1
|
Lim-Fat MJ, Iorgulescu JB, Rahman R, Bhave V, Muzikansky A, Woodward E, Whorral S, Allen M, Touat M, Li X, Xy G, Patel J, Gerstner ER, Kalpathy-Cramer J, Youssef G, Chukwueke U, McFaline-Figueroa JR, Nayak L, Lee EQ, Reardon DA, Beroukhim R, Huang RY, Bi WL, Ligon KL, Wen PY. Clinical and Genomic Predictors of Adverse Events in Newly Diagnosed Glioblastoma. Clin Cancer Res 2024; 30:1327-1337. [PMID: 38252427 DOI: 10.1158/1078-0432.ccr-23-3018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE Adverse clinical events cause significant morbidity in patients with GBM (GBM). We examined whether genomic alterations were associated with AE (AE) in patients with GBM. EXPERIMENTAL DESIGN We identified adults with histologically confirmed IDH-wild-type GBM with targeted next-generation sequencing (OncoPanel) at Dana Farber Cancer Institute from 2013 to 2019. Seizure at presentation, lymphopenia, thromboembolic events, pseudoprogression, and early progression (within 6 months of diagnosis) were identified as AE. The biologic function of genetic variants was categorized as loss-of-function (LoF), no change in function, or gain-of-function (GoF) using a somatic tumor mutation knowledge base (OncoKB) and consensus protein function predictions. Associations between functional genomic alterations and AE were examined using univariate logistic regressions and multivariable regressions adjusted for additional clinical predictors. RESULTS Our study included 470 patients diagnosed with GBM who met the study criteria. We focused on 105 genes that had sequencing data available for ≥ 90% of the patients and were altered in ≥10% of the cohort. Following false-discovery rate (FDR) correction and multivariable adjustment, the TP53, RB1, IGF1R, and DIS3 LoF alterations were associated with lower odds of seizures, while EGFR, SMARCA4, GNA11, BRD4, and TCF3 GoF and SETD2 LoF alterations were associated with higher odds of seizures. For all other AE of interest, no significant associations were found with genomic alterations following FDR correction. CONCLUSIONS Genomic biomarkers based on functional variant analysis of a routine clinical panel may help identify AE in GBM, particularly seizures. Identifying these risk factors could improve the management of patients through better supportive care and consideration of prophylactic therapies.
Collapse
Affiliation(s)
- Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J Bryan Iorgulescu
- Molecular Diagnostics Laboratory, Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rifaquat Rahman
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Varun Bhave
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alona Muzikansky
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Eleanor Woodward
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sydney Whorral
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marie Allen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mehdi Touat
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | | | | | - Jay Patel
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth R Gerstner
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - J Ricardo McFaline-Figueroa
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rameen Beroukhim
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Huang
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keith L Ligon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
2
|
Christ SM, Youssef G, Tanguturi SK, Cagney D, Shi D, McFaline-Figueroa JR, Chukwueke U, Lee EQ, Hertler C, Andratschke N, Weller M, Reardon DA, Haas-Kogan D, Guckenberger M, Wen PY, Rahman R. Re-irradiation of recurrent IDH-wildtype glioblastoma in the bevacizumab and immunotherapy era: Target delineation, outcomes and patterns of recurrence. Clin Transl Radiat Oncol 2024; 44:100697. [PMID: 38046107 PMCID: PMC10689476 DOI: 10.1016/j.ctro.2023.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 10/28/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction and background While recurrent glioblastoma patients are often treated with re-irradiation, there is limited data on the use of re-irradiation in the setting of bevacizumab (BEV), temozolomide (TMZ) re-challenge, or immune checkpoint inhibition (ICI). We describe target delineation in patients with prior anti-angiogenic therapy, assess safety and efficacy of re-irradiation, and evaluate patterns of recurrence. Materials and methods Patients with a histologically confirmed diagnosis of glioblastoma treated at a single institution between 2013 and 2021 with re-irradiation were included. Tumor, treatment and clinical data were collected. Logistic and Cox regression analysis were used for statistical analysis. Results One hundred and seventeen recurrent glioblastoma patients were identified, receiving 129 courses of re-irradiation. In 66 % (85/129) of cases, patients had prior BEV. In the 80 patients (62 %) with available re-irradiation plans, 20 (25 %) had all T2/FLAIR abnormality included in the gross tumor volume (GTV). Median overall survival (OS) for the cohort was 7.3 months, and median progression-free survival (PFS) was 3.6 months. Acute CTCAE grade ≥ 3 toxicity occurred in 8 % of cases. Concurrent use of TMZ or ICI was not associated with improved OS nor PFS. On multivariable analysis, higher KPS was significantly associated with longer OS (p < 0.01). On subgroup analysis, patients with prior BEV had significantly more marginal recurrences than those without (26 % vs. 13 %, p < 0.01). Conclusion Re-irradiation can be safely employed in recurrent glioblastoma patients. Marginal recurrence was more frequent in patients with prior BEV, suggesting a need to consider more inclusive treatment volumes incorporating T2/FLAIR abnormality.
Collapse
Affiliation(s)
- Sebastian M. Christ
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shyam K. Tanguturi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Daniel Cagney
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Diana Shi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eudocia Q. Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caroline Hertler
- Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - David A. Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Ling AL, Solomon IH, Landivar AM, Nakashima H, Woods JK, Santos A, Masud N, Fell G, Mo X, Yilmaz AS, Grant J, Zhang A, Bernstock JD, Torio E, Ito H, Liu J, Shono N, Nowicki MO, Triggs D, Halloran P, Piranlioglu R, Soni H, Stopa B, Bi WL, Peruzzi P, Chen E, Malinowski SW, Prabhu MC, Zeng Y, Carlisle A, Rodig SJ, Wen PY, Lee EQ, Nayak L, Chukwueke U, Gonzalez Castro LN, Dumont SD, Batchelor T, Kittelberger K, Tikhonova E, Miheecheva N, Tabakov D, Shin N, Gorbacheva A, Shumskiy A, Frenkel F, Aguilar-Cordova E, Aguilar LK, Krisky D, Wechuck J, Manzanera A, Matheny C, Tak PP, Barone F, Kovarsky D, Tirosh I, Suvà ML, Wucherpfennig KW, Ligon K, Reardon DA, Chiocca EA. Clinical trial links oncolytic immunoactivation to survival in glioblastoma. Nature 2023; 623:157-166. [PMID: 37853118 PMCID: PMC10620094 DOI: 10.1038/s41586-023-06623-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023]
Abstract
Immunotherapy failures can result from the highly suppressive tumour microenvironment that characterizes aggressive forms of cancer such as recurrent glioblastoma (rGBM)1,2. Here we report the results of a first-in-human phase I trial in 41 patients with rGBM who were injected with CAN-3110-an oncolytic herpes virus (oHSV)3. In contrast to other clinical oHSVs, CAN-3110 retains the viral neurovirulence ICP34.5 gene transcribed by a nestin promoter; nestin is overexpressed in GBM and other invasive tumours, but not in the adult brain or healthy differentiated tissue4. These modifications confer CAN-3110 with preferential tumour replication. No dose-limiting toxicities were encountered. Positive HSV1 serology was significantly associated with both improved survival and clearance of CAN-3110 from injected tumours. Survival after treatment, particularly in individuals seropositive for HSV1, was significantly associated with (1) changes in tumour/PBMC T cell counts and clonal diversity, (2) peripheral expansion/contraction of specific T cell clonotypes; and (3) tumour transcriptomic signatures of immune activation. These results provide human validation that intralesional oHSV treatment enhances anticancer immune responses even in immunosuppressive tumour microenvironments, particularly in individuals with cognate serology to the injected virus. This provides a biological rationale for use of this oncolytic modality in cancers that are otherwise unresponsive to immunotherapy (ClinicalTrials.gov: NCT03152318 ).
Collapse
Affiliation(s)
- Alexander L Ling
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Isaac H Solomon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ana Montalvo Landivar
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hiroshi Nakashima
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Jared K Woods
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andres Santos
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nafisa Masud
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Geoffrey Fell
- Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xiaokui Mo
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Ayse S Yilmaz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - James Grant
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Abigail Zhang
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Joshua D Bernstock
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Erickson Torio
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hirotaka Ito
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Junfeng Liu
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Naoyuki Shono
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Michal O Nowicki
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Triggs
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Patrick Halloran
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Raziye Piranlioglu
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Himanshu Soni
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Brittany Stopa
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Wenya Linda Bi
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Pierpaolo Peruzzi
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ethan Chen
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Seth W Malinowski
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael C Prabhu
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yu Zeng
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anne Carlisle
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Patrick Y Wen
- Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eudocia Quant Lee
- Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lakshmi Nayak
- Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ugonma Chukwueke
- Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - L Nicolas Gonzalez Castro
- Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Sydney D Dumont
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Tracy Batchelor
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Daniel Kovarsky
- Department of Molecular Cell Biology, Weizmann Institute of Medical Sciences, Tel Aviv, Israel
| | - Itay Tirosh
- Department of Molecular Cell Biology, Weizmann Institute of Medical Sciences, Tel Aviv, Israel
| | - Mario L Suvà
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kai W Wucherpfennig
- Department of Cancer Immunology and Virology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David A Reardon
- Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - E Antonio Chiocca
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
4
|
Ly KI, Richardson LG, Liu M, Muzikansky A, Cardona J, Lou K, Beers AL, Chang K, Brown JM, Ma X, Reardon DA, Arrillaga-Romany IC, Forst DA, Jordan JT, Lee EQ, Dietrich J, Nayak L, Wen PY, Chukwueke U, Giobbie-Hurder A, Choi BD, Batchelor TT, Kalpathy-Cramer J, Curry WT, Gerstner ER. Bavituximab Decreases Immunosuppressive Myeloid-Derived Suppressor Cells in Newly Diagnosed Glioblastoma Patients. Clin Cancer Res 2023; 29:3017-3025. [PMID: 37327319 DOI: 10.1158/1078-0432.ccr-23-0203] [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] [Received: 01/20/2023] [Revised: 03/29/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE We evaluated the efficacy of bavituximab-a mAb with anti-angiogenic and immunomodulatory properties-in newly diagnosed patients with glioblastoma (GBM) who also received radiotherapy and temozolomide. Perfusion MRI and myeloid-related gene transcription and inflammatory infiltrates in pre-and post-treatment tumor specimens were studied to evaluate on-target effects (NCT03139916). PATIENTS AND METHODS Thirty-three adults with IDH--wild-type GBM received 6 weeks of concurrent chemoradiotherapy, followed by 6 cycles of temozolomide (C1-C6). Bavituximab was given weekly, starting week 1 of chemoradiotherapy, for at least 18 weeks. The primary endpoint was proportion of patients alive at 12 months (OS-12). The null hypothesis would be rejected if OS-12 was ≥72%. Relative cerebral blood flow (rCBF) and vascular permeability (Ktrans) were calculated from perfusion MRIs. Peripheral blood mononuclear cells and tumor tissue were analyzed pre-treatment and at disease progression using RNA transcriptomics and multispectral immunofluorescence for myeloid-derived suppressor cells (MDSC) and macrophages. RESULTS The study met its primary endpoint with an OS-12 of 73% (95% confidence interval, 59%-90%). Decreased pre-C1 rCBF (HR, 4.63; P = 0.029) and increased pre-C1 Ktrans were associated with improved overall survival (HR, 0.09; P = 0.005). Pre-treatment overexpression of myeloid-related genes in tumor tissue was associated with longer survival. Post-treatment tumor specimens contained fewer immunosuppressive MDSCs (P = 0.01). CONCLUSIONS Bavituximab has activity in newly diagnosed GBM and resulted in on-target depletion of intratumoral immunosuppressive MDSCs. Elevated pre-treatment expression of myeloid-related transcripts in GBM may predict response to bavituximab.
Collapse
Affiliation(s)
- K Ina Ly
- Stephen E. and Catherine Pappas Center for Neuro-Oncology Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Leland G Richardson
- Department of Neurosurgery Massachusetts General Hospital, Boston, Massachusetts
| | - Mofei Liu
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alona Muzikansky
- Department of Biostatistics Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jonathan Cardona
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Lou
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew L Beers
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James M Brown
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - Xiaoyue Ma
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Isabel C Arrillaga-Romany
- Stephen E. and Catherine Pappas Center for Neuro-Oncology Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Deborah A Forst
- Stephen E. and Catherine Pappas Center for Neuro-Oncology Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Justin T Jordan
- Stephen E. and Catherine Pappas Center for Neuro-Oncology Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jorg Dietrich
- Stephen E. and Catherine Pappas Center for Neuro-Oncology Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Bryan D Choi
- Department of Neurosurgery Massachusetts General Hospital, Boston, Massachusetts
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - William T Curry
- Department of Neurosurgery Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth R Gerstner
- Stephen E. and Catherine Pappas Center for Neuro-Oncology Massachusetts General Hospital Cancer Center, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
5
|
Youssef G, Aquilanti E, Muzikansky A, Miller J, Vogelzang J, Lapinskas E, Lim-Fat MJ, Rahman R, Beroukhim R, Bi WL, Chukwueke U, Castro LNG, Lee E, McFaline-Figueroa JR, Nayak L, Reardon DA, Ligon K, Wen PY. PATH-15. THE PROGNOSTIC IMPLICATION OF MGMT PROMOTER METHYLATION IN IDH-MUTANT GLIOMAS. Neuro Oncol 2022. [PMCID: PMC9660908 DOI: 10.1093/neuonc/noac209.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
MGMT promoter methylation in IDH-mutant gliomas was associated with improved survival in a recent study (PMID 35386566) but did not account for the updated WHO classification of CNS tumors. We evaluated the prognostic value of MGMT methylation in IDH-mutant gliomas incorporating the 2021 WHO classification.
METHODS
We retrospectively identified 431 patients with IDH-mutant gliomas treated at a single institution from 2010-2020. Kaplan-Meier method was used to estimate OS and PFS rates. Log-Rank test was used to evaluate differences between groups.
RESULTS
Median age was 36.2 years. MGMT promoter was methylated in 49.6%, unmethylated in 17.2%, partially methylated in 6.7%, and untested in 26.5%. Histological diagnosis was consistent with astrocytoma in 45.7%, oligodendroglioma in 33.9%, glioblastoma in 16.4%, and oligoastrocytoma in 4%. After accounting for 1p/19q and CDKN2A statuses, 190 patients had an integrated diagnosis of astrocytoma, grade 2 or 3; 94 had astrocytoma, grade 4; and 147 had oligodendroglioma, grade 2 or 3. There were 101 death events. Median OS was 33.36 years and median PFS was 5.67 years in MGMT methylated gliomas, compared to median OS of 12.54 years (p=0.0064) and median PFS of 3.91 years (p=0.0034) in unmethylated tumors. Upon univariate subgroup analysis, MGMT methylation was associated with significantly longer OS in histological astrocytomas, grade 2 or 4. However, when stratifying patients according to 2021 WHO classification of CNS tumors, there was no significant difference in OS between MGMT methylated and unmethylated astrocytomas or oligodendrogliomas, irrespective of WHO grade.
CONCLUSION
MGMT promoter methylation was associated with prolonged OS in histological astrocytomas, IDH-mutant. However, MGMT status did not impact survival after incorporating 2021 WHO classification of CNS tumors, suggesting that 1p/19q co-deletion and CDKN2A homozygous deletion are stronger prognostic factors in our cohort. The number of survival events was limited; larger datasets are required for more definitive conclusions.
