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Nabors LB, Lamb LS, Goswami T, Rochlin K, Youngblood SL. Adoptive cell therapy for high grade gliomas using simultaneous temozolomide and intracranial mgmt-modified γδ t cells following standard post-resection chemotherapy and radiotherapy: current strategy and future directions. Front Immunol 2024; 15:1299044. [PMID: 38384458 PMCID: PMC10880006 DOI: 10.3389/fimmu.2024.1299044] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Cellular therapies, including chimeric antigen receptor T cell therapies (CAR-T), while generally successful in hematologic malignancies, face substantial challenges against solid tumors such as glioblastoma (GBM) due to rapid growth, antigen heterogeneity, and inadequate depth of response to cytoreductive and immune therapies, We have previously shown that GBM constitutively express stress associated NKG2D ligands (NKG2DL) recognized by gamma delta (γδ) T cells, a minor lymphocyte subset that innately recognize target molecules via the γδ T cell receptor (TCR), NKG2D, and multiple other mechanisms. Given that NKG2DL expression is often insufficient on GBM cells to elicit a meaningful response to γδ T cell immunotherapy, we then demonstrated that NKG2DL expression can be transiently upregulated by activation of the DNA damage response (DDR) pathway using alkylating agents such as Temozolomide (TMZ). TMZ, however, is also toxic to γδ T cells. Using a p140K/MGMT lentivector, which confers resistance to TMZ by expression of O(6)-methylguanine-DNA-methyltransferase (MGMT), we genetically engineered γδ T cells that maintain full effector function in the presence of therapeutic doses of TMZ. We then validated a therapeutic system that we termed Drug Resistance Immunotherapy (DRI) that combines a standard regimen of TMZ concomitantly with simultaneous intracranial infusion of TMZ-resistant γδ T cells in a first-in-human Phase I clinical trial (NCT04165941). This manuscript will discuss DRI as a rational therapeutic approach to newly diagnosed GBM and the importance of repeated administration of DRI in combination with the standard-of-care Stupp regimen in patients with stable minimal residual disease.
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Affiliation(s)
- L B Nabors
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - L S Lamb
- IN8Bio, Inc., New York, NY, United States
| | - T Goswami
- IN8Bio, Inc., New York, NY, United States
| | - K Rochlin
- IN8Bio, Inc., New York, NY, United States
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2
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Estevez-Ordonez D, Abdelrashid M, Coffee E, Laskay NMB, Atchley TJ, Chkheidze R, Fiveash JB, Markert JM, Lobbous M, Maveal BM, Burt Nabors L. Racial and socioeconomic disparities in glioblastoma outcomes: A single-center, retrospective cohort study. Cancer 2023; 129:3010-3022. [PMID: 37246417 DOI: 10.1002/cncr.34881] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common malignant primary brain tumor. Emerging reports have suggested that racial and socioeconomic disparities influence the outcomes of patients with GBM. No studies to date have investigated these disparities controlling for isocitrate dehydrogenase (IDH) mutation and O-6-methylguanine-DNA methyltransferase (MGMT) status. METHODS Adult patients with GBM were retrospectively reviewed at a single institution from 2008 to 2019. Univariable and multivariable complete survival analyses were performed. A Cox proportional hazards model was used to assess the effect of race and socioeconomic status controlling for a priori selected variables with known relevance to survival. RESULTS In total, 995 patients met inclusion criteria. Of these, 117 patients (11.7%) were African American (AA). The median overall survival for the entire cohort was 14.23 months. In the multivariable model, AA patients had better survival compared with White patients (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.2-0.69). The observed survival difference was significant in both a complete case analysis model and a multiple imputations model accounting for missing molecular data and controlling for treatment and socioeconomic status. AA patients with low income (HR, 2.17; 95% CI, 1.04-4.50), public insurance (HR, 2.25; 95% CI, 1.04-4.87), or no insurance (HR, 15.63; 95% CI, 2.72-89.67) had worse survival compared with White patients with low income, public insurance, or no insurance, respectively. CONCLUSIONS Significant racial and socioeconomic disparities were identified after controlling for treatment, GBM genetic profile, and other variables associated with survival. Overall, AA patients demonstrated better survival. These findings may suggest the possibility of a protective genetic advantage in AA patients. PLAIN LANGUAGE SUMMARY To best personalize treatment for and understand the causes of glioblastoma, racial and socioeconomic influences must be examined. The authors report their experience at the O'Neal Comprehensive Cancer Center in the deep south. In this report, contemporary molecular diagnostic data are included. The authors conclude that there are significant racial and socioeconomic disparities that influence glioblastoma outcome and that African American patients do better.
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Affiliation(s)
| | - Moaaz Abdelrashid
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Coffee
- Division of Neuro-Oncology, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicholas M B Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Travis J Atchley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rati Chkheidze
- Division of Neuropathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mina Lobbous
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brandon M Maveal
- Division of Neuropathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Louis Burt Nabors
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Neuro-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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3
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Barkhoudarian G, Badruddoja M, Blondin N, Chowdhary S, Cobbs C, Duic JP, Flores JP, Fonkem E, McClay E, Nabors LB, Salacz M, Taylor L, Vaillant B, Gill J, Kesari S. An expanded safety/feasibility study of the EMulate Therapeutics Voyager™ System in patients with recurrent glioblastoma. CNS Oncol 2023; 12:CNS102. [PMID: 37462385 PMCID: PMC10410686 DOI: 10.2217/cns-2022-0016] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Aim: The EMulate Therapeutics Voyager™ is a simple, wearable, home-use device that uses an alternating electromagnetic field to alter biologic signaling within cells. Objective: To assess the safety/feasibility of the Voyager in the treatment of recurrent glioblastoma (rGBM). Methods: In this study, patients with rGBM were treated with Voyager as monotherapy or in combination with standard chemotherapy at the Investigator's discretion. Safety was assessed by incidence of adverse events associated with the Voyager. Patients were followed until death. Results: A total of 75 patients were enrolled and treated for at least one day with the Voyager (safety population). Device-related adverse events were uncommon and generally did not result in interruption or withdrawal from treatment. There were no serious adverse events associated with Voyager. A total of 60 patients were treated for at least one month (clinical utility population). The median progression-free survival (PFS) was 17 weeks (4.3 months) in the Voyager only group (n = 24) and 21 weeks (5.3 months) in the Voyager + concurrent therapy group (n = 36). The median overall survival (OS) was 7 months in the Voyager only group and 9 months in the Voyager + concurrent therapy group. In patients treated with Voyager + concurrent therapy, the median OS for patients enrolled with their 1st or 2nd recurrence (n = 26) was 10 months, while in patients enrolled with their 3rd or 4th recurrence (n = 10) OS was 7 months. Conclusion: The data support the safety and feasibility of the Voyager for the treatment of rGBM. Further prospective study of the device is warranted. Trial Registration Number: NCT02296580 (ClinicalTrials.gov).
