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Lopez J, Häfliger S, Plummer R, Clement P, Läubli H, Roth P, Evans T, Brazil L, Tabatabai G, Wick A, Wing Y, Wunderlich B, Beebe K, Eisner J, Engelhardt M, Kaindl T, Lane H, Hau P, Hundsberger T, Steinbach J. 83P Evaluation of response-predictive biomarkers for lisavanbulin: A phase II study in patients with recurrent glioblastoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100941] [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: 04/05/2023] Open
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2
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Nagy T, Ann Gormley M, Moschella P, Lu Z, Rodriguez J, Roth P. 71 HIV Pre-exposure Prophylaxis in the Emergency Department: A Systematic Review. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.094] [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: 11/26/2022]
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3
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Villars D, Hänsch L, Silginer M, Weiss T, Weller M, Roth P. OS08.8.A Integrin-specific CAR T cells for the treatment of glioblastoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.062] [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
Current standard of care for glioblastoma patients has limited therapeutic efficacy and novel innovative treatment strategies are urgently needed. One such strategy is chimeric antigen receptor (CAR) T cell therapy that has shown great success in hematological malignancies. αv integrins are overexpressed in several neoplasms and have already been used as therapeutic targets for small molecule inhibitors and antibodies, which did not cause major toxicities. Herein, we propose αv integrins as an ideal target for CAR T cell therapy in glioblastoma.
Material and Methods
CAR T cells targeting specific heterodimers (αvβ3, αvβ5 or αvβ8) were generated by transducing primary human T cells from healthy donors with a lentiviral vector expressing a second-generation CAR. Activity and specificity of CAR T cells was determined by co-culture assays with different glioma cells. Efficacy of CAR T cells to control tumor growth in vivo was investigated in clinically relevant orthotopic xenograft glioma mouse models. Additionally, we generated CAR T cells from T cells from a glioblastoma patient and measured their activity against the patient’s autologous tumor cells.
Results
All newly generated integrin-targeting CAR T cells exerted strong anti-glioma activity in vitro. Long-term and repetitive killing assays as well as cytokine-release measurements demonstrated highest activity of αvβ5 and αvβ8 integrin-specific CAR T cells. Antigen specificity of these cells was confirmed, as glioma cells with a CRISPR/Cas9-mediated knockout of the target antigen were resistant to CAR T cell-mediated cytotoxicity. Intratumoral injection of αvβ5 or αvβ8 CAR T cells significantly prolonged the survival and cured a substantial fraction of glioma-bearing mice in two different xenograft models. When used in a patient-derived setting, matched CAR T cells exerted strong anti-glioma activity.
Conclusion
We show strong and integrin-specific anti-glioma activity of CAR T cells developed from healthy donor T cells and glioblastoma-patient-derived T cells in vitro. αvβ5- and αvβ8-specific CAR T cells exerted the best therapeutic activity in two different xenograft glioma models in vivo. These data support the evaluation of integrin-specific CAR T cells as a therapeutic strategy in clinical neuro-oncology.
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Affiliation(s)
- D Villars
- Department of Neurology, University Hospital Zurich , Zürich , Switzerland
| | - L Hänsch
- Department of Neurology, University Hospital Zurich , Zürich , Switzerland
| | - M Silginer
- Department of Neurology, University Hospital Zurich , Zürich , Switzerland
| | - T Weiss
- Department of Neurology, University Hospital Zurich , Zürich , Switzerland
| | - M Weller
- Department of Neurology, University Hospital Zurich , Zürich , Switzerland
| | - P Roth
- Department of Neurology, University Hospital Zurich , Zürich , Switzerland
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4
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Look T, Puca E, Stucchi R, Luca R, Roth P, Neri D, Weller M, Hemmerle T, Weiss T. OS08.7.A Lomustine and the immunocytokine L19TNF are a promising treatment combination for recurrent glioblastoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.061] [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
Treatment options for recurrent glioblastoma are limited and with the possible exception of regorafenib, no agent has demonstrated superior activity to lomustine. Therefore, there is an urgent need for more effective treatment strategies for recurrent glioblastoma. Here, we investigated different treatment combinations based on the tumor-stroma targeting antibody-cytokine fusion protein L19TNF in preclinical glioma models and translated the most effective treatment combination to patients with recurrent glioblastoma.
Material and Methods
Orthotopic immunocompetent mouse glioma models were used to study the anti-glioma activity of L19TNF in combination with anti-PD1, bevacizumab or lomustine. Tumor growth was monitored by MRI. Flow cytometry and microscopy were used to characterize tumor-infiltrating-immune cells. MHC immunoaffinity purification and mass spectrometry were used to characterize the MHC immunopeptidome. Genetic mouse models were used to study immune-dependent effects. Subsequently, we translated the most efficient treatment combination to patients with recurrent glioblastoma within a phase I/II clinical trial (NCT04573192).
Results
The combination of L19TNF and lomustine demonstrated strong synergistic anti-tumor activity in two immunocompetent orthotopic glioma models and cured a majority of tumor-bearing mice. In contrast, combinations with anti-PD-1 or bevacizumab had only limited anti-glioma activity. Furthermore, compared to the monotherapies, the combination of L19TNF and lomustine led to the strongest increase in tumor-infiltrating lymphoid cells as demonstrated by flow cytometry and microsopy and to the highest number of peptides presented in the context of MHC-I. The treatment effect was abrograted in different genetic immunodeficient mouse models. The treatment combination of L19TNF and lomustine was well tolerated in the first patients treated within a phase I/II clinical trial and we observed partial tumor responses also in patients with an unmethylated MGMT promoter.
Conclusion
The combination of L19TNF and lomustine demonstrated promising anti-glioma activity and patients are currently recruited within a phase I/II clinical trial for patients with recurrent glioblastoma.
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Affiliation(s)
- T Look
- University Hospital Zurich , Zürich , Switzerland
| | - E Puca
- Philogen S.p.A. , Zurich , Switzerland
| | - R Stucchi
- Philogen S.p.A. , Zurich , Switzerland
| | - R Luca
- Philogen S.p.A. , Zurich , Switzerland
| | - P Roth
- University Hospital Zurich , Zürich , Switzerland
| | - D Neri
- Philogen S.p.A. , Zurich , Switzerland
| | - M Weller
- University Hospital Zurich , Zürich , Switzerland
| | | | - T Weiss
- University Hospital Zurich , Zürich , Switzerland
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Silginer M, Papa E, Szabo E, Vasella F, Pruschy M, Stroh C, Roth P, Weiss T, Weller M. P10.20.A Mechanisms of synergistic glioma growth suppression by radiotherapy and MET inhibition. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Glioblastoma remains to be one of the most lethal solid cancers. Despite multi-modal therapy including surgery as safely feasible, radiotherapy and chemotherapy with the alkylating agent temozolomide, the median survival of affected patients is still limited to approximately one year on a population level. Thus, novel therapies are urgently needed. There is increasing interest in the role of the HGF/MET pathway in the response of glioblastoma to radiotherapy since MET may be involved in radioresistance via proinvasive and DNA damage response pathways.
Material and Methods
Here we assessed the role of the MET pathway in the response to radiotherapy in vitro and in vivo in syngeneic mouse glioma models and explored potential modes of action responsible for the synergistic effects of MET pathway inhibition and irradiation on tumor growth in vivo.