Collapse
Affiliation(s)
| | | | | | - Julie Miller
- Department of Neurology, Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School , Boston , USA
| | - Jayne Vogelzang
- Dana Farber / Boston Children’s Cancer and Blood Disorder Center , Boston , USA
| | | | - Mary Jane Lim-Fat
- Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
| | | | | | | | | | | | | | | | | | | | - Keith Ligon
- Dana-Farber Cancer Institute , Boston, MA , USA
| | | |
Collapse
|
6
|
Saraf A, Hill C, Youssef G, Christ S, Tanguturi S, McFaline-Figueroa JR, Chukwueke U, Lee E, Reardon DA, Arnaout O, Bi WL, Haas-Kogan D, Ligon K, Alexander B, Wen PY, Rahman R. BIOM-37. EVALUATION OF TEMPORALIS MUSCLE THICKNESS WITH TOXICITY AND SURVIVAL IN GLIOBLASTOMA PATIENTS RECEIVING CHEMORADIATION. Neuro Oncol 2022. [PMCID: PMC9660297 DOI: 10.1093/neuonc/noac209.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Treatment-related toxicity is common in patients with glioblastoma (GBM) receiving chemotherapy and radiotherapy (RT). Temporalis muscle thickness (TMT) is a biomarker associated with sarcopenia and worse clinical outcomes in GBM, however its relation to treatment toxicity is less studied. We hypothesize that TMT may predict toxicity and survival in GBM patients.
METHODS
We reviewed consecutive patients with IDH-wildtype GBM treated from 2014-2019 at a single academic center. TMT was retrospectively assessed on T1-weighted MRI scans and dichotomized based upon previously validated sex-specific cutoff values. TMT was measured on baseline MRI scan at time of diagnosis. Cox regression multivariable analysis (MVA) was used to assess survival.
RESULTS
We evaluated 351 patients with median age of 60y (range 20-94) and median follow-up of 14mo. Most patients were male (59%), baseline KPS >70 (95%), and MGMT unmethylated (55%). After maximal safe resection, most patients received standard (90%) or hypofractionated (10%) RT with concurrent systemic therapy (89%). On MVA, baseline low TMT (HR 1.93, p=0.01), age >65y, baseline KPS, and MGMT-unmethylated status were associated with worse OS. On MVA, baseline low TMT (HR 1.95, p=0.01), age >65y, MGMT-unmethylated status, and discontinuing systemic therapy were associated with worse profession-free survival (PFS). 21 patients did not complete anticipated treatment course of chemoradiation and adjuvant systemic therapy due to toxicity, primarily thrombocytopenia, associated with worse OS on MVA (HR 1.99, p< 0.01). Low TMT was associated with higher risk of stopping treatment due to adverse events (OR 5.25, p< 0.01) independent of age, sex, extent of resection, RT dose on MVA.
CONCLUSION
Baseline low TMT was associated with worse PFS and OS, and it was associated with treatment interruption due to treatment toxicity in GBM patients. While further validation is needed, TMT may help identify patients who will benefit from aggressive symptom management or treatment deintensification.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Daphne Haas-Kogan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center , Boston, MA , USA
| | - Keith Ligon
- Dana-Farber Cancer Institute , Boston, MA , USA
| | - Brian Alexander
- Department of Radiation Oncology, Dana-Farber Cancer Institute , Boston , USA
| | | | | |
Collapse
|
7
|
Budhu J, Porter A, Jackson S, Lee E, McFaline-Figueroa JR, Willmarth N, Dalmage M, Kawachi I, Arons D, Chang SM, Wen PY, Hervey-Jumper SL, Chukwueke U. DISP-14. DEFINING INTERVENTIONS AND METRICS TO IMPROVE DIVERSITY IN CNS CLINICAL TRIAL PARTICIPATION: A SNO AND RANO EFFORT. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Despite major strides in cancer research, care, and therapy, these advances have not been equitable across race and ethnicity. Groups underrepresented in medicine (URM) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black and Latino Americans represent 29% of the population but only reflect 8% of oncology clinical trial participants. Recent studies have shown that this disparity is also present in neuro-oncology as women, Black, and Latino Americans remain under-accrued in clinical trials. Brain tumor patients already face unique barriers to clinical trial enrollment and completion due to disease-specific conditions–such as impaired motor function, cognition, language deficits, and caregiver dependency–which pose additional difficulties in clinical trial consent, enrollment, and adherence. As part of this collaborative initiative, we evaluated the impact of how a lack of diversity in cancer research is detrimental to scientific discovery and propose interventions focused on improving URM engagement with clinical research. Recommendations include the creation of inclusive trial design at the onset, decreasing barriers to care, expanding trial eligibility, and equitable access to tumor profiling for personalized medical trials. Additionally, setting reasonable metrics and goals for accrual and engagement with patient and community stakeholders will ultimately help to diversify trial participants. Lastly, diversification and inclusion practices within the neuro-oncology workforce, including all personnel involved in clinical research, will help to minimize bias, promote concordant care, and assist with developing sustainable solutions. The diversification of participation in neuro-oncology clinical trials is imperative. The lack of diversity in clinical trials can contribute to improper generalizability of treatment efficacy, resulting in potentially harmful practices. Equitable access and inclusion of URM brain tumor patients will not only enhance research discoveries but will also result in improved patient care for all cancer patients.
Collapse
Affiliation(s)
- Joshua Budhu
- Memorial Sloan Kettering Cancer Center , Boston, MA , USA
| | | | | | | | | | | | | | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health , Boston , USA
| | | | - Susan M Chang
- University of California, San Francisco , San Francisco, CA , USA
| | | | | | | |
Collapse
|
8
|
Ricardo McFaline-Figueroa J, Prins R, Qiao Y, Sun L, Li G, Kim J, Lee E, Nayak L, Chukwueke U, Beroukhim R, Batchelor T, Chiocca EA, Doherty L, Stefanik J, Partridge K, Spearman A, Lavallee M, Myers A, Laforest-Roys C, Garcia RF, Bi WL, Arnaout O, Peruzzi P, Cosgrove GR, Ligon K, Arrillaga-Romany I, Clarke J, Reardon DA, Cloughesy T, Wen PY. CTIM-25. NEOADJUVANT ANTI-PD1 IMMUNOTHERAPY FOR SURGICALLY ACCESSIBLE RECURRENT GLIOBLASTOMA: CLINICAL AND MOLECULAR OUTCOMES OF A STAGE 2 SINGLE-ARM EXPANSION COHORT. Neuro Oncol 2022. [PMCID: PMC9660825 DOI: 10.1093/neuonc/noac209.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Glioblastoma is immunologically “cold”, with little clinical response to single-agent immune-checkpoint inhibitors (ICI). Our previous randomized study of neoadjuvant and adjuvant pembrolizumab versus adjuvant pembrolizumab in recurrent glioblastoma identified a molecular signature for ICI and suggested that neoadjuvant pembrolizumab improved survival (PMID30742122). We extended these original findings with a single-arm expansion cohort of glioblastoma patients at first or second relapse undergoing surgical resection for recurrent disease. Eligibility was identical to the original study. Patients receiving > 4mg dexamethasone, or with prior immunotherapy or anti-angiogenic therapy were excluded. The primary objective was to determine the effect of neoadjuvant pembrolizumab on cell cycle/cancer proliferation genes. Secondary objectives were PFS-6 and OS. Twenty-five patients received neoadjuvant pembrolizumab followed by tumor resection and adjuvant pembrolizumab until progression or unacceptable toxicity. The median age of participants was 60 years and median KPS was 90. Ninety-six percent of tumors were IDH wild-type and 48% were MGMT promoter methylated. Neoadjuvant pembrolizumab continued to induce alterations in the tumor microenvironment (T-cell/IFN upregulation, cell cycle downregulation; molecular responders (MR)), but the proportion of MR in this trial was 36% compared with 70% in the original treatment cohort. Median OS was 6.8 months. There were no CTCAE grade 4-5 AEs attributable to pembrolizumab. Further analysis of prognostic differences between stage 1 and 2 subjects is underway, as are additional immune and genotypic correlates to further define molecular changes induced by pembrolizumab. Anti-PD1 monotherapy triggers an intra-tumoral genetic signature associated with interferon-γ response and suppression of cell cycle/cancer proliferation in recurrent glioblastoma, though does not extend OS. This surgical window-of-opportunity paradigm allows for attribution of molecular effects to single agents. Future work will evaluate the differences in patient population, tumor characteristics, and address additional immune checkpoints and/or signaling pathways that can be targeted to augment the effectiveness of anti-PD1 in glioblastoma.
Collapse
Affiliation(s)
| | - Robert Prins
- University of California, Los Angeles , Los Angeles , USA
| | - Yu Qiao
- David Geffen School of Medicine at UCLA , Los Angeles, CA , USA
| | | | - Gang Li
- University of California Los Angeles , Los Angeles , USA
| | - Jiyoon Kim
- University of California Los Angeles , Los Angeles , USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keith Ligon
- Dana-Farber Cancer Institute , Boston, MA , USA
| | | | - Jennifer Clarke
- University of California, San Francisco , San Francisco , USA
| | | | | | | |
Collapse
|
9
|
Lim-Fat MJ, Rahman R, Iorgulescu B, Bhave V, Youssef G, Allen M, Chukwueke U, McFaline-Figueroa JR, Nayak L, Lee E, Reardon DA, Batchelor T, Beroukhim R, Huang R, Bi WL, Ligon K, Wen PY. BIOM-47. PREDICTORS OF SEIZURE AT ONSET USING A FUNCTIONAL VARIANT ANALYSIS OF TARGETED NEXT GENERATION SEQUENCING IN GBM. Neuro Oncol 2022. [PMCID: PMC9660694 DOI: 10.1093/neuonc/noac209.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Adverse events (AE) including seizures cause significant morbidity in patients with GBM. We propose a novel method for assessing genomic predictors of AEs using results from a clinical targeted sequencing platform with variant function analysis.
METHODS
We identified 1,011 consecutive adult patients with newly diagnosed, histologically confirmed IDH-wildtype GBM with targeted exome NGS (Oncopanel) at Dana-Farber Cancer Institute from 2013-2019. Seizure at presentation was retrospectively identified as an AE. Biologic function (high loss, low loss, neutral, low gain and high gain) was assigned to variants using a three-tiered approach leveraging a genetic variant database (OncoKB), followed by analysis using protein prediction tools (Sift, Polyphen2 and Provean). Univariate logistic regression was performed for each relevant altered gene against the outcome of interest with false-discovery rate correction. Genes associated with seizure at presentation were included iteratively in a multivariate logistic model including other predictors of the outcome.
RESULTS
Our analysis included 470 GBM patients with 107 genes and 12 whole chromosome or arm level candidate variants covered by all versions of Oncopanel and with >10% alteration. Seizure at presentation occurred in 143/463 patients (31%) and was associated with EGFR amplification (high gain) (OR: 2.76, 95% CI: 1.4-5.3, p = 0.04). In a multivariate analysis (including age, sex, and preoperative tumor volume), EGFR amplification remained statistically significant (OR: 1.5, 95% CI: 1.0-2.2, p = 0.03).
CONCLUSION
Genomic biomarkers based on functional variant analysis of a routine clinical panel may predict adverse events in GBM. Seizure at presentation was independently associated with EGFR amplification. Our ongoing analysis will look at predictors of myelosuppression, thromboembolism, pseudoprogression and early progression using a similar approach. Identifying molecular risk factors could improve the management of patients through supportive care and consideration of prophylactic therapies.
Collapse
Affiliation(s)
- Mary Jane Lim-Fat
- Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keith Ligon
- Dana-Farber Cancer Institute , Boston, MA , USA
| | | |
Collapse
|
10
|
Iwamoto F, Tanguturi S, Desai A, Nayak L, Uhlmann E, Wang T, Lustig R, Hertan L, Bagley S, Hayden J, Laforest-Roys C, Muzikansky A, McCluskey C, Chukwueke U, McFaline-Figueroa JR, Lee E, Wen PY, Reardon D. CTIM-18. PHASE 2 STUDY OF PD-1 BLOCKADE WITH PEMBROLIZUMAB PLUS RE-IRRADIATION FOR RECURRENT GLIOBLASTOMA (RGBM) (NCT03661723). Neuro Oncol 2022. [PMCID: PMC9661147 DOI: 10.1093/neuonc/noac209.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Re-irradiation is therapeutically considered for select rGBM patients and may induce immunogenic cell death to stimulate anti-tumor immune responses. Our phase 2 study of re-irradiation with pembrolizumab among rGBM patients evaluated the efficacy and safety of this regimen.
METHODS
Adult rGBM patients with KPS ≥ 70, a maximum supratentorial tumor diameter of 6 cm who were on ≤ 2mg dexamethasone/day and were ≥ 6 months from initial conventional radiation therapy were eligible. Cohort A (bevacizumab [BEV]-naïve) had ≤ 2 prior progressions while cohort B (BEV-refractory) allowed unlimited progressions but only one on prior BEV. Re-irradiation included 35 Gy over 10 fractions to residual enhancing (cohort A) as well as enhancing + non-enhancing (cohort B) disease. Pembrolizumab was administered at 200 mg every three weeks beginning within one week of re-irradiation start. BEV was administered at 15 mg/kg every three weeks for cohort B only.
RESULTS
Sixty patients enrolled (n = 30 per cohort) with a median age of 61 years (range 20-76), 47% were female and 53% enrolled after 2 or more progressions. Grade 3 events deemed at least possibly related to study therapy in > one patient for cohort A included headache (n = 2) and for cohort B included elevated ALT (n = 2) and hypertension (n = 5). No grade 4 events occurred in more than single patients per cohort and no grade 5 events occurred. Median PFS and PFS-6 were 4.9 months (95% CI: 3.5, 5.6) and 26.0% (95% CI: 12.3%, 43.0%) for cohort A and 4.14 months (95% CI: 3.45, 5.42) and 16.9% (95% CI: 5.4, 33.7) for cohort B. Median survival for cohorts A and B were 11.5 months (95% CI: 9.6, 14.1) and 7.6 months (95% CI 5.5, 9.3), respectively.
CONCLUSIONS
Re-irradiation with pembrolizumab was overall well tolerated and achieved comparable efficacy to historical salvage therapy established with lomustine.
Collapse
Affiliation(s)
- Fabio Iwamoto
- Division of Neuro-Oncology, New York-Presbyterian/Columbia University Medical Center , New York, NY , USA
| | | | - Arati Desai
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | | | - Erik Uhlmann
- Beth Israel Deaconess Medical Center , Boston , USA
| | - Tony Wang
- Columbia Irving Medical Center , New York City , USA
| | - Robert Lustig
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | | | - Stephen Bagley
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Antonio Chiocca E, Nakashima H, Mo X, Solomon I, Ling A, Woods J, Bernstock J, Villa G, Piranlioglu R, Landivar AM, Masud N, Triggs D, Grant J, Wen PY, Lee E, Nayak L, Chukwueke U, Batchelor T, Krisky D, Aguilar-Cordova E, Aguilar LK, Fernandez S, Matheny C, Manzanera A, Barone F, Tak PP, Ligon K, Reardon DA. CTIM-09. ENRICHED TCR/BCR VDJ REARRANGEMENTS CORRELATE WITH MRI AND SURVIVAL OUTCOMES IN PATIENTS WITH RECURRENT HIGH-GRADE GLIOMA TREATED WITH CAN-3110. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
CAN-3110 (rQNestin34.5v2) is an HSV-1 oncolytic viral immunotherapy with one copy of the inflammatory ICP34.5 gene under transcriptional control of the Nestin glioma-specific promoter. We completed a phase 1 sequential dose-escalation trial of CAN-3110 in recurrent high-grade glioma (rHGG).
METHODS
CAN-3110 was injected intratumorally starting at 1x106 plaque forming units (pfu) and dose- escalated by half log up to 1x1010 pfu in biopsy confirmed rHGG. An expansion cohort of 12 patients was then accrued at 1x109 pfus. Blood and post-injection rHGG were collected.
RESULTS
41 rHGG patients were treated (42 separate interventions): median age 56 years (range 27-74); 21 females, 20 males; median baseline KPS 90 (range 70-100). CAN-3110 administration was well-tolerated with no dose limiting toxicities. Median overall survival (mOS) was 11.9 months. Histologic and molecular analyses showed significantly increased T cell infiltration in post treatment samples with elevated T cell and/or B cell receptor (TCR/BCR) transcripts which correlated with patient survival (HR 0.26 for patients with elevated TCR/BCR rearrangements as compared to patients with low). Volumetric analyses of MRI suggest a trend between reduction in the relative change in tumor growth, TCR/BCRs enrichment and survival in CAN-3110 treated patients.