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Affiliation(s)
- Garni Barkhoudarian
- Saint John's Cancer Institute & Pacific Neuroscience Institute at Providence St. John's Health Center, Santa Monica, CA 90404, USA
| | | | - Nicholas Blondin
- Associated Neurologists of Southern Connecticut, Fairfield, CT 06824, USA
| | | | - Charles Cobbs
- Swedish Medical Center, Ben and Catherine Ivy Center For Advanced Brain Tumor Treatment, Seattle, WA 98122, USA
| | | | | | | | - Edward McClay
- cCARE (California Cancer Associates for Research & Excellence), Encinitas, CA 92024, USA
| | - Louis Burt Nabors
- University of Alabama, Division of Neuro-Oncology, Birmingham, AL 35294-3410, USA
| | - Michael Salacz
- University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Lynn Taylor
- University of Washington, Seattle, WA 98195, USA
| | | | - Jaya Gill
- Saint John's Cancer Institute & Pacific Neuroscience Institute at Providence St. John's Health Center, Santa Monica, CA 90404, USA
| | - Santosh Kesari
- Saint John's Cancer Institute & Pacific Neuroscience Institute at Providence St. John's Health Center, Santa Monica, CA 90404, USA
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4
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Horbinski C, Nabors LB, Portnow J, Baehring J, Bhatia A, Bloch O, Brem S, Butowski N, Cannon DM, Chao S, Chheda MG, Fabiano AJ, Forsyth P, Gigilio P, Hattangadi-Gluth J, Holdhoff M, Junck L, Kaley T, Merrell R, Mrugala MM, Nagpal S, Nedzi LA, Nevel K, Nghiemphu PL, Parney I, Patel TR, Peters K, Puduvalli VK, Rockhill J, Rusthoven C, Shonka N, Swinnen LJ, Weiss S, Wen PY, Willmarth NE, Bergman MA, Darlow S. NCCN Guidelines® Insights: Central Nervous System Cancers, Version 2.2022. J Natl Compr Canc Netw 2023; 21:12-20. [PMID: 36634606 DOI: 10.6004/jnccn.2023.0002] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of the following adult CNS cancers: glioma (WHO grade 1, WHO grade 2-3 oligodendroglioma [1p19q codeleted, IDH-mutant], WHO grade 2-4 IDH-mutant astrocytoma, WHO grade 4 glioblastoma), intracranial and spinal ependymomas, medulloblastoma, limited and extensive brain metastases, leptomeningeal metastases, non-AIDS-related primary CNS lymphomas, metastatic spine tumors, meningiomas, and primary spinal cord tumors. The information contained in the algorithms and principles of management sections in the NCCN Guidelines for CNS Cancers are designed to help clinicians navigate through the complex management of patients with CNS tumors. Several important principles guide surgical management and treatment with radiotherapy and systemic therapy for adults with brain tumors. The NCCN CNS Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's most recent recommendations regarding molecular profiling of gliomas.
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Affiliation(s)
- Craig Horbinski
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | - Steven Brem
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Samuel Chao
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Milan G Chheda
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Pierre Gigilio
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | - Lucien A Nedzi
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Kathryn Nevel
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | | | | | | | - Vinay K Puduvalli
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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5
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Bagley SJ, Kothari S, Rahman R, Lee EQ, Dunn GP, Galanis E, Chang SM, Burt Nabors L, Ahluwalia MS, Stupp R, Mehta MP, Reardon DA, Grossman SA, Sulman EP, Sampson JH, Khagi S, Weller M, Cloughesy TF, Wen PY, Khasraw M. Glioblastoma Clinical Trials: Current Landscape and Opportunities for Improvement. Clin Cancer Res 2022; 28:594-602. [PMID: 34561269 PMCID: PMC9044253 DOI: 10.1158/1078-0432.ccr-21-2750] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/29/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Therapeutic advances for glioblastoma have been minimal over the past 2 decades. In light of the multitude of recent phase III trials that have failed to meet their primary endpoints following promising preclinical and early-phase programs, a Society for Neuro-Oncology Think Tank was held in November 2020 to prioritize areas for improvement in the conduct of glioblastoma clinical trials. Here, we review the literature, identify challenges related to clinical trial eligibility criteria and trial design in glioblastoma, and provide recommendations from the Think Tank. In addition, we provide a data-driven context with which to frame this discussion by analyzing key study design features of adult glioblastoma clinical trials listed on ClinicalTrials.gov as "recruiting" or "not yet recruiting" as of February 2021.
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Affiliation(s)
- Stephen J. Bagley
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Shawn Kothari
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Eudocia Q. Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gavin P. Dunn
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri
| | | | - Susan M. Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Louis Burt Nabors
- Division of Neuro-oncology, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Manmeet S. Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Roger Stupp
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Minesh P. Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - David A. Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stuart A. Grossman
- Department of Oncology, Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland
| | - Erik P. Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York
| | - John H. Sampson
- Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Simon Khagi
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Timothy F. Cloughesy
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mustafa Khasraw
- Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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6
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Nabors LB, Portnow J, Ahluwalia M, Baehring J, Brem H, Brem S, Butowski N, Campian JL, Clark SW, Fabiano AJ, Forsyth P, Hattangadi-Gluth J, Holdhoff M, Horbinski C, Junck L, Kaley T, Kumthekar P, Loeffler JS, Mrugala MM, Nagpal S, Pandey M, Parney I, Peters K, Puduvalli VK, Robins I, Rockhill J, Rusthoven C, Shonka N, Shrieve DC, Swinnen LJ, Weiss S, Wen PY, Willmarth NE, Bergman MA, Darlow SD. Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:1537-1570. [PMID: 33152694 DOI: 10.6004/jnccn.2020.0052] [Citation(s) in RCA: 210] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of adult CNS cancers ranging from noninvasive and surgically curable pilocytic astrocytomas to metastatic brain disease. The involvement of an interdisciplinary team, including neurosurgeons, radiation therapists, oncologists, neurologists, and neuroradiologists, is a key factor in the appropriate management of CNS cancers. Integrated histopathologic and molecular characterization of brain tumors such as gliomas should be standard practice. This article describes NCCN Guidelines recommendations for WHO grade I, II, III, and IV gliomas. Treatment of brain metastases, the most common intracranial tumors in adults, is also described.
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Affiliation(s)
| | | | - Manmeet Ahluwalia
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Henry Brem
- 5The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Steven Brem
- 6Abramson Cancer Center at the University of Pennsylvania
| | | | - Jian L Campian
- 8Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | - Craig Horbinski
- 13Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Larry Junck
- 14University of Michigan Rogel Cancer Center
| | | | - Priya Kumthekar
- 13Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Manjari Pandey
- 19St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Vinay K Puduvalli
- 21The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Ian Robins
- 22University of Wisconsin Carbone Cancer Center
| | - Jason Rockhill
- 23Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Lode J Swinnen
- 5The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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7
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Abstract
Optimizing treatment for patients with low-grade gliomas should focus on the role of radiation and chemotherapy, as well as the prognostic impact of molecular diagnostics (1p/19q and IDH status). For anaplastic oligodendroglioma, focus should be placed on molecular markers (particularly 1p/19q status) and combination treatment with chemotherapy (temozolomide or PCV [procarbazine, lomustine, and vincristine]) and radiation. For patients with malignant glioblastomas, the role of methylguanine methyl-transferase (MGMT) methylation status has become increasingly important to treatment decisions. MGMT methylation status should be considered in elderly patients and/or those with low performance status (methylated patients benefit from temozolomide) and a hypofractionated radiation schedule should be used.