Results
Murine glioma cells express HGF and MET and show increased MET phosphorylation upon exposure to exogenous HGF. In vitro, glioma cell viability and proliferation are not affected by pharmacological MET inhibition using tepotinib or genetic MET inhibition using CRISPR/Cas9-engineered Met gene knockout and sensitization to irradiation by MET inhibition is not seen. In vivo, the combination of MET inhibition with focal radiotherapy mediates prolonged survival of syngeneic orthotopic glioma-bearing mice compared with either treatment alone. Complementary studies demonstrate that synergy is lost when gliomas are established and treated in immunodeficient mice, but also if MET gene expression is disrupted in the tumor of wildtype mice. Combination therapy suppresses a set of pro-inflammatory mediators that are upregulated by radiotherapy alone and which are positively regulated by transforming growth factor (TGF)-β. In line with this data, ex vivo analysis of mouse brains reveal increased TGF-β pathway activity upon irradiation alone that is counteracted by concomitant MET inhibition.
Conclusion
In summary, we demonstrate synergistic suppression of syngeneic glioma growth by irradiation and MET inhibition that requires MET expression in the tumor as well as an intact immune system. Clinical evaluation of this combined treatment approach in newly diagnosed glioblastoma is warranted.
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Affiliation(s)
- M Silginer
- University and University Hospital Zurich , Zürich , Switzerland
| | - E Papa
- University and University Hospital Zurich , Zürich , Switzerland
| | - E Szabo
- University and University Hospital Zurich , Zürich , Switzerland
| | - F Vasella
- University and University Hospital Zurich , Zürich , Switzerland
| | - M Pruschy
- University and University Hospital Zurich , Zürich , Switzerland
| | - C Stroh
- University and University Hospital Zurich , Zürich , Switzerland
| | - P Roth
- University and University Hospital Zurich , Zürich , Switzerland
| | - T Weiss
- University and University Hospital Zurich , Zürich , Switzerland
| | - M Weller
- University and University Hospital Zurich , Zürich , Switzerland
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Gramatzki D, Weiss T, Hänsch L, Silginer M, Rushing EJ, Roth P, Gramatzki M, Peipp M, Weller M. P10.19.B An immunotoxin targeting CD317 for the treatment of glioblastoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
CD317 is an interferon-inducible cell surface receptor expressed in several solid cancer types. HM1.24-ETA’ is a small immunotoxin with a CD317 single-chain variable fragment (svFv) antibody fused to a truncated version of Pseudomonas aeruginosa exotoxin A (ETA’) that is explored as a novel therapeutic approach in CD317-expressing tumors.
Material and Methods
CD317 mRNA expression in human gliomas and its association with survival was analyzed using the database of the Cancer Genome Atlas (TCGA). CD317 protein levels in human gliomas were assessed by immunohistochemistry. CD317 mRNA expression was assessed by RT-PCR and CD317 protein levels by flow cytometry in 13 human glioma cell lines in vitro. Efficacy of HM1.24-ETA’ was analyzed in acute cytotoxicity assays in vitro. Finally, HM1.24-ETA’ was evaluated in the intracranial human LN-229 glioma xenograft nude mouse model after intravenous injection.
Results
Interrogation of the TCGA database showed that increased CD317 mRNA expression correlated with grade of malignancy among isocitrate dehydrogenase (IDH) wildtype and IDH-mutant gliomas. Enhanced CD317 mRNA expression was associated with inferior survival in glioblastoma and astrocytoma, IDH-mutant, WHO grade 4. Immunohistochemistry confirmed CD317 overexpression in human glioblastoma compared to lower grade astrocytomas. CD317 was expressed heterogeneously on mRNA and protein levels in glioma cell lines in vitro. HM1.24-ETA’ induced acute cytotoxicity in CD317-positive glioma cells in vitro. CD317 expression and susceptibility to HM1.24-ETA’-induced cell death were enhanced by interferon-β. HM1.24-ETA’ prolonged survival in the LN-229 xenograft nude mouse model.
Conclusion
These data define CD317 as a novel target for treatment of human gliomas with immunoconjugates.
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Affiliation(s)
- D Gramatzki
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich , Zurich , Switzerland
| | - T Weiss
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich , Zurich , Switzerland
| | - L Hänsch
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich , Zurich , Switzerland
| | - M Silginer
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich , Zurich , Switzerland
| | - E J Rushing
- Department of Neuropathology, University Hospital Zurich , Zurich , Switzerland
| | - P Roth
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich , Zurich , Switzerland
| | - M Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University Hospital of Schleswig-Holstein, Campus Kiel , Kiel , Germany
| | - M Peipp
- Division of Stem Cell Transplantation and Immunotherapy, University Hospital of Schleswig-Holstein, Campus Kiel , Kiel , Germany
| | - M Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich , Zurich , Switzerland
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Höllriegl V, Roth P, Werner E, Schramel P, Wendler I, Felgenhauer N, Zilker T. Influence of calcium on the uptake of ingested strontium. KERNTECHNIK 2022. [DOI: 10.1515/kern-2003-0076] [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]
Abstract
Abstract
Radioactive isotopes of strontium, mainly 90Sr, released into the environment due to nuclear accidents may contribute significantly to the internal radiation exposure of members of the public after ingestion of strontium with contaminated foodstuffs. The committed radiation dose is significantly dependent on the fraction of the ingested activity that crossed the gut wall (f1 value). The directive 96/29/EURATOM has adopted f1 values of 0.3 for adults. This study was aimed to investigate how far the calcium content of foodstuffs influences the uptake of ingested strontium. For aqueous solutions without calcium containing 1 mg strontium, f1 values of 0.62 ± 0.13 (mean ± SD) were obtained. However, the uptake of 1 mg Sr from milk, and respectively from solutions with calcium was lower than from aqueous solution (f1: = 0.32 ± 0.06, respectively f1: = 0.31 ± 0.06). The data obtained show a significant reduction of the uptake of ingested strontium from milk in comparison to aqueous solution. The calcium content of milk could explain this reduction.
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Affiliation(s)
- V. Höllriegl
- Institute of Radiation Protection, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - P. Roth
- Institute of Radiation Protection, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - E. Werner
- Institute of Radiation Protection, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - P. Schramel
- Institute of Ecological Chemistry, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - I. Wendler
- Institute of Ecological Chemistry, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - N. Felgenhauer
- Department of Toxicology of the II. Medical Clinic of Technical University Munich , München , Germany
| | - T. Zilker
- Department of Toxicology of the II. Medical Clinic of Technical University Munich , München , Germany
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de Barbeyrac C, Roth P, Noël C, Anselem O, Gaudin A, Roumegoux C, Azcona B, Castel C, Noret M, Letamendia E, Stirnemann J, Ville Y, Lapillonne A, Viallard ML, Kermorvant-Duchemin E. The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study. BJOG 2021; 129:752-759. [PMID: 34665920 DOI: 10.1111/1471-0528.16976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care. DESIGN Multicentre prospective observational study. SETTING Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region. POPULATION All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016. METHODS Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously. MAIN OUTCOME MEASURE Final decision reached following discussions in the antenatal period. RESULTS We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan. CONCLUSIONS Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy. TWEETABLE ABSTRACT Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.
