indicating the need for a re-biopsy for tumor profiling to direct subsequent therapy. MGMT-methylation, PR and TOPO1 appeared as significant prognostic markers in sub-cohorts of GBM defined by age. The current study represents the largest biomarker study on clinical GBM tumors using multiple technologies to detect gene mutation, amplification, protein expression and promoter methylation. These data will inform planning for future personalized biomarker-based clinical trials and identifying effective treatments based on tumor biomarkers.
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Affiliation(s)
| | - David Piccioni
- Neuro-Oncology Program, Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Tiffany Juarez
- Neuro-Oncology Program, Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Sandeep C Pingle
- Neuro-Oncology Program, Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Jethro Hu
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Karen Fink
- Baylor University Medical Center, Dallas, TX, USA
| | | | | | | | | | | | | | - Nader Sanai
- Barrow Neurological Institute, Phoenix, AZ, USA
| | - Ahmed Idbaih
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMRS 975, Institut du Cerveau et de la Moelle, Paris, France.,Inserm U 975, Paris, France.,CNRS, UMR 7225, Paris, France
| | | | - Santosh Kesari
- Neuro-Oncology Program, Moores Cancer Center, UC San Diego, La Jolla, CA, USA.,Translational Neuro-Oncology Laboratories, Department of Neurosciences UC San Diego, La Jolla, CA, USA.,Department of Translational Neuro-Oncology and Neurotherapeutics, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
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29
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Reardon D, Nabors B, Kumthekar P, Badruddoja M, Fink K, Lieberman F, Hu J, Dunbar E, Walbert T, Schiff D, Sherman J, Tran D, Ashby LS, Butowski N, Iwamoto F, Moertel C, Schulder M, Chen J, Bullington J, Shemesh S, Brooks C, Goswami T, Peereboom DM. ATIM-10. PHASE 2 TRIAL OF SL-701, A NOVEL IMMUNOTHERAPY COMPRISED OF SYNTHETIC SHORT PEPTIDES AGAINST GBM TARGETS IL-13Rα2, EphA2, AND SURVIVIN, IN ADULTS WITH SECOND-LINE RECURRENT GBM. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Stupp R, Hegi ME, Idbaih A, Steinberg DM, Lhermitte B, Read W, Toms SA, Barnett GH, Nicholas G, Kim CY, Fink K, Salmaggi A, Lieberman FS, Zhu JJ, Taylor L, Stragliotto G, Hottinger AF, Kirson ED, Weinberg U, Palti Y, Ram Z. Abstract CT007: Tumor treating fields added to standard chemotherapy in newly diagnosed glioblastoma (GBM): Final results of a randomized, multi-center, phase III trial. Clin Trials 2017. [DOI: 10.1158/1538-7445.am2017-ct007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Bomfim IL, Lamb F, Fink K, Szakács A, Silveira A, Franzén L, Azhary V, Maeurer M, Feltelius N, Darin N, Hallböök T, Arnheim-Dahlström L, Kockum I, Olsson T. The immunogenetics of narcolepsy associated with A(H1N1)pdm09 vaccination (Pandemrix) supports a potent gene-environment interaction. Genes Immun 2017; 18:75-81. [PMID: 28332559 DOI: 10.1038/gene.2017.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 12/23/2022]
Abstract
The influenza A(H1N1)pdm09 vaccination campaign from 2009 to 2010 was associated with a sudden increase in the incidence of narcolepsy in several countries. Narcolepsy with cataplexy is strongly associated with the human leukocyte antigen (HLA) class II DQB1*06:02 allele, and protective associations with the DQB1*06:03 allele have been reported. Several non-HLA gene loci are also associated, such as common variants of the T-cell receptor-α (TRA), the purinergic receptor P2RY11, cathepsin H (CTSH) and TNFSF4/OX40L/CD252. In this retrospective multicenter study, we investigated if these predisposing gene loci were also involved in vaccination-associated narcolepsy. We compared HLA- along with single-nucleotide polymorphism genotypes for non-HLA regions between 42 Pandemrix-vaccinated narcolepsy cases and 1990 population-based controls. The class II gene loci associations supported previous findings. Nominal association (P-value<0.05) with TRA as well as suggestive (P-value<0.1) associations with P2RY11 and CTSH were found. These associations suggest a very strong gene-environment interaction, in which the influenza A(H1N1)pdm09 strain or Pandemrix vaccine can act as potent environmental triggers.
