Use of statins or NSAIDs and survival of patients with high-grade glioma

Background

High-grade glioma (HGG) is associated with a limited prognosis. Drug repurposing has become of increasing interest to improve standard therapy. Statins and NSAIDs inhibit glioma cell growth in vitro and in vivo, but data on statin and NSAID treatment in relation to survival of patients with HGG are sparse.

Methods

We performed multivariable adjusted Cox-regression analyses among 1,093 patients with HGG from a regional cancer registry to obtain Hazard Ratios (HRs) with 95% Confidence Intervals (CIs) for overall survival (OS) and progression-free survival (PFS) according to treatment with statins or NSAIDs. Data on dose and duration of treatment was mostly lacking in our analysis, therefore we were not able to perform dose-response analyses.

Results

Use of statins was unrelated to OS or PFS of glioma patients. Use of aspirin was associated with prolonged OS and PFS in patients with WHO grade III, but not WHO grade IV glioma. Use of other NSAIDs (diclofenac, ibuprofen) or non-NSAID analgesics (paracetamol) was mostly unrelated to survival of glioma patients. Use of selective COX-2 inhibitors and metamizol was related to inferior patient survival in parts of the analyses.

Conclusions

Use of statins or NSAIDS, including aspirin, was not associated with prolonged OS or PFS of patients with WHO grade IV glioma in our selected cohort. There was an indication for improved survival in patients with WHO grade III glioma using aspirin, but further studies are needed to confirm our first observation.

Use of metformin and survival of patients with high-grade glioma

High-grade glioma (HGG) is associated with poor prognosis. Drug repurposing evolves as new modality to improve standard therapy. The antidiabetic drug metformin has been found to inhibit glioma cell growth in vitro and in vivo. The aim of the present retrospective cohort study was to evaluate the survival of patients with HGG with or without treatment with metformin, based on a large cohort of a cancer registry. The analysis included 1,093 patients with HGG diagnosed between 1998 and 2013 from the population-based clinical cancer registry Regensburg (Germany), which covers 2.1 Mio inhabitants and 98% of all cancer diagnoses. We performed multivariable adjusted Cox-regression analyses. Hazard Ratios (HRs) with 95% Confidence Intervals (CIs) for overall survival (OS) and progression-free survival (PFS) of patients with HGG with or without treatment with metformin were obtained. Use of metformin was associated with a significantly better overall and progression-free survival of patients with WHO grade III glioma (HR for OS = 0.30; 95% CI = 0.11-0.81, HR for PFS = 0.29; 95% CI = 0.11-0.78), while there were no significant relations with OS (HR = 0.83; 95% CI = 0.57-1.20) or PFS (HR = 0.85; 95% CI = 0.59-1.22) in patients with WHO grade IV glioma. In conclusion, use of metformin is associated with better overall and progression-free survival of patients with WHO grade III. Possible underlying mechanisms include the higher prevalence of IDH mutations in WHO grade III glioma, which might sensitize to the metabolic drug metformin.

Murine CD8α+ DCs and human BDCA3+ DCs produce large amounts of IFN-λ in response to poly IC and DNA viruses (154.6)

Dendritic cells (DCs) can be segregated into various subsets based on phenotypic and functional differences. Whereas plasmacytoid DCs are known for their type I interferon (IFN) producing capacity, conventional (c) DCs are better known for their roles in T cell homeostasis and priming. Among cDCs the CD8α+ subset is especially efficient in producing IL-12p70 and the induction of immunity against various pathogens and cancer. Here, we reveal a new hallmark function of murine CD8α+ cDCs and their human BDCA3+ counterparts, namely the production of large amounts of IFN-lambda (IFN-λ, also termed IL-28/29) upon stimulation with poly IC. IFN-lambdas are potent immunomodulatory and antiviral cytokines. We demonstrate that the production of IFN-λ upon poly IC injection in vivo depends on hematopoietic cells and the presence of toll-like receptor (TLR)3, interferon regulatory factor (IRF)3, IRF7, IFN-IR, Fms-related tyrosine kinase 3 ligand (FL) and IRF8 but not on myeloid differentiation factor 88 (MyD88), Rig like helicases or lymphocytes. Furthermore, we show that both CD8α+ cDCs and plasmacytoid DCs produce large amounts of IFN-λ in response to HSV-1 or parapoxvirus. Thus, IFN-λ production in response to poly IC is a novel hallmark function of mouse CD8α+ cDCs and their human equivalents.