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Affiliation(s)
- C de Barbeyrac
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - P Roth
- Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, EA7328, Paris, France
| | - C Noël
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - O Anselem
- Department of Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Cochin - Port-Royal, Paris, France
| | - A Gaudin
- Department of Neonatal Medicine, AP-HP, Hôpital Robert-Debré, Paris, France
| | - C Roumegoux
- Department of Neonatal Medicine, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - B Azcona
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C Castel
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Quentin, Poissy, France
| | - M Noret
- Department of Obstetrics, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - E Letamendia
- Maternity Unit, AP-HP, Hôpital Antoine Béclère, Clamart, France
| | - J Stirnemann
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - Y Ville
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - A Lapillonne
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - M-L Viallard
- Palliative Medicine Unit, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - E Kermorvant-Duchemin
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
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9
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Hänsch L, Peipp M, Myburgh R, Silginer M, Weiss T, Gramatzki D, Vasella F, Manz M, Weller M, Roth P. PL03.3.A Development and characterization of CD317-specific CAR T cells as an innovative immunotherapeutic strategy against glioblastoma. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Due to the limited success of existing therapies for gliomas, innovative therapeutic options are urgently needed. Chimeric antigen receptor (CAR) T cell therapy has been successful in patients with hematological malignancies. However, using this treatment against solid tumors such as glioblastomas is more challenging. Here, we generated CAR T cells targeting the transmembrane protein CD317 (BST-2, HM1.24) which is overexpressed in glioma cells and may therefore serve as a novel target antigen for CAR T cell-based immunotherapy.
MATERIAL AND METHODS
CAR T cells targeting CD317 were generated by lentiviral transduction of human T cells from healthy donors. The anti-glioma activity of CD317-CAR T cells was determined in lysis assays using different glioma target cell lines with varying CD317 expression levels. The efficiency of CD317-CAR T cells to control tumor growth in vivo was evaluated in clinically relevant orthotopic xenograft glioma mouse models.
RESULTS
We created a second-generation CAR construct targeting CD317 and observed strong anti-glioma activity of CD317-CAR T cells in vitro. Glioma cells with a CRISPR/Cas9-mediated CD317 knockout were resistant to CD317-specific CAR T cells, demonstrating their target antigen-specificity. Since CD317 is also expressed by T cells, transduction with a CD317-directed CAR resulted in fratricide of the transduced T cells. Silencing of CD317 in CAR T cells by integrating a specific shRNA into the CAR vector significantly increased the viability, proliferation and cytotoxic function of the CAR T cells. Importantly, intratumoral treatment with CD317-CAR T cells prolonged the survival and cured a significant fraction of glioma-bearing nude mice.
CONCLUSION
We demonstrate strong CD317-specific anti-tumor activity of CD317-CAR T cells against various glioma cell lines in vitro and in xenograft glioma models in vivo. These data lay a scientific basis for the subsequent evaluation of this therapeutic strategy in clinical neuro-oncology.
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Affiliation(s)
- L Hänsch
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Peipp
- Division of Stem Cell Transplantation and Immunotherapy, Department of Medicine, Christian-Albrechts-University, Kiel, Germany
| | - R Myburgh
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Silginer
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - T Weiss
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - D Gramatzki
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - F Vasella
- Department of Neurosurgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Manz
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - P Roth
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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11
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Roth P, Pace A, Le Rhun E, Weller M, Ay C, Cohen-Jonathan Moyal E, Coomans M, Giusti R, Jordan K, Nishikawa R, Winkler F, Hong JT, Ruda R, Villà S, Taphoorn MJB, Wick W, Preusser M. Neurological and vascular complications of primary and secondary brain tumours: EANO-ESMO Clinical Practice Guidelines for prophylaxis, diagnosis, treatment and follow-up. Ann Oncol 2021; 32:171-182. [PMID: 33246022 DOI: 10.1016/j.annonc.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- P Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Pace
- Neuroncology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - E Le Rhun
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland; Université Lille, U-1192, Lille, France; Inserm, U-1192, Lille, France; Centre Hospitalier Universitaire CHU, Lille, General and Stereotaxic Neurosurgery Service, Lille, France; Oscar Lambret Center, Breast Cancer Department, Lille, France
| | - M Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - C Ay
- Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - E Cohen-Jonathan Moyal
- Radiation Oncology Department, Institut Claudius Regaud, Université Paul Sabatier, Toulouse, France; Institut Universitaire du Cancer de Toulouse IUCT Oncopole, Toulouse, France
| | - M Coomans
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Giusti
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Rome, Italy
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - R Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - F Winkler
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - J T Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, Seoul, The Catholic University of Korea, Republic of Korea
| | - R Ruda
- Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy
| | - S Villà
- Catalan Institute of Oncology, HU Germans Trias, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - W Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Niemann B, Rohrbach S, Rückert A, Willems C, Weismüller K, Wollbrück M, Roth P, Böning A. Unilateral Pulmonary Edema after Minimally Invasive Mitral Valve Surgery: Preoperative, Intraoperative, and Postoperative Risk Modification? Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Taghiyev Z, Niemann B, Roth P, Hartmann B, Hemmerich C, Böning A. Long-Term Results of Left Atrial Appendage Amputation in Patients Undergoing Concomitant AF Ablation during Cardiac Surgery. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weller M, Gramatzki D, Felsberg J, Hentschel B, Wolter M, Schackert G, Westphal M, Regli L, Thon N, Tatagiba M, Wick W, Schlegel U, Krex D, Roth P, Rushing E, Pietsch T, von Deimling A, Sabel M, Loeffler M, Reifenberger G. 360O Telomerase reverse transcriptase (TERT) promoter mutation and O6-methylguanine DNA methyltransferase (MGMT) promoter methylation-mediated sensitivity to temozolomide in IDH-wildtype glioblastoma: Is there a link? Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.469] [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: 11/29/2022] Open
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15
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Wolpert F, Kulcsár Z, Hänsel M, Rushing E, Seystahl K, Schweizer J, Roth P, Luft AR, Wegener S, Weller M. Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion. Eur J Neurol 2020; 27:2041-2046. [PMID: 32492228 DOI: 10.1111/ene.14372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is a dreaded complication in patients with cancer. Besides paraneoplastic coagulopathy, chemotherapy, radiotherapy and tumor-directed invasive procedures, circulating cancer cells may contribute to thrombus formation and embolic stroke. However, the incidence of tumor cells within the blood clots of cancer patients with stroke is unknown and the role of circulating tumor cells in the formation of cerebrovascular thrombi remains unclear. METHODS All patients who had undergone cerebrovascular thrombectomy at the University Hospital Zurich between 2014 and 2017 were screened for history of cancer. Clinical information was retrieved from the local stroke registry and the electronic charts and thrombi underwent a thorough histopathological re-review. RESULTS Thirty-two of 182 patients (18%) with thrombectomy had a history of cancer. The majority of patients had advanced stage cancer. However, even after extensive histopathological re-review, only one specimen revealed tumor cells in the thrombus: a 75-year-old patient with acute occlusion of the middle cerebral artery who had been diagnosed with non-small-cell lung cancer 8.1 months prior to stroke. CONCLUSIONS The presence of cancer cells in clots from cerebrovascular thrombectomy, indicative of a direct involvement of circulating tumor cells in the causation of stroke, is rare.
