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Marosi C, Kreye G, Weixler D, Feichtner A, Masel EK. Response to Downar J et al., Medical Assistance in Dying and Palliative Care: Shared Trajectories (DOI: 10.1089/jpm.2023.0209). J Palliat Med 2024. [PMID: 38728409 DOI: 10.1089/jpm.2024.0026] [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: 05/12/2024] Open
Affiliation(s)
- Christine Marosi
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gudrun Kreye
- Division of Palliative Care, Department of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital of Krems, Krems an Der Donau, Austria
| | - Dietmar Weixler
- President of the Austrian Association of Palliative Care, Medical University of Vienna, Vienna, Austria
| | - Angelika Feichtner
- Working Group "Ethics in Palliative Care," Austrian Association of Palliative Care, Medical University of Vienna, Vienna, Austria
| | - Eva Katharina Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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2
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Lütgendorf-Caucig C, Pelak M, Hug E, Flechl B, Surböck B, Marosi C, Mock U, Zach L, Mardor Y, Furman O, Hentschel H, Gora J, Fossati P, Stock M, Graichen U, Klee S, Georg P. Prospective Analysis of Radiation-Induced Contrast Enhancement and Health-Related Quality of Life After Proton Therapy for Central Nervous System and Skull Base Tumors. Int J Radiat Oncol Biol Phys 2024; 118:1206-1216. [PMID: 38244874 DOI: 10.1016/j.ijrobp.2024.01.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE Intracerebral radiation-induced contrast enhancement (RICE) can occur after photon as well as proton beam therapy (PBT). This study evaluated the incidence, characteristics, and risk factors of RICE after PBT delivered to, or in direct proximity to, the brain and its effect on health-related quality of life (HRQoL). METHODS AND MATERIALS Four hundred twenty-one patients treated with pencil beam scanning PBT between 2017 and 2021 were included. Follow-up included clinical evaluation and contrast-enhanced magnetic resonance imaging at 3, 6, and 12 months after treatment completion and annually thereafter. RICE was graded according to Common Terminology Criteria for Adverse Events version 4, and HRQoL parameters were assessed via European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 questionnaires. RESULTS The median follow-up was 24 months (range, 6-54), and median dose to 1% relative volume of noninvolved central nervous system (D1%CNS) was 54.3 Gy relative biologic effectiveness (RBE; range, 30-76 Gy RBE). The cumulative RICE incidence was 15% (n = 63), of which 10.5% (n = 44) were grade 1, 3.1% (n = 13) were grade 2, and 1.4% (n = 6) were grade 3. No grade 4 or 5 events were observed. Twenty-six of 63 RICE (41.3%) had resolved at the latest follow-up. The median onset after PBT and duration of RICE in patients in whom the lesions resolved were 11.8 and 9.0 months, respectively. On multivariable analysis, D1%CNS > 57.6 Gy RBE, previous in-field radiation, and diabetes mellitus were identified as significant risk factors for RICE development. Previous radiation was the only factor influencing the risk of symptomatic RICE. After PBT, general HRQoL parameters were not compromised. In a matched cohort analysis of 54/50 patients with and without RICE, no differences in global health score or functional and symptom scales were seen. CONCLUSIONS The overall incidence of clinically relevant RICE after PBT is very low and has no significant negative effect on long-term patient QoL.
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Affiliation(s)
| | - Maciej Pelak
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria; University Clinic for Radiotherapy and Radiation Oncology, Uniklinikum Salzburg, Salzburg, Austria.
| | - Eugen Hug
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Birgit Flechl
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Birgit Surböck
- Department of Neurology, Klinikum Favoriten, Vienna, Austria
| | - Christine Marosi
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulrike Mock
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Leor Zach
- Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Yael Mardor
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel; Advanced Technology Center, Sheba Medical Center, Ramat Gan, Israel
| | - Orit Furman
- Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Joanna Gora
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Piero Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Markus Stock
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Uwe Graichen
- Department of General Health Studies, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Sascha Klee
- Department of General Health Studies, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Petra Georg
- Department of Radiotherapy, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems, Austria
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Hertler C, Felsberg J, Gramatzki D, Le Rhun E, Clarke J, Soffietti R, Wick W, Chinot O, Ducray F, Roth P, McDonald K, Hau P, Hottinger AF, Reijneveld J, Schnell O, Marosi C, Glantz M, Darlix A, Lombardi G, Krex D, Glas M, Reardon DA, van den Bent M, Lefranc F, Herrlinger U, Razis E, Carpentier AF, Phillips S, Rudà R, Wick A, Tabouret E, Meyronet D, Maurage CA, Rushing E, Rapkins R, Bumes E, Hegi M, Weyerbrock A, Aregawi D, Gonzalez-Gomez C, Pellerino A, Klein M, Preusser M, Bendszus M, Golfinopoulos V, von Deimling A, Gorlia T, Wen PY, Reifenberger G, Weller M. Long-term survival with IDH wildtype glioblastoma: first results from the ETERNITY Brain Tumor Funders' Collaborative Consortium (EORTC 1419). Eur J Cancer 2023; 189:112913. [PMID: 37277265 DOI: 10.1016/j.ejca.2023.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Median survival with glioblastoma remains in the range of 12 months on population levels. Only few patients survive for more than 5 years. Patient and disease features associated with long-term survival remain poorly defined. METHODS European Organization for Research and Treatment of Cancer (EORTC) 1419 (ETERNITY) is a registry study supported by the Brain Tumor Funders Collaborative in the US and the EORTC Brain Tumor Group. Patients with glioblastoma surviving at least 5 years from diagnosis were identified at 24 sites in Europe, US, and Australia. In patients with isocitrate dehydrogenase (IDH) wildtype tumours, prognostic factors were analysed using the Kaplan-Meier method and the Cox proportional hazards model. A population-based reference cohort was obtained from the Cantonal cancer registry Zurich. RESULTS At the database lock of July 2020, 280 patients with histologically centrally confirmed glioblastoma (189 IDH wildtype, 80 IDH mutant, 11 incompletely characterised) had been registered. In the IDH wildtype population, median age was 56 years (range 24-78 years), 96 patients (50.8%) were female, 139 patients (74.3%) had tumours with O6-methylguanine DNA methyltransferase (MGMT) promoter methylation. Median overall survival was 9.9 years (95% confidence interval [95% CI] 7.9-11.9). Patients without recurrence experienced longer median survival (not reached) than patients with one or more recurrences (8.92 years) (p < 0.001) and had a high rate (48.8%) of MGMT promoter-unmethylated tumours. CONCLUSIONS Freedom from progression is a powerful predictor of overall survival in long-term survivors with glioblastoma. Patients without relapse often have MGMT promoter-unmethylated glioblastoma and may represent a distinct subtype of glioblastoma.
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Affiliation(s)
- Caroline Hertler
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jörg Felsberg
- Institute of Neuropathology, Medical Faculty, Heinrich Heine University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - Dorothee Gramatzki
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emilie Le Rhun
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland; Service de neurochirurgie, CHU Lille, F-59000 Lille, France; Univ. Lille, Inserm, CHU Lille, U1192, Laboratoire Protéomique, Réponse Inflammatoire et Spectrométrie de Masse (PRISM), Lille, France
| | - Jennifer Clarke
- UCSF Department of Neurological Surgery, Division of Neuro-Oncology, 400 Parnassus Avenue, A-808 San Francisco, CA, USA
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Wolfgang Wick
- Neurology Clinic, University of Heidelberg, Heidelberg, Germany; CCU Neurooncology, DKFZ, Heidelberg, Germany
| | - Olivier Chinot
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neuro-Oncologie, Marseille, France
| | - François Ducray
- Departments of Neuro-Oncology, Hospices Civils de Lyon, Centre de recherche en Cancérologie de Lyon, Lyon, France; INSERM U1052, CNRS UMR 5286, Université Lyon 1, Lyon, France
| | - Patrick Roth
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kerrie McDonald
- Cure Brain Cancer Neuro-Oncology group, Lowy Cancer Research Centre, University of New South Wales, Sydney, Australia
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Andreas F Hottinger
- Lundin Family Brain Tumor Center, Departments of Oncology & Clinical Neurosciences, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - Jaap Reijneveld
- Amsterdam UMC location Vrije Universiteit Amsterdam, Neurology, Brain Tumor Center Amsterdam, Amsterdam, the Netherlands; Department of Neurology, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center- University of Freiburg, Freiburg, Germany
| | - Christine Marosi
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Glantz
- Departments of Neurosurgery and Oncology, Penn State College of Medicine - Hershey Medical Center, Hershey, PA, USA
| | - Amélie Darlix
- Department of Medical Oncology, Institut régional du Cancer de Montpellier, University of Montpellier, Montpellier, France; Institut de Génomique Fonctionnelle, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Dietmar Krex
- Department of Neurosurgery, University Hospital Carl Gustav Carus, TU, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Medicine Essen, Essen, Germany
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard Medical School, Boston, USA
| | - Martin van den Bent
- Brain Tumor Center at ErasmusMC Cancer Institute, Erasmus University Hospital Rotterdam, Rotterdam, the Netherlands
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Universitaire de Bruxelles HUB, Brussels, Belgium
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University of Bonn, Bonn, Germany
| | | | - Antoine F Carpentier
- Department of Neurology, Hôpital Saint-Louis, Université Paris Cité, APHP, Paris, France
| | - Samuel Phillips
- UCSF Department of Neurological Surgery, Division of Neuro-Oncology, 400 Parnassus Avenue, A-808 San Francisco, CA, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Antje Wick
- Neurology Clinic, University of Heidelberg, Heidelberg, Germany
| | - Emeline Tabouret
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neuro-Oncologie, Marseille, France
| | - David Meyronet
- INSERM U1052, CNRS UMR 5286, Université Lyon 1, Lyon, France; Neuropathology, Hospices Civils de Lyon, Centre de recherche en Cancérologie de Lyon, Lyon, France
| | | | - Elisabeth Rushing
- Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Rapkins
- Cure Brain Cancer Neuro-Oncology group, Lowy Cancer Research Centre, University of New South Wales, Sydney, Australia
| | - Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Monika Hegi
- Neuroscience Research Center and Service of Neurosurgery & Lundin Family Brain Tumor Center, Lausanne University Hospital and University of Lausanne, 1066 Epalinges, Switzerland
| | - Astrid Weyerbrock
- Department of Neurology, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands
| | - Dawit Aregawi
- Departments of Neurosurgery and Oncology, Penn State College of Medicine - Hershey Medical Center, Hershey, PA, USA
| | - Christian Gonzalez-Gomez
- UCSF Department of Neurological Surgery, Division of Neuro-Oncology, 400 Parnassus Avenue, A-808 San Francisco, CA, USA
| | - Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Martin Klein
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital of Heidelberg, Heidelberg, Germany
| | | | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany; CCU Neuropathology, German Cancer Center (DKFZ), Heidelberg, Germany
| | | | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard Medical School, Boston, USA
| | - Guido Reifenberger
- Institute of Neuropathology, Medical Faculty, Heinrich Heine University and University Hospital Düsseldorf, Düsseldorf, Germany; German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
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Lütgendorf-Caucig C, Pelak M, Flechl B, Georg P, Fossati P, Stock M, Traub-Weidinger T, Marosi C, Haberler C, Zechmeister-Machhart G, Hermsmeyer L, Hug E, Staudenherz A. The trends and significance of SSTR PET/CT added to MRI in follow-up imaging of low-grade meningioma treated with fractionated proton therapy. Strahlenther Onkol 2023; 199:396-403. [PMID: 36260109 DOI: 10.1007/s00066-022-02010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Overexpression of the somatostatin receptor (SSTR) has led to adoption of SSTR PET/CT for diagnosis and radiotherapy planning in meningioma, but data on SSTR expression during follow-up remain scarce. We investigated PET/CT quantifiers of SSTR tracers in WHO grade I meningioma following fractionated proton beam therapy (PBT) compared to standard response assessment with MRI. METHODS Twenty-two patients diagnosed with low-grade meningioma treated by PBT were included. Follow-up included clinical visits, MRI, and [68Ga]Ga-DOTATOC PET/CT scans. Radiologic tumor response, MRI and PET volume (VMRI and VPET), maximum and mean standardied uptake value (SUVmax/SUVmean), total lesion activity (TLA), and heterogeneity index (HI) were evaluated. RESULTS Median follow-up was 35.3 months (range: 6.4-47.9). Nineteen patients (86.4%, p = 0.0009) showed a decrease of SUVmax between baseline and first follow-up PET/CT (median: -24%, range: -53% to +89%) and in 81.8% of all cases, the SUVmax, SUVmean, and TLA at last follow-up were eventually lower than at baseline (p = 0.0043). Ambiguous trends without significance between the timepoints analyzed were observed for VPET. HI increased between baseline and last follow-up in 75% of cases (p = 0.024). All patients remained radiologically and clinically stable. Median VMRI decreased by -9.3% (range 0-32.5%, p < 0.0001) between baseline and last follow-up. CONCLUSION PET/CT in follow-up of irradiated meningioma showed an early trend towards decreased binding of SSTR-specific tracers following radiation and MRI demonstrated consistently stable or decreasing tumor volume. Translational research is needed to clarify the underlying biology of the subsequent increase in SSTR PET quantifiers.