CLINICAL IMPLICATIONS
Administration of CAN-3110 into rHGG was well tolerated. OS of CAN-3110 treated subjects compare favorably to historical controls. The association of increased TCR/BCR transcripts with survival suggests that CAN-3110 induces T cell responses against rHGG, supporting further clinical development of CAN-3110 viral immunotherapy.
Collapse
Affiliation(s)
| | | | - Xiaokui Mo
- Ohio State University , Columbus, OH , USA
| | | | | | - Jared Woods
- Dana Farber Cancer Institute , Boston, MA , USA
| | | | | | | | | | | | | | - James Grant
- Brigham and Women's Hospital , Boston, MA , USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keith Ligon
- Dana-Farber Cancer Institute , Boston, MA , USA
| | | |
Collapse
|
12
|
Lim-Fat MJ, Youssef GC, Touat M, Iorgulescu JB, Whorral S, Allen M, Rahman R, Chukwueke U, McFaline-Figueroa JR, Nayak L, Lee EQ, Batchelor TT, Arnaout O, Peruzzi PP, Chiocca EA, Reardon DA, Meredith D, Santagata S, Beroukhim R, Bi WL, Ligon KL, Wen PY. Clinical utility of targeted next-generation sequencing assay in IDH-wildtype glioblastoma for therapy decision-making. Neuro Oncol 2022; 24:1140-1149. [PMID: 34878541 PMCID: PMC9248387 DOI: 10.1093/neuonc/noab282] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Targeted gene NGS testing is available through many academic institutions and commercial entities and is increasingly incorporated in practice guidelines for glioblastoma (GBM). This single-center retrospective study aimed to evaluate the clinical utility of incorporating NGS results in the management of GBM patients at a clinical trials-focused academic center. METHODS We identified 1011 consecutive adult patients with pathologically confirmed GBM (IDHwt or IDHmut) who had somatic tumor sequencing (Oncopanel, ~500 cancer gene panel) at DFCI from 2013-2019. Clinical records of all IDHwt GBM patients were reviewed to capture clinical trial enrollment and off-label targeted therapy use based on NGS results. RESULTS Of the 557 IDHwt GBM patients with sequencing, 182 entered clinical trials at diagnosis (32.7%) and 213 (38.2%) entered after recurrence. Sequencing results for 130 patients (23.3%) were utilized for clinical trial enrollment for either targeted therapy indications (6.9 % upfront and 27.7% at recurrent clinical trials and 3.1% for off-label targeted therapy) or exploratory studies (55.4% upfront and 6.9% recurrent clinical trials). Median overall survival was 20.1 months with no survival difference seen between patients enrolled in clinical trials compared to those who were not, in a posthoc analysis. CONCLUSIONS While NGS testing has become essential for improved molecular diagnostics, our study illustrates that targeted gene panels remain underutilized for selecting therapy in GBM-IDHwt. Targeted therapy and clinical trial design remain to be improved to help leverage the potential of NGS in clinical care.
Collapse
Affiliation(s)
- Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gilbert C Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mehdi Touat
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - J Bryan Iorgulescu
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sydney Whorral
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marie Allen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rifaquat Rahman
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - J Ricardo McFaline-Figueroa
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy T Batchelor
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pier Paolo Peruzzi
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David Meredith
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sandro Santagata
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rameen Beroukhim
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Keith L Ligon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Brastianos PK, Kim AE, Giobbie-Hurder A, Lee EQ, Wang N, Eichler AF, Chukwueke U, Forst DA, Arrillaga-Romany IC, Dietrich J, Corbin Z, Moliterno J, Baehring J, White M, Lou KW, Larson J, de Sauvage MA, Evancic K, Mora J, Nayyar N, Loeffler J, Oh K, Shih HA, Curry WT, Cahill DP, Barker FG, Gerstner ER, Santagata S. Phase 2 study of pembrolizumab in patients with recurrent and residual high-grade meningiomas. Nat Commun 2022; 13:1325. [PMID: 35289329 PMCID: PMC8921328 DOI: 10.1038/s41467-022-29052-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/16/2022] [Indexed: 01/16/2023] Open
Abstract
High-grade meningiomas are associated with neuro-cognitive morbidity and have limited treatments. High-grade meningiomas harbor an immunosuppressive tumor microenvironment (TME) and programmed death-ligand 1 (PD-L1) expression may contribute to their aggressive phenotype. Here, we present the results of a single-arm, open-label phase 2 trial (NCT03279692) evaluating the efficacy of pembrolizumab, a PD-1 inhibitor, in a cohort of 25 evaluable patients with recurrent and progressive grade 2 and 3 meningiomas. The primary endpoint is the proportion of patients alive and progression-free at 6 months (PFS-6). Secondary endpoints include progression-free and overall survival, best intracranial response, and toxicity. Our study has met its primary endpoint and achieved a PFS-6 rate of 0.48 (90% exact CI: 0.31-0.66) and a median PFS of 7.6 months (90% CI: 3.4-12.9 months). Twenty percent of patients have experienced one (or more) grade-3 or higher treatment-related adverse events. These results suggest that pembrolizumab exerts promising efficacy on a subset of these tumors. Further studies are needed to identify the biological facets within the meningioma TME that may drive response to immune-based therapies.
Collapse
Affiliation(s)
| | - Albert E Kim
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Eudocia Quant Lee
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nancy Wang
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - April F Eichler
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Ugonma Chukwueke
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Deborah A Forst
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Jorg Dietrich
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Zachary Corbin
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Moliterno
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Joachim Baehring
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Michael White
- Wilmot Cancer Center, University of Rochester, Division of Neuro-Oncology, Rochester, NY, USA
| | - Kevin W Lou
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Juliana Larson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Magali A de Sauvage
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Kathryn Evancic
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Joana Mora
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Naema Nayyar
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Jay Loeffler
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Kevin Oh
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Helen A Shih
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - William T Curry
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Daniel P Cahill
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Fred G Barker
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Elizabeth R Gerstner
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Sandro Santagata
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Department of Pathology, Harvard Medical School, Boston, MA, USA
- Ludwig Center at Harvard, Boston, MA, USA
| |
Collapse
|
14
|
Abstract
Primary central nervous system lymphoma is a rare and aggressive extranodal non-Hodgkin lymphoma restricted to the brain, spinal cord, cerebrospinal fluid, and eyes. Optimization of treatment including high-dose methotrexate-based chemotherapy followed by consolidation therapy in the form of autologous stem cell transplant or whole-brain radiation leads to improved survival. However, several patients do not respond to upfront therapy and the relapse risk is high. Additionally, there is a risk of delayed neurotoxicity, particularly in older patients. Recent molecular insights underlying the pathophysiology of PCNSL have led to the development of clinical trials involving targeted therapies and immunotherapies for salvage.
Collapse
Affiliation(s)
- Ugonma Chukwueke
- Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital; Harvard Medical School
| | | | - Lakshmi Nayak
- Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital; Harvard Medical School.
| |
Collapse
|
15
|
Chukwueke U, Vera E, Acquaye A, Hervey-Jumper S, Odia Y, Klesse L, Dunbar E, Sharma A, Fonkem E, Thomas A, Werbowetski-Ogilvie T, Camelo-Piragua S, Gatson NT, de la Fuente M, Armstrong T, Porter A, Jackson S. OTHR-01. SNO 2020 DIVERSITY SURVEY: DEFINING DEMOGRAPHICS, RACIAL BIASES, CAREER SUCCESS METRICS AND A PATH FORWARD FOR THE FIELD OF NEURO-ONCOLOGY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.593] [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
Neuro-oncology has grown tremendously since 2010, marked by increasing society membership, specialized clinical expertise, and new journals. Yet, modest improvement in racial/ethnic diversity amongst clinical trial participants, researchers and clinicians led us to conduct a survey identifying opportunities to enhance diversity and inclusiveness amongst neuro-oncology professionals.
METHODS
Summer 2020, the Women and Diversity Committee of the Society for Neuro-Oncology (SNO) distributed an anonymous online survey to members and affiliates (European Association of Neuro-Oncology, Asian Society for Neuro-Oncology, Society for Neuro-Oncology Latin America and Society for Neuro-Oncology Sub-Saharan Africa). The survey captured personal and professional characteristics, biases, effective mentorship qualities, career success metrics, and suggested field/society changes. Results were analyzed by geography, profession, age, racial/ethnic and sexual identity. Standard descriptive statistics characterized the study population.
RESULTS
The 386 respondents were predominantly female (58%) with a median age range of 40-49 years (31%), White (65%), and SNO members (97%). Most worked in North America (77%) in a research profession (67%). A majority of White respondents reported never experiencing biases (64%), while the majority of non-White respondents reported unconscious biases/microaggressions, followed by a lack of/limited mentorship. Qualitative assessments showcased that personal/professional success metrics were linked to needed improvements in diversity and inclusion efforts within the neuro-oncology community. CONCLUSIONS: The prevalence of racial/ethnic biases and poor mentorship rates amongst underrepresented groups in neuro-oncology is high and potentially linked to the limited diverse representation amongst members and affiliates. These findings warrant a swift implementation of equity and inclusion practices within the neuro-oncology field.
Collapse
Affiliation(s)
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Yazmin Odia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Laura Klesse
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Erin Dunbar
- Piedmont Brain Tumor Center, Atlanta, GA, USA
| | - Akanksha Sharma
- Pacific Neuroscience Institute at John Wayne Cancer Institute, Santa Monica, USA
| | | | - Alissa Thomas
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | | | | | | | | | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | |
Collapse
|
16
|
Strickland M, Lee EQ, Wang N, Cohen J, Chukwueke U, Forst D, Eichler A, Overmoyer B, Lin N, Chen W, Bardia A, Juric D, Dagogo-Jack I, White M, Dietrich J, Nayyar N, Kim A, Alvarez-Breckenridge C, Mahar M, Mora J, Nahed B, Jones P, Shih H, Gerstner E, Giobbie-Hurder A, Carter S, Oh K, Cahill D, Sullivan R, Brastianos P. CTIM-02. PHASE II STUDY OF IPILIMUMAB AND NIVOLUMAB IN LEPTOMENINGEAL CARCINOMATOSIS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.194] [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
Leptomeningeal disease (LMD) is an increasingly common complication from solid tumor malignancies with a poor prognosis and limited treatment options. We conducted a single arm Phase II study of combined ipilimumab and nivolumab in patients with LMD from solid tumor malignancies (NCT02939300). Patients received manufacturer-specific dosing regimens of combined ipilimumab and nivolumab based on primary-tumor histology until definitive progression or unacceptable toxicity. The primary end point was rate of overall survival at 3 months (OS3). A Simon two-stage design was used to compare a null hypothesis OS3 of 18% against an alternative of 44%. Eighteen patients with diverse primary tumor histologies were enrolled and all received at least one dose of combined ipilimumab and nivolumab. Median follow up based on patients still alive was 8.0 months (range: 0.5 to 15.9 months). The study met its primary endpoint as 8 of 18 (OS3 0.44; 90% CI: 0.24 to 0.66) patients were alive at three months after enrollment. One third of patients experienced one (or more) grade-3 or higher adverse events possibly related to treatment. Two patients discontinued protocol treatment due to unacceptable toxicity (hepatitis and colitis, respectively). The most frequent adverse events overall included fatigue (N=7), nausea (N=6), fever (N=6), anorexia (N=6) and rash (N=6). Combined ipilimumab and nivolumab has an acceptable safety profile and demonstrates promising activity in LMD patients; this therapeutic approach should be studied in larger, multicenter clinical trials to validate these results as well as better identify patients who will benefit.
Collapse
Affiliation(s)
| | | | - Nancy Wang
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Justine Cohen
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Deborah Forst
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - April Eichler
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Nancy Lin
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Wendy Chen
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | - Jorg Dietrich
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | - Albert Kim
- Massachusetts General Hospital, Boston, USA
| | | | | | - Joana Mora
- Massachusetts General Hospital, Boston, USA
| | | | | | - Helen Shih
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | | | - Scott Carter
- Broad Institute of Harvard and M.I.T., Boston, USA
| | - Kevin Oh
- Massachusetts General Hospital, Boston, USA
| | | | | | | |
Collapse
|
17
|
Deng D, Hammoudeh L, Cagney D, McFaline-Figueroa JR, Chukwueke U, Reardon D, Lee EQ, Nayak L, Lim-Fat MJ, Ligon K, Bi WL, Arnaout O, Alexander B, Wen P, Rahman R. BIOM-30. BLOOD COUNTS THROUGH TREATMENT COURSE IN NEWLY DIAGNOSED GLIOBLASTOMA PATIENTS RECEIVING CHEMORADIATION. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.061] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma (GBM) patients are treated with radiation therapy (RT), temozolomide, and corticosteroids which can affect hematologic and immunologic parameters. We examined lymphocytes, neutrophil-to-lymphocyte ratio and platelet measurements and their association with progression-free survival (PFS) overall survival (OS).
METHODS
We identified 759 newly diagnosed adult GBM patients treated at our institution in the temozolomide (TMZ) era with blood counts that could be automatically extracted from the electronic medical record during chemoradiation (CRT, defined as within 42 days of RT) and at first recurrence. Linear regression and Cox modeling were used to evaluate outcomes.
RESULTS
Median age was 60.3 years; 87% had KPS ≥ 70, 37.5% had gross total resection, and 90% received TMZ. Prior to RT, 56.4% (375/665) patients had a lymphocyte measurement < 1.0 × 1000 cells [K]/μL. Within 42 days of CRT, 81.7% (536/656) had a lymphocyte measurement < 1.0 K/μL, 37.8% (248/656) < 0.5 K/μL. 10.7% (58/544) patients developed grade 2 or higher neutropenia, 9.1% (50/547) patients developed grade 2 or higher thrombocytopenia. On multivariable analysis (MVA), older age (AHR1.03, p< 0.001), unmethylated MGMT status (AHR2.56,p< 0.001), lower RT dose (<54Gy, AHR 3.45, p< 0.001), male sex (AHR1.45, p=0.02), non-gross total resection (AHR1.63, p< 0.001), lymphopenia during CRT (AHR0.63, p=0.008) and higher NLR during CRT (AHR1.02, p=0.001) were significantly associated with worse OS.
Older age (AHR1.01, p=0.02), unmethylated MGMT status (AHR2.44, p< 0.001), lower RT dose (AHR1.82, p=0.02), higher NLR during CRT (AHR1.03, p < 0.001) were significantly associated with worse PFS on MVA. At first recurrence, median lymphocyte count was 0.7 K/μL with 74% (348/468) patients < 1.0 K/μL and 27% < 0.5 K/μL.
CONCLUSION
Lymphopenia and higher neutrophil-to-lymphocyte ratio are associated with inferior outcomes. Persistent lymphopenia at time of first recurrence may have implications for clinical trial eligibility and immunotherapy approaches in recurrent GBM.
Collapse
Affiliation(s)
- Davy Deng
- Harvard School of Public Health, Boston, USA
| | - Lubna Hammoudeh
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Daniel Cagney
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | | | | | | | | | | | | | - Wenya Linda Bi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Omar Arnaout
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Brian Alexander
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Patrick Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rifaquat Rahman
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| |
Collapse
|
18
|
Rahman R, Trippa L, Lee EQ, Arrillaga-Romany I, Touat M, Fell G, McCluskey C, Bruno J, Gaffey S, Drappatz J, Lassman A, Galanis E, Ahluwalia M, Colman H, Nabors LB, Hepel J, Elinzano H, Schiff D, Chukwueke U, Beroukhim R, Batchelor T, Nayak L, McFaline-Figueroa JR, Rinne M, Kaley T, Lu-Emerson C, Bi WL, Arnaout O, Haas-Kogan D, Tanguturi S, Cagney D, Aizer A, Welch M, Doherty L, Lavallee M, Fisher-Longden B, Dowling S, Pisano W, Lapinskas E, Meredith D, Chiocca EA, Reardon D, Ligon K, Alexander B, Wen P. CTNI-40. EVALUATING FEASIBILITY AND EFFICIENCY OF PHASE II ADAPTIVE PLATFORM TRIAL DESIGNS BASED ON THE INDIVIDUALIZED SCREENING TRIAL OF INNOVATIVE GLIOBLASTOMA THERAPY (INSIGhT) EXPERIENCE. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.265] [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
The Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) is a phase II platform trial with Bayesian adaptive randomization and deep genomic profiling to more efficiently test experimental agents in newly diagnosed glioblastoma and to prioritize therapies for late-stage testing.