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Affiliation(s)
- F Wolpert
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Z Kulcsár
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - M Hänsel
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - E Rushing
- Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - K Seystahl
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - J Schweizer
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - P Roth
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A R Luft
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - S Wegener
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - M Weller
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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16
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Grieshaber P, Oswald I, Albert M, Sodah A, Roth P, Diegeler A, Sedding D, Franke U, Böning A. Staged Complete Hybrid Revascularization in Patients with Multivessel Disease and Acute Myocardial Infarction—A Prospective Angiographic and Clinical Study. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | - A. Sodah
- Bad Neustadt an der Saale, Germany
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17
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Wirsching HG, Tabatabai G, Roelcke U, Hottinger AF, Jörger F, Schmid A, Plasswilm L, Schrimpf D, Mancao C, Capper D, Conen K, Hundsberger T, Caparrotti F, von Moos R, Riklin C, Felsberg J, Roth P, Jones DTW, Pfister S, Rushing EJ, Abrey L, Reifenberger G, Held L, von Deimling A, Ochsenbein A, Weller M. Bevacizumab plus hypofractionated radiotherapy versus radiotherapy alone in elderly patients with glioblastoma: the randomized, open-label, phase II ARTE trial. Ann Oncol 2019; 29:1423-1430. [PMID: 29648580 DOI: 10.1093/annonc/mdy120] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The addition of bevacizumab to temozolomide-based chemoradiotherapy (TMZ/RT → TMZ) did not prolong overall survival (OS) in patients with newly diagnosed glioblastoma in phase III trials. Elderly and frail patients are underrepresented in clinical trials, but early reports suggested preferential benefit in this population. Patients and methods ARTE was a 2 : 1 randomized, multi-center, open-label, non-comparative phase II trial of hypofractionated RT (40 Gy in 15 fractions) with bevacizumab (10 mg/kg×14 days) (arm A, N = 50) or without bevacizumab (arm B, N = 25) in patients with newly diagnosed glioblastoma aged ≥65 years. The primary objective was to obtain evidence for prolongation of median OS by the addition of bevacizumab to RT. Response was assessed by RANO criteria. Quality of life (QoL) was monitored by the EORTC QLQ-C30/BN20 modules. Exploratory studies included molecular subtyping by 450k whole methylome and gene expression analyses. Results Median PFS was longer in arm A than in arm B (7.6 and 4.8 months, P = 0.003), but OS was similar (12.1 and 12.2 months, P = 0.77). Clinical deterioration was delayed and more patients came off steroids in arm A. Prolonged PFS in arm A was confined to tumors with the receptor tyrosine kinase (RTK) I methylation subtype (HR 0.25, P = 0.014) and proneural gene expression (HR 0.29, P = 0.025). In a Cox model of OS controlling for established prognostic factors, associations with more favorable outcome were identified for age <70 years (HR 0.52, P = 0.018) and Karnofsky performance score 90%-100% (HR 0.51, P = 0.026). Including molecular subtypes into that model identified an association of the RTK II gene methylation subtype with inferior OS (HR 1.73, P = 0.076). Conclusion Efficacy outcomes and exploratory analyses of ARTE do not support the hypothesis that the addition of bevacizumab to RT generally prolongs survival in elderly glioblastoma patients. Molecular biomarkers may identify patients with preferential benefit from bevacizumab. Clinical trial registration number NCT01443676.
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Affiliation(s)
- H-G Wirsching
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - G Tabatabai
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - U Roelcke
- Department of Neurology, Brain Tumor Center Aarau, Cantonal Hospital Aarau, Aarau, Switzerland
| | - A F Hottinger
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland; Department of Medical Oncology, University Hospital Lausanne, Lausanne, Switzerland
| | - F Jörger
- Department of Clinical Trials Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Schmid
- Department of Medical Oncology, University Hospital Bern, Bern, Switzerland
| | - L Plasswilm
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - D Schrimpf
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Mancao
- Genentech, Oncology Biomarker Development, Basel, Switzerland
| | - D Capper
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Conen
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - T Hundsberger
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - F Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - R von Moos
- Department of Medical Oncology, Cantonal Hospital Chur, Chur, Switzerland
| | - C Riklin
- Department of Medical Oncology, Cantonal Hospital Lucerne, Lucerne Switzerland
| | - J Felsberg
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - P Roth
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - D T W Jones
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - S Pfister
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - E J Rushing
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - L Abrey
- F. Hoffmann-La Roche, Pharma Division, Product Development Oncology, Basel, Switzerland
| | - G Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Cancer Research Center, Essen/Düsseldorf, Germany
| | - L Held
- Biostatistics Department, University of Zurich, Zurich, Switzerland
| | - A von Deimling
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Ochsenbein
- Department of Medical Oncology, University Hospital Bern, Bern, Switzerland
| | - M Weller
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
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18
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Roth P, Wong GKL, Frosz MH, Ahmed G, Russell PSJ. Full-field characterization of helical Bloch modes guided in twisted coreless photonic crystal fiber. Opt Lett 2019; 44:5049-5052. [PMID: 31613260 DOI: 10.1364/ol.44.005049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
It was recently reported that a photonic crystal fiber (PCF) with no structural core guides light if a permanent chiral twist is introduced by spinning the fiber preform during the draw. The intriguing guidance mechanism behind this novel effect has many remarkable features; for example, it intrinsically supports circularly polarized helical Bloch modes (HBMs) that carry multiple optical vortices, making twisted PCFs of interest in fields such as optical micro-manipulation, imaging, quantum optics, and optical communications. Here we report for the first time, to the best of our knowledge, that a twisted coreless PCF supports not just one but a family of guided HBMs, each member of which has a unique transverse field distribution and harmonic spectrum. By making detailed interferometric measurements of the near-field phase and amplitude distributions of HBMs, and expanding them as a series of Bessel beams, we are able to extract the amplitude of each azimuthal and radial HBM harmonic. Good agreement is found with the numerical solutions of Maxwell's equations. The results shed light on the properties of this curious new optical phenomenon.
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Beauchamp G, Lauber P, Allen J, Boateng N, Shaak S, Roth P, Laubach L, Crowley L, Burmeister D, Greenberg M. 309 Overcoming Brick and Mortar: Feasibility of Implementation of a Medication for Addiction Treatment and Linkage to Treatment Program by Leveraging Community Partnerships. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Lassman AB, Sepúlveda-Sánchez JM, Cloughesy T, Gil-Gil JM, Puduvalli VK, Raizer J, De Vos FY, Wen PY, Butowski N, Clement P, Groves MD, Belda-Iniesta C, Steward K, Moran S, Ye Y, Roth P. OS10.6 Infigratinib (BGJ398) in patients with recurrent gliomas with fibroblast growth factor receptor (FGFR) alterations: a multicenter phase II study. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
FGFR mutations and translocations occur in approximately 10% of glioblastomas (GBMs). FGFR3-TACC3 fusion has been reported as predictive of response to FGFR tyrosine kinase inhibitor therapy both pre-clinically and clinically. Infigratinib (BGJ398) is a selective small-molecule pan-FGFR kinase inhibitor that has demonstrated anti-tumor activity in several solid tumors with FGFR genetic alterations. Therefore, we conducted a phase II trial to test the efficacy of infigratinib in FGFR-altered recurrent GBM (NCT01975701).
METHODS
This open-label trial accrued adults with recurrent high-grade gliomas following failure of initial therapy that harbored FGFR1-TACC1 or FGFR3-TACC3 fusions; activating mutations in FGFR1, 2 or 3; or FGFR1, 2, 3, or 4 amplification. Oral infigratinib was administered 125 mg on days 1–21 every 28 days. Prophylaxis for hyperphosphatemia, a common toxicity, was recommended. The primary endpoint was the 6-month progression-free survival (6mPFS) rate by RANO (locally assessed, estimated by K-M method), with a goal of >40%.