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Affiliation(s)
| | - Maciej Pelak
- MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria.
| | - Birgit Flechl
- MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria
| | - Petra Georg
- MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria
| | - Piero Fossati
- MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria
| | - Markus Stock
- MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Division of Palliative Care, Department of Internal Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gloria Zechmeister-Machhart
- MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Lauritz Hermsmeyer
- MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Eugen Hug
- MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria
| | - Anton Staudenherz
- Department of Nuclear Medicine, University Clinic St. Poelten, St. Poelten, Austria
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Marosi C, Urbanic Purkart T. Does increase of symptoms mean progression? Neuro Oncol 2022; 24:2170-2171. [PMID: 36112492 PMCID: PMC9713505 DOI: 10.1093/neuonc/noac218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Christine Marosi
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währiger Gürtel 18-20, 1090 Vienna, Austria
| | - Tadeja Urbanic Purkart
- Department of Neurology, Medical University of Graz, Auenbruggerpl. 22, 8036 Graz, Austria
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Oberndorfer S, Woehrer A, Borkovec M, Marosi C, Payer F, Urbanic-Purkart T, Nowosielski M, Iglseder S, Stockhammer G, Kleindienst W, Florea C, Hager A, Tinchon A, Stultschnig M, Surboeck B, Pichler J, Leibetseder A, Weiss S, Hutterer M, Seebrecht L, Roetzer T, Hainfellner A, Hainfellner J. OS06.6.A Real-World Pattern of Care Study on Glioblastoma in the Austrian Population. Final results from 2014-2020. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.044] [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 Austrian ABTR-SANO Glioblastoma Registry is the first population-based assessment of patterns of care for patients with Glioblastoma across Austrian healthcare institutions. The primary aim is to assess the real world effectiveness of administered therapies.
Material and Methods
Clinical data are collected via a common web-based IT platform “ABTR-SANO Net” since 2014. The database and the ongoing evaluation of clinical parameters, as well as interims analysis are provided in cooperation with a review board. First Outcome analysis, including patients from 2014-2020, was performed at the end of 2021.
Results
Eleven centers across Austria are involved, and the data of 1416 patients (m/f ratio: 1,35, median age: 66 years) were recently analyzed in detail. Age, extent of resection, as well as ECOG was associated with improved survival. Methylated MGMT Status also showed a moderate survival benefit. Patients with re-resection and re-radiation also exhibited improved survival, which however may be attributed to a selection bias.Second line treatment manly comprised of antiangiogenic treatment, followed by alkylated agents, re-radiation and re-surgery. Median overall survival of all patients was 344 days and clearly age dependent (best for <50 years, worse for>80 years).
Conclusion
This is the first population based outcome analysis of Glioblastoma in Austria. Results regarding prognostic markers and outcome are mostly comparable with international data. Robust population based data are important in order to monitor quality of health care, and to match the data with results from clinical studies.
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Affiliation(s)
- S Oberndorfer
- Department Neurology, University Clinic , St Poelten , Austria
- KL-Institute for Neurology and Neuropsychology , St. Poelten, St. Poelten , Austria
| | - A Woehrer
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - M Borkovec
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - C Marosi
- Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - F Payer
- Department Neurology, University Clinic Graz , Graz , Austria
| | | | - M Nowosielski
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - S Iglseder
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - G Stockhammer
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - W Kleindienst
- Department Neurology, CDK-University Clinic Salzburg , Salzburg , Austria
| | - C Florea
- Department Neurology, CDK-University Clinic Salzburg , Salzburg , Austria
| | - A Hager
- Department Neurology, LKH Wiener Neustadt , Wiener Neustadt , Austria
| | - A Tinchon
- Department Neurology, KLPU, University Clinic , St Pölten , Austria
| | - M Stultschnig
- Department Neurology, Clinic Klagenfurt , Klagenfurt , Austria
| | - B Surboeck
- Department Neurology, KFJ Vienna , Vienna , Austria
| | - J Pichler
- Department Internal Medicine, J Kepler University Clinic, Linz , Linz , Austria
| | - A Leibetseder
- Department Neurology, J Kepler University Clinic, Linz , Linz , Austria
| | - S Weiss
- Department Neurolopathology, J Kepler University Clinic Linz , Linz , Austria
| | - M Hutterer
- Department Neurology, J Kepler University Clinic, Linz , Linz , Austria
| | - L Seebrecht
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - T Roetzer
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - A Hainfellner
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - J Hainfellner
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
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Marosi C, Fodor Z, Csukly G. Consequence of the magnocellular dysfunction on processing facial affect recognition in Schizophrenia. Eur Psychiatry 2022. [PMCID: PMC9566046 DOI: 10.1192/j.eurpsy.2022.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Magnocellular deficit in visual perception and impaired emotion recognition are core features of schizophrenia, however their relationship and the neurobiological underpinnings are still unclear. Objectives The aim of our research was to investigate the oscillatory background of perception and emotion recognition in schizophrenia and to examine the relationship between these processes. Methods Thirty-nine subjects with schizophrenia and forty healthy controls subjects were enrolled in the study; the two study groups did not differ in age, gender and education. In the visual paradigm the participants viewed magnocellular biased low-spatial frequency (LSF) and parvocellular biased high-spatial frequency (HSF) Gabor-patches and in the second paradigm happy, sad and neutral faces were presented, while 128-channel EEG was recorded. Results Significantly weaker theta (4-7 Hz) event related synchronisation (ERS) was observed in patients compared to controls in the LSF condition, whereas in the HSF condition there was no difference between the two groups. Event related changes in theta amplitude were also found to be significantly weaker in patients compared to healthy controls in the emotion recognition task, which difference was disappeared after correction for ERS to LSF condition. In the correlational analysis theta activity in the magnocellular biased stimuli correlated significantly with theta activity in the emotion recognition task, while theta to parvocellular biased stimuli showed no similar correlation with emotion recognition. Conclusions In schizophrenia, emotion recognition impairments are closely related to the dysfunction of the magnocellular system, which supports the bottom-up model of schizophrenia. Disclosure No significant relationships.
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Becske M, Marosi C, Molnár H, Fodor Z, Tombor L, Csukly G. Working Memory Deficit and Attentional Distractibility in Schizophrenia. Eur Psychiatry 2022. [PMCID: PMC9563822 DOI: 10.1192/j.eurpsy.2022.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Meta-analyses suggest that patients with schizophrenia show deficit in working memory – both verbal and visual – and are more distractible. Working memory disturbances are even regarded as the central deficit in schizophrenia by some researchers. Theta synchronization (especially over fronto-central areas) is related to cognitive control and executive functioning during working memory encoding and retention.
Objectives
The main goal of the study was to gain more understanding of the nature of working memory deficit and attentional distractibility in schizophrenia.
Methods
35 patients with schizophrenia and 39 matched controls were enrolled in our study. Participants performed a modified Sternberg working memory task that contained salient and non-salient distractor items in the retention period. A high-density 128 channel EEG was recorded during the task. Event-related theta (4-7 Hz) synchronization was analyzed during working memory encoding (learning) and retention (distractor filtering) in a later time window (350-550 ms).
Results
Patients with schizophrenia showed weaker working memory performance and increased attentional distractibility compared to the control group: patients had significantly lower hit rates (p < 0.0001) and higher distractor-related commission error rates (p < 0.0001). Theta synchronization was modulated by condition (learning < distractor) in both groups but it was modulated by salience only in controls (salient distractor > non-salient distractor, p[patients] = 0.95, p[controls] < 0.001).
Conclusions
Our results suggest that patients with schizophrenia show diminished cognitive control compared to controls in response to salient distractors. Difficulties in cognitive control allocation may contribute to the behavioral results observed in this study.
Disclosure
No significant relationships.
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9
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Kast RE, Alfieri A, Assi HI, Burns TC, Elyamany AM, Gonzalez-Cao M, Karpel-Massler G, Marosi C, Salacz ME, Sardi I, Van Vlierberghe P, Zaghloul MS, Halatsch ME. MDACT: A New Principle of Adjunctive Cancer Treatment Using Combinations of Multiple Repurposed Drugs, with an Example Regimen. Cancers (Basel) 2022; 14:2563. [PMID: 35626167 PMCID: PMC9140192 DOI: 10.3390/cancers14102563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
In part one of this two-part paper, we present eight principles that we believe must be considered for more effective treatment of the currently incurable cancers. These are addressed by multidrug adjunctive cancer treatment (MDACT), which uses multiple repurposed non-oncology drugs, not primarily to kill malignant cells, but rather to reduce the malignant cells' growth drives. Previous multidrug regimens have used MDACT principles, e.g., the CUSP9v3 glioblastoma treatment. MDACT is an amalgam of (1) the principle that to be effective in stopping a chain of events leading to an undesired outcome, one must break more than one link; (2) the principle of Palmer et al. of achieving fractional cancer cell killing via multiple drugs with independent mechanisms of action; (3) the principle of shaping versus decisive operations, both being required for successful cancer treatment; (4) an idea adapted from Chow et al., of using multiple cytotoxic medicines at low doses; (5) the idea behind CUSP9v3, using many non-oncology CNS-penetrant drugs from general medical practice, repurposed to block tumor survival paths; (6) the concept from chess that every move creates weaknesses and strengths; (7) the principle of mass-by adding force to a given effort, the chances of achieving the goal increase; and (8) the principle of blocking parallel signaling pathways. Part two gives an example MDACT regimen, gMDACT, which uses six repurposed drugs-celecoxib, dapsone, disulfiram, itraconazole, pyrimethamine, and telmisartan-to interfere with growth-driving elements common to cholangiocarcinoma, colon adenocarcinoma, glioblastoma, and non-small-cell lung cancer. gMDACT is another example of-not a replacement for-previous multidrug regimens already in clinical use, such as CUSP9v3. MDACT regimens are designed as adjuvants to be used with cytotoxic drugs.
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Affiliation(s)
| | - Alex Alfieri
- Department of Neurosurgery, Cantonal Hospital of Winterthur, 8400 Winterthur, Switzerland; (A.A.); (M.-E.H.)
| | - Hazem I. Assi
- Naef K. Basile Cancer Center, American University of Beirut, Beirut 1100, Lebanon;
| | - Terry C. Burns
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Ashraf M. Elyamany
- Oncology Unit, Hemato-Oncology Department, SECI Assiut University Egypt/King Saud Medical City, Riyadh 7790, Saudi Arabia;
| | - Maria Gonzalez-Cao
- Translational Cancer Research Unit, Dexeus University Hospital, 08028 Barcelona, Spain;
| | | | - Christine Marosi
- Clinical Division of Medical Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| | - Michael E. Salacz
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA;
| | - Iacopo Sardi
- Department of Pediatric Oncology, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
| | - Pieter Van Vlierberghe
- Department of Biomolecular Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Mohamed S. Zaghloul
- Children’s Cancer Hospital & National Cancer Institute, Cairo University, Cairo 11796, Egypt;
| | - Marc-Eric Halatsch
- Department of Neurosurgery, Cantonal Hospital of Winterthur, 8400 Winterthur, Switzerland; (A.A.); (M.-E.H.)
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10
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Bady P, Marosi C, Weller M, Grønberg BH, Schultz H, Taphoorn MJB, Gijtenbeek JMM, van den Bent MJ, von Deimling A, Stupp R, Malmström A, Hegi ME. DNA methylation-based age acceleration observed in IDH wild-type glioblastoma is associated with better outcome-including in elderly patients. Acta Neuropathol Commun 2022; 10:39. [PMID: 35331339 PMCID: PMC8944086 DOI: 10.1186/s40478-022-01344-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/05/2022] [Indexed: 12/24/2022] Open
Abstract
Elderly patients represent a growing proportion of individuals with glioblastoma, who however, are often excluded from clinical trials owing to poor expected prognosis. We aimed at identifying age-related molecular differences that would justify and guide distinct treatment decisions in elderly glioblastoma patients. The combined DNA methylome (450 k) of four IDH wild-type glioblastoma datasets, comprising two clinical trial cohorts, was interrogated for differences based on the patients' age, DNA methylation (DNAm) age acceleration (DNAm age "Horvath-clock" minus patient age), DNA methylation-based tumor classification (Heidelberg), entropy, and functional methylation of DNA damage response (DDR) genes. Age dependent methylation included 19 CpGs (p-value ≤ 0.1, Bonferroni corrected), comprising a CpG located in the ELOVL2 gene that is part of a 13-gene forensic age predictor. Most of the age related CpGs (n = 16) were also associated with age acceleration that itself was associated with a large number of CpGs (n = 50,551). Over 70% age acceleration-associated CpGs (n = 36,348) overlapped with those associated with the DNA methylation based tumor classification (n = 170,759). Gene set enrichment analysis identified associated pathways, providing insights into the biology of DNAm age acceleration and respective commonalities with glioblastoma classification. Functional methylation of several DDR genes, defined as correlation of methylation with gene expression (r ≤ -0.3), was associated with age acceleration (n = 8), tumor classification (n = 12), or both (n = 4), the latter including MGMT. DNAm age acceleration was significantly associated with better outcome in both clinical trial cohorts, whereof one comprised only elderly patients. Multivariate analysis included treatment (RT, RT/TMZ→TMZ; TMZ, RT), MGMT promoter methylation status, and interaction with treatment. In conclusion, DNA methylation features of age acceleration are an integrative part of the methylation-based tumor classification (RTK I, RTK II, MES), while patient age seems hardly reflected in the glioblastoma DNA methylome. We found no molecular evidence justifying other treatments in elderly patients, not owing to frailty or co-morbidities.