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8
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Le Rhun E, Genbrugge E, Stupp R, Chinot OL, Nabors LB, Cloughesy T, Reardon DA, Wick W, Gorlia T, Weller M. P01.032 Associations of anticoagulant use with outcome in newly diagnosed glioblastoma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.074] [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)
- E Le Rhun
- University Hospital and University of Lille, Lille, France
- University Hospital and University of Zurich, Zurich, Switzerl
| | | | - R Stupp
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerl
| | - O L Chinot
- Aix-Marseille University, Marseille, France
| | - L B Nabors
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - T Cloughesy
- UCLA Neuro-Oncology Program, Los Angeles, CA, United States
| | - D A Reardon
- Dana-Farber Cancer Research Institute, Boston, MA, United States
| | - W Wick
- University Hospital Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - T Gorlia
- EORTC Headquarters, Brussels, Belgium
| | - M Weller
- University Hospital and University of Zurich, Zurich, Switzerl
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9
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Nabors LB, Portnow J, Ammirati M, Baehring J, Brem H, Butowski N, Fenstermaker RA, Forsyth P, Hattangadi-Gluth J, Holdhoff M, Howard S, Junck L, Kaley T, Kumthekar P, Loeffler JS, Moots PL, Mrugala MM, Nagpal S, Pandey M, Parney I, Peters K, Puduvalli VK, Ragsdale J, Rockhill J, Rogers L, Rusthoven C, Shonka N, Shrieve DC, Sills AK, Swinnen LJ, Tsien C, Weiss S, Wen PY, Willmarth N, Bergman MA, Engh A. NCCN Guidelines Insights: Central Nervous System Cancers, Version 1.2017. J Natl Compr Canc Netw 2018; 15:1331-1345. [PMID: 29118226 DOI: 10.6004/jnccn.2017.0166] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For many years, the diagnosis and classification of gliomas have been based on histology. Although studies including large populations of patients demonstrated the prognostic value of histologic phenotype, variability in outcomes within histologic groups limited the utility of this system. Nonetheless, histology was the only proven and widely accessible tool available at the time, thus it was used for clinical trial entry criteria, and therefore determined the recommended treatment options. Research to identify molecular changes that underlie glioma progression has led to the discovery of molecular features that have greater diagnostic and prognostic value than histology. Analyses of these molecular markers across populations from randomized clinical trials have shown that some of these markers are also predictive of response to specific types of treatment, which has prompted significant changes to the recommended treatment options for grade III (anaplastic) gliomas.
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10
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Miller B, Peeri NC, Nabors LB, Creed JH, Thompson ZJ, Rozmeski CM, LaRocca RV, Chowdhary S, Olson JJ, Thompson RC, Egan KM. Handedness and the risk of glioma. J Neurooncol 2018; 137:639-644. [PMID: 29332185 DOI: 10.1007/s11060-018-2759-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/05/2018] [Indexed: 12/01/2022]
Abstract
Gliomas are the most common type of malignant primary brain tumor and few risk factors have been linked to their development. Handedness has been associated with several pathologic neurological conditions such as schizophrenia, autism, and epilepsy, but few studies have evaluated a connection between handedness and risk of glioma. In this study, we examined the relationship between handedness and glioma risk in a large case-control study (1849 glioma cases and 1354 healthy controls) and a prospective cohort study (326,475 subjects with 375 incident gliomas). In the case-control study, we found a significant inverse association between left handedness and glioma risk, with left-handed persons exhibiting a 35% reduction in the risk of developing glioma [odds ratio (OR) = 0.65, 95% confidence interval (CI) 0.51-0.83] after adjustment for age, gender, race, education, and state of residence; similar inverse associations were observed for GBM (OR = 0.69, 95% CI 0.52-0.91), and non-GBM (OR = 0.59, 95% CI 0.42-0.82) subgroups. The association was consistent in both males and females, and across age strata, and was observed in both glioblastoma and in lower grade tumors. In the prospective cohort study, we found no association between handedness and glioma risk (hazards ratio = 0.92, 95% CI 0.67-1.28) adjusting for age, gender, and race. Further studies on this association may help to elucidate mechanisms of pathogenesis in glioma.
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Affiliation(s)
- Briana Miller
- Neuro-Oncology Program, University of Alabama at Birmingham, FOT 1020, 510 20th St. South, Birmingham, AL, 35294, USA
| | - Noah C Peeri
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612-9416, USA
| | - Louis Burt Nabors
- Neuro-Oncology Program, University of Alabama at Birmingham, FOT 1020, 510 20th St. South, Birmingham, AL, 35294, USA
| | - Jordan H Creed
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612-9416, USA
| | - Zachary J Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Carrie M Rozmeski
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612-9416, USA
| | - Renato V LaRocca
- Norton Cancer Institute, 676 So Floyd St., Louisville, KY, 40202, USA
| | - Sajeel Chowdhary
- Neuro-Oncology Program, Lynn Cancer Institute, 701 NW 13th Street, Boca Raton, FL, 33486, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, 1365-B Clifton Rd., NE, Ste. 2200, Atlanta, GA, 30322, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt University Medical Center, 691 Preston Building, Nashville, TN, 37232, USA
| | - Kathleen M Egan
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612-9416, USA.
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11
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Weller M, Nabors LB, Gorlia T, Leske H, Rushing E, Bady P, Hicking C, Perry J, Hong YK, Roth P, Wick W, Goodman SL, Hegi ME, Picard M, Moch H, Straub J, Stupp R. Cilengitide in newly diagnosed glioblastoma: biomarker expression and outcome. Oncotarget 2017; 7:15018-32. [PMID: 26918452 PMCID: PMC4924768 DOI: 10.18632/oncotarget.7588] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 01/03/2016] [Accepted: 01/29/2016] [Indexed: 11/25/2022] Open
Abstract
Integrins αvβ3 and αvβ5 regulate angiogenesis and invasiveness in cancer, potentially by modulating activation of the transforming growth factor (TGF)-β pathway. The randomized phase III CENTRIC and phase II CORE trials explored the integrin inhibitor cilengitide in patients with newly diagnosed glioblastoma with versus without O6-methylguanine DNA methyltransferase (MGMT) promoter methylation. These trials failed to meet their primary endpoints. Immunohistochemistry was used to assess the levels of the target integrins of cilengitide, αvβ3 and αvβ5 integrins, of αvβ8 and of their putative target, phosphorylation of SMAD2, in tumor tissues from CENTRIC (n=274) and CORE (n=224). αvβ3 and αvβ5 expression correlated well in tumor and endothelial cells, but showed little association with αvβ8 or pSMAD2 levels. In CENTRIC, there was no interaction between the biomarkers and treatment for prediction of outcome. In CORE, higher αvβ3 levels in tumor cells were associated with improved progression-free survival by central review and with improved overall survival in patients treated with cilengitide. Integrins αvβ3, αvβ5 and αvβ8 are differentially expressed in glioblastoma. Integrin levels do not correlate with the activation level of the canonical TGF-β pathway. αvβ3 integrin expression may predict benefit from integrin inhibition in patients with glioblastoma lacking MGMT promoter methylation.
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Affiliation(s)
- Michael Weller
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Henning Leske
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Elisabeth Rushing
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Pierre Bady
- Department of Education and Research, University of Lausanne, Lausanne, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Christine Hicking
- Department of Translational and Biomarkers Research, Oncology, Merck KGaA, Darmstadt, Germany
| | - James Perry
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yong-Kil Hong
- The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit (CCU) Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon L Goodman
- Department of Translational and Biomarkers Research, Oncology, Merck KGaA, Darmstadt, Germany
| | - Monika E Hegi
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Martin Picard
- Department of Translational and Biomarkers Research, Oncology, Merck KGaA, Darmstadt, Germany
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Josef Straub
- Department of Translational and Biomarkers Research, Oncology, Merck KGaA, Darmstadt, Germany
| | - Roger Stupp
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
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Abstract
Over the past 30 years, the incidence of primary brain tumors has been increasing. Primary brain tumors are a heterogeneous group of central nervous system cancers with a wide range of outcomes and therapeutic strategies. As a result, prognostic features and molecular markers play a critical role in selecting treatment options for patients with brain tumors. At the NCCN 21st Annual Conference, Louis Burt Nabors, MD, reviewed the most appropriate adjuvant therapy for 3 types of brain tumors-primary low-grade gliomas, anaplastic oligodendrogliomas, and malignant gliomas-and shared supportive clinical trial data and NCCN recommendations.