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Affiliation(s)
- I L Bomfim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - F Lamb
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - A Szakács
- Department of Pediatrics, Halmstad County Hospital, Halmstad, Sweden
| | - A Silveira
- Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden.,Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - L Franzén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - V Azhary
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - M Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Stockholm, Sweden.,Center for Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | | | - N Darin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - I Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - T Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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32
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Plamper M, Gohlke B, Woelfle J, Konrad K, Rohrer T, Hofer S, Bonfig W, Fink K, Holl RW. Interaction of Pubertal Development and Metabolic Control in Adolescents with Type 1 Diabetes Mellitus. J Diabetes Res 2017; 2017:8615769. [PMID: 29238730 PMCID: PMC5697126 DOI: 10.1155/2017/8615769] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/07/2017] [Accepted: 09/27/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In T1DM, delayed pubertal development and reduced final height are associated with inadequate metabolic control. OBJECTIVE To assess whether T1DM affects pubertal growth spurt and whether metabolic control during puberty is gender-related. METHODS Using a large multicentre database, longitudinal data from 1294 patients were analysed. Inclusion criteria: complete records of height and HbA1c from the age of seven to 16 years. Exclusion criteria: other significant chronic diseases and medications, T1DM duration less than three months, and initial BMI < 3rd or >97th percentile. RESULTS Growth velocity (GV) was impaired with a significant reduction of peak GV by 1.2 cm in boys. HbA1c increase during male puberty was lower except for a period of 1.5 years. The highest HbA1c increase in boys coincided with maximum growth spurt. In girls, the highest HbA1c increase was observed during late puberty. Even though there is impaired GV, both sexes reach a height at 16 years of age which corresponds to the background population height. CONCLUSION Worsening of metabolic control is sex-discordant and associated with gender-specific alterations of GV. However, the vast majority of boys and girls with T1DM seems to reach normal height at the age of 16 years.
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Affiliation(s)
- M. Plamper
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - B. Gohlke
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - J. Woelfle
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - K. Konrad
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
- Department of Pediatric and Adolescent Medicine, Elisabeth Hospital Essen, Essen, Germany
| | - T. Rohrer
- Department of Pediatrics, University of Saarland, Homburg, Germany
| | - S. Hofer
- Department of Pediatrics, University of Innsbruck, Innsbruck, Austria
| | - W. Bonfig
- Department of Pediatrics, Technical University Munich, Munich, Germany
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - K. Fink
- Institute for Epidemiology and Medical Biometry, ZIBMT University of Ulm and German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - R. W. Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT University of Ulm and German Center for Diabetes Research (DZD), Neuherberg, München, Germany
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33
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Stupp R, Idbaih A, Steinberg DM, Read W, Toms S, Barnett G, Nicholas G, Kim CY, Fink K, Salmaggi A, Lieberman F, Zhu J, Taylor L, Stragliotto G, Hottinger A, Kirson ED, Weinberg U, Palti Y, Hegi ME, Ram Z. LTBK-01: PROSPECTIVE, MULTI-CENTER PHASE III TRIAL OF TUMOR TREATING FIELDS TOGETHER WITH TEMOZOLOMIDE COMPARED TO TEMOZOLOMIDE ALONE IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now260] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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)
- Roger Stupp
- University Hospital Zurich and University of Zurich, Zurich, Switzerland,
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,
| | - Ahmed Idbaih
- Groupe Hospitalier Pitié-Salpêtrière, Paris, France,
| | | | - William Read
- Emory University Hospital Midtown, Atlanta, GA, USA,
| | - Steven Toms
- Geisinger Medical Center, Danville, PA, USA,
| | - Gene Barnett
- Cleveland Clinic Foundation, Cleveland, OH, USA,
| | - Garth Nicholas
- Ottawa Hospital Research Institute, Ottawa, ON, Canada – on behalf of the Canadian Brain Tumour Consortium (CBTC),
| | - Chae-Yong Kim