METHODS
In the ongoing INSIGhT trial, patients with newly diagnosed MGMT-unmethylated glioblastoma are randomized to the control arm or one of three experimental therapy arms (CC-115, abemaciclib, and neratinib). The control arm therapy is radiotherapy with concomitant and adjuvant temozolomide, and primary endpoint is overall survival. Randomization has been adapted based on Bayesian estimation of biomarker-specific probability of treatment impact on progression-free survival (PFS). All tumors undergo detailed molecular sequencing, and this is facilitated with the companion ALLELE protocol. To evaluate feasibility of this approach, we assessed the status of this ongoing trial.
RESULTS
Since INSIGhT was activated 4.3 years ago, it has expanded to include 12 sites across the United States. A total of 247 patients have been enrolled. Randomization probabilities have been repeatedly adjusted over time based upon early PFS results to alter the randomization ratio from standard 1:1:1:1 randomization. All three arms have completed accrual and efficacy estimates are available based upon comparison to the common control arm in context of relevant biomarkers. There are 87 patients alive and in follow-up, and there are ongoing plans to add additional arms to evaluate further treatments in the future.
CONCLUSION
The INSIGhT trial demonstrates that a multi-center Bayesian adaptive platform trial is a feasible and effective approach to help prioritize therapies and biomarkers for newly diagnosed GBM. The trial has maintained robust accrual, and the simultaneous testing of multiple agents, sharing a common control arm and adaptive randomization serve as features to increase trial efficiency relative to traditional clinical trial designs.
Collapse
Affiliation(s)
- Rifaquat Rahman
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Jan Drappatz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew Lassman
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Howard Colman
- University of Utah - Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - L Burt Nabors
- University of Alabama, Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | - Tracy Batchelor
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | | | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Wenya Linda Bi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Omar Arnaout
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Shyam Tanguturi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Daniel Cagney
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Ayal Aizer
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Mary Welch
- Columbia / New York Presbyterian, New York, USA
| | | | | | | | | | | | | | | | - E Antonio Chiocca
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA, Boston, MA, USA
| | | | - Keith Ligon
- Massachusetts General Hospital, Boston, ME, USA
| | - Brian Alexander
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
19
|
Alvarez-Breckenridge C, Prakadan S, Markson S, Kim A, Nayyar N, Kuter B, Mora J, Shaw B, Lee EQ, Chukwueke U, Cahill D, Sullivan R, Carter S, Shalek A, Brastianos P. IMMU-02. GENOMIC AND TRANSCRIPTOMIC CORRELATES OF IMMUNOTHERAPY RESPONSE WITHIN THE TUMOR MICROENVIRONMENT OF LEPTOMENINGEAL METASTASES. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.362] [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
Leptomeningeal disease (LMD) is a devastating complication of solid tumor malignancies, with dire prognosis and no effective systemic treatment options. Over the past decade, the incidence of LMD has steadily increased due to therapeutics that have extended the survival of cancer patients, highlighting the need for new interventions. To examine the efficacy of immune checkpoint inhibitors (ICI) in patients with LMD, we completed two phase II clinical trials utilizing either Pembrolizumab alone or the combination of Ipilimumab and Nivolumab. We investigated the cellular and molecular features underpinning observed patient trajectories in these trials by applying single-cell RNA and cell-free DNA profiling to longitudinal cerebrospinal fluid (CSF) draws from enrolled patients. We isolated and sequenced 34,742 cells from both the malignant and immune compartment within CSF. Amongst the 19 patients included in the cohort, there were 13 pre-treatment and 24 post-treatment samples, and 9 patients were sampled across multiple timepoints. We detected dynamic changes in immune cell recruitment into the CSF and activation within 30 days of ICI, including increased effector T cell activation and IFN-gamma response pathways within T cells. Moreover, the overall level of IFN-gamma response and antigen processing within 30 days of ICI in malignant cells correlated with survival past clinical trial primary endpoint. Lastly, we observed evidence of longitudinal outgrowth of distinct immunogenic clones over the course of ICI. Overall, our study describes the liquid LMD tumor microenvironment prior to and following ICI treatment and provides unique insights into the compartmental and temporal variation during the course of ICI. Moreover, our findings demonstrate the clinical utility of cell- free and single-cell genomic measurements for LMD research.
Collapse
Affiliation(s)
| | | | | | - Albert Kim
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Joana Mora
- Massachusetts General Hospital, Boston, MA, USA
| | - Brian Shaw
- Drexel University College of Medicine, Boston, MA, USA
| | | | | | | | | | - Scott Carter
- Broad Institute of Harvard and M.I.T., Boston, USA
| | - Alex Shalek
- Massachusetts Institute of Technology, Boston, USA
| | | |
Collapse
|
20
|
Lim-Fat MJ, Allen M, Smith T, Youssef G, Andersen B, Akintola O, Berger T, Budhu J, Hsieh A, Aquilanti E, Batchelor T, Beroukhim R, Chukwueke U, Castro LNG, Lee EQ, McFaline-Figueroa JR, Doherty L, Stefanik J, Taubert C, Torres A, Wen P, Reardon D, Nayak L. INNV-40. REAL WORLD INTEGRATION OF THE NEUROLOGIC ASSESSMENT IN NEURO-ONCOLOGY (NANO) SCALE IN CLINICAL PRACTICE IN PATIENTS WITH IDH-WT GBM. Neuro Oncol 2021. [PMCID: PMC8598454 DOI: 10.1093/neuonc/noab196.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The neurologic assessment in neuro-oncology (NANO) scale was developed as a standardized metric to objectively measure neurologic function in patients with brain tumors and complement radiographic assessment in defining overall outcome. The scale has been incorporated in clinical trials. Early data is suggestive of feasibility and that NANO contributes to overall outcome assessment. However, real-world use of the NANO scale to drive clinical-decision making and the predictive value of the NANO scale to determine overall survival remains unclear in IDH-wt GBM. METHODS We report on an ongoing study using the NANO scale to evaluate neurologic function in patients with IDH-wt GBM, seen at Dana-Farber Cancer Institute (DFCI). Patient demographics, tumor histology and molecular status, treatment history and progression dates are being captured. NANO score, as collected by a built-in scale in our institutional electronic medical record (EMR), functional status (Karnofsky performance status) and corticosteroid dose are collected at prespecified time points (prior to start of therapy, and during each subsequent MRI visit). Changes in the NANO score will be correlated to overall survival. Statistical analyses including descriptive data analysis and generalized linear models will be performed using R (version 3.4.3). RESULTS Since June 2020, 50 patients have been enrolled in this study, including 42 (84%) with ≥2 follow up visits. Study accrual was initially impacted by the COVID-19 pandemic, but adaptation to a virtual platform for NANO allowed for improved recruitment and follow up of patients. Study results will be available for discussion at the 2021 SNO conference. CONCLUSIONS Evaluation of neurologic function by NANO is feasible in a virtual framework in a prospective study in patients with GBM, aided by integration of the scale in our institutional EMR. NANO is able to objectively track neurologic function throughout disease course in IDH-wt GBM.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Tracy Batchelor
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | | | | | | | | | | | | | | | | | - Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | |
Collapse
|
21
|
Shi D, Lim-Fat MJ, Nassar A, Woods J, Youssef G, Pisano W, Whorral S, Allen M, Cagney D, Tanguturi S, Haas-Kogan D, Aizer A, McFaline-Figueroa JR, Chukwueke U, Lee EQ, Reardon D, Nayak L, Bi WL, Beroukhim R, Ligon K, Alexander B, Wen P, Rahman R. PATH-16. EVALUATION OF SEX-BASED DIFFERENCES IN CLINICAL OUTCOMES AND TUMOR GENOMICS IN PATIENTS WITH NEWLY DIAGNOSED IDH-WILDTYPE GLIOBLASTOMA RECEIVING CHEMORADIATION. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.468] [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
We evaluated sex-based differences in clinical outcomes and tumor genomics in patients with newly-diagnosed GBM.
METHODS
We reviewed 665 IDH-wild type GBM patients with Karnofsky Performance Status (KPS) ≥60 treated at our institution from 2010-2019 including; 585 patients with targeted exome sequencing of 447 cancer associated genes (OncoPanel). Deleterious mutations were defined as homozygous deletions or loss of function mutations of known tumor suppressors (as reported in TCGA, ≥ 3 times in the COSMIC database, or predicted as “damaging” in SIFT and/or “probably damaging” in Polyphen 2) or known oncogenic mutations in proto-oncogenes (reported in TCGA or ≥ 3 times in COSMIC).
RESULTS
There were 384 (57.7%) males and 281 (42.3%) females. Median OS was 22.5 months for females and 19.3 months for males (hazard ratio [HR] 0.81, 95% CI 1.03-1.48, p = 0.02). On multivariable analysis adjusted for age, KPS ≥90, extent of resection, and MGMT methylation status, female sex (adjusted hazard ratio 0.78, 95% CI [0.64-0.95], p = 0.015) was associated with improved OS. Superior OS in females was observed in MGMT-unmethylated patients (HR 0.69, 95% CI [0.54-0.90], p = 0.005) but not MGMT-methylated patients. Thirteen genes were deleteriously altered in ≥5% of our cohort: CDK4 (12.1% male vs. 7.8% female), CDKN2A (46.5% vs. 45.7%), CDKN2B (41.8% vs. 43.3%), EGFR (34.7% vs. 40.0%, MTAP (18.2% vs. 18.8%), NF1 (11.5% vs. 9.4%), PTEN (28.2% vs. 29.8%), TP53 (28.2% vs. 30.2%), RB1 (5.6% vs. 6.5%), MDM4 (6.2% vs. 5.7%), ATM (5.9% vs. 3.7%), MDM2 (7.4% vs. 4.1%), PIK3R1 (6.2% vs. 4.1%). There were no differences in frequency of mutations in these individual genes between males and females (χ 2 [1, N=585] = 0.05-2.86, p = 0.09-0.86).
CONCLUSIONS
Female sex is associated with improved survival. We did not identify sex-based differences in deleterious genomic alterations amongst commonly altered genes in GBM.
Collapse
Affiliation(s)
- Diana Shi
- Harvard Radiation Oncology Program, Boston, MA, USA
| | | | - Amin Nassar
- Brigham and Women's Hospital, Boston, MA, USA
| | - Jared Woods
- Department of Oncologic Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | | | | | | | - Daniel Cagney
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Shyam Tanguturi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Ayal Aizer
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | | | | | | | | | - Wenya Linda Bi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Keith Ligon
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brian Alexander
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rifaquat Rahman
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| |
Collapse
|
22
|
Brastianos P, Kim A, Giobbie-Hurder A, Lee EQ, Wang N, Eichler A, Chukwueke U, Forst D, Arrillaga-Romany I, Dietrich J, Lou K, Larson J, Mora J, Nayyar N, Loeffler J, Oh K, Shih H, Curry W, Cahill D, Barker F, Gerstner E, Santagata S. CTIM-30. PHASE II TRIAL OF PEMBROLIZUMAB IN RECURRENT AND RESIDUAL HIGH-GRADE MENINGIOMAS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.222] [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
INTRODUCTION
High-grade meningiomas are associated with significant neuro-cognitive morbidity and a poor prognosis. Systemic therapies, to date, have demonstrated minimal efficacy. We recently found that high-grade meningiomas harbor an immunosuppressive tumor microenvironment and that programmed cell death-ligand 1 (PD-L1) expression may contribute to the aggressive phenotype of these tumors. Therefore, we conducted a single-arm, open-label phase II trial evaluating efficacy of pembrolizumab, a PD-1 inhibitor, in a cohort of 24 patients with recurrent and progressive grade II and III meningiomas.
METHODS
The primary endpoint was the rate of progression-free survival at 6 months. The trial distinguished between 6-month PFS (PFS-6) rates of 26% vs. 52%. If at least 10 patients demonstrated a 6-month PFS, among the 24 patients, the agent would be considered worthy of further study. This design has at least 88% power using an exact binomial test with a one-sided significance level of 0.1.
RESULTS
Between November 2017 to December 2019, twenty-four patients were enrolled. The majority of the patients in our cohort were heavily pre-treated; prior to enrolling to the study, twenty patients underwent more than one surgical resection and twelve patients had received more than one round of radiotherapy. Our study met its primary endpoint and achieved a 6-month progression-free survival rate of 0.50 (90% exact CI: 0.32-0.68) and a median PFS of 8.3 months (90% CI: 4.1-12.9 months). For the twelve patients who achieved the PFS-6 primary endpoint, median PFS from the start of treatment was 17.3 months (90% CI: 9.7 – 24.3 months). Four patients had grade-3 or higher adverse events that were at least possibly treatment-related, including colitis, skin infection, encephalopathy and transaminitis.
CONCLUSION
Our study achieved its primary endpoint. These results suggest that pembrolizumab exerts promising activity on these tumors and results in prolonged PFS compared to historical controls.
Collapse
Affiliation(s)
| | - Albert Kim
- Massachuestts General Hospital, Boston, MA, USA
| | | | | | - Nancy Wang
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - April Eichler
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Deborah Forst
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jorg Dietrich
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin Lou
- Massachuestts General Hospital, Boston, MA, USA
| | | | - Joana Mora
- Massachuestts General Hospital, Boston, MA, USA
| | | | - Jay Loeffler
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Kevin Oh
- Massachuestts General Hospital, Boston, MA, USA
| | - Helen Shih
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | | | - Fred Barker
- Massachuestts General Hospital, Boston, MA, USA
| | | | | |
Collapse
|
23
|
Arrillaga-Romany I, Trippa L, Fell G, Lee EQ, Rahman R, Touat M, McCluskey C, Bruno J, Gaffey S, Drappatz J, Lassman A, Galanis E, Ahluwalia M, Colman H, Nabors LB, Hepel J, Elinzano H, Kaley T, Mellinghoff IK, Schiff D, Chukwueke U, Beroukhim R, Nayak L, McFaline-Figueroa JR, Batchelor T, Lu-Emerson C, Bi WL, Arnaout O, Peruzzi P, Haas-Kogan D, Tanguturi S, Cagney D, Aizer A, Welch M, Doherty L, Lavallee M, Fisher-Longden B, Dowling S, Geduldig J, Watkinson F, Santagata S, Meredith D, Chiocca EA, Reardon D, Ligon K, Alexander B, Wen P. CTNI-05. PRELIMINARY RESULTS OF THE NERATINIB ARM IN THE INDIVIDUALIZED SCREENING TRIAL OF INNOVATIVE GLIOBLASTOMA THERAPY (INSIGHT): A PHASE II PLATFORM TRIAL USING BAYESIAN ADAPTIVE RANDOMIZATION. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
EGFR is amplified in over 50% of glioblastoma and 20-30% have EGFRvIII mutations. Neratinib is a potent inhibitor of EGFR/HER2 approved for metastatic HER2+ breast cancer. To efficiently evaluate the potential impact of neratinib on overall survival (OS) in newly-diagnosed glioblastoma and to simultaneously develop information regarding potential genomic biomarker associations, neratinib was included as an arm on the Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) trial. INSIGhT is a phase II platform trial using response adaptive randomization and deep genomic profiling to more efficiently test experimental agents in MGMT unmethylated glioblastoma and accelerate identification of novel therapies for phase III testing. Initial randomization was equal between neratinib, control, and two other experimental arms but subsequent randomization was adapted based on efficacy as determined by progression-free survival (PFS). We report preliminary results for the neratinib arm.
METHODS
Patients with newly diagnosed MGMT-unmethylated glioblastoma were randomized to receive either radiotherapy with concomitant and adjuvant temozolomide or standard radiochemotherapy followed by adjuvant neratinib (240 mg daily). Treatment continued until progression or development of unacceptable toxicities. The primary endpoint was OS. Association between neratinib efficacy and EGFR amplification was also investigated.