RESULTS
As of the Sep 2017 data cut-off, 26 patients (16 men, 10 women; median age 55 years, range 20–76 years; 50% with ≥2 prior regimens) were treated, and 24 (92.3%) discontinued for disease progression (n=21) or other reasons (n=3). All patients had FGFR1 or FGFR3 gene alterations, and 4 had >1 gene alteration. The estimated 6mPFS rate was 16% (95% CI 5.0–32.5%); median PFS was 1.7 months (95% CI 1.1–2.8 months); median OS was 6.7 months (95% CI 4.2–11.7 months); ORR was 7.7% (95% CI 1.0–25.1%). The best overall response was: partial response 7.7% (FGFR1 mutation n=1; FGFR3 amplification n=1); stable disease 26.9%; progressive disease 50.0%; missing/unknown 15.3%. The most common (>15%) all-grade treatment-related adverse events (AEs) were hyperphosphatemia, fatigue, diarrhea, hyperlipasemia, and stomatitis. There were no grade 4 treatment-related AEs. Eleven patients (42.3%) had treatment-related AEs requiring dose interruptions or reductions (most commonly hyperphosphatemia).
CONCLUSIONS
Infigratinib induced partial response or stable disease in approximately one-third of patients with recurrent GBM and/or other glioma subtypes harboring FGFR alterations. Most AEs were reversible and manageable. Further potential combinations are being explored in patients with proven FGFR-TACC fusion genes and analysis of biomarker data is ongoing.
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Affiliation(s)
- A B Lassman
- Columbia University Irving Medical Center, New York, NY, United States
| | | | - T Cloughesy
- University of California at Los Angeles, Los Angeles, CA, United States
| | - J M Gil-Gil
- Hospital Durans I Reynals. ICO, Hospitalet. Barcelona, Spain
| | - V K Puduvalli
- The Ohio State University, Columbus, OH, United States
| | - J Raizer
- Northwestern University, Evanston, IL, United States
| | - F Y De Vos
- University Medical Center Utrecht Cancer Center, Utrecht University, Utrecht, Netherlands
| | - P Y Wen
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - N Butowski
- University of California San Francisco, San Francisco, CA, United States
| | - P Clement
- UZ Leuven Campus Gasthuisberg, Leuven, Belgium
| | - M D Groves
- Texas Oncology, Austin, TX, United States
| | | | - K Steward
- QED Therapeutics, San Francisco, CA, United States
| | - S Moran
- QED Therapeutics, San Francisco, CA, United States
| | - Y Ye
- QED Therapeutics, San Francisco, CA, United States
| | - P Roth
- University Hospital Zurich, Zurich, Switzerland
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21
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Weiss T, Puca E, Weller M, Neri D, Roth P. P12.08 Immunocytokines are a novel immunotherapeutic approach against glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma is the most common malignant primary brain tumor in adults with an urgent need for novel treatment options. The administration of pro-inflammatory cytokines could be a potent immunotherapeutic approach to shift the balance between tumor-associated immunosuppression and immune activation. However, the systemic administration of therapeutically active doses of pro-inflammatory cytokines is not feasible due to toxic side effects and there is a need for strategies that enable a targeted delivery of pro-inflammatory cytokines to the tumor site.
METHODS
We investigated different antibody-cytokine fusion products that enable a targeted delivery of interleukin (IL)-2, IL-12 or tumor necrosis factor (TNF)-α to the tumor site by binding to a tumor-specific epitope of fibronectin. We investigated the expression of this tumor-specific epitope ex vivo in tumor-bearing mouse brains and human glioblastoma samples. Subsequently, we assessed the anti-tumor activity of IL-2, IL-12 or TNF-α fused to an antibody targeting this tumor-specific epitope in orthotopic syngeneic mouse glioma models.
RESULTS
The tumor-specfic extra domain B of fibronectin is expressed in murine glioma models and human glioblastoma samples. A fluorochrome-labeled antibody targeting this tumor-specific epitope accumulated at the tumor site in the brain in vivo upon systemic administration. IL-2, IL-12, or TNF-α fused to this antibody conferred a survival benefit in orthotopic tumor-bearing mice and cured a fraction of tumor-bearing mice. Mechanistically, antibody-fused TNF-α induced tumor necrosis and increased the activation of tumor-infiltrating natural killer (NK) cells, whereas antibody-fused IL-12 mainly boosted an anti-tumor immune response mediated by NK cells and T cells.
CONCLUSION
We demonstrate the expression of a tumor-specific epitope of fibronectin in glioblastoma and exploit this for the targeted delivery of IL-2, IL-12 or TNF-α to the tumor site. Our preclinical assessments indicate potent anti-tumor activity in orthotopic, syngneic glioma mouse models and reveal the mode of action for the different immunocytokines. Based on these findings, we initiated a phase I/II clinical trial in patients with recurrent glioma to investigate the targeted delivery of TNF-α (ClinicalTrials.gov identifier NCT03779230).
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Affiliation(s)
- T Weiss
- University Hospital Zurich, Zurich, Switzerland
| | - E Puca
- Swiss Federal Institute of Technology (ETH Zürich), Zurich, Switzerland
| | - M Weller
- University Hospital Zurich, Zurich, Switzerland
| | - D Neri
- Swiss Federal Institute of Technology (ETH Zürich), Zurich, Switzerland
| | - P Roth
- University Hospital Zurich, Zurich, Switzerland
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22
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Roth P, Reijneveld J, Gorlia T, Dhermain F, De Vos F, Vanlancker M, O’Callaghan C, Le Rhun E, van den Bent M, Mason W, Weller M. P14.124 EORTC 1709/CCTG CE.8: A phase III trial of marizomib in combination with standard temozolomide-based radiochemotherapy versus standard temozolomide-based radiochemotherapy alone in patients with newly diagnosed glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The standard of care for patients with newly diagnosed glioblastoma includes maximal debulking surgery followed by radiotherapy (RT), and concomitant as well as maintenance therapy with the alkylating agent, temozolomide (TMZ). However, the prognosis remains poor and novel treatment strategies are urgently needed. Targeting the proteasome has been considered a promising anti-cancer approach for several years. Marizomib is a novel, irreversible and pan-proteasome inhibitor, which crosses the blood-brain barrier and has been assessed in phase I trials in patients with newly diagnosed or recurrent glioblastoma.
MATERIAL AND METHODS
EORTC 1709/CCTG CE.8 is a randomized, controlled, open label phase III superiority trial. Patients with histologically confirmed newly diagnosed glioblastoma and a performance status >70 are eligible. Patients are randomized in a 1:1 ratio to receive standard of care (TMZ/RT→TMZ) alone or TMZ/RT→TMZ plus marizomib. The study aims at enrolling 750 patients. Stratification factors include study site, age, performance status and extent of resection. The primary objective of this trial is to compare overall survival in patients receiving marizomib in addition to standard of care with those receiving standard treatment only. The testing strategy specifies the determination of this objective in the intent-to-treat population as well as the subgroup of patients with MGMT-unmethylated tumors. Secondary endpoints include progression-free survival, safety, neurocognitive function and quality of life. A translational research program has been set up. The study will be activated at approximately 50 EORTC sites across Europe, 25 sites in Canada and additional sites in the US. Patient recruitment started in June 2018 and as of April 29, 2019, a total of 164 patients have been randomized. An update on the enrolment status will be provided at the EANO meeting. ClinicalTrials.gov Identifier: NCT03345095
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Affiliation(s)
- P Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - F Dhermain
- Institut Gustave Roussy, Villejuif, France
| | - F De Vos
- University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | | | | | - E Le Rhun
- University Hospital Lille, Lille, France
| | | | - W Mason
- Princess Margaret Hospital, Toronto, ON, Canada
| | - M Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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23
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Weiss T, Meister H, Weller M, Sentman C, Roth P. PL2.1 Exploiting the DNAM-1 system for chimeric antigen receptor (CAR) T cell therapy of glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Cancer immunotherapy with genetically engineered T cells that express a chimeric antigen receptor (CAR) has led to impressive responses in extracranial malignancies and is also explored against glioblastoma. However, CAR T cell strategies that are currently being explored against glioblastoma target single tumor antigens, which are non-homogeneously expressed and are prone to antigen escape. Furthermore, the immunosuppressive brain tumor microenvironment hampers anti-tumor efficacy.