- Seoul National University Bundang, Seoul, South Korea,
| | - Karen Fink
- Baylor Charles A. Sammons Cancer Center, Dallas, TX, USA,
| | | | - Frank Lieberman
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA,
| | - Jay Zhu
- Memorial Hermann Hospital, Houston, TX, USA,
| | | | | | - Andreas Hottinger
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,
| | | | | | | | - Monika E. Hegi
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,
| | - Zvi Ram
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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34
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Reardon D, Peereboom D, Nabors B, Fink K, Phuphanich S, Mikkelsen T, Dunbar E, Badruddoja M, Schiff D, Lieberman F, Tran D, Schulder M, Butowski N, Ashby L, Moertel C, Iwamoto F, Sherman J, Chen J, McDonald P, Poradosu E, Brooks C, Shemesh S, Raizer J. ATIM-11. PHASE 2 TRIAL OF SL-701, A NOVEL IMMUNOTHERAPY COMPRISED OF SYNTHETIC SHORT PEPTIDES AGAINST GBM TARGETS IL-13Rα2, EphA2, AND SURVIVIN, IN ADULTS WITH SECOND-LINE RECURRENT GBM: INTERIM RESULTS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Charntikov S, Falco AM, Fink K, Dwoskin LP, Bevins RA. The effect of sazetidine-A and other nicotinic ligands on nicotine controlled goal-tracking in female and male rats. Neuropharmacology 2016; 113:354-366. [PMID: 27765626 DOI: 10.1016/j.neuropharm.2016.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
Nicotine is the primary addictive component of tobacco products and its complex stimulus effects are readily discriminated by human and non-human animals. Previous research with rodents directly investigating the nature of the nicotine stimulus has been limited to males. The current study began to address this significant gap in the literature by training female and male rats to discriminate 0.4 mg/kg nicotine from saline in the discriminated goal-tracking task. In this task, access to sucrose was intermittently available on nicotine session. On interspersed saline session, sucrose was not available. Both sexes acquired the discrimination as evidenced by increased head entries into sucrose receptacle (goal-tracking) evoked by nicotine; the nicotine generalization curves were also similar between females and males. The pharmacological profile of the nicotine stimulus was assessed using substitution and targeted combination tests with the following ligands: sazetidine-A, PHA-543613, PNU-120596, bupropion, nornicotine, and cytisine. For females and males, nornicotine fully substituted for the nicotine stimulus, whereas sazetidine-A, bupropion, and cytisine all evoked partial substitution. Female and male rats responded in a similar manner to interaction tests where a combination of 1 mg/kg of sazetidine-A plus nicotine or nornicotine shifted the nicotine dose-effect curve to the left. The combination of sazetidine-A plus bupropion or cytisine failed to do so. These findings begin to fill a significant gap the in scientific literature by studying the nature of the nicotine stimulus and response to therapeutically interesting combinations using a model that includes both sexes.
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Affiliation(s)
- S Charntikov
- Department of Psychology, University of New Hampshire, 15 Academic Way, Durham, NH 03824, USA
| | - A M Falco
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| | - K Fink
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| | - L P Dwoskin
- Department of Pharmaceutical Sciences, University of Kentucky, 465 College of Pharmacy, 789 S. Limestone Street, Lexington, KY 40536-0596, USA
| | - R A Bevins
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA.
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36
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Bohn B, Rosenbauer J, Icks A, Vogel C, Beyer P, Rütschle H, Hermann U, Holterhus P, Wagner V, von Sengbusch S, Fink K, Holl R. Regional Disparities in Diabetes Care for Pediatric Patients with Type 1 Diabetes. A Cross-sectional DPV Multicenter Analysis of 24 928 German Children and Adolescents. Exp Clin Endocrinol Diabetes 2016; 124:111-9. [DOI: 10.1055/s-0042-101159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- B. Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - J. Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany
| | - A. Icks
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany
| | - C. Vogel
- Children’s Hospital Chemnitz, Chemnitz, Germany
| | - P. Beyer
- Clinic for Pediatrics, Protestant Hospital, Oberhausen, Germany
| | - H. Rütschle
- Pediatric Diabetes Practice, Mutterstadt, Germany
| | - U. Hermann
- Pediatric Diabetes Practice, Reutlingen, Germany
| | - P. Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, Kiel, Germany
| | - V. Wagner
- Pediatric Practice, Rostock, Germany
| | - S. von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, University of Lübeck, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - K. Fink