RESULTS
There were 144 patients (70 control; 74 neratinib). Neratinib was reasonably well-tolerated with no new toxicity signals identified. PFS was compared (HR 0.84; p=0.38, logrank test – not significant) between the neratinib (median 6.05 months) and control (median 5.82 months) arms. For patients EGFR pathway activation the PFS HR was 0.53 (p-value=0.03 – significant, median PFS: neratinib, 6.21 months, control, 5.26 months). However, there was no significant improvement in OS in EGFR amplified/mutated patients (HR 1.05; p-value 0.87) between neratinib (median 14.2) compared to the control arm (median 14.6).
CONCLUSION
Neratinib prolonged PFS in the EGFR positive subpopulation but there was no overall PFS benefit, or any OS improvement.
Collapse
Affiliation(s)
| | | | | | | | - Rifaquat Rahman
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | | | | | | | - Jan Drappatz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew Lassman
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Howard Colman
- University of Utah - Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - L Burt Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | - Tracy Batchelor
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Mary Welch
- Columbia / New York Presbyterian, New York, NY, USA
| | | | | | | | | | | | | | | | | | - E Antonio Chiocca
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Keith Ligon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
24
|
Reihl S, Patil N, Morshed R, Mehari M, Aabedi A, Chukwueke U, Porter A, Fontil V, Cioffi G, Waite K, Kruchko C, Ostrom Q, Barnholtz-Sloan J, Hervey-Jumper S. EPID-11. A POPULATION STUDY OF CLINICAL TRIAL ACCRUAL FOR WOMEN AND MINORITIES IN NEURO-ONCOLOGY FOLLOWING THE NIH REVITALIZATION ACT. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.344] [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
INTRODUCTION
The NIH Revitalization Act, implemented 29 years ago, set to improve the representation of women and minorities in clinical trials. In this study, we investigate the progress made in neuro-oncology in all phase therapeutic clinical trials for neuro-epithelial central nervous system tumors in comparison to their demographic-specific age-adjusted disease incidence and mortality.
METHODS
Registry study of all published clinical trials for World Health Organization (WHO) defined neuro-epithelial CNS tumors between January 2000 and December 2019. Study participants for trials were obtained from PubMed and ClinicalTrials.gov. Population-based data from the CBTRUS for incidence analyses. SEER-18 Incidence-Based Mortality data was used for mortality analysis. Descriptive statistics, Fisher exact, and c2 tests were used to analyze the data.
RESULTS
Among 662 published clinical trial articles representing 49, 907 accrued participants, 62.5% of study participants were men and 37.5% were women (P< 0.0001) representing a mortality specific over-accrual for men (P= 0.001) and under-accrual for women (P= 0.001). Whites, Asians, Blacks, and Hispanics represented 91.7%, 1.5%, 2.6%, and 1.7% of trial participants. Compared with their US cancer mortality, Blacks (47% of expected mortality, P=.008), Hispanics (17% of expected mortality, P< .001) and Asians (33% of expected mortality, P< .001) were underrepresented compared with Whites (114% of expected mortality, P< .001).
CONCLUSIONS
Nearly 30 years since the Revitalization Act, minorities and women are consistently underrepresented when compared with their demographic-specific incidence and mortality in therapeutic clinical trials for neuroepithelial tumors. This study provides a framework for investigating cancer clinical trial accrual and offers guidance regarding workforce factors associated with enrollment of vulnerable patients.
Collapse
Affiliation(s)
- Sheantel Reihl
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Ramin Morshed
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Valy Fontil
- University of California, San Francisco, San Francisco, CA, USA
| | - Gino Cioffi
- Case Western Reserve University, Cleveland, OH, USA
| | - Kristin Waite
- Cleveland Center for Health Outcomes (CCHOR), Cleveland, OH, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Quinn Ostrom
- Duke University School of Medicine, Durham, NC, USA
| | | | | |
Collapse
|
25
|
Prakadan SM, Alvarez-Breckenridge CA, Markson SC, Kim AE, Klein RH, Nayyar N, Navia AW, Kuter BM, Kolb KE, Bihun I, Mora JL, Bertalan MS, Shaw B, White M, Kaplan A, Stocking JH, Wadsworth MH, Lee EQ, Chukwueke U, Wang N, Subramanian M, Rotem D, Cahill DP, Adalsteinsson VA, Miller JW, Sullivan RJ, Carter SL, Brastianos PK, Shalek AK. Genomic and transcriptomic correlates of immunotherapy response within the tumor microenvironment of leptomeningeal metastases. Nat Commun 2021; 12:5955. [PMID: 34642316 PMCID: PMC8511044 DOI: 10.1038/s41467-021-25860-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/25/2021] [Indexed: 12/30/2022] Open
Abstract
Leptomeningeal disease (LMD) is a devastating complication of solid tumor malignancies, with dire prognosis and no effective systemic treatment options. Over the past decade, the incidence of LMD has steadily increased due to therapeutics that have extended the survival of cancer patients, highlighting the need for new interventions. To examine the efficacy of immune checkpoint inhibitors (ICI) in patients with LMD, we completed two phase II clinical trials. Here, we investigate the cellular and molecular features underpinning observed patient trajectories in these trials by applying single-cell RNA and cell-free DNA profiling to longitudinal cerebrospinal fluid (CSF) draws from enrolled patients. We recover immune and malignant cell types in the CSF, characterize cell behavior changes following ICI, and identify genomic features associated with relevant clinical phenomena. Overall, our study describes the liquid LMD tumor microenvironment prior to and following ICI treatment and demonstrates clinical utility of cell-free and single-cell genomic measurements for LMD research.
Collapse
Affiliation(s)
- Sanjay M Prakadan
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA
| | - Christopher A Alvarez-Breckenridge
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Neurosurgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Samuel C Markson
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Albert E Kim
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Robert H Klein
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naema Nayyar
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Andrew W Navia
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA
| | - Benjamin M Kuter
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Kellie E Kolb
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA
| | - Ivanna Bihun
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Joana L Mora
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Mia Solana Bertalan
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Brian Shaw
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Michael White
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Alexander Kaplan
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Jackson H Stocking
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Marc H Wadsworth
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ugonma Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nancy Wang
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Megha Subramanian
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Denisse Rotem
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Viktor A Adalsteinsson
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeffrey W Miller
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ryan J Sullivan
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Scott L Carter
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Priscilla K Brastianos
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.
- Massachusetts General Hospital Cancer Center, Boston, MA, USA.
| | - Alex K Shalek
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA.
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA.
- Division of Health Science & Technology, Harvard Medical School, Cambridge, MA, USA.
- Program in Computational & Systems Biology, Massachusetts Institute of Technology, Cambridge, MA, USA.
| |
Collapse
|
26
|
Brastianos PK, Strickland MR, Lee EQ, Wang N, Cohen JV, Chukwueke U, Forst DA, Eichler A, Overmoyer B, Lin NU, Chen WY, Bardia A, Juric D, Dagogo-Jack I, White MD, Dietrich J, Nayyar N, Kim AE, Alvarez-Breckenridge C, Mahar M, Mora JL, Nahed BV, Jones PS, Shih HA, Gerstner ER, Giobbie-Hurder A, Carter SL, Oh K, Cahill DP, Sullivan RJ. Phase II study of ipilimumab and nivolumab in leptomeningeal carcinomatosis. Nat Commun 2021; 12:5954. [PMID: 34642329 PMCID: PMC8511104 DOI: 10.1038/s41467-021-25859-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
Leptomeningeal disease (LMD) is a common complication from solid tumor malignancies with a poor prognosis and limited treatment options. We present a single arm Phase II study of 18 patients with LMD receiving combined ipilimumab and nivolumab until progression or unacceptable toxicity (NCT02939300). The primary end point is overall survival at 3 months (OS3). Secondary end points include toxicity, cumulative time-to-progression at 3 months, and progression-free survival. A Simon two-stage design is used to compare a null hypothesis OS3 of 18% against an alternative of 44%. Median follow up based on patients still alive is 8.0 months (range: 0.5 to 15.9 months). The study has met its primary endpoint as 8 of 18 (OS3 0.44; 90% CI: 0.24 to 0.66) patients are alive at three months. One third of patients have experienced one (or more) grade-3 or higher adverse events. Two patients have discontinued protocol treatment due to unacceptable toxicity (hepatitis and colitis, respectively). The most frequent adverse events include fatigue (N = 7), nausea (N = 6), fever (N = 6), anorexia (N = 6) and rash (N = 6). Combined ipilimumab and nivolumab has an acceptable safety profile and demonstrates promising activity in LMD patients. Larger, multicenter clinical trials are needed to validate these results.
Collapse
Affiliation(s)
| | - Matthew R Strickland
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Eudocia Quant Lee
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy Wang
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Justine V Cohen
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ugonma Chukwueke
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | | | - April Eichler
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Beth Overmoyer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Wendy Y Chen
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Aditya Bardia
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Dejan Juric
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Michael D White
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jorg Dietrich
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Naema Nayyar
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Albert E Kim
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Maura Mahar
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joana L Mora
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Brian V Nahed
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Pamela S Jones
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Helen A Shih
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | | | - Scott L Carter
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Kevin Oh
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daniel P Cahill
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ryan J Sullivan
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| |
Collapse
|
27
|
Bi WL, Nayak L, Meredith DM, Driver J, Du Z, Hoffman S, Li Y, Lee EQ, Beroukhim R, Rinne M, McFaline-Figueroa R, Chukwueke U, McCluskey C, Gaffey S, Cherniack AD, Stefanik J, Doherty L, Taubert C, Cifrino M, LaFrankie D, Graillon T, Wen PY, Ligon KL, Al-Mefty O, Huang RY, Muzikansky A, Chiocca EA, Santagata S, Dunn IF, Reardon DA. Activity of PD-1 blockade with Nivolumab among patients with recurrent atypical/anaplastic meningioma: Phase II trial results. Neuro Oncol 2021; 24:101-113. [PMID: 34015129 DOI: 10.1093/neuonc/noab118] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Programmed death-1 ligand (PD-L1) contributes to tumor immunosuppression and is upregulated in aggressive meningiomas. We performed a phase II study of nivolumab, a programmed death-1 (PD-1) blocking antibody among patients with grade ≥2 meningioma that recurred after surgery and radiation therapy. METHODS Twenty-five patients received nivolumab (240 mg biweekly) until progression, voluntary withdrawal, unacceptable toxicity, or death. Tumor mutational burden (TMB) and quantification of tumor infiltrating lymphocytes (TIL) were evaluated as potential immunocorrelative biomarkers. Change in neurologic function was prospectively assessed using the Neurologic Assessment in Neuro-Oncology (NANO) scale. RESULTS Enrolled patients had multiple recurrences including ≥3 prior surgeries and ≥2 prior courses of radiation in 60% and 72%, respectively. Nivolumab was well tolerated with no unexpected AEs. PFS-6 was 42.4% (95% CI: 22.8, 60.7) and the median OS was 30.9 months (95% CI: 17.6, NA). One patient achieved radiographic response (ongoing at 4.5 years). TMB was > 10/Mb in 2 of 15 profiled tumors (13.3%). Baseline TIL density was low but increased post-treatment in 3 patients including both patients with elevated TMB. Most patients who achieved PFS-6 maintained neurologic function prior to progression as assessed by NANO. CONCLUSION Nivolumab was well tolerated but failed to improve PFS-6, although a subset of patients appeared to derive benefit. Low levels of TMB and TIL density were typically observed. NANO assessment of neurologic function contributed to outcome assessment. Future studies may consider rationally designed combinatorial regimens.
Collapse
Affiliation(s)
- Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - David M Meredith
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Driver
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ziming Du
- Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Samantha Hoffman
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yvonne Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Eudocia Quant Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rameen Beroukhim
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Mikael Rinne
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christine McCluskey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah Gaffey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrew D Cherniack
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer Stefanik
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lisa Doherty
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christina Taubert
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meghan Cifrino
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Deborah LaFrankie
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas Graillon
- Faculté de Médecine, Aix Marseille Université, Marseille, France
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| |
Collapse
|
28
|
Hammoudeh L, Lim-Fat MJ, Cagney D, Aizer AA, Tanguturi S, Arvold N, Mcfaline-Figueroa J, Chukwueke U, Reardon D, Lee E, Nayak L, Rinne M, Ligon K, Wen P, Alexander B, Rahman R. RADT-25. EVALUATING LYMPHOCYTE COUNTS IN NEWLY DIAGNOSED GLIOBLASTOMA PATIENTS RECEIVING CHEMORADIATION. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.778] [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
Glioblastoma (GBM) patients are treated with chemotherapy, radiation therapy (RT) and often corticosteroids, which can all contribute to lymphopenia. We examined lymphopenia with respect to incidence, predictors, and association with progression-free survival (PFS) and overall survival (OS).
METHODS
We reviewed 349 newly diagnosed adult GBM patients treated at our institution in the temozolomide (TMZ) era with available lymphocyte and RT records. Data was reviewed from diagnosis through the chemoradiation (CRT) phase, defined as the period upto 6 weeks after RT. Linear regression and Cox proportional hazards modeling were used to evaluate outcomes.
RESULTS
Median age was 60 years (range, 19-90); 86% had KPS ≥ 70, 30% had gross total resection (GTR), and 91% received TMZ. Prior to RT, 60% (205/341) patients had a lymphocyte measurement < 1.0 x 1000 cells [K]/μL and 15% (50/341) had < 0.5 K/μL. During the CRT phase of therapy, 83% (270/324) had at least one lymphocyte measurement < 1.0 K/μL, 42% (135/324) < 0.5 K/μL, and 5% (16/324) < 0.2 K/μL. Older age was associated with lower lymphocytes pre-RT, while subtotal resection, TMZ use, and RT dose was associated with lower lymphocyte counts during CRT (p< 0.05). On multivariable analysis (MVA), age (AHR 1.03, p< 0.01), KPS > 70 (AHR 0.35, p< 0.01), MGMT status (AHR 0.47, p< 0.01), GTR (AHR 0.67, p=0.03), TMZ (AHR 0.27, p< 0.01) and lymphopenia during CRT (AHR 1.80, p< 0.01) were significantly associated with OS. Pre-RT lymphocyte level was associated with PFS on UVA (HR 0.81, p=0.03) but not on MVA (p=0.27). Lymphocyte count during CRT was not associated with PFS (p=0.24).
CONCLUSION
Lymphopenia is common in GBM, and chemoradiation-related lymphopenia was associated with inferior OS relative to patients without lymphopenia. Further characterization of the mechanism and optimal treatment of patients with lymphopenia are warranted to improve outcomes.
Collapse
Affiliation(s)
- Lubna Hammoudeh
- Brigham and Women’s Hospital/ Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eudocia Lee
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Patrick Wen
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Rifaquat Rahman
- Brigham and Women’s Hospital/ Dana Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
29
|
Lee E, Muzikansky A, Arrillaga-Romany I, Chukwueke U, Cloughesy T, Colman H, Daras M, de Groot J, Mcfaline-Figueroa J, Nayak L, Prins R, Reardon D, Taylor J, Ligon K, Wen P. CTNI-47. PHASE II STUDY OF ABEMACICLIB IN RECURRENT GBM PATIENTS WITH CDKN2A/B LOSS AND INTACT RB. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.213] [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
Deregulation of the cyclin-dependent kinases (CDK) 4 and 6 (cdk4/6)–cyclin D-INK4—retinoblastoma protein (Rb) signaling pathway is among the most common aberrations found in glioblastoma (GBM) with more than 80% of patients estimated to be affected. We conducted an open label, multi-center, phase II trial of abemaciclib in participants with recurrent glioblastoma (GBM) at their first relapse and with documented evidence of CDKN2A/B loss and intact RB from archival tissue. A total of 32 patients enrolled on the non-surgical arm of the study with 13 women (40.63%) and median KPS 90 [range 60–100]. The PFS6 rate was 9.37% [95% CI, 2.4%, 22.27%], median PFS 55 days [95% CI, 49, 56], and median OS 384 days [95% CI, 228, 488]. Out of 31 evaluable patients, best response was PR 1 (3.2%), SD 11 (35.5%), and PD 19 (61.3%). The most common grade 3 or higher toxicities at least possibly related to abemaciclib included leukopenia (21.9%), neutropenia (18.6%), lymphopenia (9.4%), and thrombocytopenia (6.3%). Abemaciclib has minimal activity in this preselected recurrent GBM population. Correlative studies from the surgical arm of this study are pending.