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Affiliation(s)
- Louis Burt Nabors
- Presented by Louis Burt Nabors, MD, Department of Neurology, Division of Neuro-Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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13
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Nabors LB, Portnow J, Ammirati M, Baehring J, Brem H, Brown P, Butowski N, Chamberlain MC, Fenstermaker RA, Friedman A, Gilbert MR, Hattangadi-Gluth J, Holdhoff M, Junck L, Kaley T, Lawson R, Loeffler JS, Lovely MP, Moots PL, Mrugala MM, Newton HB, Parney I, Raizer JJ, Recht L, Shonka N, Shrieve DC, Sills AK, Swinnen LJ, Tran D, Tran N, Vrionis FD, Weiss S, Wen PY, McMillian N, Engh AM. Central Nervous System Cancers, Version 1.2015. J Natl Compr Canc Netw 2016; 13:1191-202. [PMID: 26483059 DOI: 10.6004/jnccn.2015.0148] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Central Nervous System (CNS) Cancers provide interdisciplinary recommendations for managing adult CNS cancers. Primary and metastatic brain tumors are a heterogeneous group of neoplasms with varied outcomes and management strategies. These NCCN Guidelines Insights summarize the NCCN CNS Cancers Panel's discussion and highlight notable changes in the 2015 update. This article outlines the data and provides insight into panel decisions regarding adjuvant radiation and chemotherapy treatment options for high-risk newly diagnosed low-grade gliomas and glioblastomas. Additionally, it describes the panel's assessment of new data and the ongoing debate regarding the use of alternating electric field therapy for high-grade gliomas.
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14
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Nabors LB, Portnow J, Ammirati M, Brem H, Brown P, Butowski N, Chamberlain MC, DeAngelis LM, Fenstermaker RA, Friedman A, Gilbert MR, Hattangadi-Gluth J, Hesser D, Holdhoff M, Junck L, Lawson R, Loeffler JS, Moots PL, Mrugala MM, Newton HB, Raizer JJ, Recht L, Shonka N, Shrieve DC, Sills AK, Swinnen LJ, Tran D, Tran N, Vrionis FD, Wen PY, McMillian NR, Ho M. Central nervous system cancers, version 2.2014. Featured updates to the NCCN Guidelines. J Natl Compr Canc Netw 2015; 12:1517-23. [PMID: 25361798 DOI: 10.6004/jnccn.2014.0151] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Central Nervous System Cancers provide multidisciplinary recommendations for the clinical management of patients with cancers of the central nervous system. These NCCN Guidelines Insights highlight recent updates regarding the management of metastatic brain tumors using radiation therapy. Use of stereotactic radiosurgery (SRS) is no longer limited to patients with 3 or fewer lesions, because data suggest that total disease burden, rather than number of lesions, is predictive of survival benefits associated with the technique. SRS is increasingly becoming an integral part of management of patients with controlled, low-volume brain metastases.
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Affiliation(s)
- Louis Burt Nabors
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Jana Portnow
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Mario Ammirati
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Henry Brem
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Paul Brown
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Nicholas Butowski
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Marc C Chamberlain
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Lisa M DeAngelis
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Robert A Fenstermaker
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Allan Friedman
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Mark R Gilbert
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Jona Hattangadi-Gluth
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Deneen Hesser
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Matthias Holdhoff
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Larry Junck
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Ronald Lawson
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Jay S Loeffler
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Paul L Moots
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Maciej M Mrugala
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Herbert B Newton
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Jeffrey J Raizer
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Lawrence Recht
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Nicole Shonka
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Dennis C Shrieve
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Allen K Sills
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Lode J Swinnen
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - David Tran
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Nam Tran
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Frank D Vrionis
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Patrick Yung Wen
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Nicole R McMillian
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
| | - Maria Ho
- From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; The University of Texas MD Anderson Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Roswell Park Cancer Institute; Duke Cancer Institute; UC San Diego Moores Cancer Center; American Brain Tumor Association; University of Michigan Comprehensive Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Stanford Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; and National Comprehensive Cancer Network
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Stupp R, Hegi ME, Gorlia T, Erridge SC, Perry J, Hong YK, Aldape KD, Lhermitte B, Pietsch T, Grujicic D, Steinbach JP, Wick W, Tarnawski R, Nam DH, Hau P, Weyerbrock A, Taphoorn MJB, Shen CC, Rao N, Thurzo L, Herrlinger U, Gupta T, Kortmann RD, Adamska K, McBain C, Brandes AA, Tonn JC, Schnell O, Wiegel T, Kim CY, Nabors LB, Reardon DA, van den Bent MJ, Hicking C, Markivskyy A, Picard M, Weller M. Cilengitide combined with standard treatment for patients with newly diagnosed glioblastoma with methylated MGMT promoter (CENTRIC EORTC 26071-22072 study): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2014; 15:1100-8. [PMID: 25163906 DOI: 10.1016/s1470-2045(14)70379-1] [Citation(s) in RCA: 700] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cilengitide is a selective αvβ3 and αvβ5 integrin inhibitor. Data from phase 2 trials suggest that it has antitumour activity as a single agent in recurrent glioblastoma and in combination with standard temozolomide chemoradiotherapy in newly diagnosed glioblastoma (particularly in tumours with methylated MGMT promoter). We aimed to assess cilengitide combined with temozolomide chemoradiotherapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter. METHODS In this multicentre, open-label, phase 3 study, we investigated the efficacy of cilengitide in patients from 146 study sites in 25 countries. Eligible patients (newly diagnosed, histologically proven supratentorial glioblastoma, methylated MGMT promoter, and age ≥18 years) were stratified for prognostic Radiation Therapy Oncology Group recursive partitioning analysis class and geographic region and centrally randomised in a 1:1 ratio with interactive voice response system to receive temozolomide chemoradiotherapy with cilengitide 2000 mg intravenously twice weekly (cilengitide group) or temozolomide chemoradiotherapy alone (control group). Patients and investigators were unmasked to treatment allocation. Maintenance temozolomide was given for up to six cycles, and cilengitide was given for up to 18 months or until disease progression or unacceptable toxic effects. The primary endpoint was overall survival. We analysed survival outcomes by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00689221. FINDINGS Overall, 3471 patients were screened. Of these patients, 3060 had tumour MGMT status tested; 926 patients had a methylated MGMT promoter, and 545 were randomly assigned to the cilengitide (n=272) or control groups (n=273) between Oct 31, 2008, and May 12, 2011. Median overall survival was 26·3 months (95% CI 23·8-28·8) in the cilengitide group and 26·3 months (23·9-34·7) in the control group (hazard ratio 1·02, 95% CI 0·81-1·29, p=0·86). None of the predefined clinical subgroups showed a benefit from cilengitide. We noted no overall additional toxic effects with cilengitide treatment. The most commonly reported adverse events of grade 3 or worse in the safety population were lymphopenia (31 [12%] in the cilengitide group vs 26 [10%] in the control group), thrombocytopenia (28 [11%] vs 46 [18%]), neutropenia (19 [7%] vs 24 [9%]), leucopenia (18 [7%] vs 20 [8%]), and convulsion (14 [5%] vs 15 [6%]). INTERPRETATION The addition of cilengitide to temozolomide chemoradiotherapy did not improve outcomes; cilengitide will not be further developed as an anticancer drug. Nevertheless, integrins remain a potential treatment target for glioblastoma. FUNDING Merck KGaA, Darmstadt, Germany.