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - R. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
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Charntikov S, Swalve N, Pittenger S, Fink K, Schepers S, Hadlock G, Fleckenstein A, Hu G, Li M, Bevins R. Corrigendum to “Iptakalim attenuates self-administration and acquired goal-tracking behavior controlled by nicotine” [Neuropharmacology 75 (2013) 138–144]. Neuropharmacology 2016. [DOI: 10.1016/j.neuropharm.2015.03.025] [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: 10/23/2022]
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38
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Wen P, Reardon D, Phuphanich S, Aiken R, Landolfi J, Curry W, Zhu JJ, Glantz M, Peereboom D, Markert J, Larocca R, O'Rourke D, Fink K, Kim L, Gruber M, Lesser G, Pan E, Santos R, Pinilla C, Yu J. IMCT-20ASSOCIATION OF SURVIVAL AND PROGRESSION-FREE SURVIVAL WITH IMMUNE RESPONSE IN HLA-A2+ NEWLY-DIAGNOSED GBM PATIENTS IN RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED PHASE 2 TRIAL OF DENDRITIC CELL (DC) IMMUNOTHERAPY WITH ICT-107. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov218.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Schmid B, Fritz H, Fink K, Eichwede F, Storm C, Elste T, Rössler M, Koberne F, Busch HJ. Präklinische transnasale Kühlung während der Reanimation in Deutschland. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0043-7] [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: 10/23/2022]
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40
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Wu J, Puduvalli VK, Yuan Y, Armstrong T, Walker B, Upshaw C, Giglio P, Colman H, Groves MD, Raizer J, Walbert T, Tran D, Avgeropoulos N, Iwamoto F, Peereboom D, Chamberlain M, Merrell R, Paleologos N, Fink K, Gilbert MR. ATCT-34BAYESIAN ADAPTIVE RANDOMIZED PHASE II TRIAL OF BEVACIZUMAB PLUS VORINOSTAT VERSUS BEVACIZUMAB ALONE IN ADULTS WITH RECURRENT GLIOBLASTOMA. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov206.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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41
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Ambati A, Poiret T, Svahn BM, Valentini D, Khademi M, Kockum I, Lima I, Arnheim-Dahlström L, Lamb F, Fink K, Meng Q, Kumar A, Rane L, Olsson T, Maeurer M. Increased β-haemolytic group A streptococcal M6 serotype and streptodornase B-specific cellular immune responses in Swedish narcolepsy cases. J Intern Med 2015; 278:264-76. [PMID: 25683265 DOI: 10.1111/joim.12355] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Type 1 narcolepsy is a neurological disorder characterized by excessive daytime sleepiness and cataplexy associated with the HLA allele DQB1*06:02. Genetic predisposition along with external triggering factors may drive autoimmune responses, ultimately leading to the selective loss of hypocretin-positive neurons. OBJECTIVE The aim of this study was to investigate potential aetiological factors in Swedish cases of postvaccination (Pandemrix) narcolepsy defined by interferon-gamma (IFNγ) production from immune cells in response to molecularly defined targets. METHODS Cellular reactivity defined by IFNγ production was examined in blood from 38 (HLA-DQB1*06:02(+) ) Pandemrix-vaccinated narcolepsy cases and 76 (23 HLA-DQB1*06:02(+) and 53 HLA-DQB1*06:02(-) ) control subjects, matched for age, sex and exposure, using a variety of different antigens: β-haemolytic group A streptococcal (GAS) antigens (M5, M6 and streptodornase B), influenza (the pandemic A/H1N1/California/7/09 NYMC X-179A and A/H1N1/California/7/09 NYMC X-181 vaccine antigens, previous Flu-A and -B vaccine targets, A/H1N1/Brisbane/59/2007, A/H1N1/Solomon Islands/3/2006, A/H3N2/Uruguay/716/2007, A/H3N2/Wisconsin/67/2005, A/H5N1/Vietnam/1203/2004 and B/Malaysia/2506/2004), noninfluenza viral targets (CMVpp65, EBNA-1 and EBNA-3) and auto-antigens (hypocretin peptide, Tribbles homolog 2 peptide cocktail and extract from rat hypothalamus tissue). RESULTS IFN-γ production was significantly increased in whole blood from narcolepsy cases in response to streptococcus serotype M6 (P = 0.0065) and streptodornase B protein (P = 0.0050). T-cell recognition of M6 and streptodornase B was confirmed at the single-cell level by intracellular cytokine (IL-2, IFNγ, tumour necrosis factor-alpha and IL-17) production after stimulation with synthetic M6 or streptodornase B peptides. Significantly, higher (P = 0.02) titres of serum antistreptolysin O were observed in narcolepsy cases, compared to vaccinated controls. CONCLUSION β-haemolytic GAS may be involved in triggering autoimmune responses in patients who developed narcolepsy symptoms after vaccination with Pandemrix in Sweden, characterized by a Streptococcus pyogenes M-type-specific IFN-γ cellular immune response.