Collapse
Affiliation(s)
- Eudocia Lee
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | | | - Mariza Daras
- University of California, San Francisco, San Francisco, CA, USA
| | - John de Groot
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Robert Prins
- University of California Los Angeles, Los Angeles, CA, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennie Taylor
- Department of Neurological Surgery, University of California (UCSF), San Francisco, San Francisco, CA, USA, San Francisco, CA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Patrick Wen
- Dana Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
30
|
Zeng Y, Pelton K, Yerrum S, Kao PL, Sinai C, Tran T, Sinha R, Shetty A, Tolstorukov M, Jaber A, Freitas D, Pisano W, Verselis SJ, Herbert ZT, Lin N, Zhao JJ, Weinstock DM, Chukwueke U, Aizer AA, Chiocca EA, Bi WL, Wen P, Lee E, Nayak L, Meredith D, Santagata S, Chow KH, Ligon K. TMOD-03. PAN-CANCER ANALYSIS OF ORTHOTOPIC PATIENT DERIVED XENOGRAFTS FROM BRAIN METASTASES. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.954] [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
Brain metastases (BM) are a leading cause of cancer death and prognosis remains poor despite treatment advances at other sites. Models are central to therapeutic development, but few orthotopic patient-derived xenograft (PDX) models of BM exist. To represent diversity across BM types, we established a program to create orthotopic PDX at scale from all BM patients. To date BM were received from 100 patients and PDX attempted by direct brain injection (PDX, n=89) or injection of low passage patient-derived cell lines (PDCLX, n=11). We created 65 successful BM PDX from 13 cancers: 17 lung (55% take), 15 breast (68%), 6 melanoma (75%), 5 CNS lymphoma (83%), 3 gastrointestinal (75%), 2 esophageal (40%), 2 ovarian (67%), 1 sarcoma (100%), 1 laryngeal (100%), 1 prostate (100%), 1 pancreatic (100%), 1 uterine adenosarcoma (100%), and 1 yolk sac tumor (100%). Take rate was similar for models derived from patients with prior chemotherapy-only versus immune/targeted therapy-only (63 vs 58%). Fifteen patients had live tumor and matching PBMCs archived for modeling in vitro immunotherapy responses. Mean time to moribund among different cancer types ranged from 27 days (yolk sac tumor) to 177.5 days (ovarian). BM PDX had a favorable timeline for preclinical study (90% moribund at 180 days). All PDX retained high fidelity to the patient driver SNVs and copy aberrations, even at >P4. No significant differences noted by immunodeficient strain (SCID versus NSG) or injection site (orthotopic versus heterotopic). Explants from BM PDX were able to generate long-term cell lines (60%) or short-term cultures with qualitative concordance of model-to-patient responses to targeted therapy (Osimertinib, EGFRi) and immunotherapy (Pembrolizumab, PD1i). Genomic and clinical data were used to create the DFCI BM PDX cBioPortal for public release and models distribution will be available through the DFCI Center for Patient Derived Models.
Collapse
Affiliation(s)
- Yu Zeng
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristine Pelton
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Smitha Yerrum
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pei-Lun Kao
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Claire Sinai
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tony Tran
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rileen Sinha
- Data Science and Bioinformatics Group, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aniket Shetty
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael Tolstorukov
- Data Science and Bioinformatics Group, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aliya Jaber
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dylan Freitas
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William Pisano
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sigitas J Verselis
- Molecular Diagnostics Laboratory, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zach T Herbert
- The Molecular Biology Core Facilities, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nancy Lin
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Jean J Zhao
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David M Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - E Antonio Chiocca
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Patrick Wen
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Eudocia Lee
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | - David Meredith
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kin Hoe Chow
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
31
|
Jane Lim-Fat M, Youssef G, Touat M, Iorgulescu B, Woodward E, Whorral S, Allen M, Vogelzang J, Pisano W, Rahman R, Chukwueke U, Mcfaline-Figueroa J, Nayak L, Lee E, Batchelor T, Chiocca EA, Meredith D, Santagata S, Reardon D, Beroukhim R, Bi WL, Ligon K, Wen P. PATH-03. CLINICAL UTILITY OF NEXT GENERATION SEQUENCING IN IDH-WILDTYPE GLIOBLASTOMA: THE DANA-FARBER CANCER INSTITUTE EXPERIENCE. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
Comprehensive next generation sequencing (NGS) is available through many academic institutions and commercial entities, and is incorporated in practice guidelines for glioblastoma (GBM). We retrospective evaluated the practice patterns and utility of incorporating NGS data into routine care of GBM patients at a clinical trials-focused academic center.
METHODS
We identified 1,011 consecutive adult patients with histologically confirmed GBM with OncoPanel testing, a targeted exome NGS platform of 447 cancer-associated genes at Dana Farber Cancer Institute (DFCI), from 2013-2019. We selected and retrospectively reviewed clinical records of all IDH-wildtype GBM patients treated at DFCI.
RESULTS
We identified 557 GBM IDH-wildtype patients, of which 227 were male (40.7%). OncoPanel testing revealed 833 single nucleotide variants and indels in 44 therapeutically relevant genes (Tier 1 or 2 mutations) including PIK3CA (n=51), BRAF (n=9), FGFR1 (n=8), MSH2 (n=4), MSH6 (n=2) and MLH1 (n=1). Copy number analysis revealed 509 alterations in 18 therapeutically relevant genes including EGFR amplification (n= 186), PDGFRA amplification (N=39) and CDKN2A/2B homozygous loss (N=223). Median overall survival was 17.5 months for the whole cohort. Seventy-four therapeutic clinical trials accrued 144 patients in the upfront setting (25.9%) and 203 patients (36.4%) at recurrence. Altogether, NGS data for 107 patients (19.2%) were utilized for clinical trial enrollment or targeted therapy indications. High mutational burden (>17mutations/Mb) was identified in 11/464 samples (2.4%); of whom 3/11 received immune checkpoint blockade. Four patients received compassionate use therapy targeting EGFRvIII (rindopepimut, n=2), CKD4/6 (abemaciclib, n=1) and BRAFV600E (dabrafenib/trametinib, n=1).
CONCLUSION
While NGS has greatly improved diagnosis and molecular classification, we highlight that NGS remains underutilized in selecting therapy in GBM, even in a setting where clinical trials and off-label therapies are relatively accessible. Continued efforts to develop better targeted therapies and efficient clinical trial design are required to maximize the potential benefits of genomically-stratified data.
Collapse
Affiliation(s)
| | | | - Mehdi Touat
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | | | | | | | - Marie Allen
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | - William Pisano
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rifaquat Rahman
- Brigham and Women’s/Dana-Farber Cancer Center, Boston, MA, USA
| | | | | | | | - Eudocia Lee
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | - E Antonio Chiocca
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Meredith
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Patrick Wen
- Dana Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
32
|
Kim A, Cardona J, Chang K, Beers A, Brown J, Emblem K, Kalpathy-Cramer J, Lee E, Lin N, Tolaney S, Nayak L, Chukwueke U, Oh K, Shih H, White M, Lawrence D, Moy B, Cohen J, Giobbie-Hurder A, Cahill D, Sullivan R, Brastianos P, Gerstner E. NIMG-05. ADVANCED IMAGING TO ASSESS LONGITUDINAL VASCULAR CHANGES IN BRAIN METASTASES TREATED WITH CHECKPOINT INHIBITION. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.618] [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
Immune checkpoint inhibitors (ICI) have recently been shown to be effective for brain metastases (BM) in melanoma and lung cancer. However, accurately assessing intracranial response in patients undergoing ICI is a challenge, as current measures cannot reliably distinguish pseudoprogression from true tumor progression. To identify potential biomarkers of response, we analyzed standard post-contrast and dynamic susceptibility contrast MRI to identify characteristic vascular signatures as part of an ongoing Phase 2 study of pembrolizumab for patients with untreated or progressive, previously treated BM from any histology. Tumor volume measurements were calculated by summating all enhancing voxels. A volumetric increase of >40% was categorized as progressive disease (PD), a decrease of >60% as partial response (PR), and stable disease (SD) as between -60% and +40%. 78 patients have been enrolled, of whom 44 have received at least baseline advanced MR imaging. Histologies include 21 with breast cancer, 5 with non-small cell lung cancer, 4 with melanoma, and 13 with other cancers. At baseline, the total number of BM was 1-50+ per patient. Based on summing the entire enhancing intracranial disease burden, best volumetric responses for the 33 evaluable patients include 4 PR, 10 SD, and 19 PD. On preliminary analysis, there was a correlation between increased tumor cerebral blood volume/flow with tumor progression. Correlation of additional vascular physiologic parameters (e.g. vessel caliber, tissue oxygenation) to volumetric response, patient outcome, and standardized response criteria (iRANO) are ongoing. Our data provides potential evidence that effective ICI is associated with a decrease in perfusion. Ongoing analyses to uncover additional vascular changes – specifically longitudinal metrics reflecting vascular structure and function - within BM to ICI are pending. These findings have potential to explore mechanisms of ICI response and resistance, as well as biomarkers of response.
Collapse
Affiliation(s)
- Albert Kim
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Ken Chang
- Massachusetts General Hospital, Boston, MA, USA
| | | | - James Brown
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Eudocia Lee
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Nancy Lin
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Kevin Oh
- Massachusetts General Hospital, Boston, MA, USA
| | - Helen Shih
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Beverly Moy
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Daniel Cahill
- Department of Neurosurgery, Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | |
Collapse
|
33
|
Jane Lim-Fat M, Rahman R, Muzikansky A, Woodward E, Whorral S, Allen M, Touat M, Iorgulescu B, Youssef G, Chukwueke U, Mcfaline-Figueroa J, Nayak L, Lee E, Reardon D, Huang R, Beroukhim R, Bi WL, Ligon K, Wen P. BIOM-44. GENOMIC PREDICTORS OF ADVERSE EVENTS IN NEWLY DIAGNOSED IDH-WILDTYPE GLIOBLASTOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Adverse outcomes including lymphopenia, thromboembolism (VTE), pseudoprogression and seizures cause significant morbidity in glioblastoma (GBM) patients. The association between genomic biomarkers and adverse outcomes in IDH-wildtype (IDH-wt) GBM needs to be further validated.
METHODS
We identified 1,011 consecutive adult patients with histologically confirmed GBM with OncoPanel testing (capture-based next-generation sequencing of 447 cancer-associated genes) at Dana-Farber Cancer Institute from 2013–2019. IDH-mutant patients and those without consistent follow-up at DFCI were excluded. Seizure at presentation, lymphopenia (absolute lymphocyte count < 1.0x109/L) at the beginning and end of chemoradiation, VTE, radiographic pseudoprogression (< 6 months of RT end) and early progression (< 6 months since completing RT) were identified retrospectively as adverse events. Single nucleotide variants and indels of relevant genes (Tier 1 or 2 mutations) and copy number analysis were derived. Variables were compared using Wilcoxon rank-sum test or Fisher’s Exact test with p< 0.05 indicating statistical significance.
RESULTS
Among 557 patients included, 198/508 (39%) had MGMT-methylated GBMs. Seizure at presentation occurred in 176/542 (32%) and was more common in TP53- or RB1-mutant GBM. Pre-RT 83/338 (25%), but not post-RT lymphopenia (249/367, 68%), was associated with PIK3CA mutation. VTE was detected in 74/509 (15%) during follow-up and was associated with mutations in PIK3CA and POLE. Pseudoprogression was noted in 43/457 (9%) of patients and was not associated with MGMT status or genomic alterations. Early progressive disease occurred in 33% of patients and was associated with unmethylated MGMT, PIK3CA, STAG2 and PTPN11 mutations. Median overall survival for the entire cohort was 17.5 months.
CONCLUSION
PIK3CA mutations were associated with baseline lymphopenia, risk of VTE and early progression in this cohort. Genomic biomarkers may help identify patients at higher risk of select adverse events in IDH-wt GBM. This could benefit patients through tailoring of supportive care and prophylactic therapies.
Collapse
Affiliation(s)
| | - Rifaquat Rahman
- Brigham and Women’s/Dana-Farber Cancer Center, Boston, MA, USA
| | | | | | | | - Marie Allen
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mehdi Touat
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | | | | | | | | | | | - Eudocia Lee
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
34
|
Rahman R, Trippa L, Fell G, Lee E, Arrillaga-Romany I, Touat M, McCluskey C, Brunno J, Gaffey S, Drappatz J, Lassman A, Galanis E, Ahluwalia M, Colman H, Nabors L, Hepel J, Elinzano H, Schiff D, Chukwueke U, Beroukhim R, Nayak L, Mcfaline-Figueroa J, Batchelor T, Rinne M, Kaley T, Lu-Emerson C, Bi WL, Arnaout O, Haas-Kogan D, Tanguturi S, Cagney D, Aizer AA, Welch M, Doherty L, Lavallee M, Fisher-Longden B, Dowling S, Geduldig J, Watkinson F, Santagata S, Meredith D, Chiocca EA, Reardon D, Ligon K, Alexander B, Wen P. CTNI-11. CC-115 IN NEWLY DIAGNOSED MGMT UNMETHYLATED GLIOBLASTOMA IN THE INDIVIDUALIZED SCREENING TRIAL OF INNOVATIVE GLIOBLASTOMA THERAPY (INSIGHT): A PHASE II RANDOMIZED BAYESIAN ADAPTIVE PLATFORM TRIAL. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
CC-115 is an oral, CNS-penetrant, selective inhibitor of mammalian target of rapamycin kinase (mTOR) and deoxyribonucleic acid-dependent protein kinase (DNA-PK). Both targets are important in glioblastoma; PI3K/Akt/mTOR signaling is hyperactive in most glioblastomas, and DNA-PK is integral to repair of radiotherapy-mediated DNA damage. To investigate CC-115 in newly diagnosed glioblastoma and explore potential genomic biomarker associations, CC-115 was evaluated in the Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) trial, an adaptive platform trial designed to efficiently test experimental agents.
METHODS
Adults with newly diagnosed MGMT-unmethylated glioblastoma, with genomic data available, are eligible for this ongoing trial. Patients are adaptively randomized to one of several experimental arms or the control arm: standard radiotherapy with concurrent and adjuvant temozolomide. The primary endpoint is overall survival (OS). Patients randomized to CC-115 (10mg po BID) received it concurrently with radiotherapy and as adjuvant monotherapy. As the first in-human use of CC-115 with radiation, a safety lead-in 3 + 3 design was used.
RESULTS
Twelve patients were randomized to CC-115; seven patients had possible treatment-related CTCAE grade > 3 toxicity, including four pre-specified dose-limiting toxicities: liver function abnormality (n=1), hyperlipidemia (n=1), lipase elevation (n=1) and cerebral edema (n=1). There was no significant difference in progression-free survival (PFS, median 4.2 months [CC-115] vs. 5.2 months, p=0.9) or OS (median 10.1 months [CC-115] vs. 14.5 months, p=0.9) compared to the 50 patients randomized to the control arm. Based on early PFS results, randomization probability to CC-115 decreased from 25% to < 10% at time of the trial arm closure.
CONCLUSION
Concurrent and adjuvant CC-115 was associated with toxicity and failed to improve PFS or OS. The INSIGhT trial design allowed for more efficient testing of CC-115, decreasing patients and resources allocated to a therapy that was discontinued due to concerns about toxicity and unfavorable risk-to-benefit ratio.