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11
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Gaiger A, Lubowitzki S, Krammer K, Zeilinger EL, Acel A, Cenic O, Schrott A, Unseld M, Rassoulian AP, Skrabs C, Valent P, Gisslinger H, Marosi C, Preusser M, Prager G, Kornek G, Pirker R, Steger GG, Bartsch R, Raderer M, Simonitsch-Klupp I, Thalhammer R, Zielinski C, Jäger U. The cancer survival index-A prognostic score integrating psychosocial and biological factors in patients diagnosed with cancer or haematologic malignancies. Cancer Med 2022; 11:3387-3396. [PMID: 35315594 PMCID: PMC9487871 DOI: 10.1002/cam4.4697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022] Open
Abstract
Objective We aimed to investigate whether (1) psychological and social indicators influence survival in patients diagnosed with cancer or haematologic malignancies when important biological aspects are controlled for, (2) psychological, social and biological indicators can be utilised to design one collated index for survival, usable in clinical practice to identify patients at risk of shorter survival and to improve personalised healthcare provision. Methods In this cross‐sectional study, 2263 patients with cancer or haematologic malignancies participated. We analysed 15 biological, psychological and social indicators as risk factors for survival with a Cox proportional hazards model. Indicators significantly associated with survival were combined to compute models for the identification of patient groups with different risks of death. The training sample contained 1122 patients. Validation samples included the remaining 1141 patients, the total sample, as well as groups with different cancer entities. Results Five indicators were found to significantly impact survival: Cancer site (HR: 3.56), metastatic disease (HR: 1.88), symptoms of depression (HR: 1.34), female sex (HR: 0.73) and anaemia (HR: 0.48). Combining these indicators to a model, we developed the Cancer Survival Index, identifying three distinct groups of patients with estimated survival times of 47.2 months, 141 months and 198.2 months (p < 0.001). Post hoc analysis of the influence of depression on survival showed a mediating effect of the following four factors, related to both depression and survival: previous psychiatric conditions, employment status, metastatic disease and haemoglobin levels. Conclusions Psychosocial and biological factors impact survival in various malignancies and can be utilised jointly to compute an index for estimating the survival of each patient individually—the Cancer Survival Index.
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Affiliation(s)
- Alexander Gaiger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Katharina Krammer
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth L Zeilinger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Andras Acel
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Olivera Cenic
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Unseld
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Anahita Paula Rassoulian
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Cathrin Skrabs
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Heinz Gisslinger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Gabriela Kornek
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Robert Pirker
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Günther G Steger
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | | | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Ulrich Jäger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
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12
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Berghoff AS, Hielscher T, Ricken G, Furtner J, Schrimpf D, Widhalm G, Rajky U, Marosi C, Hainfellner JA, von Deimling A, Sahm F, Preusser M. Prognostic impact of genetic alterations and methylation classes in meningioma. Brain Pathol 2022; 32:e12970. [PMID: 35213082 PMCID: PMC8877750 DOI: 10.1111/bpa.12970] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/24/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Meningiomas are classified based on histological features, but genetic and epigenetic features are emerging as relevant biomarkers for outcome prediction and may supplement histomorphological evaluation. We investigated meningioma‐relevant mutations and their correlation with DNA methylation clusters and patient survival times. Formalin‐fixed and paraffin‐embedded samples of 126 meningioma patients (WHO grade I 52/126; 41.3%; WHO grade II: 48/126; 38.1%; WHO grade III: 26/126; 20.6%) were investigated. We analyzed NF2, TRAF7, KLF4, ARID, SMO, AKT,TERT promotor, PIK3CA, and SUFU mutations using panel sequencing and correlated them to DNA methylation classes (MC) determined using 850k EPIC arrays. The TRAKL mutation genotype was characterized by the presence of any of the following mutations: TRAF7, AKT1, and KLF4. Survival data including progression‐free survival (PFS) and overall survival (OS) was retrieved from chart review. Mutations were evident in 90/126 (71.4%) specimens with mutations in NF2 (39/126; 31.0%), TRAF7 (39/126; 31.0%) and KLF4 (25/126; 19.8%) being the most frequent ones. Two or more mutations were observed in 35/126 (27.8%) specimens. While TRAKL was predominantly found in benign MC, NF2 was associated with malign MC (p < 0.05). TRAF7, KLF4, and TRAKL mutation genotype were associated with improved PFS and OS (p < 0.05). TERT promotor methylation, intermediate, and malign MC were associated with impaired PFS and OS (p < 0.05). Methylation cluster showed better prognostic discrimination for PFS and OS (c‐index 0.77/0.75) than each of the individual mutations (c‐index 0.63/0.68). In multivariate analysis correcting for age, gender, MC, and WHO grade, none of the individual mutations except TERT remained an independent significant prognostic factor for PFS. Molecular profiling including mutational analysis and DNA methylation classification may facilitate more precise prognostic assessment and identification of potential targets for personalized therapy in meningioma patients.
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Affiliation(s)
- Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ, Heidelberg, Germany
| | - Gerda Ricken
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Schrimpf
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Ursula Rajky
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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13
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Affiliation(s)
- Christine Marosi
- Clinical Division of Palliative Care, Department for Internal Medicine, Medical University of Vienna, Vienna, Austria
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14
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Heugenhauser J, Galijasevic M, Mangesius S, Buchroithner J, Erhart F, Pichler J, Widhalm G, Preusser M, Stockhammer G, Iglseder S, Freyschlag C, Oberndorfer S, Bordihn K, von Campe G, Czech T, Surboeck B, Purkart TU, Marosi C, Felzmann T, Nowosielski M. NIMG-13. RESPONSE ASSESSMENT IN GLIOBLASTOMA PATIENTS TREATED WITH DENDRITIC CELL-BASED IMMUNOTHERAPY: A COMPARATIVE ANALYSIS OF MACDONALD, RANO, MRANO, IRANO AND VOLUMETRIC MEASUREMENTS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.513] [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
Response assessment in the treatment of glioblastoma (GB) based on MR-imaging is still challenging, in particular for immunotherapeutic strategies. Several assessment tools have been proposed. In this post-hoc analysis we compared response assessment criteria (MacDonald, RANO, mRANO, Vol.-mRANO, iRANO) in newly diagnosed GB patients treated with tumor lysate-charged autologous dendritic cells (Audencel) and determined the differences in prediction of progression free survival (PFS) and overall survival (OS).
METHODS
76 patients with newly diagnosed GB enrolled in a multicenter randomized phase II trial receiving standard of care (SOC, n= 40) or SOC + Audencel vaccine (n= 36) were included. Tumor volumes were calculated by semiautomatic segmentation. To detect differences in PFS among the assessment criteria Kruskal-Wallis-test, for correlation analysis Spearman test was used.
RESULTS
There was a significant difference in median PFS based on the different assessments (mRANO 8.55 months [9.10-14.03], Vol.-mRANO 8.61 months [9.72-14.92] compared to MacDonald 4.04 months [5.21-8.75] and RANO 4.16 months [5.28-8.61]. For the vaccination arm only, median PFS by iRANO was 5.95 months [5.70-11.54]). There was no difference in PFS between SOC and SOC + Audencel using the different response criteria. The best correlation between PFS and OS was detected for mRANO (r= 0.65, p< 0.001) and Vol.-mRANO (r= 0.69, p< 0.001). At an 8-month landmark, the impact of progressive disease on median OS was best shown for mRANO (13.70 months [13.13-18.98], and Vol.-mRANO 12.03 months [12.51-17.94]) compared to MacDonald 17.97 months [15.45-20.92], RANO 17.97 months [15.92-20.95] and iRANO 17.34 months [14.99-22.73].
CONCLUSION
When comparing different response assessments in GB patients treated with dendritic cell-based immunotherapy the best correlation between PFS and OS was observed for mRANO and Vol.-mRANO. Overall, no difference in PFS and OS was seen between the two treatment arms. iRANO was not superior for predicting OS in patients treated with Audencel.
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Affiliation(s)
| | - Malik Galijasevic
- Department of Neuroradiology, Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Johanna Buchroithner
- University Clinic for Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Oberosterreich, Austria
| | - Friedrich Erhart
- Department of Neurosurgery, Medical University of Vienna, Vienna, Wien, Austria
| | - Josef Pichler
- Department of Internal Medicine and Neurooncology, Kepler University Hospital, Johannes Kepler University, Linz, Oberosterreich, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Wien, Austria
| | - Matthias Preusser
- Dept. of Medicine, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Sarah Iglseder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Stefan Oberndorfer
- Department of Neurology, University Clinic of St. Pölten, Karl Landsteiner Private University, St. Pölten, Austria
| | - Karin Bordihn
- Department of Neurosurgery, University Clinic of Salzburg, Paracelsus Private Medical University, Salzburg, Austria
| | - Gord von Campe
- Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Wien, Austria
| | - Birgit Surboeck
- Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria
| | - Tadeja Urbanic Purkart
- Department of General Neurology and Department of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Christine Marosi
- Clinical Division of Medical Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Martha Nowosielski
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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15
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Preusser M, Silvani A, Le Rhun E, Soffietti R, Lombardi G, Sepulveda JM, Brandal P, Brazil L, Bonneville-Levard A, Lorgis V, Vauleon E, Bromberg J, Erridge S, Cameron A, Lefranc F, Clement PM, Dumont S, Sanson M, Bronnimann C, Balaná C, Thon N, Lewis J, Mair MJ, Sievers P, Furtner J, Pichler J, Bruna J, Ducray F, Reijneveld JC, Mawrin C, Bendszus M, Marosi C, Golfinopoulos V, Coens C, Gorlia T, Weller M, Sahm F, Wick W. Trabectedin for recurrent WHO grade 2 or 3 meningioma: a randomized phase 2 study of the EORTC Brain Tumor Group (EORTC-1320-BTG). Neuro Oncol 2021; 24:755-767. [PMID: 34672349 DOI: 10.1093/neuonc/noab243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND No systemic treatment has been established for meningioma progressing after local therapies. METHODS This randomized, multicenter, open-label, phase 2 study included adult patients with recurrent WHO grade 2 or 3 meningioma. Patients were 2:1 randomly assigned to intravenous trabectedin (1.5 mg/m 2 every three weeks) or local standard of care (LOC). The primary endpoint was progression-free survival (PFS). Secondary endpoints comprised overall survival (OS), objective radiological response, safety, quality of life (QoL) assessment using the QLQ-C30 and QLQ-BN20 questionnaires, and we performed tissue-based exploratory molecular analyses. RESULTS Ninety patients were randomized (n=29 in LOC, n=61 in trabectedin arm). With 71 events, median PFS was 4.17 months in the LOC and 2.43 months in the trabectedin arm (hazard ratio [HR]=1.42; 80% CI, 1.00-2.03; p=0.294) with a PFS-6 rate of 29.1% (95% CI, 11.9%-48.8%) and 21.1% (95% CI, 11.3%-32.9%), respectively. Median OS was 10.61 months in the LOC and 11.37 months in the trabectedin arm (HR=0.98; 95% CI, 0.54-1.76; p=0.94). Grade ≥3 adverse events occurred in 44.4% patients in the LOC and 59% of patients in the trabectedin arm. Enrolled patients had impeded global QoL and overall functionality and high fatigue before initiation of systemic therapy. DNA methylation class, performance status, presence of a relevant co-morbidity, steroid use, and right hemisphere involvement at baseline were independently associated with OS. CONCLUSIONS Trabectedin did not improve PFS and OS and was associated with higher toxicity than LOC treatment in patients with non-benign meningioma. Tumour DNA methylation class is an independent prognostic factor for OS.
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Affiliation(s)
- Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Antonio Silvani
- Department of Neuro-oncology, IRCCS Fondazione Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133 Milan, Italy
| | - Emilie Le Rhun
- University of Lille, U-1192, F-59000 Lille, France; Inserm, U-1192, F-59000 Lille, France; CHU Lille, General and Stereotaxic Neurosurgery service, F-59000 Lille, France; Oscar Lambret Center, Medical Oncology Department, F-59000 Lille
| | - Riccardo Soffietti
- Dept. Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, 10126 Turin, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV- IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Juan Manuel Sepulveda
- Neurooncology Unit, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Petter Brandal
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
| | - Lucy Brazil
- St Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, United Kingdom
| | | | - Veronique Lorgis
- Department of Medical Oncology, Centre Georges François Leclerc, 1 Rue du Professeur Marion, 21000 Dijon, France
| | - Elodie Vauleon
- Department of Medical Oncology, Centre Eugene Marquis, Avenue de la Bataille Flandres Dunkerque, 25042 Rennes, France
| | - Jacoline Bromberg
- Department of Neuro-Oncology, Erasmus MC University Medical Center Cancer Center, Doctor Molewaterplein 40, 3015 Rotterdam, The Netherlands
| | - Sara Erridge
- Edinburgh Cancer Centre, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, United Kingdom
| | - Alison Cameron
- Bristol Cancer Institute, University Hospitals Bristol, Marlborough St, Bristol BS1 3NU, United Kingdom
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Erasme; Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Paul M Clement
- Department of Oncology, KU Leuven and Department of General Medical Oncology, UZ Leuven, Leuven Cancer Institute, Herestraat 49, 3000 Leuven, Belgium
| | - Sarah Dumont
- Institut Gustave-Roussy, Université Paris-Saclay, Medical Oncology Department, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Marc Sanson
- 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, 47-83 Boulevard del l'Hôpital, 75013, Paris, France
| | - Charlotte Bronnimann
- Department of Medical Oncology, Bordeaux University Hospital-CHU, Bordeaux, France, University of Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - Carmen Balaná
- Department of Medical Oncology, Catalan Institute of Oncology, Carretera Canyet sn, 08916 Badalona , Barcelona, Spain
| | - Niklas Thon
- Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Munich LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - Joanne Lewis
- Freeman Hospital, Freeman Rd, High Heaton, Newcastle NE7 7DN, United Kingdom
| | - Maximilian J Mair
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Philipp Sievers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany, Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research DKTK), German Cancer Research Center DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Josef Pichler
- Department of Internal Medicine and Neurooncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-Institut Català D'Oncologia L'Hospitalet, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francois Ducray
- Unit of Neuro-Oncology, Hospices Civils de Lyon and Department of Cancer Cell Plasticity, Cancer Research Center of Lyon, Claude Bernard University, 28 Rue Laennec, 69008 Lyon, France
| | - Jaap C Reijneveld
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, Netherlands and Stichting Epilepsie Instellingen Nederland, Achterweg 3, 2103 SW Heemstede, Netherlands
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Vassilis Golfinopoulos
- European Organisation for Research and Treatment of Cancer EORTCHeadquarter, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer EORTCHeadquarter, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Thierry Gorlia
- European Organisation for Research and Treatment of Cancer EORTCHeadquarter, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany, Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research DKTK), German Cancer Research Center DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Wolfgang Wick
- Neurology Clinic, Heidelberg University Medical Center, Clinical Cooperation Unit, Neurooncology, German Cancer Research Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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16
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Mair MJ, Pajenda S, Ilhan-Mutlu A, Steindl A, Kiesel B, Widhalm G, Dieckmann K, Feldmann K, Hainfellner J, Marosi C, Müllauer L, Wagner L, Preusser M, Berghoff AS. Soluble PD-L1 is associated with local and systemic inflammation markers in primary and secondary brain tumours. ESMO Open 2021; 5:e000863. [PMID: 33184096 PMCID: PMC7662140 DOI: 10.1136/esmoopen-2020-000863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background Immune-modulatory treatments have so far shown limited clinical activity in primary brain tumours. We aimed to investigate soluble programmed death receptor ligand 1 (sPD-L1) as systemic inflammation parameter in patients with brain tumour. Methods EDTA plasma was collected from 81 glioma (55 glioblastoma (GBM), 26 lower-grade glioma (LGG)), 17 meningioma and 44 brain metastasis (BM) patients and 24 controls. sPD-L1 concentrations were determined by ELISA. Correlations with the local tumour microenvironment were assessed by immunohistochemical analysis for PD-L1, CD3 and CD8. Results sPD-L1 was detected in 62 out of 166 (37.7%) patients (glioma: 41/81, 50.6%; meningioma: 5/17, 29.4%; BM: 7/44, 15.9%; controls: 9/24, 37.5%; p=0.002). sPD-L1 concentrations were lower in BM than in LGG (p=0.003) or GBM (p<0.001). Membranous PD-L1 expression on tumour cells was not associated with sPD-L1 concentrations (p=0.953). sPD-L1 concentration was inversely correlated with the density of CD8+ (r=−0.713, p=0.001) and CD3+ (r=−0.484, p=0.042) tumour-infiltrating lymphocytes in LGG. sPD-L1 is correlated with neutrophil counts (r=−0.318, p=0.045) and C reactive protein levels (r=−0.363, p=0.008) in GBM. sPD-L1+ patients had longer overall survival in GBM (p=0.006) and worse OS in LGG (p=0.028). Conclusions sPD-L1 is detectable in a fraction of patients with brain tumour. Although it is not correlated with tissue PD-L1 expression, correlations with other local and systemic inflammation parameters could be detected in LGG and GBM.