METHODS
By immunohistochemistry and flow cytometry, we investigated the expression of CD155 and CD112, which are ligands to the activating immune cell receptor DNAX accessory molecule-1 (DNAM-1), in human and mouse glioma cell lines as well as in human glioblastoma samples. To understand their functional role, we generated CD155 or CD112 knock-out glioma cell lines using CRISPR/Cas9 and studied proliferation, sensitivity to irradiation or temozolomide as well as migration. To exploit the promiscuous binding features of DNAM-1, we generated different first or second-generation CAR T cells that use DNAM-1 as a tumor-binding domain. Subsequently, we investigated their anti-tumor activity in vitro in co-culture assays and in vivo in syngeneic orthotopic murine glioma models.
RESULTS
CD155 and CD112 are homogenously expressed in human and mouse glioma cell lines and human glioblastoma tissues. Knock-out of these ligands affected the migration of tumor cells, but did not affect proliferation or sensitivity to irradition or temozolomide. DNAM-1-based CAR T cells demonstrated high cytolytic activity and effector cytokine secretion in vitro. In vivo, DNAM-1 based CAR T cells reached to the tumor site in the brain upon intravenous administration, prolonged survival of orthotopic glioma-bearing mice and led to a durable anti-tumor response in a fraction of mice. The treatment was tolerated without toxicities.
CONCLUSION
We elucidated the tumor-intrinisic role of CD155 and CD112 and provide the first systematical preclincal assessment of DNAM-1 CAR T cells against glioma. These findings provide a rationale to test this immunotherapeutic strategy also in human glioma patients.
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Affiliation(s)
- T Weiss
- University Hospital Zurich, Zurich, Switzerland
| | - H Meister
- University Hospital Zurich, Zurich, Switzerland
| | - M Weller
- University Hospital Zurich, Zurich, Switzerland
| | - C Sentman
- Geisel School of Medicine, Hanover, NH, United States
| | - P Roth
- University Hospital Zurich, Zurich, Switzerland
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24
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Gramatzki D, Felsberg J, Bähr O, Hentschel B, Westphal M, Schackert G, Tonn JC, Herrlinger U, Löffler M, Pietsch T, Steinbach J, Reifenberger G, Roth P, Weller M. OS2.2 Chemotherapy for spinal gliomas in adults. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Chemotherapy is a treatment option in patients diagnosed with anaplastic gliomas or glioblastomas of the spinal cord, or with recurrent lower graded WHO spinal gliomas that are no longer amenable to local treatment. The low incidence of spinal cord gliomas, particularly in adults, limits the ability to perform clinical trials. The role of chemotherapy in these tumors has remained unclear.
MATERIAL AND METHODS
We performed a retrospective study of 22 patients diagnosed with spinal gliomas who were treated with chemotherapy at any time during the disease course. Benefit from chemotherapy was estimated by applying Response assessment in neuro-oncology criteria. Data on radiotherapy, as well as the number of neurosurgical interventions were taken into consideration.
RESULTS
Most patients were diagnosed with astrocytoma WHO grade I-IV (N=14), the remaining patients were diagnosed with ependymoma (N=8). Median follow-up from start of chemotherapy was 92 months (95% CI, 72.6–111.4). The O6-methylguanyl-DNA-methyltransferase(MGMT)promoter methylation status was available in tumors of 12 patients: 9 tumors (75%) had an unmethylated MGMTpromoter. More than 50% of the patients had more than one neurosurgical intervention. After prior surgery 10 patients in the first-line setting had chemotherapy combined with radiotherapy, while 3 patients received chemotherapy only. The remaining 9 patients had initially received radiation therapy and chemotherapy was given at time of recurrence. In patients diagnosed with astrocytoma mainly temozolomide (TMZ) was applied (N=10), while one patient received CCNU and three patients had combination chemotherapy. Patients diagnosed with ependymoma had hydroxyurea (N=1), CCNU (N=1), TMZ (N=3) or combination chemotherapy (N=3). In the group of patients who had chemotherapy combined with radiation, response rates were as follows: anaplastic astrocytoma 3 stable diseases (SD), glioblastoma 1 complete response (CR) and 1 SD, and anaplastic ependymoma 1 SD. After chemotherapy in the group of patients previously irradiated, the following response rates were observed: 1 SD in pilocytic astrocytoma, 1 SD in diffuse astrocytoma, 3 SD in myxopapillary ependymoma, and 2 SD and 1 partial response (PR) in anaplastic ependymoma. All other patients experienced progressive disease. There was no indication for a favorable prognostic role ofMGMTpromoter methylation.
CONCLUSION
Spinal cord gliomas represent a heterogeneous group of tumors. Survival outcomes in response to chemotherapy in adult spinal glioma patients vary substantially, but individual patients appear to derive benefit from chemotherapy.
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Affiliation(s)
- D Gramatzki
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - J Felsberg
- Department of Neuropathology, Heinrich-Heine-University, Düsseldorf, Germany
| | - O Bähr
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | - B Hentschel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - M Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Schackert
- Department of Neurosurgery, Technical University Dresden, Dresden, Germany
| | - J C Tonn
- Department of Neurosurgery, Ludwig Maximilian University Munich, Munich, Germany
| | - U Herrlinger
- Division of Clinical Neurooncology, University Hospital Bonn, Bonn, Germany
| | - M Löffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - T Pietsch
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - J Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | - G Reifenberger
- Department of Neuropathology, Heinrich-Heine-University, Düsseldorf, Germany
| | - P Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - M Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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Wolpert F, Grossenbacher B, Lareida A, Roth P, Neidert MC, Andratschke N, Le Rhun E, Weller M. P14.25 Venous thromboembolic events in patients with brain metastases: the PICOS score. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Venous thromboembolic events are significant complications in patients and possibly associated with an unfavorable outcome. Thrombosis risk is poorly defined for patients with brain metastasis, and available risk calculation scores are not validated for these patients.
MATERIAL AND METHODS
We identified 811 patients with brain metastasis followed at our institution and screened electronic charts retrospectively for the occurrence of venous thromboembolic events, along with candidate risk factors. Risk factors were tested in uni- and multivariate analyses and finally integrated in a score model for risk prediction.
RESULTS
Venous thromboembolic events were documented in 97 of 811 patients (12.0%). Primary tumors with high thrombogenicity (p=0.02, odds ratio 1.7, 95% CI 1.1–2.8), dexamethasone (p=0.011, odds ratio 2.27, 95% CI 1.5–4.5), chemotherapy (p=0.005, odds ratio 3.4, 95% CI 1.6–7.5), BMI > 35 kg/m2 (p=0.002, odds ratio 3.4, 95% CI 1.6–7.5) and immobilization (p=0.003, odds ratio 2.4, 95% CI 1.3–4.3) were confirmed as independent predictors of VTE. We derived a score model for venous thromboembolic event prediction, the PICOS (thrombogenic Primary, Immobilization, Chemotherapy, Obesity, Steroids) score (0–7 points). Receiver Operating Characteristic Curve Analysis demonstrated its prognostic accuracy (AUC=0.71, 95% CI 0.64–0.77), and its predictive capability was superior to that of other scores proposed for the evaluation of venous thromboembolic event risk such as the Khorana (AUC=0.51) or CONKO (AUC=0.52) scores.