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Affiliation(s)
- A Ambati
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allogeneic Stem Cell Transplantation Karolinska University Hospital, Stockholm, Sweden
| | - T Poiret
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - B-M Svahn
- Centre for Allogeneic Stem Cell Transplantation Karolinska University Hospital, Stockholm, Sweden
| | - D Valentini
- Centre for Allogeneic Stem Cell Transplantation Karolinska University Hospital, Stockholm, Sweden
| | - M Khademi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - I Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - I Lima
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - L Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - F Lamb
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Q Meng
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Kumar
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - L Rane
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Maeurer
- Centre for Allogeneic Stem Cell Transplantation Karolinska University Hospital, Stockholm, Sweden.,Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Weisser-Thomas J, Kempelmann H, Nickenig G, Grohe C, Djoufack P, Fink K, Meyer R. Influence of gelsolin deficiency on excitation contraction coupling in adult murine cardiomyocytes. J Physiol Pharmacol 2015; 66:373-383. [PMID: 26084219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 03/05/2015] [Indexed: 06/04/2023]
Abstract
Ion channels involved in cardiac excitation-contraction coupling are linked to the cytoskeleton. Therefore changes in the cytoskeletal actin filaments may influence cardiac membrane currents and electro-mechanical coupling. Depolymerization of actin filaments by gelsolin (gsn) is involved in the organisation of the cytoskeleton by leading to a lower polymerization state. Gsn is activated by Ca(2+) and inhibited by phosphoinositol-bisphosphate (PIP2). Furthermore, gsn has been linked to pathological conditions with reduced contractility like heart failure, amyloidosis and apoptosis. Thus, we hypothesize, that gsn deficiency may change electromechanical properties of freshly isolated ventricular cardiomyocytes. We recorded L-type Ca(2+) current (ICa,L) in whole-cell patch clamp mode in freshly isolated ventricular cardiomyocytes from gsn deficient ((-/-)) and control (gsn(+/+)) mice. Sarcomere shortening was monitored in field-stimulated myocytes from 0.5 Hz to 10 Hz by video microscopy. Shortening-frequency relation, post-rest potentiation and β-adrenergic stimulation were investigated. ICa,L was increased in gsn(-/-) vs. gsn(+/+) myocytes. Sarcomere shortening amplitude and velocity were enhanced in gsn(-/-) vs. gsn(+/+) at all frequencies. Shortening-frequency relationship showed a biphasic pattern with decay in shortening amplitude between 0.5 and 2 Hz and an increase at higher frequencies in both genotypes. Post-rest characteristics revealed a frequency-dependent decay of post-rest potentiation in gsn(+/+) while it remained stable in gsn(-/-). In gsn(-/-) a reduced response to β-adrenergic stimulation was observed. Resting sarcomere length was shorter in gsn(-/-) but neither increasing frequency nor β-adrenergic stimulation induced further decay in any of the genotypes. In summary, gsn deficiency had a profound effect on excitiation-contraction properties and improved systolic function while not affecting diastolic function in unloaded isolated cardiomyocytes. Therefore, gsn mediated effects on contractility may play a role in patients with heart failure and cancer, where gsn levels are known to be elevated.
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Affiliation(s)
- J Weisser-Thomas
- Medizinische Klinik und Poliklinik II, Universitaetsklinikum Bonn, Bonn, Germany.