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Affiliation(s)
- Maximilian J Mair
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Sahra Pajenda
- Department of Medicine III, Medical University of Vienna, Vienna, Vienna, Austria
| | - Aysegül Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ariane Steindl
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Vienna, Austria
| | - Katharina Feldmann
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Johannes Hainfellner
- Department of Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Vienna, Austria
| | - Ludwig Wagner
- Department of Medicine III, Medical University of Vienna, Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.
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17
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Mir Seyed Nazari P, Berghoff AS, Preusser M, Moik F, Posch F, Ricken G, Riedl J, Hell L, Marosi C, Hainfellner JA, Pabinger I, Ay C. Association of programmed cell death ligand 1 and circulating lymphocytes with risk of venous thromboembolism in patients with glioma. ESMO Open 2021; 5:e000647. [PMID: 32424065 PMCID: PMC7239522 DOI: 10.1136/esmoopen-2019-000647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/12/2020] [Accepted: 03/09/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction The role of the adaptive immune system in the pathophysiology of cancer-associated venous thromboembolism (VTE) has not been investigated in detail. Programmed cell death ligand 1 (PD-L1) is an immune checkpoint molecule responsible for immune evasion in several cancer entities, as expression on tumour cells silences the T cell-mediated immune response. Given the interrelation between inflammation, haemostasis and cancer, we aimed to investigate the association of players of the adaptive immunity (eg, lymphocytes, tumour PD-L1) with risk of VTE in patients with glioma, one of the most prothrombotic cancer types. Methods In this prospective observational single-centre cohort study, patients with newly diagnosed glioma or regrowth after resection were included. Primary endpoint was objectively confirmed VTE. At study inclusion, a blood draw was performed. Tumour PD-L1 expression was assessed via immunohistochemistry. Results In total, 193 patients were included. PD-L1 expression in ≥1% of tumour cells was observed in 20/193 (10.4%) glioma. In multivariable cox-regression analysis, on adjustment for age, sex and WHO grade IV, systemic lymphocyte counts were significantly associated with risk of VTE (HR per 1 G/L increase (95% CI): 1.15 (1.03 to 1.29), p=0.013). In contrast, no significant difference in risk of VTE was found regarding the PD-L1 status: the cumulative 24 months probability of VTE was 17.0% in patients with no PD-L1 and 11.8% in those with PD-L1 expressing tumours (p=0.663). Conclusion In summary, PD-L1 expression was not associated with risk of VTE. Interestingly, peripheral lymphocytes, which are key players in adaptive immunity, were linked to an increased risk of glioma-associated VTE.
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Affiliation(s)
- Pegah Mir Seyed Nazari
- Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Florian Moik
- Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Florian Posch
- Division of Oncology, Medical University of Graz, Graz, Austria
| | - Gerda Ricken
- Institute of Neurology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Julia Riedl
- Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Lena Hell
- Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Division of Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Institute of Neurology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Cihan Ay
- Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria; I M Sechenov First Moscow State Medical University, Moscow, Russian Federation.
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18
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Mair MJ, Ilhan-Mutlu A, Pajenda S, Kiesel B, Wöhrer A, Widhalm G, Dieckmann K, Marosi C, Wagner L, Preusser M, Berghoff AS. Circulating PD-L1 levels change during bevacizumab-based treatment in recurrent glioma. Cancer Immunol Immunother 2021; 70:3643-3650. [PMID: 33956203 PMCID: PMC8571215 DOI: 10.1007/s00262-021-02951-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/26/2021] [Indexed: 01/09/2023]
Abstract
Purpose In primary brain tumors, the efficacy of immune-modulating therapies is still under investigation as inflammatory responses are restricted by tight immunoregulatory mechanisms in the central nervous system. Here, we measured soluble PD-L1 (sPD-L1) in the plasma of patients with recurrent glioblastoma (GBM) and recurrent WHO grade II–III glioma treated with bevacizumab-based salvage therapy. Methods Thirty patients with recurrent GBM and 10 patients with recurrent WHO grade II–III glioma were treated with bevacizumab-based salvage therapy at the Medical University of Vienna. Prior to each treatment cycle, EDTA plasma was drawn and sPD-L1 was measured applying a sandwich ELISA with a lower detection limit of 0.050 ng/ml. Leukocyte counts and C-reactive protein (CRP) levels were measured according to institutional practice. Results Median number of sPD-L1 measurements was 6 per patient (range: 2–24). At baseline, no significant difference in sPD-L1 concentrations was observed between WHO grade II–III glioma and GBM. Intra-patient variability of sPD-L1 concentrations was significantly higher in WHO grade II–III glioma than in GBM (p = 0.014) and tendentially higher in IDH-mutant than in IDH-wildtype glioma (p = 0.149) In WHO grade II–III glioma, sPD-L1 levels were significantly lower after one administration of bevacizumab than at baseline (median: 0.039 ng/ml vs. 0.4855 ng/ml, p = 0.036). In contrast, no significant change could be observed in patients with GBM. Conclusions Changes in systemic inflammation markers including sPD-L1 are observable in patients with recurrent glioma under bevacizumab-based treatment and differ between WHO grade II–III glioma and GBM. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-02951-2.
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Affiliation(s)
- Maximilian J Mair
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Ayseguel Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Sahra Pajenda
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Department of Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ludwig Wagner
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria. .,Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria.
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19
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Frass M, Lechleitner P, Gründling C, Pirker C, Grasmuk-Siegl E, Domayer J, Hochmair M, Gaertner K, Duscheck C, Muchitsch I, Marosi C, Schumacher M, Zöchbauer-Müller S, Manchanda RK, Schrott A, Burghuber O. Homeopathic Treatment as an Add-On Therapy May Improve Quality of Life and Prolong Survival in Patients with Non-Small Cell Lung Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blind, Three-Arm, Multicenter Study. Oncologist 2021; 26:e523. [PMID: 33660386 DOI: 10.1002/onco.13693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Indexed: 11/06/2022] Open
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20
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Marosi C. Elderly patients with cancer. Memo 2021; 14:1-2. [PMID: 33688378 PMCID: PMC7931784 DOI: 10.1007/s12254-021-00677-6] [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] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Christine Marosi
- Clinical Division of Palliative Medicine, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
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21
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Frass M, Lechleitner P, Gründling C, Pirker C, Grasmuk‐Siegl E, Domayer J, Hochmair M, Gaertner K, Duscheck C, Muchitsch I, Marosi C, Schumacher M, Zöchbauer‐Müller S, Manchanda RK, Schrott A, Burghuber O. Homeopathic Treatment as an Add-On Therapy May Improve Quality of Life and Prolong Survival in Patients with Non-Small Cell Lung Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blind, Three-Arm, Multicenter Study. Oncologist 2020; 25:e1930-e1955. [PMID: 33010094 PMCID: PMC8108047 DOI: 10.1002/onco.13548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/28/2020] [Indexed: 01/14/2023] Open
Abstract
LESSONS LEARNED Conventional medicine and homeopathy work well together. Quality of life improves with additive homeopathy in patients with non-small cell lung cancer (NSCLC). Survival improves with additive homeopathy in patients with NSCLC. BACKGROUND Patients with advanced non-small cell lung cancer (NSCLC) have limited treatment options. Alongside conventional anticancer treatment, additive homeopathy might help to alleviate side effects of conventional therapy. The aim of the present study was to investigate whether additive homeopathy might influence quality of life (QoL) and survival in patients with NSCLC. METHODS In this prospective, randomized, placebo-controlled, double-blind, three-arm, multicenter, phase III study, we evaluated the possible effects of additive homeopathic treatment compared with placebo in patients with stage IV NSCLC, with respect to QoL in the two randomized groups and survival time in all three groups. Treated patients visited the outpatients' centers every 9 weeks: 150 patients with stage IV NSCLC were included in the study; 98 received either individualized homeopathic remedies (n = 51) or placebo (n = 47) in a double-blinded fashion; and 52 control patients without any homeopathic treatment were observed for survival only. The constituents of the different homeopathic remedies were mainly of plant, mineral, or animal origin. The remedies were manufactured by stepwise dilution and succussion, thereby preparing stable Good Manufacturing Practice grade formulations. RESULTS QoL as well as functional and symptom scales showed significant improvement in the homeopathy group when compared with placebo after 9 and 18 weeks of homeopathic treatment (p < .001). Median survival time was significantly longer in the homeopathy group (435 days) versus placebo (257 days; p = .010) as well as versus control (228 days; p < .001). Survival rate in the homeopathy group differed significantly from placebo (p = .020) and from control (p < .001). CONCLUSION QoL improved significantly in the homeopathy group compared with placebo. In addition, survival was significantly longer in the homeopathy group versus placebo and control. A higher QoL might have contributed to the prolonged survival. The study suggests that homeopathy positively influences not only QoL but also survival. Further studies including other tumor entities are warranted.
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Affiliation(s)
- Michael Frass
- Medical University of Vienna, Department of Medicine I, Clinical Division of Oncology and Institute for Homeopathic ResearchViennaAustria
- Scientific Society for Homeopathy (WissHom)KoethenGermany
| | | | | | - Claudia Pirker
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Erwin Grasmuk‐Siegl
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Julian Domayer
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | | | - Cornelia Duscheck
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | - Ilse Muchitsch
- Austrian Chamber of Pharmacists, Department Vienna, HomResearch, Interdisciplinary Homeopathic Research GroupViennaAustria
| | - Christine Marosi
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | | | - Sabine Zöchbauer‐Müller
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | - Raj K. Manchanda
- Central Council for Research in Homeopathy, Ministry of AYUSH, Government of India and LMHI, West DelhiDelhiIndia
| | - Andrea Schrott
- StatistikAmbulanz, Consulting Company, LeobendorfAustria
| | - Otto Burghuber
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for Lung Health, Otto Wagner Hospital and Sigmund Freud University, Medical SchoolViennaAustria
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22
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Nenning KH, Furtner J, Kiesel B, Schwartz E, Roetzer T, Fortelny N, Bock C, Grisold A, Marko M, Leutmezer F, Liu H, Golland P, Stoecklein S, Hainfellner JA, Kasprian G, Prayer D, Marosi C, Widhalm G, Woehrer A, Langs G. Distributed changes of the functional connectome in patients with glioblastoma. Sci Rep 2020; 10:18312. [PMID: 33110138 PMCID: PMC7591862 DOI: 10.1038/s41598-020-74726-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 04/14/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022] Open
Abstract
Glioblastoma might have widespread effects on the neural organization and cognitive function, and even focal lesions may be associated with distributed functional alterations. However, functional changes do not necessarily follow obvious anatomical patterns and the current understanding of this interrelation is limited. In this study, we used resting-state functional magnetic resonance imaging to evaluate changes in global functional connectivity patterns in 15 patients with glioblastoma. For six patients we followed longitudinal trajectories of their functional connectome and structural tumour evolution using bi-monthly follow-up scans throughout treatment and disease progression. In all patients, unilateral tumour lesions were associated with inter-hemispherically symmetric network alterations, and functional proximity of tumour location was stronger linked to distributed network deterioration than anatomical distance. In the longitudinal subcohort of six patients, we observed patterns of network alterations with initial transient deterioration followed by recovery at first follow-up, and local network deterioration to precede structural tumour recurrence by two months. In summary, the impact of focal glioblastoma lesions on the functional connectome is global and linked to functional proximity rather than anatomical distance to tumour regions. Our findings further suggest a relevance for functional network trajectories as a possible means supporting early detection of tumour recurrence.