CONCLUSION
We report a rate of venous thrombotic events of 12.0% in our cohort of 811 patients with brain metastasis. We define a risk model for prediction in of venous thrombotic events in patients with BM, the PICOS score. It may become a valuable tool for the identification of brain metastasis patients at high risk for venous thromboembolic events and be helpful for guidance of clinicians towards decision whether to start thrombosis prophylaxis. Further, the PICOS score might be used for stratification in controlled studies.
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Affiliation(s)
- F Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - B Grossenbacher
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Lareida
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - P Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - M C Neidert
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - E Le Rhun
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
- Neuro-Oncology, Department of Neurosurgery, University Hospital Lille, Salengro Hospital, Rue Emile Laine, Lille, France
| | - M Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Wirsching H, Morel C, Roth P, Weller M. OS7.6 Socioeconomic burden and associations with quality of life in meningioma patients. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Socioeconomics affect the outcome of neurological patients, but the socioeconomic burden of brain tumors has not been studied in detail.
PATIENTS AND METHODS
This survey study in a clinically well-annotated cohort of meningioma patients was designed to explore socioeconomic status parameters at diagnosis and one year thereafter. The survey comprised level of education, profession, employment status, subjective work ability, monthly income and the EPICES social deprivation score. Quality of life (QoL) and symptom burden were queried utilizing the EORTC-QLQ-C30/BN20 and MDASI-BT. A multivariate binary regression model was applied to explore associations of socioeconomics with QoL.
RESULTS
Completed surveys were obtained from 249 of 410 patients (61%) who were invited to participate. The level of education was an apprenticeship or higher in 214 patients (86%). One year after diagnosis, there was a 20% decline in the fraction of employed patients and a more than twofold increase in unemployment and disability (p<0.001). There was a decrease in monthly income among patients with a baseline income below national average (p=0.008). On multivariate analyses, there was an association of inferior QoL with pre-operative unemployment or retirement (OR 2.43, 95% CI 1.02–5.88), whereas a subjective work ability of >70% was associated with better QoL (OR 0.37, 95% CI 0.15–0.92).
CONCLUSION
Socioeconomics assessments should be incorporated in prospective neuro-oncology clinical trials. A more detailed knowledge of the effects of socioeconomics on patient outcome will aid in identifying patients at risk for deterioration and allow to implement improved preventive and supportive strategies.
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Affiliation(s)
- H Wirsching
- University Hospital and University of Zurich, Zürich, Switzerland
| | - C Morel
- University Hospital and University of Zurich, Zürich, Switzerland
| | - P Roth
- University Hospital and University of Zurich, Zürich, Switzerland
| | - M Weller
- University Hospital and University of Zurich, Zürich, Switzerland
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Kaidar-Person O, Saez J, Andratschke N, de Abrunhosa Branquinho A, Clementel E, Corning C, Hurkmans C, Monti A, Roth P, Verhoeff J, Dhermain F. A Multi-Institutional Estimation of Interobserver Variability in Glioblastoma Delineation in the EORTC-1709-BTG /CCTG CE.8 Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Monti A, de Abrunhosa Branquinho A, Andratschke N, Clementel E, Corning C, Dhermain F, Hurkmans C, Kaidar-Person O, Roth P, Saez J, Verhoeff J. A Multi-Institutional Estimation of Interobserver Variability in Glioblastoma Treatment Planning in the EORTC-1709-BTG / CCTG CE.8 trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dominik E, Rohrbach S, Grieshaber P, Roth P, Böning A, Niemann B. Why Say Never—Ablation of “Permanent” Atrial Fibrillation? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- E. Dominik
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - S. Rohrbach
- Justus Liebig Universität Giessen, Physiologisches Institut, Giessen, Germany
| | - P. Grieshaber
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - P. Roth
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - A. Böning
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - B. Niemann
- Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
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Grieshaber P, Kreuder J, Görlach G, Roth P, Niemann B, Reents W, Böning A. Good University Teaching Inspires Medical Students for Cardiothoracic and Vascular Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- P. Grieshaber
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - J. Kreuder
- Justus-Liebig-Universität Giessen, Studiendekanat Fachbereich 11, Giessen, Germany
| | - G. Görlach
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - P. Roth
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - B. Niemann
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
| | - W. Reents
- Herz- und Gefäßklinik Bad Neustadt, Klinik für Kardiochirurgie, Bad Neustadt a.d. Saale, Germany
| | - A. Böning
- Universitätsklinikum Giessen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Germany
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Balbi A, Gak A, Kim E, Park T, Quinn J, Colon M, Roth P, Weaver K, Richardson D, Cannon R, Greenberg M. 75 Medical Student Brief Motivational Interviewing for Substance Use in the Emergency Department. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Amaducci A, Anderson R, Frey A, Sheen A, Colon M, Roth P, Stephens J, Weaver K, Burmeister D, Greenberg M, Cannon R. 361 Sex-Specific Outcomes in a Substance Use Intervention Program. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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33
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Hertler C, Roelcke U, Conen K, Huber F, Weiss T, Hofer S, Heese O, Westphal M, Roth P, Weller M, Eisele G. P01.108 Use of complementary and alternative medicine in glioma patients. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.150] [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)
- C Hertler
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - U Roelcke
- Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerl
| | - K Conen
- Department of Oncology, University Hospital Basel, Basel, Switzerl
- McMaster University Department of Family Medicine > Palliative and Supportive Care Clinic, Walker Family Cancer Centre, St. Catharines, ON, Canada
| | - F Huber
- Department of Neurology, Zurich, Switzerl
| | - T Weiss
- Department of Neurology, Zurich, Switzerl
| | - S Hofer
- Department of Oncology, University Hospital Zurich, Zurich, Switzerl
- Luzerner Kantonsspital, Luzern, Switzerl
| | - O Heese
- Department of Neurosurgery, Helios Kliniken Schwerin, Schwerin, Germany
| | - M Westphal
- Department of Neurosurgery, University Hospital Eppendorf, Hamburg, Germany
| | - P Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - M Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - G Eisele
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
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34
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Gramatzki D, Roth P, Rushing E, Weller J, Andratschke N, Hofer S, Korol D, Regli L, Pangalu A, Pless M, Oberle J, Bernays R, Moch H, Rohrmann S, Weller M. Bevacizumab may improve quality of life, but not overall survival in glioblastoma: an epidemiological study. Ann Oncol 2018; 29:1431-1436. [DOI: 10.1093/annonc/mdy106] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Schneider C, Brumberg A, Roller FC, Rixe J, Roth P, Krombach GA. Multimodality imaging evaluation before transcatheter aortic valve implantation: incidence of contrast medium-induced acute kidney injury, risk factors and prognosis. Clin Radiol 2018; 73:502.e1-502.e8. [PMID: 29329731 DOI: 10.1016/j.crad.2017.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/27/2017] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the incidence, risk factors, and prognostic implications of contrast medium-induced acute kidney injury (CI-AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) evaluation. MATERIALS AND METHODS Datasets from 98 out of 207 consecutive patients referred for multidetector computed tomography (MDCT) for TAVI evaluation were eligible for evaluation and were analysed retrospectively. The incidence of CI-AKI was correlated to outcome and to potential risk factors: kidney function (estimated glomerular filtration rate [eGFR]), heart failure, diabetes, amount of contrast medium, and duration of examination period. RESULTS CI-AKI occurred in 67 patients (68.4%) and mainly correlated with eGFR (p=0.01) and the amount of contrast medium as a function of eGFR (p=0.04). CI-AKI occurred before TAVI in 36 (53.7%) patients of which 13 (19.4%) did not undergo TAVI. In-hospital all-cause mortality was 21.4%, and of those 21 patients, 18 (85.7%) had CI-AKI and nine (42.9%) did not undergo TAVI. One-year all-cause mortality was 39.8%, and of those 39 patients who died within 1 year, 31 (79.5%) had CI-AKI. CONCLUSION CI-AKI mostly occurs already before TAVI as a consequence of pre-procedural imaging, which therefore represents the main contributor for CI-AKI in relation to TAVI. Regarding the observation that some patients will ultimately have no benefit because TAVI is not performed and the poor prognosis linked to CI-AKI should encourage improvement in patient selection when referring to pre-procedural imaging.