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Affiliation(s)
- Roger Stupp
- UniversitätsSpital Zürich, Zurich, Switzerland; Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
| | - Monika E Hegi
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | - Sara C Erridge
- Edinburgh Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - James Perry
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yong-Kil Hong
- The Catholic University of Korea, Seoul St Mary's Hospital, Seoul, South Korea
| | - Kenneth D Aldape
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benoit Lhermitte
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Torsten Pietsch
- Department of Neuropathology, Universität Bonn, Bonn, Germany
| | - Danica Grujicic
- Clinic for Neurosurgery, Clinical Center Serbia and Medical Faculty University of Belgrade, Belgrade, Serbia
| | | | - Wolfgang Wick
- Heidelberg University Medical Center & German Cancer Research Center, Heidelberg, Germany
| | - Rafał Tarnawski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Do-Hyun Nam
- Samsung Medical Center, Sungkyunkwan Univ School of Medicine, Seoul, South Korea
| | - Peter Hau
- Universitätsklinikum Regensburg, Regensburg, Germany
| | | | | | | | - Nalini Rao
- Bangalore Institute of Oncology, Bangalore, India
| | | | | | | | | | | | | | - Alba A Brandes
- Bellaria-Maggiore Hospital, AUSL-IRCCS Institute of Neurological Sciences-Bologna, Italy
| | | | | | | | - Chae-Yong Kim
- Seoul National University Bundang Hospital, SNU College of Medicine, Seoul, South Korea
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16
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Nabors LB, Ammirati M, Bierman PJ, Brem H, Butowski N, Chamberlain MC, DeAngelis LM, Fenstermaker RA, Friedman A, Gilbert MR, Hesser D, Holdhoff M, Junck L, Lawson R, Loeffler JS, Maor MH, Moots PL, Morrison T, Mrugala MM, Newton HB, Portnow J, Raizer JJ, Recht L, Shrieve DC, Sills AK, Tran D, Tran N, Vrionis FD, Wen PY, McMillian N, Ho M. Central nervous system cancers. J Natl Compr Canc Netw 2014; 11:1114-51. [PMID: 24029126 DOI: 10.6004/jnccn.2013.0132] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary and metastatic tumors of the central nervous system are a heterogeneous group of neoplasms with varied outcomes and management strategies. Recently, improved survival observed in 2 randomized clinical trials established combined chemotherapy and radiation as the new standard for treating patients with pure or mixed anaplastic oligodendroglioma harboring the 1p/19q codeletion. For metastatic disease, increasing evidence supports the efficacy of stereotactic radiosurgery in treating patients with multiple metastatic lesions but low overall tumor volume. These guidelines provide recommendations on the diagnosis and management of this group of diseases based on clinical evidence and panel consensus. This version includes expert advice on the management of low-grade infiltrative astrocytomas, oligodendrogliomas, anaplastic gliomas, glioblastomas, medulloblastomas, supratentorial primitive neuroectodermal tumors, and brain metastases. The full online version, available at NCCN. org, contains recommendations on additional subtypes.
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17
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Xiao Y, Decker PA, Rice T, McCoy LS, Smirnov I, Patoka JS, Hansen HM, Wiemels JL, Tihan T, Prados MD, Chang SM, Berger MS, Kosel ML, Fridley BL, Lachance DH, O'Neill BP, Buckner JC, Thompson RC, Nabors LB, Olson JJ, Brem S, Madden MH, Browning JE, Wiencke JK, Egan KM, Jenkins RB, Wrensch MR. SSBP2 variants are associated with survival in glioblastoma patients. Clin Cancer Res 2012; 18:3154-62. [PMID: 22472174 PMCID: PMC3607457 DOI: 10.1158/1078-0432.ccr-11-2778] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE Glioblastoma is a devastating, incurable disease with few known prognostic factors. Here, we present the first genome-wide survival and validation study for glioblastoma. EXPERIMENTAL DESIGN Cox regressions for survival with 314,635 inherited autosomal single-nucleotide polymorphisms (SNP) among 315 San Francisco Adult Glioma Study patients for discovery and three independent validation data sets [87 Mayo Clinic, 232 glioma patients recruited from several medical centers in Southeastern United States (GliomaSE), and 115 The Cancer Genome Atlas patients] were used to identify SNPs associated with overall survival for Caucasian glioblastoma patients treated with the current standard of care, resection, radiation, and temozolomide (total n = 749). Tumor expression of the gene that contained the identified prognostic SNP was examined in three separate data sets (total n = 619). Genotype imputation was used to estimate hazard ratios (HR) for SNPs that had not been directly genotyped. RESULTS From the discovery and validation analyses, we identified a variant in single-stranded DNA-binding protein 2 (SSBP2) on 5q14.1 associated with overall survival in combined analyses (HR, 1.64; P = 1.3 × 10(-6)). Expression of SSBP2 in tumors from three independent data sets also was significantly related to patient survival (P = 5.3 × 10(-4)). Using genotype imputation, the SSBP2 SNP rs17296479 had the strongest statistically significant genome-wide association with poorer overall patient survival (HR, 1.79; 95% CI, 1.45-2.22; P = 1.0 × 10(-7)). CONCLUSION The minor allele of SSBP2 SNP rs17296479 and the increased tumor expression of SSBP2 were statistically significantly associated with poorer overall survival among glioblastoma patients. With further confirmation, previously unrecognized inherited variations influencing survival may warrant inclusion in clinical trials to improve randomization. Unaccounted for genetic influence on survival could produce unwanted bias in such studies.
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Affiliation(s)
- Yuanyuan Xiao
- Department of Epidemiology and Biostatistics, University of California, San Francisco 185 Berry St, Suite 5700, San Francisco, CA 94107, USA.
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18
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Nabors LB, Supko JG, Rosenfeld M, Chamberlain M, Phuphanich S, Batchelor T, Desideri S, Ye X, Wright J, Gujar S, Grossman SA. Phase I trial of sorafenib in patients with recurrent or progressive malignant glioma. Neuro Oncol 2011; 13:1324-30. [PMID: 21954442 DOI: 10.1093/neuonc/nor145] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sorafenib is an inhibitor of multiple kinases that has demonstrated antiproliferative and antiangiogenic activity in a number of in vitro and in vivo model systems. A phase I study was conducted to determine the maximum tolerated dose (MTD) of sorafenib in patients with recurrent malignant glioma. Sorafenib was given orally, twice a day (BID), continuously in 28-day cycles. The dose was escalated in 2 groups of patients stratified by use of enzyme-inducing antiseizure drugs (± EIASDs). Dose-limiting toxicity (DLT) was defined as any grades 3-4 nonhematological toxicity, grade 4 hematological toxicity, and febrile neutropenia. The number of evaluable patients enrolled in the +EIASD and -EIASD arms were 23 and 24, respectively. DLTs were predominantly dermatological and gastrointestinal effects, as observed in previous clinical trials of sorafenib. The MTD was 600 mg BID for patients receiving EIASDs and 800 mg BID for those who were not. The plasma pharmacokinetics of sorafenib were not significantly affected by the concurrent administration of EIASDs. The MTD of sorafenib given orally BID on a continuous basis was established as 600 mg BID in patients with malignant glioma who were concurrently receiving EIASDs and 800 mg BID in those who were not. Further evaluation is warranted of sorafenib at the recommended MTD against recurrent or progressive malignant glioma in combination with other molecularly targeted drugs or in the newly diagnosed setting concurrent with chemoradiation.
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Affiliation(s)
- L B Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
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19
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Reardon DA, Neyns B, Weller M, Tonn JC, Nabors LB, Stupp R. Cilengitide: an RGD pentapeptide ανβ3 and ανβ5 integrin inhibitor in development for glioblastoma and other malignancies. Future Oncol 2011; 7:339-54. [PMID: 21417900 DOI: 10.2217/fon.11.8] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cilengitide, a cyclicized arginine-glycine-aspartic acid-containing pentapeptide, potently blocks ανβ3 and ανβ5 integrin activation. Integrins are upregulated in many malignancies and mediate a wide variety of tumor-stroma interactions. Cilengitide and other integrin-targeting therapeutics have preclinical activity against many cancer subtypes including glioblastoma (GBM), the most common and deadliest CNS tumor. Cilengitide is active against orthotopic GBM xenografts and can augment radiotherapy and chemotherapy in these models. In Phase I and II GBM trials, cilengitide and the combination of cilengitide with standard temozolomide and radiation demonstrate consistent antitumor activity and a favorable safety profile. Cilengitide is currently under evaluation in a pivotal, randomized Phase III study (Cilengitide in Combination With Temozolomide and Radiotherapy in Newly Diagnosed Glioblastoma Phase III Randomized Clinical Trial [CENTRIC]) for newly diagnosed GBM. In addition, randomized controlled Phase II studies with cilengitide are ongoing for non-small-cell lung cancer and squamous cell carcinoma of the head and neck. Cilengitide is the first integrin inhibitor in clinical Phase III development for oncology.