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Affiliation(s)
- Karl-Heinz Nenning
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Julia Furtner
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Ernst Schwartz
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Thomas Roetzer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Fortelny
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martha Marko
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hesheng Liu
- A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Cambridge, USA
| | - Polina Golland
- Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, USA
| | - Sophia Stoecklein
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. .,Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, USA.
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23
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Marhold M, Topakian T, Agis H, Bartsch R, Berghoff AS, Brodowicz T, Fuereder T, Ilhan-Mutlu A, Kiesewetter B, Krainer M, Locker GJ, Marosi C, Prager G, Schmidinger M, Thallinger C, Zöchbauer-Müller S, Raderer M, Preusser M, Lamm W. Thirteen-year analyses of medical oncology outpatient day clinic data: a changing field. ESMO Open 2020; 5:e000880. [PMID: 33051192 PMCID: PMC7555099 DOI: 10.1136/esmoopen-2020-000880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/28/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background Novel treatment modalities like targeted therapy and immunotherapy are currently changing treatment strategies and protocols in the field of medical oncology. Methods Numbers of patients and patient contacts admitted to medical oncology day clinics of a large European academic cancer centre in the period from 2006 to 2018 were analysed using our patient administration system. Results A patient cohort of 9.870 consecutive individual patients with 125.679 patient contacts was descriptively and retrospectively characterised. Mean age was 59.9 years. A substantial increase in both individual patients treated per year (+45.4%; 2006: 1.100; 2018: 1.599) and annual patient contacts (+63.3%; 2006: 8.857; 2018: 14.467) between 2006 and 2018 was detected. Hence and most interestingly, the ratio of visits per patient increased by approximately one visit per patient per year over the last 12 years (+12.4%; 2006: 8.0; 2018: 9.0). Further, a decrease of patient contacts in more prevalent entities like breast cancer was found, while contacts for orphan diseases like myeloma and sarcoma increased substantially. Interestingly, female patients showed more per patient contacts as compared with men (13.5 vs 11.9). Lastly, short-term safety data of outpatient day clinic admissions are reported. Conclusions We present a representative and large set of patient contacts over time that indicates an increasing load in routine clinical work of outpatient cancer care. Increases observed were highest for orphan diseases, likely attributed to centralisation effects and increased treatment complexity.
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Affiliation(s)
- Maximilian Marhold
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria.
| | - Thais Topakian
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Hermine Agis
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Rupert Bartsch
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Anna S Berghoff
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Thomas Brodowicz
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Thorsten Fuereder
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Aysegül Ilhan-Mutlu
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Barbara Kiesewetter
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Michael Krainer
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Gottfried J Locker
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Christine Marosi
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Gerald Prager
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Manuela Schmidinger
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Christiane Thallinger
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Markus Raderer
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Matthias Preusser
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
| | - Wolfgang Lamm
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Wien, Austria
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24
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Steindl A, Yadavalli S, Gruber K, Seiwald M, Gatterbauer B, Dieckmann K, Frischer JM, Klikovits T, Zöchbauer‐Müller S, Grisold A, Hoda MAR, Marosi C, Widhalm G, Preusser M, Berghoff AS. Neurological symptom burden impacts survival prognosis in patients with newly diagnosed non-small cell lung cancer brain metastases. Cancer 2020; 126:4341-4352. [PMID: 32678971 PMCID: PMC7540353 DOI: 10.1002/cncr.33085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 03/09/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Brain metastases (BM) are a frequent complication of advanced cancer and are characterized by a variety of neurological symptoms. Although the presence of neurological symptoms is included in the response assessment in patients with primary brain tumors, to the authors' knowledge little is known regarding the prognostic impact of neurological symptoms in patients with BM. METHODS Patients with newly diagnosed BM from non-small cell lung cancer were identified from the Vienna Brain Metastasis Registry and were evaluated according to the incidence, distribution, and prognostic impact of neurological symptoms at the time of diagnosis of BM. RESULTS A total of 1608 patients (57.3% male and 42.7% female; median age, 62 years) were available for further analyses. Neurological symptoms including focal deficits (985 patients; 61.3%), signs of increased intracranial pressure (483 patients; 30.0%), epileptic seizures (224 patients; 13.9%), and neuropsychological symptoms (233 patients; 14.5%) were documented in 1186 of the 1608 patients (73.8%). Patients with asymptomatic BM presented with a longer median overall survival after the diagnosis of BM compared with patients with symptomatic BM (11 months vs 7 months; P < .001). In multivariate analysis with a diagnosis-specific graded prognostic assessment (hazard ratio, 1.41; 95% CI, 1.33-1.50 [P < .001]), the presence of neurological symptoms (hazard ratio, 1.39; 95% CI, 1.23-1.57 [P < .001]) was found to be independently associated with survival prognosis from the time of diagnosis of BM. CONCLUSIONS Neurological symptoms at the time of BM diagnosis demonstrated a strong and independent association with survival prognosis. The results of the current study have highlighted the need for the integration of the presence of neurological symptoms into the prognostic assessment of patients with BM from non-small cell lung cancer. LAY SUMMARY Neurological symptom evaluation is included regularly in the assessment of patients with primary brain tumors. However, to the authors' knowledge, little is known regarding the prognostic impact in patients with newly diagnosed brain metastases (BM). The current study has provided a detailed clinical characterization of the incidence, distribution, and prognostic impact of neurological symptoms in a large, real-life cohort of patients with BM from non-small cell lung cancer. In this cohort, neurological symptoms at the time of diagnosis of BM demonstrated a strong, independent prognostic impact on the survival prognosis. The results of the current study have highlighted the need for the integration of neurological symptom burden into the prognostic assessment of patients with BM from non-small cell lung cancer.
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Affiliation(s)
- Ariane Steindl
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Sarah Yadavalli
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Katharina‐Anna Gruber
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Maria Seiwald
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Brigitte Gatterbauer
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Karin Dieckmann
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of RadiotherapyMedical University of ViennaViennaAustria
| | - Josa M. Frischer
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Thomas Klikovits
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Division of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Sabine Zöchbauer‐Müller
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Anna Grisold
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Mir Ali Reza Hoda
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Division of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Christine Marosi
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Georg Widhalm
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Matthias Preusser
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Anna Sophie Berghoff
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
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25
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Pace A, Koekkoek JAF, van den Bent MJ, Bulbeck HJ, Fleming J, Grant R, Golla H, Henriksson R, Kerrigan S, Marosi C, Oberg I, Oberndorfer S, Oliver K, Pasman HRW, Le Rhun E, Rooney AG, Rudà R, Veronese S, Walbert T, Weller M, Wick W, Taphoorn MJB, Dirven L. Determining medical decision-making capacity in brain tumor patients: why and how? Neurooncol Pract 2020; 7:599-612. [PMID: 33312674 DOI: 10.1093/nop/npaa040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Brain tumor patients are at high risk of impaired medical decision-making capacity (MDC), which can be ethically challenging because it limits their ability to give informed consent to medical treatments or participation in research. The European Association of Neuro-Oncology Palliative Care Multidisciplinary Task Force performed a systematic review to identify relevant evidence with respect to MDC that could be used to give recommendations on how to cope with reduced MDC in brain tumor patients. Methods A literature search in several electronic databases was conducted up to September 2019, including studies with brain tumor and other neurological patients. Information related to the following topics was extracted: tools to measure MDC, consent to treatment or research, predictive patient- and treatment-related factors, surrogate decision making, and interventions to improve MDC. Results A total of 138 articles were deemed eligible. Several structured capacity-assessment instruments are available to aid clinical decision making. These instruments revealed a high incidence of impaired MDC both in brain tumors and other neurological diseases for treatment- and research-related decisions. Incapacity appeared to be mostly determined by the level of cognitive impairment. Surrogate decision making should be considered in case a patient lacks capacity, ensuring that the patient's "best interests" and wishes are guaranteed. Several methods are available that may help to enhance patients' consent capacity. Conclusions Clinical recommendations on how to detect and manage reduced MDC in brain tumor patients were formulated, reflecting among others the timing of MDC assessments, methods to enhance patients' consent capacity, and alternative procedures, including surrogate consent.
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Affiliation(s)
- Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J van den Bent
- Department of Neurology, The Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Jane Fleming
- Department of Palliative Medicine, University Hospital Waterford, Waterford, Ireland
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland, UK
| | - Heidrun Golla
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
| | | | - Christine Marosi
- Department of Internal Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Stefan Oberndorfer
- Department Neurology, University Clinic St Pölten, KLPU and KLI-Neurology and Neuropsychology, St Pölten, Austria
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland, UK
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Simone Veronese
- Department of Palliative Care, Fondazione FARO, Turin, Italy
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan, US
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany.,German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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Abstract
PURPOSE OF REVIEW The incidence of glioblastoma multiforme (GBM) increases with age; more than half of newly diagnosed patients are older than 65 years. Due to age-dependent decreasing organ functions, comorbidities, functional decline, and increasing risk of social isolation, not all patients are able to tolerate standard therapy of GBM with 6 weeks of radiochemotherapy. RECENT FINDINGS A set of alleviated therapies, e.g., chemotherapy or radiotherapy alone, hypofractionated radiotherapies with different total doses and variable fractionation regimens as well as hypofractionated radiotherapy with concomitant and adjuvant chemotherapy, have been evaluated during the last years. However, clinicians are still unsure which therapy would fit best to a given patient. Recently, the predictive value of comprehensive geriatric assessment regarding tolerance of chemotherapy and prediction of early mortality has been validated for older GBM patients in a retrospective trial. Thus, it appears that neuro-oncology is now ready for the prospective implementation of geriatric assessment to guide treatment planning for elderly GBM patients.
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Affiliation(s)
| | | | - Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christine Marosi
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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27
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Berghoff AS, Wippel C, Starzer AM, Ballarini N, Wolpert F, Bergen E, Wolf P, Steindl A, Widhalm G, Gatterbauer B, Marosi C, Dieckmann K, Bartsch R, Scherer T, Koenig F, Krebs M, Weller M, Preusser M. Hypothyroidism correlates with favourable survival prognosis in patients with brain metastatic cancer. Eur J Cancer 2020; 135:150-158. [PMID: 32603949 DOI: 10.1016/j.ejca.2020.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several preclinical and epidemiologic studies have indicated tumour-promoting effects of thyroid hormones (THs). However, very limited knowledge exists on the prognostic impact of thyroid function in metastatic cancer. METHODS We compiled a discovery cohort of 1692 patients with newly diagnosed brain metastases (BMs) of solid cancers treated at the Medical University of Vienna and an independent validation cohort of 191 patients with newly diagnosed BMs treated at the University Hospital Zurich. RESULTS Hypothyroidism before diagnosis of cancer was evident in 133 of 1692 (7.9%) patients of the discovery, and in 18 of 191 (9.4%) patients of the validation cohort. In the discovery cohort, hypothyroidism was statistically significantly associated with favourable survival prognosis from diagnosis of cancer (31 vs. 21 months; p = 0.0026) and with survival prognosis from diagnosis of BMs (12 vs. 7 months; p = 0.0079). In multivariate analysis including the diagnosis-specific graded prognostic assessment score, primary tumour type and sex, hypothyroidism was an independent factor associated with survival after diagnosis of BMs (hazard ratio: 0.76; 95% confidence interval [CI]: (0.63; 0.91; p = 0.0034). In the validation cohort, the association of hypothyroidism and favourable survival prognosis from diagnosis of cancer (55 vs. 11 months; p = 0.00058), as well as from diagnosis of BMs (40 vs. 10 months; p = 0.0036) was confirmed. CONCLUSION Pre-existing hypothyroidism was strongly and independently associated with prognosis in patients with newly diagnosed BMs, supporting the evidence from preclinical data that THs may indeed have a tumour-promoting effect. Further investigation of the underlying pathobiological mechanism and potential therapeutic implications are required.
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Affiliation(s)
- Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Christoph Wippel
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Angelika M Starzer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Nicolas Ballarini
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria
| | - Fabian Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Elisabeth Bergen
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Peter Wolf
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Austria
| | - Ariane Steindl
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Georg Widhalm
- Comprehensive Cancer Center, Medical University of Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Austria
| | - Brigitte Gatterbauer
- Comprehensive Cancer Center, Medical University of Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center, Medical University of Vienna, Austria; Department of Radiotherapy, Medical University of Vienna, Austria
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Thomas Scherer
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Austria
| | - Franz Koenig
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria
| | - Michael Krebs
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Austria
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria.
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28
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Mir Seyed Nazari P, Marosi C, Moik F, Riedl J, Özer Ö, Berghoff AS, Preusser M, Hainfellner JA, Pabinger I, Zlabinger GJ, Ay C. Low Systemic Levels of Chemokine C-C Motif Ligand 3 (CCL3) are Associated with a High Risk of Venous Thromboembolism in Patients with Glioma. Cancers (Basel) 2019; 11:cancers11122020. [PMID: 31847343 PMCID: PMC6966639 DOI: 10.3390/cancers11122020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022] Open
Abstract
A tight interplay between inflammation and hemostasis has been described as a potential driver for developing venous thromboembolism (VTE). Here, we investigated the association of systemic cytokine levels and risk of VTE in patients with glioma. This analysis was conducted within the prospective, observational Vienna Cancer and Thrombosis Study. Patients with glioma were included at time of diagnosis or progression and were observed for a maximum of two years. Primary endpoint was objectively confirmed VTE. At study entry, a single blood draw was performed. A panel of nine cytokines was measured in serum samples with the xMAP technology developed by Luminex. Results: Overall, 76 glioma patients were included in this analysis, and 10 (13.2%) of them developed VTE during the follow-up. Chemokine C-C motif ligand 3 (CCL3) levels were inversely associated with risk of VTE (hazard ratio [HR] per double increase, 95% confidence interval [CI]: 0.385, 95% CI: 0.161–0.925, p = 0.033), while there was no association between the risk of VTE and serum levels of interleukin (IL)-1β, IL-4, IL-6, IL-8, IL-10, IL-11, tumor necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF), respectively. In conclusion, low serum levels of CCL3 were associated with an increased risk of VTE. CCL3 might serve as a potential biomarker to predict VTE risk in patients with glioma.