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Affiliation(s)
- C Schneider
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany.
| | - A Brumberg
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
| | - F C Roller
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
| | - J Rixe
- Department of Cardiology and Angiology, University Hospital Giessen, Giessen, Germany
| | - P Roth
- Department of Cardiac Surgery, University Hospital Giessen, Giessen, Germany
| | - G A Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
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36
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Grieshaber P, Heim N, Herzberg M, Niemann B, Roth P, Böning A. Active Chest Tube Clearance after Cardiac Surgery Reduces Postoperative Reexploration Rates. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- P. Grieshaber
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - N. Heim
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - M. Herzberg
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - B. Niemann
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - P. Roth
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - A. Böning
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
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37
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Grieshaber P, Schneider T, Oster L, Orhan C, Roth P, Niemann B, Böning A. Prophylactic Intra-aortic Balloon Counterpulsation before Surgical Myocardial Revascularization in Patients with Acute Myocardial Infarction Reduces Perioperative Cardiac Injury. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- P. Grieshaber
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - T. Schneider
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - L. Oster
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - C. Orhan
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - P. Roth
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - B. Niemann
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - A. Böning
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
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38
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Niemann B, Salzmann M, Giesler T, Rohrbach S, Mirow N, Vogt S, Grieshaber P, Roth P, Böning A. New Onset Postoperative Atrial Fibrillation: Relevance of Peri- and Intraoperative Characteristics for Incidence of Atrial Fibrillation and Patient Outcome? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B. Niemann
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - M. Salzmann
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - T. Giesler
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - S. Rohrbach
- Institute of Physiology, Justus Liebig University Giessen, Giessen, Germany
| | - N. Mirow
- Department for Cardiac Surgery and Thoracic Vascular Surgery, UKGM - Marburg, Marburg, Germany
| | - S. Vogt
- Department for Cardiac Surgery and Thoracic Vascular Surgery, UKGM - Marburg, Marburg, Germany
| | - P. Grieshaber
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - P. Roth
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - A. Böning
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
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Money N, Newman J, Demissie S, Roth P, Blau J. Anti-microbial stewardship: antibiotic use in well-appearing term neonates born to mothers with chorioamnionitis. J Perinatol 2017; 37:1304-1309. [PMID: 28981079 DOI: 10.1038/jp.2017.137] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/05/2017] [Accepted: 07/18/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine if implementation of a protocol based on a neonatal early-onset sepsis (EOS) calculator developed by Kaiser Permanente would safely reduce antibiotic use in well-appearing term infants born to mothers with chorioamnionitis in the unique setting of an Observation Nursery. STUDY DESIGN Data obtained from a retrospective chart review of well-appearing term infants born between 2009 and 2016 were entered into the EOS calculator to obtain management recommendations. RESULTS Three hundred and sixty-two infants met the study criteria. Management according to the EOS calculator would reduce antibiotic use from 99% to 2.5% (P<0.0001) of patients. Average length of therapy would also decrease from 2.08 to 0.05 days (P<0.0001). One infant, who remained asymptomatic, had Enterococcus bacteremia and received a 7-day course of broad-spectrum antibiotics. CONCLUSIONS Culture-positive sepsis in asymptomatic neonates born to mothers with chorioamnionitis is rare. Management according to the EOS calculator would markedly reduce the potential complications of antibiotic use. These data should initiate re-examination of existing protocols for management of this cohort of patients.
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Affiliation(s)
- N Money
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - J Newman
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - S Demissie
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, Staten Island, NY, USA
| | - P Roth
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA.,Department of Pediatrics, Hofstra Northwell School of Medicine, Staten Island, NY, USA
| | - J Blau
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA.,Department of Pediatrics, Hofstra Northwell School of Medicine, Staten Island, NY, USA
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Seystahl K, Burghardt I, Gramatzki D, Schneider H, Papachristodoulou A, Hasenbach K, Frei K, Janicot M, Roth P, Weller M. P01.30 In vivo effects of isoform-specific inhibition of TGF-β3 in glioblastoma. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.106] [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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41
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Weiss T, Weller M, Pruschy M, Sentman C, Roth P. OS09.3 Synergistic activity of NKG2D-based chimeric antigen receptor (CAR)-T cells and radiotherapy against glioma. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Silginer M, Nagy S, Happold C, Schneider H, Weller M, Roth P. P08.56 Autocrine activation of the IFN signaling pathway modulates the immunogenicity of glioma cells. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.245] [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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Papachristodoulou A, Weller M, Hasenbach K, Janicot M, Roth P. P08.48 Therapeutic targeting of TGF- β1/2 in experimental gliomas. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.237] [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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44
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Gramatzki D, Roth P, Rushing EJ, Weller J, Andratschke N, Hofer S, Regli L, Oberle J, Rohrmann S, Weller M. OS01.6 Glioblastoma in the era of bevacizumab: an epidemiological study in the Canton of Zurich, Switzerland. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Grieshaber P, Roth P, Böning A, Niemann B. Steady Establishment of Conferences on Perioperative Morbidity and Mortality - Continuous Assessment of Treatment and Process Quality. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P. Grieshaber
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - P. Roth
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - A. Böning
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - B. Niemann
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
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Weiss T, Schneider H, Silginer M, Steinle A, Pruschy M, Weller M, Roth P. P08.22 The NKG2D System mediates anti-tumor effects of chemotherapy and radiotherapy against glioblastoma. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.155] [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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Seystahl K, Burghardt I, Schneider H, Papachristodoulou A, Hasenbach K, Janicot M, Roth P, Weller M. P01.02 Biological role and therapeutic targeting of TGF-β3 in glioblastoma. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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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Böning A, Grieshaber P, Glass S, Roth P, Niemann B, Wolff M. Individualized Approach for Patients Undergoing Cardiac Surgery under Dual-Platelet Inhibition. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571784] [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: 10/22/2022]
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Niemann B, Dominik E, Rohrbach S, Roth P, Djufri M, Grieshaber P, Böning A. Stroke in Surgical Post-MAZE-Patients: Freedom from Ischemic and Bleeding Complications in an All Comers Study over 24 Months Post MAZE. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571548] [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: 10/22/2022]
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Grieshaber P, Oster L, Schneider T, Roth P, Orhan C, Niemann B, Böning A. Delaying Surgery in Acute Myocardial Infarction: Safe or Senseless? Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571785] [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: 10/22/2022]
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