Collapse
Affiliation(s)
- Rifaquat Rahman
- Brigham and Women’s/Dana-Farber Cancer Center, Boston, MA, USA
| | | | | | - Eudocia Lee
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Mehdi Touat
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | - Andrew Lassman
- New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | - Louis Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | | | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | | | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daphne Haas-Kogan
- Dana-Farber Cancer Institute/Boston Children’s Hospital, Boston, MA, USA
| | | | | | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Mary Welch
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | | | | | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - David Meredith
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - E Antonio Chiocca
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
35
|
Wen P, Trippa L, Lee E, Fell G, Rahman R, Arrillaga-Romany I, Touat M, McCluskey C, Brunno J, Gaffey S, Drappatz J, Lassman A, Galanis E, Ahluwalia M, Colman H, Nabors L, Hepel J, Elinzano H, Schiff D, Chukwueke U, Beroukhim R, Nayak L, Mcfaline-Figueroa J, Batchelor T, Rinne M, Kaley T, Lu-Emerson C, Bi WL, Arnaout O, Peruzzi PP, Doherty L, Haas-Kogan D, Tanguturi S, Cagney D, Aizer AA, Welch M, Lavallee M, Fisher-Longden B, Dowling S, Geduldig J, Santagata S, Meredith D, Chiocca EA, Reardon D, Ligon K, Alexander B. CTNI-12. PRELIMINARY RESULTS OF THE ABEMACICLIB ARM IN THE INDIVIDUALIZED SCREENING TRIAL OF INNOVATIVE GLIOBLASTOMA THERAPY (INSIGHT): A PHASE II PLATFORM TRIAL USING BAYESIAN ADAPTIVE RANDOMIZATION. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
The cyclin D-CDK4/6-Rb pathway is activated in most glioblastomas. Abemaciclib is a potent CDK4/6 inhibitor with good brain penetration approved for ER/PR/HER2- breast cancer. In order to efficiently evaluate the potential impact of abemaciclib on overall survival (OS) in newly diagnosed glioblastoma and to simultaneously develop information regarding potential genomic biomarker associations, abemaciclib was included as an arm on the Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) trial. INSIGhT is a phase II platform trial using response adaptive randomization and deep genomic profiling to more efficiently test experimental agents in MGMT unmethylated glioblastoma and potentially accelerate identification of novel therapies for phase III testing. Initial randomization was equal between abemaciclib, control, and two other experimental arms but subsequent randomization was adapted based on efficacy as determined by progression-free survival (PFS). Ineffective arms were discontinued and new arms added by protocol amendment. We report preliminary results for the abemaciclib arm which has completed accrual.
METHODS
Patients with newly diagnosed MGMT-unmethylated glioblastoma were randomized to receive either radiotherapy with concomitant and adjuvant temozolomide at standard doses or standard radiochemotherapy followed by adjuvant abemaciclib (150–200 mg orally BID) without temozolomide. Treatment continued until progression or development of unacceptable toxicities. The primary endpoint was OS. Association between abemaciclib efficacy and cyclin D-CDK4/6-Rb pathway genomic alterations was also investigated.
RESULTS
There were 123 patients (50 control; 73 treated with abemaciclib). Abemaciclib was generally well-tolerated with no new toxicity signals identified. PFS was significantly longer (p=0.03, logrank test) with abemaciclib (median 6.31 months 95% CI [5.29, 8.18]) compared to the control arm (5.16 months 95% CI [4.37, 6.28]). 28/50 control and 36/73 abemaciclib patients remain alive.
CONCLUSION
Preliminary analysis suggests that abemaciclib increases PFS compared to control. Updated toxicity, PFS and survival data and potential genomic biomarker associations will be presented.
Collapse
Affiliation(s)
- Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Eudocia Lee
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Rifaquat Rahman
- Brigham and Women’s/Dana-Farber Cancer Center, Boston, MA, USA
| | | | | | | | | | | | | | - Andrew Lassman
- New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | - Louis Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | | | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | | | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Lisa Doherty
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Daphne Haas-Kogan
- Dana-Farber Cancer Institute/Boston Children’s Hospital, Boston, MA, USA
| | | | | | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Mary Welch
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - David Meredith
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - E Antonio Chiocca
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | | |
Collapse
|
36
|
Nayyar N, Shih DJ, Bihun I, Dagogo-Jack I, Gill CM, Aquilanti E, Bertalan M, Kaplan A, D'Andrea MR, Chukwueke U, Alvarez-Breckenridge C, Lastrapes M, Kuter B, Strickland MR, Martinez-Gutierrez JC, Nagabhushan D, De Sauvage M, White MD, Castro BA, Hoang K, Paek SH, Park SH, Martinez-Lage M, Berghoff AS, Merrill P, Gerstner ER, Batchelor TT, Frosch MP, Frazier RP, Borger DR, Iafrate AJ, Santagata S, Preusser M, Cahill DP, Carter SL, Brastianos PK. Abstract 4729: Identifying genomic drivers of lung adenocarcinoma brain metastases. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-4729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Although lung adenocarcinomas frequently metastasize to the brain, treatment options for lung adenocarcinoma brain metastases (BM-LUAD) are limited. We discovered novel candidate drivers of progression by using case-control analyses to compare whole-exome sequencing data from a cohort of 73 BM-LUAD to a control cohort of 503 primary lung adenocarcinomas. We identified MYC, YAP1 and MMP13 as genomic regions with significantly more frequent amplifications in BM-LUAD compared to control cohort. We validated that MYC, YAP1 and MMP13 can drive brain metastases in a patient-derived xenograft mouse model, where incidence of brain metastases was higher in mice injected with tumor cells expressing the candidate drivers compared to tumor cells expressing LacZ. These results indicate that somatic alterations can drive lung adenocarcinomas to metastasize to the brain. These candidate drivers may serve as therapeutic targets in patients with brain metastatic lung adenocarcinomas.
Citation Format: Naema Nayyar, David J. Shih, Ivanna Bihun, Ibiayi Dagogo-Jack, Corey M. Gill, Elisa Aquilanti, Mia Bertalan, Alexander Kaplan, Megan R. D'Andrea, Ugonma Chukwueke, Christopher Alvarez-Breckenridge, Matthew Lastrapes, Ben Kuter, Matthew R. Strickland, Juan Carlos Martinez-Gutierrez, Deepika Nagabhushan, Magali De Sauvage, Michael D. White, Brandyn A. Castro, Kaitlin Hoang, Sun Ha Paek, Sun Hye Park, Maria Martinez-Lage, Anna S. Berghoff, Parker Merrill, Elizabeth R. Gerstner, Tracy T. Batchelor, Matthew P. Frosch, Ryan P. Frazier, Darrell R. Borger, A John Iafrate, Sandro Santagata, Matthias Preusser, Daniel P. Cahill, Scott L. Carter, Priscilla K. Brastianos. Identifying genomic drivers of lung adenocarcinoma brain metastases [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4729.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ben Kuter
- 3Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | | | - Sun Ha Paek
- 4Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Hye Park
- 4Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Shih DJH, Nayyar N, Bihun I, Dagogo-Jack I, Gill CM, Aquilanti E, Bertalan M, Kaplan A, D'Andrea MR, Chukwueke U, Ippen FM, Alvarez-Breckenridge C, Camarda ND, Lastrapes M, McCabe D, Kuter B, Kaufman B, Strickland MR, Martinez-Gutierrez JC, Nagabhushan D, De Sauvage M, White MD, Castro BA, Hoang K, Kaneb A, Batchelor ED, Paek SH, Park SH, Martinez-Lage M, Berghoff AS, Merrill P, Gerstner ER, Batchelor TT, Frosch MP, Frazier RP, Borger DR, Iafrate AJ, Johnson BE, Santagata S, Preusser M, Cahill DP, Carter SL, Brastianos PK. Genomic characterization of human brain metastases identifies drivers of metastatic lung adenocarcinoma. Nat Genet 2020; 52:371-377. [PMID: 32203465 PMCID: PMC7136154 DOI: 10.1038/s41588-020-0592-7] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/18/2020] [Indexed: 01/08/2023]
Abstract
Brain metastases from lung adenocarcinoma (BM-LUAD) frequently cause patient mortality. To identify genomic alterations that promote brain metastases, we performed whole-exome sequencing of 73 BM-LUAD cases. Using case-control analyses, we discovered candidate drivers of brain metastasis by identifying genes with more frequent copy-number aberrations in BM-LUAD compared to 503 primary LUADs. We identified three regions with significantly higher amplification frequencies in BM-LUAD, including MYC (12 versus 6%), YAP1 (7 versus 0.8%) and MMP13 (10 versus 0.6%), and significantly more frequent deletions in CDKN2A/B (27 versus 13%). We confirmed that the amplification frequencies of MYC, YAP1 and MMP13 were elevated in an independent cohort of 105 patients with BM-LUAD. Functional assessment in patient-derived xenograft mouse models validated the notion that MYC, YAP1 or MMP13 overexpression increased the incidence of brain metastasis. These results demonstrate that somatic alterations contribute to brain metastases and that genomic sequencing of a sufficient number of metastatic tumors can reveal previously unknown metastatic drivers.
Collapse
Affiliation(s)
- David J H Shih
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Naema Nayyar
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Program in Molecular Medicine, UMass Medical School, Worcester, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ivanna Bihun
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Corey M Gill
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Elisa Aquilanti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mia Bertalan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander Kaplan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Megan R D'Andrea
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ugonma Chukwueke
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Franziska Maria Ippen
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Nicholas D Camarda
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew Lastrapes
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Devin McCabe
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ben Kuter
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin Kaufman
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew R Strickland
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Juan Carlos Martinez-Gutierrez
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Deepika Nagabhushan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Magali De Sauvage
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael D White
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Brandyn A Castro
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kaitlin Hoang
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Kaneb
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Emily D Batchelor
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun Hye Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Parker Merrill
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tracy T Batchelor
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew P Frosch
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan P Frazier
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Darrell R Borger
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Bruce E Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Laboratory for Systems Pharmacology, Harvard Medical School, Boston, MA, USA
- Ludwig Center at Harvard Medical School, Boston, MA, USA
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Scott L Carter
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Priscilla K Brastianos
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
38
|
Chukwueke U, Kim A, Ng S, Fisher D, Stuver R, Larocca C, Louissaint A, Weinstock D, Nayak L, Meredith D. RARE-22. CHALLENGES IN MANAGEMENT OF CNS INVOLVEMENT OF CUTANEOUS T-CELL LYMPHOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.945] [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
Cutaneous T-cell lymphoma (CTCL) is a group of T-cell lymphomas occurring primarily in the skin, without evidence of disease elsewhere. Central nervous system (CNS) involvement of CTCL is extremely rare, with a reported incidence of 5–9%. Due to its infrequency and radiographic appearance which mimics other CNS processes, CNS CTCL may be misdiagnosed. Here, we describe 8 cases of CNS CTCL at a single institution.
METHODS
The electronic medical records at our institution were queried for cases of CNS involvement by CTCL, between 2004–19. Clinical data, imaging and surgical pathology were reviewed.
RESULTS
Eight patients were diagnosed with CNS CTCL with median age of 68 and median time to development of CNS disease of 17 months. 1 patient had synchronous presentation of cutaneous and CNS disease identified at autopsy. Seven out of eight patients presented neurologically with behavioral and mental status changes and 1 patient had concurrent intraocular disease. Imaging showed bilateral non-enhancing T2/FLAIR signal changes in three patients; multifocal enhancement was noted in the others. Malignancy, inflammatory processes and infections including progressive multifocal leukoencephalopathy (PML) were often included in the radiographic differential diagnosis. Prior systemic therapies were variable, including palliative radiation, phototherapy, myeloablative chemotherapy followed by allogeneic stem cell transplant and oral methotrexate. 5 of 8 patients had active cutaneous disease at the time of CNS relapse. Six patients received initial treatment for CNS disease with high-dose methotrexate (HD-MTX). Comprehensive genomic analysis revealed recurrent alterations in genes associated with regulatory T-cell differentiation (SOCS1, NOTCH1), tumor suppressors (CDKN2A, PTEN, TP53); one case was hypermutated.
CONCLUSIONS
CNS involvement of CTCL is rare, occurring more than a year after initial cutaneous disease. Clinical and radiographic findings may be variable, necessitating high clinical suspicion. Most patients respond to HD-MTX. Further molecular analysis is ongoing.
Collapse
Affiliation(s)
| | - Albert Kim
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Samuel Ng
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Brastianos P, Cohen J, Wang N, Lee E, Ligibel J, Chukwueke U, Keeley M, Oh K, White M, Gerstner E, Batchelor T, Lawrence D, Ryan DP, John Iafrate A, Giobbie-Hurder A, Flaherty K, Santagata S, Carter S, Cahill D, Sullivan R. CMET-33. PHASE II STUDY OF PALBOCICLIB IN BRAIN METASTASES HARBORING CDK PATHWAY ALTERATIONS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.234] [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
Up to 25% of all cancer patients will develop brain metastases and prognosis remains poor. In preclinical work, we discovered that more than 50% brain metastases genomically diverge from primary tumors and harbor alterations in genes involved with cell cycle regulation. We thus initiated a phase II study to evaluate the efficacy and safety of the cyclin dependent kinase (CDK) 4/6 inhibitor, palbociclib, in patients with recurrent brain metastases with alterations in the CDK pathway (NCT02896335).
METHODS
The primary endpoint of the trial is the rate of intracranial benefit (defined as CR, PR, or SD, per RANO) at 8 weeks after the start of palbociclib. A Simon two-stage design was used to compare the rate of intracranial benefit for a null rate of 10% against an alternative of 30%. Fifteen patients were to be enrolled in the first stage. If fewer than 2 responders were observed, then the study would stop for insufficient evidence of efficacy. If 6 or more responders were observed among the total of 30, this treatment regimen would be considered worthy of further study. CSF, blood samples and tumor samples were collected to elucidate the genomic determinants of response to CDK inhibitors in the brain.
RESULTS
A total of 14 patients have been accrued (5 with breast cancer, 4 with melanoma, 3 esophageal and 2 with non-small cell lung cancer) thus far. One or more grade-3 or higher adverse events at least possibly related to treatment were seen in six (42%) patients, the majority being hematologic toxicities. At the time of the data analysis, eight (57%) patients had achieved intracranial benefit. Therefore, the study met primary endpoint.
CONCLUSIONS
In this unique, genomically-guided brain metastasis trial, we demonstrate that the CDK 4/6 inhibitor, palbociclib, is well-tolerated and has activity in patients with brain metastases.
Collapse
Affiliation(s)
| | | | - Nancy Wang
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | - Kevin Oh
- Massachusetts General Hospital, Boston, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Zhu L, Narloch JL, Onkar S, Joy M, Broadwater G, Luedke C, Hall A, Kim R, Pogue-Geile K, Sammons S, Nayyar N, Chukwueke U, Brastianos PK, Anders CK, Soloff AC, Vignali DAA, Tseng GC, Emens LA, Lucas PC, Blackwell KL, Oesterreich S, Lee AV. Metastatic breast cancers have reduced immune cell recruitment but harbor increased macrophages relative to their matched primary tumors. J Immunother Cancer 2019; 7:265. [PMID: 31627744 PMCID: PMC6798422 DOI: 10.1186/s40425-019-0755-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/20/2019] [Indexed: 01/06/2023] Open
Abstract
The interplay between the immune system and tumor progression is well recognized. However, current human breast cancer immunophenotyping studies are mostly focused on primary tumors with metastatic breast cancer lesions remaining largely understudied. To address this gap, we examined exome-capture RNA sequencing data from 50 primary breast tumors (PBTs) and their patient-matched metastatic tumors (METs) in brain, ovary, bone and gastrointestinal tract. We used gene expression signatures as surrogates for tumor infiltrating lymphocytes (TILs) and compared TIL patterns in PBTs and METs. Enrichment analysis and deconvolution methods both revealed that METs had a significantly lower abundance of total immune cells, including CD8+ T cells, regulatory T cells and dendritic cells. An exception was M2-like macrophages, which were significantly higher in METs across the organ sites examined. Multiplex immunohistochemistry results were consistent with data from the in-silico analysis and showed increased macrophages in METs. We confirmed the finding of a significant reduction in immune cells in brain METs (BRMs) by pathologic assessment of TILs in a set of 49 patient-matched pairs of PBT/BRMs. These findings indicate that METs have an overall lower infiltration of immune cells relative to their matched PBTs, possibly due to immune escape. RNAseq analysis suggests that the relative levels of M2-like macrophages are increased in METs, and their potential role in promoting breast cancer metastasis warrants further study.