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Affiliation(s)
- David A Reardon
- Department of Surgery, Division of Neurosurgery, 047 Baker House, Duke University Medical Center, Box 3624, Durham, NC 27710, USA.
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20
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Brem SS, Bierman PJ, Brem H, Butowski N, Chamberlain MC, Chiocca EA, DeAngelis LM, Fenstermaker RA, Friedman A, Gilbert MR, Hesser D, Junck L, Linette GP, Loeffler JS, Maor MH, Michael M, Moots PL, Morrison T, Mrugala M, Nabors LB, Newton HB, Portnow J, Raizer JJ, Recht L, Shrieve DC, Sills AK, Vrionis FD, Wen PY. Central Nervous System Cancers. J Natl Compr Canc Netw 2011; 9:352-400. [DOI: 10.6004/jnccn.2011.0036] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Egan KM, Thompson RC, Nabors LB, Olson JJ, Brat DJ, Larocca RV, Brem S, Moots PL, Madden MH, Browning JE, Ann Chen Y. Cancer susceptibility variants and the risk of adult glioma in a US case-control study. J Neurooncol 2011; 104:535-42. [PMID: 21203894 DOI: 10.1007/s11060-010-0506-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 12/13/2010] [Indexed: 01/07/2023]
Abstract
Malignant gliomas are the most common and deadly brain tumors. Although their etiology remains elusive, recent studies have narrowed the search for genetic loci that influence risk. We examined variants implicated in recent cancer genome-wide association studies (GWAS) for associations with glioma risk in a US case-control study. Cases were identified from neurosurgical and neuro-oncology clinics at major academic centers in the Southeastern US. Controls were identified from the community or were friends or other associates of cases. We examined a total of 191 susceptibility variants in genes identified in published cancer GWAS including glioma. A total of 639 glioma cases and 649 controls, all Caucasian, were included in analysis. Cases were enrolled a median of 1 month following diagnosis. Among glioma GWAS-identified variants, we detected associations in CDKN2B, RTEL1, TERT and PHLDB1, whereas we did not find overall associations for CCDC26. Results showed clear heterogeneity according to histologic subtypes of glioma, with TERT and RTEL variants a feature of astrocytic tumors and glioblastoma (GBM), CCDC26 and PHLDB1 variants a feature of astrocytic and oligodendroglial tumors, and CDKN2B variants most prominent in GBM. No examined variant in other cancer GWAS was found to be related to risk after adjustment for multiple comparisons. These results suggest that GWAS-identified SNPs in glioma mark different molecular etiologies in glioma. Stratification by broad histological subgroups may shed light on molecular mechanisms and assist in the discovery of novel loci in future studies of genetic susceptibility variants in glioma.
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Affiliation(s)
- Kathleen M Egan
- Department of Cancer Epidemiology & Genetics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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22
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Lu L, Wang S, Zheng L, Li X, Suswam EA, Zhang X, Wheeler CG, Nabors LB, Filippova N, King PH. Amyotrophic lateral sclerosis-linked mutant SOD1 sequesters Hu antigen R (HuR) and TIA-1-related protein (TIAR): implications for impaired post-transcriptional regulation of vascular endothelial growth factor. J Biol Chem 2009; 284:33989-98. [PMID: 19805546 DOI: 10.1074/jbc.m109.067918] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Down-regulation of vascular endothelial growth factor (VEGF) in the mouse leads to progressive and selective degeneration of motor neurons similar to amyotrophic lateral sclerosis (ALS). In mice expressing ALS-associated mutant superoxide dismutase 1 (SOD1), VEGF mRNA expression in the spinal cord declines significantly prior to the onset of clinical manifestations. In vitro models suggest that dysregulation of VEGF mRNA stability contributes to that decline. Here, we show that the major RNA stabilizer, Hu Antigen R (HuR), and TIA-1-related protein (TIAR) colocalize with mutant SOD1 in mouse spinal cord extracts and cultured glioma cells. The colocalization was markedly reduced or abolished by RNase treatment. Immunoanalysis of transfected cells indicated that colocalization occurred in insoluble aggregates and inclusions. RNA immunoprecipitation showed a significant loss of VEGF mRNA binding to HuR and TIAR in mutant SOD1 cells, and there was marked depletion of HuR from polysomes. Ectopic expression of HuR in mutant SOD1 cells more than doubled the mRNA half-life of VEGF and significantly increased expression to that of wild-type SOD1 control. Cellular effects produced by mutant SOD1, including impaired mitochondrial function and oxidative stress-induced apoptosis, were reversed by HuR in a gene dose-dependent pattern. In summary, our findings indicate that mutant SOD1 impairs post-transcriptional regulation by sequestering key regulatory RNA-binding proteins. The rescue effect of HuR suggests that this impairment, whether related to VEGF or other potential mRNA targets, contributes to cytotoxicity in ALS.
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Affiliation(s)
- Liang Lu
- Department of Neurology, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama 35294, USA
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23
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Pike MM, Stoops CN, Langford CP, Akella NS, Nabors LB, Gillespie GY. High-resolution longitudinal assessment of flow and permeability in mouse glioma vasculature: Sequential small molecule and SPIO dynamic contrast agent MRI. Magn Reson Med 2009; 61:615-25. [PMID: 19235262 DOI: 10.1002/mrm.21931] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The poor prognosis associated with malignant glioma is largely attributable to its invasiveness and robust angiogenesis. Angiogenesis involves host-tumor interaction and requires in vivo evaluation. Despite their versatility, few studies have used mouse glioma models with perfusion MRI approaches, and generally lack longitudinal study design. Using a micro-MRI system (8.5 Tesla), a novel dual bolus-tracking perfusion MRI strategy was implemented. Using the small molecule contrast agent Magnevist, dynamic contrast enhanced MRI was implemented in the intracranial 4C8 mouse glioma model to determine K(trans) and v(e), indices of tumor vascular permeability and cellularity, respectively. Dynamic susceptibility contrast MRI was subsequently implemented to assess both cerebral blood flow and volume, using the macromolecular superparamagnetic iron oxide, Feridex, which circumvented tumor bolus susceptibility curve distortions from first-pass extravasation. The high-resolution parametric maps obtained over 4 weeks, indicated a progression of tumor vascularization, permeability, and decreased cellularity with tumor growth. In conclusion, a comprehensive array of key parameters were reliably quantified in a longitudinal mouse glioma study. The syngeneic 4C8 intracerebral mouse tumor model has excellent characteristics for studies of glioma angiogenesis. This approach provides a useful platform for noninvasive and highly diagnostic longitudinal investigations of anti-angiogenesis strategies in a relevant orthotopic animal model.
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Affiliation(s)
- M M Pike
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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24
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Nabors LB, Palmer CA, Julian BA, Przekwas AM, Kew CE. Isolated central nervous system posttransplant lymphoproliferative disorder treated with high-dose intravenous methotrexate. Am J Transplant 2009; 9:1243-8. [PMID: 19422350 DOI: 10.1111/j.1600-6143.2009.02598.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is an uncommon neoplastic complication of kidney transplantation, affecting about 1% of recipients. It is generally associated with Epstein-Barr virus (EBV) infection of B-lineage lymphocytes. Central nervous system (CNS) involvement is rare. There is little clinical experience with treatment of CNS PTLD due to the relative rarity of the disease other than reduction or withdrawal of immunosuppression, but it is usually fatal. We describe six patients with renal allografts and histologically proven isolated CNS PTLD. Tissue analysis from the biopsy specimens was positive for EBV material in five of the six patients. All six patients were treated with high-dose intravenous methotrexate (HD IV MTX). Methotrexate was initiated at 8 g/m2, with later adjustments for creatinine clearance. With MTX therapy, four patients have had a sustained complete response, and two had progressive disease and were referred for radiation therapy. This finding suggests a subgroup of patients may benefit from MTX but our case series is inadequate to describe overall efficacy. No unexpected toxicities were encountered in 37 courses of treatment. HD IV MTX chemotherapy should be considered as an alternative for treatment of CNS PTLD.