| | - H Kempelmann
- Institut fur Physiologie II, Universitaetsklinikum Bonn, Bonn, Germany
| | - G Nickenig
- Medizinische Klinik und Poliklinik II, Universitaetsklinikum Bonn, Bonn, Germany
| | - C Grohe
- Evangelische Lungenklinik Berlin, Berlin, Germany
| | - P Djoufack
- Institut fur Pharmakologie und Toxikologie, Universitaetsklinikum Bonn, Bonn, Germany
| | - K Fink
- Medizinische Klinik und Poliklinik II, Universitaetsklinikum Bonn, Bonn, Germany
| | - R Meyer
- Institut fur Physiologie II, Universitaetsklinikum Bonn, Bonn, Germany
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Wen P, Reardon D, Phuphanich S, Aiken R, Landolfi J, Curry W, Zhu JJ, Glantz M, Peereboom D, Markert J, Larocca R, O'Rourke D, Fink K, Kim L, Gruber M, Lesser G, Pan E, Kesari S, Yu J. AT-60 * A RANDOMIZED DOUBLE BLIND PLACEBO-CONTROLLED PHASE 2 TRIAL OF DENDRITIC CELL (DC) VACCINE ICT-107 FOLLOWING STANDARD TREATMENT IN NEWLY DIAGNOSED PATIENTS WITH GBM. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reardon D, Schuster J, Tran D, Fink K, Nabors L, Li G, Lukas R, Desjardins A, Ashby L, Duic JP, Aneiro L, Hawthorne T, Green J, Yellin M, Davis T, Sampson J. IT-30 * ReACT: A PHASE II STUDY OF RINDOPEPIMUT VACCINE (CDX-110) PLUS BEVACIZUMAB IN RELAPSED GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou258.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cairncross G, Wang M, Jenkins R, Shaw E, Giannini C, Brachman D, Buckner J, Fink K, Souhami L, Laperriere N, Huse JT, Mehta M. BENEFICIAL OUTCOMES AFTER PCV PLUS RT IN OLIGODENDROGLIAL TUMORS ARE ASSOCIATED WITH DETECTION OR RISK OF AN IDH MUTATION. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou209.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schloot N, Haupt A, Schütt M, Nicolay C, Reaney M, Fink K, Holl RW. Severe hypoglycaemia under therapy with sulfonylurea in patients with type 2 diabetes (T2D) in Germany/Austria: Event rate and identification of patients at risk. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374998] [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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Hatanpaa KJ, Hu T, Vemireddy V, Foong C, Raisanen JM, Oliver D, Hiemenz MC, Burns DK, White CL, Whitworth LA, Mickey B, Stegner M, Habib AA, Fink K, Maher EA, Bachoo RM. High expression of the stem cell marker nestin is an adverse prognostic factor in WHO grade II-III astrocytomas and oligoastrocytomas. J Neurooncol 2014; 117:183-189. [PMID: 24519516 DOI: 10.1007/s11060-014-1376-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/19/2014] [Indexed: 12/17/2022]
Abstract
Infiltrating astrocytomas and oligoastrocytomas of low to anaplastic grade (WHO grades II and III), in spite of being associated with a wide range of clinical outcomes, can be difficult to subclassify and grade by the current histopathologic criteria. Unlike oligodendrogliomas and anaplastic oligodendrogliomas that can be identified by the 1p/19q codeletion and the more malignant glioblastomas (WHO grade IV astrocytomas) that can be diagnosed solely based on objective features on routine hematoxylin and eosin sections, no such objective criteria exist for the subclassification of grade II-III astrocytomas and oligoastrocytomas (A+OA II-III). In this study, we evaluated the prognostic and predictive value of the stem cell marker nestin in adult A+OA II-III (n = 50) using immunohistochemistry and computer-assisted analysis on tissue microarrays. In addition, the correlation between nestin mRNA level and total survival was analyzed in the NCI Rembrandt database. The results showed that high nestin expression is a strong adverse prognostic factor for total survival (p = 0.0004). The strength of the correlation was comparable to but independent of the isocitrate dehydrogenase 1/2 (IDH 1/2) mutation status. Histopathological grading and subclassification did not correlate significantly with outcome, although the interpretation of this finding is limited by the fact that grade III tumors were treated more aggressively than grade II tumors. These results suggest that nestin level and IDH 1/2 mutation status are strong prognostic features in A+OA II-III and possibly more helpful for treatment planning than routine histopathological variables such as oligodendroglial component (astrocytoma vs. oligoastrocytoma) and WHO grade (grade II vs. III).