Collapse
Affiliation(s)
- Li Zhu
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica L Narloch
- Clinical Research Training Program, Duke University Medical Center (DUMC), Durham, NC, USA
- Breast Cancer Program, Duke Cancer Institute, DUMC, Durham, NC, USA
| | - Sayali Onkar
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, USA
| | - Marion Joy
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA
| | | | | | | | - Rim Kim
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA
| | | | - Sarah Sammons
- Breast Cancer Program, Duke Cancer Institute, DUMC, Durham, NC, USA
- Division of Hematology/Oncology, Department of Medicine, DUMC, Durham, NC, USA
| | - Naema Nayyar
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ugonma Chukwueke
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Priscilla K Brastianos
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carey K Anders
- Division of Medical Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam C Soloff
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dario A A Vignali
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, USA
| | - George C Tseng
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leisha A Emens
- Tumor Microenvironment Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, USA
| | - Peter C Lucas
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kimberly L Blackwell
- Breast Cancer Program, Duke Cancer Institute, DUMC, Durham, NC, USA
- Department of Radiation Oncology, DUMC, Durham, NC, USA
| | - Steffi Oesterreich
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, USA
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, USA
| | - Adrian V Lee
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, USA.
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, USA.
| |
Collapse
|
41
|
Lim-Fat MJ, Bi WL, Lo J, Lee EQ, Ahluwalia MS, Batchelor TT, Chang SM, Chiocca EA, Chukwueke U, Cloughesy TF, Colman H, Deangelis LM, Galanis E, Gilbert MR, De Groot JF, Lassman AB, Liau LM, Mason W, McFaline-Figueroa JR, Mehta MP, Mellinghoff IK, Nabors LB, Nayak L, Reardon DA, Wen PY. Letter: When Less is More: Dexamethasone Dosing for Brain Tumors. Neurosurgery 2019; 85:E607-E608. [PMID: 31215634 DOI: 10.1093/neuros/nyz186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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)
- Mary Jane Lim-Fat
- Center for Neuro-Oncology Dana Farber Cancer Institute Boston, Massachusetts
| | - Wenya Linda Bi
- Department of Neurosurgery Brigham and Women's Hospital Boston, Massachusetts
| | - Janet Lo
- Neuroendocrine Unit Massachusetts General Hospital Boston, Massachusetts
| | - Eudocia Quant Lee
- Center for Neuro-Oncology Dana Farber Cancer Institute Boston, Massachusetts.,Department of Neurology Brigham and Women's Hospital Boston, Massachusetts
| | - Manmeet S Ahluwalia
- Burkhardt Brain Tumor and Neuro-Oncology Center Cleveland Clinic Cleveland, Ohio
| | - Tracy T Batchelor
- Center for Neuro-Oncology Dana Farber Cancer Institute Boston, Massachusetts.,Department of Neurology Brigham and Women's Hospital Boston, Massachusetts
| | - Susan M Chang
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - E Antonio Chiocca
- Department of Neurosurgery Brigham and Women's Hospital Boston, Massachusetts
| | - Ugonma Chukwueke
- Center for Neuro-Oncology Dana Farber Cancer Institute Boston, Massachusetts.,Department of Neurology Brigham and Women's Hospital Boston, Massachusetts
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program University of California, Los Angeles Los Angeles, California
| | - Howard Colman
- Huntsman Cancer Institute and Department of Neurosurgery University of Utah Salt Lake City, Utah
| | - Lisa M Deangelis
- Department of Neurology Memorial Sloan Kettering Cancer Center New York, New York
| | | | - Mark R Gilbert
- Neuro-Oncology Branch Center for Cancer Research National Cancer Institute Bethesda, Maryland
| | - John F De Groot
- Department of Neuro-Oncology The University of Texas M.D. Anderson Cancer Center Houston, Texas
| | - Andrew B Lassman
- Division of Neuro-Oncology Department of Neurology, and Herbert Irving Comprehensive Cancer Center Columbia University Irving Medical Center New York-Presbyterian Hospital New York, New York
| | - Linda M Liau
- Department of Neurosurgery University of California, Los Angeles Los Angeles, California
| | - Warren Mason
- Division of Neurology Princess Margaret Hospital, Toronto Ontario, Canada
| | - J Ricardo McFaline-Figueroa
- Center for Neuro-Oncology Dana Farber Cancer Institute Boston, Massachusetts.,Department of Neurology Brigham and Women's Hospital Boston, Massachusetts
| | - Minesh P Mehta
- Department of Radiation Oncology Miami Cancer Institute Coral Gables, Florida
| | - Ingo K Mellinghoff
- Department of Neurology Memorial Sloan Kettering Cancer Center New York, New York
| | - L Burt Nabors
- UAB Comprehensive Cancer Center The University of Alabama at Birmingham Birmingham, Alabama
| | - Lakshmi Nayak
- Center for Neuro-Oncology Dana Farber Cancer Institute Boston, Massachusetts.,Department of Neurology Brigham and Women's Hospital Boston, Massachusetts
| | - David A Reardon
- Center for Neuro-Oncology Dana Farber Cancer Institute Boston, Massachusetts.,Department of Neurology Brigham and Women's Hospital Boston, Massachusetts
| | - Patrick Y Wen
- Center for Neuro-Oncology Dana Farber Cancer Institute Boston, Massachusetts.,Department of Neurology Brigham and Women's Hospital Boston, Massachusetts
| |
Collapse
|
42
|
Cagney DN, Miller MB, Dubuc A, Delalle I, Ligon AH, Chukwueke U, Al-Mefty O, Aizer A, Ligon K, Wen P. Clinical Importance of CDKN2A Loss and Monosomy 10 in Pilocytic Astrocytoma. Cureus 2019; 11:e4726. [PMID: 31355086 PMCID: PMC6649926 DOI: 10.7759/cureus.4726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This case of a radiation-naive patient with pilocytic astrocytoma highlights how deletions of CDKN2A (cyclin-dependent kinase Inhibitor 2A) and PTEN (phosphatase and tensin homolog) portended a poor clinical outcome. Pilocytic astrocytomas are grade 1 tumors usually occurring in children and young adults with KIAA1549-BRAF fusion defining the majority of pilocytic astrocytomas. The presence of CDKN2A and PTEN loss may be associated with aggressive biology in pilocytic astrocytoma and further studies should include comprehensive genomics in a larger series of adult pilocytic astrocytoma to evaluate this previously unreported finding. Providers need to be aware of this possibility given the potential for poor outcomes.
Collapse
Affiliation(s)
- Daniel N Cagney
- Radiation Oncology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Michael B Miller
- Pathology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Adrian Dubuc
- Pathology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Ivana Delalle
- Pathology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Azra H Ligon
- Pathology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Ugonma Chukwueke
- Neuro-Oncology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Ossama Al-Mefty
- Neurosurgery, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Ayal Aizer
- Radiation Oncology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Keith Ligon
- Pathology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| | - Patrick Wen
- Neuro-Oncology, Dana-Farber / Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
| |
Collapse
|
43
|
Alvarez-Breckenridge C, Prakadan S, Lee E, Tolaney S, Nayak L, Lin N, Bihun I, Chukwueke U, Oh K, White M, Gerstner E, Lawrence D, Cohen J, Giobbie-Hurder A, Cahill D, Carter S, Shalek A, Sullivan R, Brastianos P. CMET-20. EVIDENCE OF CNS RESPONSE OF PEMBROLIZUMAB FOR LEPTOMENINGEAL CARCINOMATOSIS AT A SINGLE CELL RESOLUTION. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Eudocia Lee
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Nancy Lin
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Kevin Oh
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | - Daniel Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Alex Shalek
- Massachusetts Institute of Technology, Boston, MA, USA
| | | | - Priscilla Brastianos
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
44
|
Gerstner E, Cardona J, Chang K, Beers A, Brown J, Kalpathy-Cramer J, Lee E, Lin N, Tolaney S, Nayak L, Chukwueke U, Oh K, Shih H, White M, Lawrence D, Moy B, Cohen J, Giobbie-Hurder A, Cahill D, Sullivan R, Brastianos P. NIMG-63. ADVANCED IMAGING FOR ASSESSING VOLUMETRIC RESPONSES IN BRAIN METASTASES TREATED WITH CHECKPOINT BLOCKADE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Jonathan Cardona
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Ken Chang
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Andrew Beers
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - James Brown
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | | | - Eudocia Lee
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nancy Lin
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Kevin Oh
- Massachusetts General Hospital, Boston, MA, USA
| | - Helen Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Beverly Moy
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Daniel Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Priscilla Brastianos
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
45
|
Abstract
Melanoma is the third most common systemic cancer that leads to brain metastases. The annual incidence of melanoma has increased over time, with brain metastases developing in 40% to 50% of patients with advanced melanoma. Traditional management of melanoma-related brain metastases has focused on symptom control as a result of the significant neurologic morbidity associated with the disease. Median overall survival for these patients, if untreated, is approximately 3 months. As with other brain metastases, a multidisciplinary treatment approach that includes surgery and radiation therapy is typically used, with historically little role for systemic, cytotoxic therapy. During the past decade, advancement within the field of genomics has led to the identification of melanoma-specific mutations, namely, v-Raf murine sarcoma viral oncogene homolog B and neuroblastoma RAS viral oncogene homolog, as well as to the development of agents that target these driver mutations. In addition, the advent of immunotherapies, specifically, agents that target cytotoxic T-lymphocyte antigen-4, anti-programmed death-1, and programmed death ligand-1, has increased the potential therapeutic options available to patients with both systemic and brain disease. With these advances, early trials have demonstrated improved overall survival in patients with brain metastases who receive these therapies either as single agents or as part of multimodality treatment regimens.
Collapse
Affiliation(s)
- Ugonma Chukwueke
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Tracy Batchelor
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | |
Collapse
|
46
|
Chukwueke U, Gill C, Batchelor T, Brastianos P. RARE-32. CLINICAL OUTCOMES IN PATIENTS WITH CENTRAL NEUROCYTOMA. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.695] [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
|
47
|
Yoshida T, Mett I, Bhunia AK, Bowman J, Perez M, Zhang L, Gandjeva A, Zhen L, Chukwueke U, Mao T, Richter A, Brown E, Ashush H, Notkin N, Gelfand A, Thimmulappa RK, Rangasamy T, Sussan T, Cosgrove G, Mouded M, Shapiro SD, Petrache I, Biswal S, Feinstein E, Tuder RM. Rtp801, a suppressor of mTOR signaling, is an essential mediator of cigarette smoke-induced pulmonary injury and emphysema. Nat Med 2010; 16:767-73. [PMID: 20473305 PMCID: PMC3956129 DOI: 10.1038/nm.2157] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 04/15/2010] [Indexed: 12/20/2022]
Abstract
Rtp801, a stress – related protein triggered by adverse environmental conditions, inhibits mTOR and enhances oxidative stress – dependent cell death. We postulated that Rtp801 acts as potential amplifying switch in the development of cigarette smoke – induced lung injury, leading to emphysema. Rtp801 was overexpressed in human emphysematous lungs and in lungs of mice exposed to cigarette smoke. The upregulation of Rtp801 expression by cigarette smoke in the lung relied on oxidative stress – dependent activation of the CCAAT response element. Rtp801 was necessary and sufficient for NF – κ B activation in cultured cells and, when forcefully expressed in mouse lungs, it promoted NF – kB activation, alveolar inflammation, oxidative stress, and apoptosis of alveolar septal cells. On the other hand, Rtp801 − / − mice were markedly protected against acute cigarette smoke – induced lung injury, partly via increased mTOR signaling, and, when exposed chronically, against emphysema. Our data support the notion that Rtp801 may represent an important molecular sensor and mediator of lung injury to cigarette smoke.
Collapse
Affiliation(s)
- Toshinori Yoshida
- Division of Cardiopulmonary Pathology, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Giordano RJ, Lahdenranta J, Zhen L, Chukwueke U, Petrache I, Langley RR, Fidler IJ, Pasqualini R, Tuder RM, Arap W. Targeted induction of lung endothelial cell apoptosis causes emphysema-like changes in the mouse. J Biol Chem 2008; 283:29447-60. [PMID: 18718906 PMCID: PMC2570855 DOI: 10.1074/jbc.m804595200] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pulmonary gas exchange relies on a rich capillary network, which, together
with alveolar epithelial type I and II cells, form alveolar septa, the
functional units in the lung. Alveolar capillary endothelial cells are
critical in maintaining alveolar structure, because disruption of endothelial
cell integrity underlies several lung diseases. Here we show that targeted
ablation of lung capillary endothelial cells recapitulates the cellular events
involved in cigarette smoke-induced emphysema, one of the most prevalent
nonneoplastic lung diseases. Based on phage library screening on an
immortalized lung endothelial cell line, we identified a lung endothelial
cell-binding peptide, which preferentially homes to lung blood vessels. This
peptide fused to a proapoptotic motif specifically induced programmed cell
death of lung endothelial cells in vitro as well as targeted
apoptosis of the lung microcirculation in vivo. As early as 4 days
following peptide administration, mice developed air space enlargement
associated with enhanced oxidative stress, influx of macrophages, and
up-regulation of ceramide. Given that these are all critical elements of the
corresponding human emphysema caused by cigarette smoke, these data provide
evidence for a central role for the alveolar endothelial cells in the
maintenance of lung structure and of endothelial cell apoptosis in the
pathogenesis of emphysema-like changes. Thus, our data enable the generation
of a convenient mouse model of human emphysema. Finally, combinatorial
screenings on immortalized cells followed by in vivo targeting
establishes an experimental framework for discovery and validation of
additional ligand-directed pharmacodelivery systems.
Collapse
Affiliation(s)
- Ricardo J Giordano
- University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Petrache I, Medler TR, Richter AT, Kamocki K, Chukwueke U, Zhen L, Gu Y, Adamowicz J, Schweitzer KS, Hubbard WC, Berdyshev EV, Lungarella G, Tuder RM. Superoxide dismutase protects against apoptosis and alveolar enlargement induced by ceramide. Am J Physiol Lung Cell Mol Physiol 2008; 295:L44-53. [PMID: 18441093 DOI: 10.1152/ajplung.00448.2007] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The molecular events leading to emphysema development include generation of oxidative stress and alveolar cell apoptosis. Oxidative stress upregulates ceramides, proapoptotic signaling sphingolipids that trigger further oxidative stress and alveolar space enlargement, as shown in an experimental model of emphysema due to VEGF blockade. As alveolar cell apoptosis and oxidative stress mutually interact to mediate alveolar destruction, we hypothesized that the oxidative stress generated by ceramide is required for its pathogenic effect on lung alveoli. To model the direct lung effects of ceramide, mice received ceramide intratracheally (Cer(12:0) or Cer(8:0); 1 mg/kg) or vehicle. Apoptosis was inhibited with a general caspase inhibitor. Ceramide augmentation shown to mimic levels found in human emphysema lungs increased oxidative stress, and decreased, independently of caspase activation, the lung superoxide dismutase activity at 48 h. In contrast to their wild-type littermates, transgenic mice overexpressing human Cu/Zn SOD were significantly protected from ceramide-induced superoxide production, apoptosis, and air space enlargement. Activation of lung acid sphingomyelinase in response to ceramide treatment was abolished in the Cu/Zn SOD transgenic mice. Since cigarette smoke-induced emphysema in mice is similarly ameliorated by the Cu/Zn SOD overexpression, we hypothesized that cigarette smoke may induce ceramides in the mouse lung. Utilizing tandem mass spectrometry, we documented increased lung ceramides in adult mice exposed to cigarette smoke for 4 wk. In conclusion, ceramide-induced superoxide accumulation in the lung may be a critical step in ceramide's proapoptotic effect in the lung. This work implicates excessive lung ceramides as amplifiers of lung injury through redox-dependent mechanisms.
Collapse
Affiliation(s)
- Irina Petrache
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University, Indianapolis, Indiana 46202-5120, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|