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Affiliation(s)
- L B Nabors
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Dixon DA, Tolley ND, King PH, Nabors LB, McIntyre TM, Zimmerman GA, Prescott SM. Altered expression of the mRNA stability factor HuR promotes cyclooxygenase-2 expression in colon cancer cells. J Clin Invest 2001; 108:1657-65. [PMID: 11733561 PMCID: PMC200983 DOI: 10.1172/jci12973] [Citation(s) in RCA: 340] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cyclooxygenase-2 (COX-2) expression is normally tightly regulated. However, constitutive overexpression plays a key role in colon carcinogenesis. To understand the molecular nature of enhanced COX-2 expression detected in colon cancer, we examined the ability of the AU-rich element-containing (ARE-containing) 3' untranslated region (3'UTR) of COX-2 mRNA to regulate rapid mRNA decay in human colon cancer cells. In tumor cells displaying enhanced growth and tumorigenicity that is correlated with elevated COX-2, vascular endothelial growth factor (VEGF), and IL-8 protein levels, the corresponding mRNAs were transcribed constitutively and turned over slowly. The observed mRNA stabilization is owing to defective recognition of class II-type AREs present within the COX-2, VEGF, and IL-8 3'UTRs; c-myc mRNA, containing a class I ARE decayed rapidly in the same cells. Correlating with cellular defects in mRNA stability, the RNA-binding of trans-acting cellular factors was altered. In particular, we found that the RNA-stability factor HuR binds to the COX-2 ARE, and overexpression of HuR, as detected in tumors, results in elevated expression of COX-2, VEGF, and IL-8. These findings demonstrate the functional significance rapid mRNA decay plays in controlling gene expression and show that dysregulation of these trans-acting factors can lead to overexpression of COX-2 and other angiogenic proteins, as detected in neoplasia.
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Affiliation(s)
- D A Dixon
- Department of Oncological Sciences, University of Utah, Salt Lake City, Utah, USA.
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Nabors LB, Gillespie GY, Harkins L, King PH. HuR, a RNA stability factor, is expressed in malignant brain tumors and binds to adenine- and uridine-rich elements within the 3' untranslated regions of cytokine and angiogenic factor mRNAs. Cancer Res 2001; 61:2154-61. [PMID: 11280780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Tumors of the central nervous system (CNS) often have sustained expression of labile genes, including angiogenic growth factors and immunosuppressive cytokines, which promote tumor progression. Stabilization of the RNA transcripts for these genes, such as vascular endothelial growth factor (VEGF), is an important molecular pathway for this up-regulation. HuR, a member of the Elav family of RNA-binding proteins, has been implicated in this pathway through its binding to adenine and uridine (AU)-rich stability elements (ARE) located in the 3' untranslated regions (3'-UTRs) of the mRNA. Whereas three of the Elav family members (Hel-N1, HuC, and HuD) are restricted to young and mature neurons, HuR is more broadly expressed, including proliferating cells of the developing CNS. Because RNA stabilization of labile genes may promote tumor growth, we analyzed and compared the expression pattern of HuR in 35 freshly resected and cultured CNS tumors to determine whether there was any correlation with tumor grade or histological type. We found that HuR mRNA was consistently expressed in all of the tumors, regardless of cell origin or degree of malignancy. Using a novel HuR-specific polyclonal antibody, we found that strong HuR protein expression was limited to high-grade malignancies (glioblastoma multiforme and medulloblastoma). Within the glioblastoma multiforme, prominent HuR expression was also detected in perinecrotic areas in which angiogenic growth factors are up-regulated. To further define its role as a potential RNA stabilizer, we analyzed whether HuR could bind to the stability motifs within the 3'-UTRs of cytokines and growth factors linked to brain tumor progression. We used a novel ELISA-based RNA binding assay and focused on the 3'-UTRs of angiogenic factors VEGF, COX-2, and (interleukin) IL-8 as well as the immunomodulating factors IL-6, transforming growth factor (TGF)-beta and tumor necrosis factor (TNF)-alpha as potential RNA ligands. Our results indicated overall a very high binding affinity to these RNA targets. A comparison of these ligands revealed a hierarchy of binding affinities with the angiogenic factors, and TGF-beta showing the highest (Kd of 1.8-3.4 nM), and TNF-alpha the lowest (Kd of 18.3 nM). The expression pattern of HuR, coupled with the RNA binding data, strongly suggests a role for this protein in the posttranscriptional regulation of these genes in CNS tumors.
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Affiliation(s)
- L B Nabors
- Department of Neurology, University of Alabama at Birmingham, 35233-7340, USA
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King PH, Fuller JJ, Nabors LB, Detloff PJ. Analysis of the 5' end of the mouse Elavl1 (mHuA) gene reveals a transcriptional regulatory element and evidence for conserved genomic organization. Gene 2000; 242:125-31. [PMID: 10721704 DOI: 10.1016/s0378-1119(99)00537-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
mHuA (Elavl1) belongs to a highly conserved family of genes encoding RNA-binding proteins and has been linked to cell growth and proliferation through its regulation of mRNA stability. Here, we use an RNase protection assay to demonstrate that the mHuA transcript is relatively abundant in a range of mouse tissues, with the highest levels being found in lung and embryonic stem cells. We then cloned and mapped an 18 kb DNA fragment which encompasses the 5' end of the mHuA gene. The genomic organization in this region is similar to the neural-restricted family members, Hel-N1 (ELAVL2) and mHuD (Elavl4). The first exon is lengthy and untranslated, and the second exon, which includes the methionine start site, ends between the ribonucleoprotein motifs of the first RNA binding domain. Mapping of the mHuA transcript by primer extension demonstrated three potential transcription-initiation sites which were detected consistently among different tissues and cell lines. Analysis of the sequence flanking these sites revealed the presence of transcriptional elements including TATA, CREB, c-ets, and AP1 sites. Transfection analysis of this promoter region using a luciferase-reporter-gene assay indicated strong transcriptional activity both in HeLa and in mouse macrophage (RAW) cells which is consistent with the ubiquitous expression pattern of mHuA. Thus, while the genomic organization of mHuA is similar to the neural-restricted members of the Elav family, the promoter element differs substantially both by sequence analysis and transcriptional activity in non-neural cell types.
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Affiliation(s)
- P H King
- Department of Neurology, University of Alabama, Birmingham 35295, USA.
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Abstract
Despite a broad clinical spectrum, paraneoplastic enecephalomyelitis/sensory neuronopathy (PEM/SSN) is characterized by the presence of a common autoantibody, referred to as anti-Hu or type I anti-neuronal nuclear antibody (ANNA-1). The target of these antibodies is a family of four Hu antigens: three (Hel-N1, HuC, HuD) are neural-specific, while the fourth (HuR) is ubiquitous. Here, we have analysed by enzyme-linked immunosorbent assay (ELISA) the immunoreactivity of all four Hu antigens in serum from 75 patients with ANNA-1 autoantibodies and looked for clinical correlations. IgG in all the patients' sera bound to each of the four antigens, and the titers correlated with those of the ANNA-I immunofluorescence assay. Median titers for the neural-specific antigens (range: 56, 892-90,051) were significantly higher than for HuR (36,799). Patients with gastrointestinal dysmotility or subacute sensory neuronopathy had the highest median titers to all four antigens, while patients with sensorineural deafness had the lowest titers. The results indicate a heterogeneous immune response to individual Hu antigens in patients with PEM/SSN, and that the titers to these antigens as a group, rather than individually, correlate with clinical profile. Furthermore, these results suggest that ELISA analysis of a single neural-specific Hu antigen is sufficient for serological screening in PEM/SSN.