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Affiliation(s)
- Kimmo J Hatanpaa
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Tianshen Hu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vamsidhara Vemireddy
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Chan Foong
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jack M Raisanen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dwight Oliver
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew C Hiemenz
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dennis K Burns
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - L Anthony Whitworth
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Bruce Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Martha Stegner
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Amyn A Habib
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX.,VA North Texas Health Care System, Dallas, TX
| | - Karen Fink
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Elizabeth A Maher
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Robert M Bachoo
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Charntikov S, Swalve N, Pittenger S, Fink K, Schepers S, Hadlock GC, Fleckenstein AE, Hu G, Li M, Bevins RA. Iptakalim attenuates self-administration and acquired goal-tracking behavior controlled by nicotine. Neuropharmacology 2013; 75:138-44. [PMID: 23916479 PMCID: PMC3864985 DOI: 10.1016/j.neuropharm.2013.07.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/05/2013] [Accepted: 07/10/2013] [Indexed: 12/22/2022]
Abstract
Iptakalim is an ATP-sensitive potassium channel opener, as well as an α4β2-containing nicotinic acetylcholine receptor (nAChR) antagonist. Pretreatment with iptakalim diminishes nicotine-induced dopamine (DA) and glutamate release in the nucleus accumbens. This neuropharmacological profile suggests that iptakalim may be useful for treatment of nicotine dependence. Thus, we examined the effects of iptakalim in two preclinical models. First, the impact of iptakalim on the interoceptive stimulus effect of nicotine was evaluated by training rats in a discriminated goal-tracking task that included intermixed nicotine (0.4 mg/kg, SC) and saline sessions. Sucrose was intermittently presented in a response-independent manner only on nicotine sessions. On intervening test days, rats were pretreated with iptakalim (10, 30, 60 mg/kg, IP). Results revealed that iptakalim attenuated nicotine-evoked responding controlled by the nicotine stimulus in a dose-dependent manner. In a separate study, the impact of iptakalim on the reinforcing effects of nicotine was investigated by training rats to lever-press to self-administer nicotine (0.01 mg/kg/infusion) [Dosage error corrected]. Results revealed that pretreatment with iptakalim (1, 3, 6 mg/kg, IV) decreased nicotine intake (i.e., less active lever responding). Neither behavioral effect was due to a non-specific motor effect of iptakalim, nor to an ability of iptakalim to inhibit DA transporter (DAT) or serotonin transporter (SERT) function. Together, these finding support the notion that iptakalim may be an effective pharmacotherapy for increasing smoking cessation and a better understanding of its action could contribute to medication development.
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Affiliation(s)
- S Charntikov
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| | - N Swalve
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| | - S Pittenger
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| | - K Fink
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| | - S Schepers
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| | - G C Hadlock
- Department of Pharmacology and Toxicology, University of Utah, 30 South 2000 East, Room 201, Salt Lake City, UT 84112, USA
| | - A E Fleckenstein
- Department of Pharmacology and Toxicology, University of Utah, 30 South 2000 East, Room 201, Salt Lake City, UT 84112, USA
| | - G Hu
- Jiangsu Province Key Lab of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, PR China
| | - M Li
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| | - R A Bevins
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA.