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Affiliation(s)
- Pegah Mir Seyed Nazari
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Christine Marosi
- Division of Oncology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (C.M.); (A.S.B.); (M.P.)
| | - Florian Moik
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Julia Riedl
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Öykü Özer
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Anna Sophie Berghoff
- Division of Oncology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (C.M.); (A.S.B.); (M.P.)
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (C.M.); (A.S.B.); (M.P.)
| | - Johannes A. Hainfellner
- Institute of Neurology and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria;
| | - Ingrid Pabinger
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Gerhard J. Zlabinger
- Institute of Immunology, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Cihan Ay
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow, Russia
- Correspondence:
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29
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Arfsten H, Cho A, Freitag C, Raderer M, Goliasch G, Bartko PE, Wurm R, Strunk G, Gisslinger H, Marosi C, Kornek G, Zielinski C, Hülsmann M, Pavo N. GDF-15 in solid vs non-solid treatment-naïve malignancies. Eur J Clin Invest 2019; 49:e13168. [PMID: 31463975 PMCID: PMC6899906 DOI: 10.1111/eci.13168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 07/30/2019] [Accepted: 08/25/2019] [Indexed: 12/12/2022]
Abstract
AIM GDF-15 is an established cardiovascular risk marker but is equally implicated in tumour biology. Elevated levels of GDF-15 have indeed been observed in distinct tumour entities. This study aimed to explore the relation of GDF-15 to other cardiac biomarkers and the general association of GDF-15 on prognosis in an unselected cohort of treatment-naïve cancer patients. METHODS We prospectively enrolled 555 consecutive patients at time of diagnosis of malignant disease prior receiving anticancer therapy. Plasma GDF-15 concentrations were determined alongside other cardiac and routine laboratory markers. All-cause mortality was defined as primary endpoint. RESULTS GDF-15 levels were 338 ng/L (IQR:205-534) for the total cohort, and values were comparable for different tumour entities except breast cancer. Metastatic disease was characterized by higher plasma GDF-15 [435 ng/L (IQR:279-614) vs 266 ng/L (IQR:175-427), P < .001]. GDF-15 correlated positively with inflammatory status reflected by CRP, SAA and IL-6 [r = .31, P < .001, r = .23, P < .001 and r = .14, P = .002] and cardiac biomarkers as NT-proBNP, hsTnT, MR-proADM and CT-proET-1 [r = .46; r = .46; r = .59 and r = .50; P < .001 for all]. GDF-15 was significantly associated with all-cause mortality after multivariate adjustment [adj.HR for ln(GDF-15) 1.78, 95%CI:1.47-2.16, P < .001]. There was a significant interaction between solid and haematological malignancies with loss of association of GDF-15 with outcome in myelodysplastic and myeloproliferative disease. CONCLUSIONS Elevated plasma GDF-15 is associated with progressing disease severity and poor prognosis in solid tumours of treatment-naïve cancer patients. GDF-15 increase is accompanied by worsening systemic inflammation and a subclinical functional impairment of different organs including the heart. GDF-15 represents a promising target for our pathophysiologic understanding in cardio-oncology linking conditions of both cardiac and neoplastic disease.
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Affiliation(s)
- Henrike Arfsten
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Anna Cho
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Claudia Freitag
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Markus Raderer
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Georg Goliasch
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Philipp E. Bartko
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Raphael Wurm
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Guido Strunk
- Complexity ResearchViennaAustria
- FH Campus ViennaViennaAustria
- Technical University DortmundDortmundGermany
| | - Heinz Gisslinger
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Christine Marosi
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Gabriela Kornek
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Christoph Zielinski
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Martin Hülsmann
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Noemi Pavo
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
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30
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Starzer A, Deischinger C, Steindl A, Mair M, Widhalm G, Frischer J, Gatterbauer B, Marosi C, Dieckmann K, Preusser M, Berghoff A. Markers of systemic inflammation correlate with survival prognosis in patients with newly diagnosed brain metastases. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Mir Seyed Nazari P, Ay C, Preusser M, Riedl J, Marosi C, Moik F, Ricken G, Hainfellner J, Pabinger-Fasching I, Berghoff A. Association of systemic inflammation with local tumour characteristics and survival in glioma patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mair M, Ilhan-Mutlu A, Pajenda S, Widhalm G, Dieckmann K, Hainfellner J, Marosi C, Wagner L, Preusser M, Berghoff A. Circulating PD-L1 levels vary across brain tumour entities and are oppositely linked to survival in glioblastoma and lower grade glioma patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Steindl A, Yadavalli S, Gruber K, Seiwald M, Frischer J, Gatterbauer B, Dieckmann K, Marosi C, Widhalm G, Preusser M, Berghoff A. Impact of neurological symptom burden on the survival prognosis in a real-life cohort of patients with non-small cell lung cancer brain metastases. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Preusser M, Silvani A, Le Rhun E, Soffietti R, Lombardi G, Sepulveda J, Brandal P, Beaney R, Bonneville-Levard A, Lorgis V, Bromberg J, Erridge S, Cameron A, Marosi C, Golfinopoulos V, Gorlia T, Weller M, Wick W. PL3.2 Trabectedin for recurrent WHO grade II or III meningioma: a randomized phase II study of the EORTC Brain Tumor Group (EORTC-1320-BTG). Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
EORTC-1320-BTG investigated the activity, safety and quality of life of therapy with the tetrahydroisoquinoline alkaloid trabectedin (Yondelis®) in patients with recurrent higher-grade meningiomas. Trabectedin was originally derived from the Caribbean sea squirt, Ecteinascidia turbinata, and currently is manufactured by total synthesis.
METHODS
Adult patients with histological diagnosis of WHO grade II or III meningioma and radiologically documented progression after maximal feasible surgery and radiotherapy were randomly assigned in a 2:1 ratio to receive intravenous trabectedin (1.5 mg/m2every three weeks) or local standard of care (LOC). The primary endpoint was progression-free survival (PFS).
RESULTS
Within 22.1 months, we randomized a total of 90 patients (n=29 in LOC arm, n=61 in trabectedin arm) in 35 institutions and nine countries. In the LOC arm, the following treatments were administered: hydroxyurea (n=11), bevacizumab (n=9), none (n=4), chemotherapy (n=3), somatostatin analogue (n=1), combined chemotherapy and somatostatin analogue (n=1). With 71 PFS events, median PFS was 4.17 months in the LOC and 2.43 months in the trabectedin arm (hazard ratio [HR] for progression, 1.42; 80% CI, 1.00–2.03; p=0.204) with a PFS-6 rate of 29.1% (95% CI, 11.9%-48.8%) in the LOC and 21.1% (95% CI, 11.3%-32.9%) in the trabectedin arm. Median OS was 10.61 months in the LOC and 11.37 months in the trabectedin arm (HR for death, 0.98; 95% CI, 0.54–1.76; p=0.94).Grade 3 to 5 adverse events occurred in 44.4% (18.5% related, 4 serious adverse events, 0 lethal events) of the patients in the LOC and 59% (32.8% related, 57 serious adverse events and 2 toxic deaths) of patient in the trabectedin arm.
CONCLUSIONS
In this first prospective randomized trial performed in recurrent grade II or III meningioma, trabectedin did not improve PFS and OS and was associated with significantly higher toxicity as compared to LOC treatment. The data collected in this study may serve as benchmark for future clinical trials in this setting.
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Affiliation(s)
| | - A Silvani
- Department of neuro-oncology, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - R Soffietti
- Dept. Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - G Lombardi
- Medical Oncology 1, Veneto Institue of Oncology- IRCCS, Padua, Italy
| | - J Sepulveda
- Neurooncology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Brandal
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - R Beaney
- St Thomas’ Hospital, London, United Kingdom
| | | | - V Lorgis
- Department of Medical Oncology, Center Georges François Leclerc, Dijon, France
| | - J Bromberg
- Department of Neuro-Oncology, Erasmus MC University Medical Center Cancer Center, Rotterdam, Netherlands
| | - S Erridge
- Western General Hospital, Edinburgh, United Kingdom
| | - A Cameron
- Bristol Cancer Institute, University Hospitals Bristol, Bristol, United Kingdom
| | - C Marosi
- Division of Oncology, Vienna, Austria
| | - V Golfinopoulos
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarter, Brussels, Belgium
| | - T Gorlia
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarter, Brussels, Belgium
| | - M Weller
- Department of Neurology University Hospital Zurich, Zurich, Switzerland
| | - W Wick
- Neurology Clinic, Heidelberg University Medical Center, Clinical Cooperation Unit, Neurooncology#8232;German Cancer Research Center, Heidelberg, Germany
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Grilz E, Marosi C, Königsbrügge O, Riedl J, Posch F, Lamm W, Lang IM, Pabinger I, Ay C. Association of complete blood count parameters, d-dimer, and soluble P-selectin with risk of arterial thromboembolism in patients with cancer. J Thromb Haemost 2019; 17:1335-1344. [PMID: 31099477 PMCID: PMC6771479 DOI: 10.1111/jth.14484] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 03/01/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with cancer are at risk of developing arterial thromboembolism (ATE). With the prevalence of cancer and cardiovascular diseases on the rise, the identification of risk factors for ATE in patients with cancer is of emerging importance. OBJECTIVES As data on the association of potential biomarkers with risk of ATE in patients with cancer are scarce, we conducted a cohort study with the aim to identify blood-based biomarkers for ATE risk prediction in patients with cancer. PATIENTS/METHODS Overall, 1883 patients with newly diagnosed cancer or progressive disease after complete or partial remission were included and followed for 2 years. Venous blood was drawn at study inclusion for measurement of complete blood count parameters, total cholesterol, d-dimer, and soluble P-selectin (sP-selectin) levels. RESULTS The 2-year cumulative incidence of ATE was 2.5%. In univariable analysis, red cell distribution width (subdistribution hazard ratio (SHR) per doubling: 4.4, 95% CI: 1.4-14.1), leukocyte count (1.2, 1.1-1.5), neutrophil count (1.6, 1.1-2.3), and sP-selectin levels (1.9, 1.3-2.7) were associated with risk of ATE in patients with cancer; d-dimer was not associated with the risk of ATE (1.1, 0.9-1.4). After adjustment for age, sex, and smoking status the association prevailed for the neutrophil count (adjusted [adj.] SHR per doubling: 1.6, 1.1-2.4), and sP-selectin levels (1.8, 1.2-2.8). CONCLUSIONS An elevated absolute neutrophil count and higher sP-selectin levels were associated with an increased risk of ATE in patients with cancer. Their role for predicting cancer-related ATE needs to be validated in further studies.
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Affiliation(s)
- Ella Grilz
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Christine Marosi
- Clinical Division of OncologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Oliver Königsbrügge
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Julia Riedl
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Florian Posch
- Division of OncologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - Wolfgang Lamm
- Clinical Division of OncologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Irene M. Lang
- Clinical Division of CardiologyDepartment of Medicine IIMedical University of ViennaViennaAustria
| | - Ingrid Pabinger
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Cihan Ay
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
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Kieler M, Unseld M, Bianconi D, Waneck F, Mader R, Wrba F, Fuereder T, Marosi C, Raderer M, Staber P, Berger W, Sibilia M, Polterauer S, Müllauer L, Preusser M, Zielinski CC, Prager GW. Interim analysis of a real-world precision medicine platform for molecular profiling of metastatic or advanced cancers: MONDTI. ESMO Open 2019; 4:e000538. [PMID: 31423337 PMCID: PMC6677998 DOI: 10.1136/esmoopen-2019-000538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/09/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022] Open
Abstract
Background High-throughput genomic profiling of tumour specimens facilitates the identification of individual actionable mutations which could be used for individualised targeted therapy. This approach is becoming increasingly more common in the clinic; however, the interpretation of results from molecular profiling tests and efficient guiding of molecular therapies to patients with advanced cancer offer a significant challenge to the oncology community. Experimental design MONDTI is a precision medicine platform for molecular characterisation of metastatic solid tumours to identify actionable genomic alterations. From 2013 to 2016, comprehensive molecular profiles derived from real-time biopsy specimens and archived tumour tissue samples of 295 patients were performed. Results and treatment suggestions were discussed within multidisciplinary tumour board meetings. Results The mutational profile was obtained from 293 (99%) patients and a complete immunohistochemical (IHC) and cytogenetic profile was obtained in 181 (61%) and 188 (64%) patients. The most frequent cancer types were colorectal cancer (12%), non-Hodgkin's lymphomas (9.8%) and head and neck cancers (7.8%). The most commonly detected mutations were TP53 (39%), KRAS (19%) and PIK3CA (9.5%), whereas ≥1 mutation were identified in 217 (74%) samples. Regarding the results for IHC testing, samples were positive for phospho-mammalian target of rapamycin (phospho-mTOR) (71%), epidermal growth factor receptor (EGFR) (68%), mesenchymal epithelial transition (MET) (56%) and/or platelet-derived growth factor alpha (PDGFRα)-expression (48%). Of the 288 tumour samples with one or more genetic alteration detected, 160 (55.6%) targeted therapy recommendations through 67 multidisciplinary tumour board meetings were made; in 69 (24%) cases, an individual treatment concept was initiated. Conclusions The results reveal that the open concept for all solid tumours characterised for molecular profile and immunotherapy could not only match individualised treatment concepts at a high rate but also underscores the challenges encountered when offering molecularly matched therapies to a patient population with an advanced stage cancer.