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Affiliation(s)
- P H King
- Department of Neurology, University of Alabama, Birmingham, AL 35295, USA.
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Abstract
Paraneoplastic encephalomyelitis (PEM) is characterized by a diverse set of clinical signs that are limited to the nervous system. The serologic hallmark of PEM is the presence of circulating autoantibodies, collectively referred to as 'anti-Hu,' which immunoreact specifically with members of the Elav protein family. Until recently, the ELAV antigens were only detected in neurons, thus strongly supporting a role for anti-Hu antibodies in the selective neural tissue injury in PEM. The identification of HuR, however, a new member with a broad, non-neural pattern of RNA expression, raises several fundamental questions regarding PEM. First, why are non-neural tissues spared in PEM? Second, why is PEM predominantly associated with neuroendocrine tumors? To begin addressing these questions, we sought to determine whether the antibody response to HuR differs from the neural-specific counterparts in patients with PEM, and to characterize the protein expression pattern of this novel antigen in peripheral tissues and tumors. Using sera from 11 patients with Hu-positive PEM, we found that the majority of samples (73%) were weakly or non-reactive for recombinant HuR on Western blot, in contrast to consistently strong immunoreactivity with the neural-specific members HuD and Hel-N1. We also demonstrate that HuR is expressed at the protein level in both non-neural tissues and non-neuroendocrine tumors. These findings suggest that immunoreactive differences among Elav family members may contribute to the neural-restrictive pattern of tissue injury in patients with PEM.
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Affiliation(s)
- L B Nabors
- Department of Neurology, University of Alabama, Birmingham 35295, USA
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Geyer JD, Nabors LB, Harrell LE, Gomez CR. Magnetic resonance cisternography in the diagnosis of delayed iatrogenic cerebrospinal fistula: a case report. J Neuroimaging 1997; 7:244-7. [PMID: 9344009 DOI: 10.1111/jon199774244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 52-year-old woman presented with a clinical picture consistent with bacterial meningitis 3 years after functional endoscopic sinus surgery. Diagnosis of a cerebrospinal fluid (CSF) fistula was made clinically, and the site of the fistula was confirmed using magnetic resonance cisternography. The utilization of this technique in the diagnosis of CSF disorders is gaining popularity. Its usefulness in the context of other imaging modalities is discussed.
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Affiliation(s)
- J D Geyer
- Department of Neurology, University of Alabama at Birmingham, USA
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Nabors LB, Mize RR. A unique neuronal organization in the cat pretectum revealed by antibodies to the calcium-binding protein calbindin-D 28K. J Neurosci 1991; 11:2460-76. [PMID: 1869924 PMCID: PMC6575509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The pretectum is an important center for visual reflexes. However, the location, boundaries, and connections of individual nuclei of the pretectum are incompletely understood. In cat, the traditionally defined nuclear boundaries have been placed in doubt by recent evidence showing that the retinal input to the pretectum forms four continuous projection zones that do not match the cytoarchitectural boundaries of individual pretectal nuclei defined by previous studies. We now show that antibodies to the calcium-binding protein calbindin-D 28K (CaBP) label clusters of neurons within the pretectum that match the zones of retinal termination. Four obvious cell clusters within the pretectum were labeled by CaBP antisera. Computer three-dimensional reconstruction of these cell clusters revealed that they form four distinct but continuous zones that run the rostrocaudal length of the pretectum in a medial-to-lateral direction. By combining anterograde HRP labeling of retinal terminals with CaBP immunocytochemistry, these CaBP-labeled cell clusters were found virtually to overlap the retinal projection zones. The CaBP-labeled neurons included both multipolar and fusiform morphologies, and most were medium- to large-sized cells. HRP retrograde transport studies showed that many CaBP-labeled neurons in the clusters projected to the LGN, while none projected to the inferior olive (IO). GABA-immunoreactive neurons were also found within the CaBP cell clusters, but these neurons were smaller than most CaBP-labeled neurons, and none were retrogradely labeled following HRP injections into the LGN or IO. Two-color antibody double-labeling experiments did not reveal any GABA neurons within the clusters that colocalized CaBP. In summary, calbindin is a precise marker of neuron clusters that overlap the retinal projection zones in the cat pretectum. Many of these CaBP neurons project to the LGN, and none contain GABA.
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Affiliation(s)
- L B Nabors
- Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee, Memphis 38163
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Mize RR, Holdefer RN, Nabors LB. Quantitative immunocytochemistry using an image analyzer. I. Hardware evaluation, image processing, and data analysis. J Neurosci Methods 1988; 26:1-23. [PMID: 3199846 DOI: 10.1016/0165-0270(88)90125-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In this review we describe how video-based image analysis systems are used to measure immunocytochemically labeled tissue. The general principles underlying hardware and software procedures are emphasized. First, the characteristics of image analyzers are described, including the densitometric measure, spatial resolution, gray scale resolution, dynamic range, and acquisition and processing speed. The errors produced by these instruments are described and methods for correcting or reducing the errors are discussed. Methods for evaluating image analyzers are also presented, including spatial resolution, photometric transfer function, short- and long-term temporal variability, and measurement error. The procedures used to measure immunocytochemically labeled cells and fibers are then described. Immunoreactive profiles are imaged and enhanced using an edge sharpening operator and then extracted using segmentation, a procedure which captures all labeled profiles above a threshold gray level. Binary operators, including erosion and dilation, are applied to separate objects and to remove artifacts. The software then automatically measures the geometry and optical density of the extracted profiles. The procedures are rapid and efficient methods for measuring simultaneously the position, geometry, and labeling intensity of immunocytochemically labeled tissue, including cells, fibers, and whole fields. A companion paper describes non-biological standards we have developed to estimate antigen concentration from the optical density produced by antibody labeling (Nabors et al., 1988).
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Affiliation(s)
- R R Mize
- Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee Health Science Center, Memphis 38163
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Nabors LB, Songu-Mize E, Mize RR. Quantitative immunocytochemistry using an image analyzer. II. Concentration standards for transmitter immunocytochemistry. J Neurosci Methods 1988; 26:25-34. [PMID: 2904512 DOI: 10.1016/0165-0270(88)90126-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Image analyzers can measure both the optical density and geometry of immunocytochemically labeled cells and fibers, as reviewed in a companion paper (Mize et al., 1988). In this paper, we report a procedure which allows us to estimate the concentration of a neurotransmitter based upon the optical density of antibody labeling produced by immunocytochemistry. To accomplish this, we developed a standard which binds conjugated neurotransmitters. Several artificial media for the standard were compared, including agar, gelatin, and agar-gelatin. A 3% agar matrix was found to be most suitable because it cut well and was nearly transparent. The agar sections were activated with cyanogen bromide/acetonitrile to promote coupling to the antigen. To test the standard, we used gamma-aminobutyric acid (GABA) conjugated to bovine serum albumin (BSA) as the antigen. The antibody was directed against this conjugate. Activated agar sections were incubated in serial dilutions of the tritium-labeled GABA/BSA conjugate. The radioactivity of some of these sections was measured to estimate the amount of coupled antigen. The remaining sections were incubated in the GABA antibody and processed for immunocytochemistry. The optical density of these sections was measured with an image analyzer. A linear relationship was found between GABA concentration and optical density over a range of at least 0.01 to 1 nmol/mg of agar. These results show that the concentration of bound GABA can be estimated from the optical density of sections labeled by antibody immunocytochemistry. The applicability of this technique to fixed brain tissue is discussed.
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Affiliation(s)
- L B Nabors
- Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee Health Science Center, Memphis 38163
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