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Campian J, Gladstone D, Ambady P, Ye X, King K, Borrello I, Petrik S, Golightly M, Holdhoff M, Grossman S, Bhardwaj R, Chakravadhanula M, Ozols V, Georges J, Carlson E, Hampton C, Decker W, Chiba Y, Hashimoto N, Kagawa N, Hirayama R, Tsuboi A, Oji Y, Oka Y, Sugiyama H, Yoshimine T, Choi B, Gedeon P, Herndon J, Sanchez-Perez L, Mitchell D, Bigner D, Sampson J, Choi YA, Pandya H, Gibo DM, Debinski W, Cloughesy TF, Liau LM, Chiocca EA, Jolly DJ, Robbins JM, Ostertag D, Ibanez CE, Gruber HE, Kasahara N, Vogelbaum MA, Kesari S, Mikkelsen T, Kalkanis S, Landolfi J, Bloomfield S, Foltz G, Pertschuk D, Everson R, Jin R, Safaee M, Lisiero D, Odesa S, Liau L, Prins R, Gholamin S, Mitra SS, Richard CE, Achrol A, Kahn SA, Volkmer AK, Volkmer JP, Willingham S, Kong D, Shin JJ, Monje-Deisseroth M, Cho YJ, Weissman I, Cheshier SH, Kanemura Y, Sumida M, Yoshioka E, Yamamoto A, Kanematsu D, Takada A, Nonaka M, Nakajima S, Goto S, Kamigaki T, Takahara M, Maekawa R, Shofuda T, Moriuchi S, Yamasaki M, Kebudi R, Cakir FB, Gorgun O, Agaoglu FY, Darendeliler E, Lin Y, Wang Y, Qiu X, Jiang T, Lin Y, Wang Y, Jiang T, Zhang G, Wang J, Okada H, Butterfield L, Hamilton R, Drappatz J, Engh J, Amankulor N, Lively M, Chan M, Salazar A, Potter D, Shaw E, Lieberman F, Pandya H, Choi Y, Park J, Phuphanich S, Wheeler C, Rudnick J, Hu J, Mazer M, Wang H, Nuno M, Guevarra A, Sanchez C, Fan X, Ji J, Chu R, Bender J, Hawkins E, Black K, Yu J, Reap E, Archer G, Sanchez-Perez L, Norberg P, Schmittling R, Nair S, Cui X, Snyder D, Chandramohan V, Choi B, Kuan CT, Mitchell D, Bigner D, Yan H, Sampson J, Reardon D, Li G, Recht L, Fink K, Nabors L, Tran D, Desjardins A, Chandramouli N, Duic JP, Groves M, Clarke A, Hawthorne T, Green J, Yellin M, Sampson J, Rigakos G, Spyri O, Nomikos P, Stavridi F, Grossi I, Theodorakopoulou I, Assi A, Kouvatseas G, Papadopoulou E, Nasioulas G, Labropoulos S, Razis E, Rudnick J, Ravi A, Sanchez C, Tang DN, Hu J, Yu J, Sharma P, Black K, Sengupta S, Sampath P, Soto H, Erickson K, Malone C, Hickey M, Ha E, Young E, Ellingson B, Prins R, Liau L, Kruse C, Sul J, Hilf N, Kutscher S, Schoor O, Lindner J, Reinhardt C, Kreisl T, Iwamoto F, Fine H, Singh-Jasuja H, Teijeira L, Gil-Arnaiz I, Hernandez-Marin B, Martinez-Aguillo M, Sanchez SDLC, Viudez A, Hernandez-Garcia I, Lecumberri MJ, Grandez R, de Lascoiti AF, Garcia RV, Thomas A, Fisher J, Baron U, Olek S, Rhodes H, Gui J, Hampton T, Tafe L, Tsongalis G, Lefferts J, Wishart H, Kleen J, Miller M, Ernstoff M, Fadul C, Vlahovic G, Desjardins A, Peters K, Ranjan T, Herndon J, Friedman A, Friedman H, Bigner D, Archer G, Lally-Goss D, Sampson J, Wainwright D, Dey M, Chang A, Cheng Y, Han Y, Lesniak M, Weller M, Kaulich K, Hentschel B, Felsberg J, Gramatzki D, Pietsch T, Simon M, Westphal M, Schackert G, Tonn JC, Loeffler M, Reifenberger G, Yu J, Rudnick J, Hu J, Phuphanich S, Mazer M, Wang H, Xu M, Nuno M, Patil C, Chu R, Black K, Wheeler C. IMMUNOTHERAPY/BIOLOGICAL THERAPIES. Neuro Oncol 2013; 15:iii68-iii74. [PMCID: PMC3823893 DOI: 10.1093/neuonc/not178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
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Giller CA, Berger BD, Fink K, Bastian E. A volumetric study of CyberKnife hypofractionated stereotactic radiotherapy as salvage for progressive malignant brain tumors: initial experience. Neurol Res 2013; 29:563-8. [PMID: 17535568 DOI: 10.1179/016164107x166245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Radiosurgery is frequently offered to patients with progressive malignant brain tumors if radiation therapy or chemotherapy fails to provide local control. The use of single-shot regimens, however, is limited by the risk of complications when the tumor is large, surrounded by edema or has been pre-treated with radiation. Hypofractionation may confer safety but has not been tested for these difficult tumors. We report the results of hypofractionation as an alternative option in a small cohort of progressive malignant brain tumors. METHODS Hypofractionated CyberKnife radiotherapy was chosen for 18 progressive malignant brain tumors (six high-grade gliomas and 12 metastatic lesions) in 15 patients because of size, previous treatment with radiation or surrounding edema. The mean dose was 21 +/- 4 Gy and the number of fractions was 5 +/- 0.6. The volume of each tumor at treatment was compared with the volume at follow-up. RESULTS Thirteen of the 18 tumors (72%) showed a volume decrease. The average volume change was a decrease of 16 +/- 58% (median: 20%) with a follow-up of 180 +/- 121 days (median: 172 days). Toxicity occurred in only one patient, with symptoms improving on steroids. DISCUSSION Progression of malignant brain tumors not ideal for single-shot radiosurgery can be arrested or reversed, at least for short periods, with minimal toxicity using hypofractionated radiotherapy. Longer studies will be needed to assess durability of this response in these difficult tumors.
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Affiliation(s)
- Cole A Giller
- Baylor Radiosurgery Center, Baylor University Medical Center, Dallas, TX 75246, USA.
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