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Affiliation(s)
- Markus Kieler
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Matthias Unseld
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Daniela Bianconi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Fredrik Waneck
- Department of Biomedical Imaging and Image-guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Wien, Austria
| | - Robert Mader
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Fritz Wrba
- Department of Pathology, Medical University of Vienna, Wien, Austria
| | - Thorsten Fuereder
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Philipp Staber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Wien, Austria
| | - Walter Berger
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Wien, Austria
| | - Maria Sibilia
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Wien, Austria
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Wien, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Wien, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Christoph C Zielinski
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
| | - Gerald W Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Wien, Austria
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Neuhauser M, Roetzer T, Oberndorfer S, Kitzwoegerer M, Payer F, Unterluggauer JJ, Haybaeck J, Stockhammer G, Iglseder S, Moser P, Thomé C, Stultschnig M, Wuertz F, Brandner-Kokalj T, Weis S, Bandke D, Pichler J, Hutterer M, Krenosz KJ, Boehm A, Mayrbaeurl B, Hager-Seifert A, Kaufmann H, Dumser M, Reiner-Concin A, Hoenigschnabl S, Kleindienst W, Hoffermann M, Dieckmann K, Kiesel B, Widhalm G, Marosi C, Jaeger U, Hainfellner A, Hackl M, Hainfellner JA, Preusser M, Woehrer A. Increasing use of immunotherapy and prolonged survival among younger patients with primary CNS lymphoma: a population-based study. Acta Oncol 2019; 58:967-976. [PMID: 30994047 DOI: 10.1080/0284186x.2019.1599137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Primary CNS lymphoma is a highly aggressive and rare type of extranodal non-Hodgkin lymphoma. Although, new therapeutic approaches have led to improved survival, the management of the disease poses a challenge, practice patterns vary across institutions and countries, and remain ill-defined for vulnerable patient subgroups. Material and Methods: Using information from the Austrian Brain Tumor Registry we followed a population-based cohort of 189 patients newly diagnosed from 2005 to 2010 through various lines of treatment until death or last follow-up (12-31-2016). Prognostic factors and treatment-related data were integrated in a comprehensive survival analysis including conditional survival estimates. Results: We find variable patterns of first-line treatment with increasing use of rituximab and high-dose methotrexate (HDMTX)-based poly-chemotherapy after 2007, paralleled by an increase in median overall survival restricted to patients aged below 70 years. In the entire cohort, 5-year overall survival was 24.4% while 5-year conditional survival increased with every year postdiagnosis. Conclusion: In conclusion, we show that the use of poly-chemotherapy and immunotherapy has disseminated to community practice to a fair extent and survival has increased over time at least in younger patients. Annually increasing conditional survival rates provide clinicians with an adequate and encouraging prognostic measure.
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Affiliation(s)
- Magdalena Neuhauser
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Melitta Kitzwoegerer
- Department of Pathology, University Hospital St. Poelten Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Franz Payer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Julia J. Unterluggauer
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Johannes Haybaeck
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Graz, Austria
- Department of Pathology, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Günther Stockhammer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sarah Iglseder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Patrizia Moser
- Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Franz Wuertz
- Institute of Pathology, State Hospital Klagenfurt, Klagenfurt, Austria
| | | | - Serge Weis
- Department of Neuropathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Dave Bandke
- Department of Neuropathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Josef Pichler
- Department of Internal Medicine and Neurooncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Markus Hutterer
- Department of Neurology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Karl J. Krenosz
- Department of Hematology and Oncology, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Alexandra Boehm
- Department of Internal Medicine, Hematology and Oncology, Hospital Elisabethinen, Linz, Austria
| | - Beate Mayrbaeurl
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - Andrea Hager-Seifert
- Department of Neurology, State Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Hannes Kaufmann
- Department of Oncology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Martina Dumser
- Department of Pathology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | | | | | - Waltraud Kleindienst
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Markus Hoffermann
- Department of Neurosurgery, State Hospital Feldkirch, Feldkirch, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jaeger
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Andreas Hainfellner
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Monika Hackl
- Austrian National Cancer Registry, Statistics Austria, Vienna, Austria
| | - Johannes A. Hainfellner
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Grilz E, Mauracher L, Posch F, Königsbrügge O, Zöchbauer‐Müller S, Marosi C, Lang I, Pabinger I, Ay C. Citrullinated histone H3, a biomarker for neutrophil extracellular trap formation, predicts the risk of mortality in patients with cancer. Br J Haematol 2019; 186:311-320. [PMID: 30968400 PMCID: PMC6618331 DOI: 10.1111/bjh.15906] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [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: 12/03/2018] [Accepted: 02/19/2019] [Indexed: 12/15/2022]
Abstract
Prior studies indicate that neutrophil extracellular traps (NETs) are associated with arterial thromboembolism (ATE) and mortality. We investigated the association between NET formation biomarkers (citrullinated histone H3 [H3Cit], cell-free DNA [cfDNA], and nucleosomes) and the risk of ATE and all-cause mortality in patients with cancer. In this prospective cohort study, H3Cit, cfDNA and nucleosome levels were determined at study inclusion, and patients with newly diagnosed cancer or progressive disease after remission were followed for 2 years for ATE and death. Nine-hundred and fifty-seven patients were included. The subdistribution hazard ratios for ATE of H3Cit, cfDNA and nucleosomes were 1·0 per 100 ng/ml increase (95% confidence interval [95% CI]: 0·7-1·4, P = 0·949), 1·0 per 100 ng/ml (0·9-1·2, P = 0·494) increase and 1·1 per 1-unit increase (1·0-1·2, P = 0·233), respectively. Three-hundred and seventy-eight (39·5%) patients died. The hazard ratio (HR) for mortality of H3Cit and cfDNA per 100 ng/ml increase was 1·1 (1·0-1·1, P < 0·001) and 1·1 (1·0-1·1, P < 0·001), respectively. The HR for mortality of nucleosome levels per 1-unit increase was 1·0 (1·0-1·1, P = 0·233). H3Cit, cfDNA and nucleosome levels were not associated with the risk of ATE in patients with cancer. Elevated H3Cit and cfDNA levels were associated with higher mortality in patients with cancer.
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Affiliation(s)
- Ella Grilz
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Lisa‐Marie Mauracher
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Florian Posch
- Division of OncologyDepartment of MedicineMedical University of GrazGrazAustria
| | - Oliver Königsbrügge
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Sabine Zöchbauer‐Müller
- Clinical Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Christine Marosi
- Clinical Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Irene Lang
- Clinical Division of CardiologyDepartment of Medicine IIMedical University of ViennaViennaAustria
| | - Ingrid Pabinger
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Cihan Ay
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
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Preusser M, Silvani A, Le Rhun E, Soffietti R, Lombardi G, Sepúlveda JM, Brandal P, Beaney RP, Bonneville-Levard A, Lorgis V, Vauleon E, Bromberg J, Erridge S, Cameron A, Marosi C, Golfinopoulos V, Gorlia T, Weller M, Wick W. Trabectedin for recurrent WHO grade II or III meningioma: A randomized phase II study of the EORTC Brain Tumor Group (EORTC-1320-BTG). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2007 Background: EORTC-1320-BTG investigated the activity, safety and quality of life of therapy with the tetrahydroisoquinoline alkaloid trabectedin (Yondelis) in patients with recurrent higher-grade meningiomas. Trabectedin was originally derived from the Caribbean sea squirt, Ecteinascidia turbinata, and currently is manufactured by total synthesis. Methods: Adult patients with histological diagnosis of WHO grade II or III meningioma and radiologically documented progression after maximal feasible surgery and radiotherapy were randomly assigned in a 2:1 ratio to receive intravenous trabectedin (1.5 mg/m2every three weeks) or local standard of care (LOC). The primary endpoint was progression-free survival (PFS). Results: Within 22.1 months, we randomized a total of 90 patients (n=29 in LOC arm, n=61 in trabectedin arm) in 35 institutions and nine countries. In the LOC arm, the following treatments were administered: hydroxyurea (n=11), bevacizumab (n=9), none (n=4), chemotherapy (n=3), somatostatin analogue (n=1), combined chemotherapy and somatostatin analogue (n=1). With 71 PFS events, median PFS was 4.17 months in the LOC and 2.43 months in the trabectedin arm (hazard ratio [HR] for progression, 1.42; 80% CI, 1.00-2.03; p=0.204) with a PFS-6 rate of 29.1% (95% CI, 11.9%-48.8%) in the LOC and 21.1% (95% CI, 11.3%-32.9%) in the trabectedin arm. Median OS was 10.61 months in the LOC and 11.37 months in the trabectedin arm (HR for death, 0.98; 95% CI, 0.54-1.76; p=0.94).Grade 3 to 5 adverse events occurred in 44.4% (18.5% related, 4 serious adverse events, 0 lethal events) of the patients in the LOC and 59% (32.8% related, 57 serious adverse events and 2 toxic deaths) of patient in the trabectedin arm. Conclusions: In this first prospective randomized trial performed in recurrent grade II or III meningioma, trabectedin did not improve PFS and OS and was associated with significantly higher toxicity as compared to LOC treatment. The data collected in this study may serve as benchmark for future clinical trials in this setting. Clinical trial information: NCT02234050.
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Affiliation(s)
- Matthias Preusser
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - Antonio Silvani
- Dept of Neuro-Oncology, Neurologic Institute Carlo Besta, Milan, Italy
| | | | - Riccardo Soffietti
- Department of Neuro-Oncology, University of Turin and City of Health and Science, Turin, Italy
| | - Giuseppe Lombardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | | | | | | | | | | | | | | | - Sara Erridge
- University of Edinbugh, Edinburgh, United Kingdom
| | - Alison Cameron
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | | | | | | | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Mir Seyed Nazari P, Ay C, Marosi C, Moik F, Riedl J, Ricken G, Hainfellner JA, Preusser M, Pabinger I, Berghoff AS. Correlation of systemic and local inflammation with survival prognosis in glioma patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2052 Background: Immune modulating therapies have been a long withstanding treatment approach in glioma. However, gliomas are characterized by a particular absence of tumor infiltrating lymphocytes in the local tumor microenvironment. We aimed to gain insight on the distinct patterns of inflammation associated with survival prognosis in glioma. Methods: Patients were recruited at time of glioma diagnosis or progression in the prospective observational Vienna Cancer and Thrombosis Study (CATS). A single blood draw was performed at study inclusion. PD-L1 expression in the tumor tissue was investigated via immunohistochemistry. Optimal cut-off according to ROC curve was used to assess cut off values for survival analysis. Results: 193 patients with glioma (75.6% glioblastoma (WHO grade IV), 19.7% anaplastic glioma (WHO grade III), and 4.7% diffuse glioma (WHO grade II)) were included. 40/193 (20.7%) glioma had an IDH1 mutation. Membranous PDL1 expression in the tumor tissue was observed in 20/193 (10.4%) patients. 1/20 patient presented with PD-L1 expression and IDH1 mutation ( p = 0.082). PD-L1 significantly correlated with increased monocyte count (median: 0.657 vs. 0.450 [G/L], p = 0.008), higher C-reactive protein (CRP) (0.43 vs. 0.1 [mg/dL], p = 0.005) and higher fibrinogen (379 vs. 303 [mg/dL], p = 0.001). Presence of IDH1 mutation significantly correlated with increased platelet count (303 vs. 232 [G/L], p = 0.001) and lower Neutrophil/Lymphocyte (N/L) ratio (3.34 vs. 5.13, p = 0.016). Higher lymphocyte count ( > 1.484 [G/L], log-rank: p = 0.011), higher platelet count ( > 245.5 [G/L], p = 0.0001), as well as decreased N/L ratio ( < 5.13, p = 0.001) were significantly associated with increased survival prognosis. Conclusions: PD-L1 expression in tumor tissue was associated with markers of systemic inflammation in glioma patients. Systemic inflammation markers furthermore predicted improved survival. Immune modulating therapy approaches might be a promising approach in subgroups of glioma associated with increased baseline interaction of immune system and glioma.
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Affiliation(s)
- Pegah Mir Seyed Nazari
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Moik
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Julia Riedl
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Gerda Ricken
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Weller M, Reifenberger G, Le Rhun E, Clarke JL, Soffietti R, Wick A, Chinot OL, Ducray F, Hau P, McDonald KL, Marosi C, Schnell O, Hottinger AF, Reijneveld JC, Lombardi G, Wen PY, Klein M, Gorlia T, Felsberg J, Hertler C. Molecular genetic, host-derived and clinical determinants of long-term survival in glioblastoma: First results from the ETERNITY study (EORTC 1419). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2056 Background: Glioblastoma represents the most aggressive primary brain tumor in adults, and less than 5% of patients survive 5 years from diagnosis. Factors influencing this long-term survival are poorly understood. Methods: In cooperation with the European Organisation for Research and Treatment of Cancer (EORTC) in Brussels, Belgium, more than 20 clinical sites in the US, Europe and Australia have registered patients with centrally confirmed glioblastoma who survived ≥ 5 years, collecting clinical data including therapy and quality of life-related factors, as well as biospecimens allowing to analyse molecular and immunological parameters. Results: At the cut-off of December 31, 2018, 392 patients were registered, of which 232 had glioblastoma confirmed by central pathology review; 59 dropped out due to histology other than glioblastoma. Glioblastomas were isocitrate dehydrogenase (IDH)-wildtype in 70.7% and had a positive O6-methylguanine DNA methyltransferase (MGMT) promotor methylation status in 75.9%. Median age at diagnosis was 52 years (range: 21-77 years). There was enrichment for patients with gross total resection. Further analyses are ongoing. Conclusions: In a comprehensive effort, the consortium funded by the US Brain Tumor Funders’ Collaborative characterizes factors modulating long-term survival in glioblastoma in a unique large patient cohort. Clinical trial information: NCT 03770468.
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Affiliation(s)
- Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | | | | | - Riccardo Soffietti
- Department of Neuro-Oncology, University of Turin and City of Health and Science, Turin, Italy
| | - Antje Wick
- Neurology Clinic, University of Heidelberg, National Center for Tumor Diseases, Heidelberg, Germany
| | - Olivier L. Chinot
- Aix-Marseille University, AP-HM, Service de Neuro-Oncologie, CHU Timone, Marseille, France
| | - Francois Ducray
- Service de Neuro-oncologie, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France
| | - Peter Hau
- University of Regensburg, Regensburg, Germany
| | | | | | - Oliver Schnell
- Department of Neurosurgery, University Hospital Munich LMU, Munich, Germany
| | | | - Jaap C. Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | - Giuseppe Lombardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Patrick Y. Wen
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA
| | | | | | - Joerg Felsberg
- Department of Neuropathology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Caroline Hertler
- University Hospital Zurich, Department of Neurology, Zurich, Switzerland
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Affiliation(s)
| | - Thomas Brodowicz
- Clinical Division of Medical Oncology, Department for Internal Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Clinical Division of Medical Oncology, Department for Internal Medicine 1, Medical University of Vienna, Vienna, Austria
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Erhart F, Buchroithner J, Reitermaier R, Fischhuber K, Klingenbrunner S, Sloma I, Hibsh D, Kozol R, Efroni S, Ricken G, Wöhrer A, Haberler C, Hainfellner J, Krumpl G, Felzmann T, Dohnal AM, Marosi C, Visus C. Immunological analysis of phase II glioblastoma dendritic cell vaccine (Audencel) trial: immune system characteristics influence outcome and Audencel up-regulates Th1-related immunovariables. Acta Neuropathol Commun 2018; 6:135. [PMID: 30518425 PMCID: PMC6280511 DOI: 10.1186/s40478-018-0621-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/16/2018] [Indexed: 01/19/2023] Open
Abstract
Audencel is a dendritic cell (DC)-based cellular cancer immunotherapy against glioblastoma multiforme (GBM). It is characterized by loading of DCs with autologous whole tumor lysate and in vitro maturation via “danger signals”. The recent phase II “GBM-Vax” trial showed no clinical efficacy for Audencel as assessed with progression-free and overall survival in all patients. Here we present immunological research accompanying the trial with a focus on immune system factors related to outcome and Audencel’s effect on the immune system. Methodologically, peripheral blood samples (from apheresis before Audencel or venipuncture during Audencel) were subjected to functional characterization via enzyme-linked immunospot (ELISPOT) assays connected with cytokine bead assays (CBAs) as well as phenotypical characterization via flow cytometry and mRNA quantification. GBM tissue samples (from surgery) were subjected to T cell receptor sequencing and immunohistochemistry. As results we found: Patients with favorable pre-existing anti-tumor characteristics lived longer under Audencel than Audencel patients without them. Pre-vaccination blood CD8+ T cell count and ELISPOT Granzyme B production capacity in vitro upon tumor antigen exposure were significantly correlated with overall survival. Despite Audencel’s general failure to induce a significant clinical response, it nevertheless seemed to have an effect on the immune system. For instance, Audencel led to a significant up-regulation of the Th1-related immunovariables ELISPOT IFNγ, the transcription factor T-bet in the blood and ELISPOT IL-2 in a dose-dependent manner upon vaccination. Post-vaccination levels of ELISPOT IFNγ and CD8+ cells in the blood were indicative of a significantly better survival. In summary, Audencel failed to reach an improvement of survival in the recent phase II clinical trial. No clinical efficacy was registered. Our concomitant immunological work presented here indicates that outcome under Audencel was influenced by the state of the immune system. On the other hand, Audencel also seemed to have stimulated the immune system. Overall, these immunological considerations suggest that DC immunotherapy against glioblastoma should be studied further – with the goal of translating an apparent immunological response into a clinical response. Future research should concentrate on investigating augmentation of immune reactions through combination therapies or on developing meaningful biomarkers.
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Berghoff A, Ricken G, Rajky U, Marosi C, Hainfellner J, von Deimling A, Sahm F, Preusser M. MNGI-28. CORRELATION OF METHYLATION CLASS AND GENETIC ALTERATIONS WITH PROGRESSION FREE SURVIVAL IN MENINGIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Felix Sahm
- University of Heidelberg and DKFZ, Heidelberg, Germany
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Handisurya A, Rumpold T, Caucig-Lütgendorf C, Flechl B, Preusser M, Ilhan-Mutlu A, Dieckmann K, Widhalm G, Grisold A, Wöhrer A, Hainfellner J, Ristl R, Kurz C, Marosi C, Gessl A, Hassler M. Are hypothyroidism and hypogonadism clinically relevant in patients with malignant gliomas? A longitudinal trial in patients with glioma. Radiother Oncol 2018; 130:139-148. [PMID: 30389240 DOI: 10.1016/j.radonc.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/24/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND So far, the development and course of therapy-induced deficiencies in hypothalamic-pituitary hormones in adult patients with malignant gliomas has not received much attention. However, such deficiencies may impact patient's quality of life substantially. METHODS In this monocentric longitudinal trial, we examined hormonal levels of TSH, T3, T4, fT3, fT4, FSH, LH, testosterone, estradiol and prolactin in patients with malignant high grade gliomas before the start of radiochemotherapy (RCT), at the end of RCT and then every three months for newly diagnosed patients and every six months in patients diagnosed more than two years before study inclusion. Growth hormone was not measured in this trial. RESULTS 436 patients (198 female, 238 male) with high-grade gliomas, aged 19-83 years (median 50 years), were included in this study. Low levels of thyroid hormones were observed in around 10% of patients within the first six months of follow up and increasingly after 36 months. Half of premenopausal women at study entry developed premature menopause, 35% showed hyperprolactinemia. Low testosterone levels were measured in 37% of men aged less than 50 years and in 35/63 (55%) of men aged 50 years or older. DISCUSSION The results of this study show that a significant percentage of patients with malignant gliomas develop hormonal deficiencies mandating regular clinical follow up, state of the art counseling and if clinically necessary substitution therapy.
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Affiliation(s)
- Ammon Handisurya
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Tamara Rumpold
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | | | - Birgit Flechl
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria; Institute of Radiooncology, Kaiser Franz-Josef Spital SMZ-Süd, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Aysegül Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Austria
| | | | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Christine Kurz
- Department of Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
| | - Alois Gessl
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Austria
| | - Marco Hassler
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
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Crevenna R, Kainberger F, Wiltschke C, Marosi C, Wolzt M, Cenik F, Keilani M. Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center. Disabil Rehabil 2018; 42:2-7. [PMID: 30328719 DOI: 10.1080/09638288.2018.1514665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.
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Affiliation(s)
- Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Wiltschke
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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Grilz E, Posch F, Königsbrügge O, Schwarzinger I, Lang I, Marosi C, Pabinger I, Ay C. Association of Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio with the Risk of Thromboembolism and Mortality in Patients with Cancer. Thromb Haemost 2018; 118:1875-1884. [DOI: 10.1055/s-0038-1673401] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractPatients with cancer are at risk of developing venous and arterial thromboembolism (VTE and ATE). Elevated platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte ratios (NLR) have been suggested as potential biomarkers for cancer-associated chronic inflammation, VTE and mortality. We investigated the association between PLR and NLR with VTE, ATE and mortality in patients with cancer. Within a prospective cohort study, we followed-up patients with newly diagnosed or progressing cancer for objectively confirmed, symptomatic VTE, ATE and death. Fine and Gray competing-risk regression was used to model the risk of VTE and ATE. Overall survival was analysed with Kaplan–Meier estimators. From 2003 to 2013, 1,469 patients with solid cancer (median age: 61 years; 47.3% female) were recruited and followed for 2 years. Overall, 128 (8.7%) patients developed VTE, 41 (2.8%) ATE and 643 (43.8%) patients died. The sub-distribution hazard ratios (SHRs) for VTE per doubling of PLR and NLR were 1.0 (95% confidence interval [CI]: 0.8–1.3, p = 0.899) and 1.2 (1.0–1.4, p = 0.059), respectively. For ATE, the SHR per doubling of PLR and NLR were 1.0 (0.7–1.5, p = 0.940) and 1.2 (0.9–1.6, p = 0.191), respectively. A higher PLR (hazard ratio [HR] per doubling = 1.5, 1.4–1.7, p < 0.001) and a higher NLR (HR per doubling = 1.5, 1.4–1.7, p < 0.001) were associated with an increased risk of mortality after adjusting for age, sex and cancer stage. There was no statistically significant association between NLR and VTE occurrence in patients with cancer. Neither PLR nor NLR were associated with the risk of ATE. Both elevated PLR and NLR were independently associated with a twofold increased risk of mortality.
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Affiliation(s)
- Ella Grilz
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Oliver Königsbrügge
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ilse Schwarzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Irene Lang
- Clinical Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Cihan Ay
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Buchroithner J, Erhart F, Pichler J, Widhalm G, Preusser M, Stockhammer G, Nowosielski M, Iglseder S, Freyschlag CF, Oberndorfer S, Bordihn K, von Campe G, Hoffermann M, Ruckser R, Rössler K, Spiegl-Kreinecker S, Fischer MB, Czech T, Visus C, Krumpl G, Felzmann T, Marosi C. Audencel Immunotherapy Based on Dendritic Cells Has No Effect on Overall and Progression-Free Survival in Newly Diagnosed Glioblastoma: A Phase II Randomized Trial. Cancers (Basel) 2018; 10:E372. [PMID: 30301187 PMCID: PMC6210090 DOI: 10.3390/cancers10100372] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/22/2018] [Accepted: 09/30/2018] [Indexed: 11/17/2022] Open
Abstract
Dendritic cells (DCs) are antigen-presenting cells that are capable of priming anti-tumor immune responses, thus serving as attractive tools to generate tumor vaccines. In this multicentric randomized open-label phase II study, we investigated the efficacy of vaccination with tumor lysate-charged autologous DCs (Audencel) in newly diagnosed glioblastoma multiforme (GBM). Patients aged 18 to 70 years with histologically proven primary GBM and resection of at least 70% were randomized 1:1 to standard of care (SOC) or SOC plus vaccination (weekly intranodal application in weeks seven to 10, followed by monthly intervals). The primary endpoint was progression-free survival at 12 months. Secondary endpoints were overall survival, safety, and toxicity. Seventy-six adult patients were analyzed in this study. Vaccinations were given for seven (3⁻20) months on average. No severe toxicity was attributable to vaccination. Seven patients showed flu-like symptoms, and six patients developed local skin reactions. Progression-free survival at 12 months did not differ significantly between the control and vaccine groups (28.4% versus 24.5%, p = 0.9975). Median overall survival was similar with 18.3 months (vaccine: 564 days, 95% CI: 436⁻671 versus control: 568 days, 95% CI: 349⁻680; p = 0.89, harzard ratio (HR) 0.99). Hence, in this trial, the clinical outcomes of patients with primary GBM could not be improved by the addition of Audencel to SOC.
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Affiliation(s)
- Johanna Buchroithner
- University Clinic for Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg-Weg 15, 4020 Linz, Austria.
| | - Friedrich Erhart
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
- Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Josef Pichler
- Department of Internal Medicine and Neurooncology, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg-Weg 15, 4020 Linz, Austria.
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Matthias Preusser
- Clinical Division of Medical Oncology, Department for Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Günther Stockhammer
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020 Innsbruck, Austria.
| | - Martha Nowosielski
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020 Innsbruck, Austria.
| | - Sarah Iglseder
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020 Innsbruck, Austria.
| | - Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020 Innsbruck, Austria.
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic St. Pölten, Karl Landsteiner Privat Universität, Dunant-Platz 1, 3100 St. Pölten, Austria.
| | - Karin Bordihn
- Department of Neurosurgery, Landeskrankenhaus Salzburg, University Clinic of the Paracelsus Private Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
| | - Gord von Campe
- Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Markus Hoffermann
- Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Reinhard Ruckser
- Department of Internal Medicine 2, Donauspital, Langobardenstraße 122, 1220 Vienna, Austria.
| | - Karl Rössler
- Department of Neurosurgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Sabine Spiegl-Kreinecker
- University Clinic for Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg-Weg 15, 4020 Linz, Austria.
| | - Michael B Fischer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Carmen Visus
- Activartis Biotech GmbH, Wilhelminenstraße 91/IIf, 1160 Vienna, Austria.
| | - Günther Krumpl
- Activartis Biotech GmbH, Wilhelminenstraße 91/IIf, 1160 Vienna, Austria.
| | - Thomas Felzmann
- Activartis Biotech GmbH, Wilhelminenstraße 91/IIf, 1160 Vienna, Austria.
| | - Christine Marosi
- Clinical Division of Medical Oncology, Department for Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Wippel C, Starzer A, Berghoff A, Bergen E, Wolf P, Widhalm G, Frischer J, Gatterbauer B, Marosi C, Dieckmann K, Bartsch R, Preusser M. Hypothyroidism is associated with improved survival prognosis in patients with newly diagnosed brain metastases. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy273.366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Berghoff A, Erguener B, Schuster M, Rajky U, Ricken G, Frischer J, Gatterbauer B, Marosi C, Dieckmann K, Widhalm G, Bock C, Preusser M. Mutational and inflammatory microenvironment characteristics in primary and matched local recurrent non-small cell lung cancer brain metastases. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy273.360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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