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Rahman R, Trippa L, Lee EQ, Arrillaga-Romany I, Fell G, Touat M, McCluskey C, Wiley J, Gaffey S, Drappatz J, Welch MR, Galanis E, Ahluwalia MS, Colman H, Nabors LB, Hepel J, Elinzano H, Schiff D, Chukwueke UN, Beroukhim R, Nayak L, McFaline-Figueroa JR, Batchelor TT, Rinne ML, Kaley TJ, Lu-Emerson C, Mellinghoff IK, Bi WL, Arnaout O, Peruzzi PP, Haas-Kogan D, Tanguturi S, Cagney D, Aizer A, Doherty L, Lavallee M, Fisher-Longden B, Dowling S, Geduldig J, Watkinson F, Pisano W, Malinowski S, Ramkissoon S, Santagata S, Meredith DM, Chiocca EA, Reardon DA, Alexander BM, Ligon KL, Wen PY. Inaugural Results of the Individualized Screening Trial of Innovative Glioblastoma Therapy: A Phase II Platform Trial for Newly Diagnosed Glioblastoma Using Bayesian Adaptive Randomization. J Clin Oncol 2023; 41:5524-5535. [PMID: 37722087 DOI: 10.1200/jco.23.00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/17/2023] [Accepted: 07/24/2023] [Indexed: 09/20/2023] Open
Abstract
PURPOSE The Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) is a phase II platform trial that uses response adaptive randomization and genomic profiling to efficiently identify novel therapies for phase III testing. Three initial experimental arms (abemaciclib [a cyclin-dependent kinase [CDK]4/6 inhibitor], neratinib [an epidermal growth factor receptor [EGFR]/human epidermal growth factor receptor 2 inhibitor], and CC-115 [a deoxyribonucleic acid-dependent protein kinase/mammalian target of rapamycin inhibitor]) were simultaneously evaluated against a common control arm. We report the results for each arm and examine the feasibility and conduct of the adaptive platform design. PATIENTS AND METHODS Patients with newly diagnosed O6-methylguanine-DNA methyltransferase-unmethylated glioblastoma were eligible if they had tumor genotyping to identify prespecified biomarker subpopulations of dominant glioblastoma signaling pathways (EGFR, phosphatidylinositol 3-kinase, and CDK). Initial random assignment was 1:1:1:1 between control (radiation therapy and temozolomide) and the experimental arms. Subsequent Bayesian adaptive randomization was incorporated on the basis of biomarker-specific progression-free survival (PFS) data. The primary end point was overall survival (OS), and one-sided P values are reported. The trial is registered with ClinicalTrials.gov (identifier: NCT02977780). RESULTS Two hundred thirty-seven patients were treated (71 control; 73 abemaciclib; 81 neratinib; 12 CC-115) in years 2017-2021. Abemaciclib and neratinib were well tolerated, but CC-115 was associated with ≥ grade 3 treatment-related toxicity in 58% of patients. PFS was significantly longer with abemaciclib (hazard ratio [HR], 0.72; 95% CI, 0.49 to 1.06; one-sided P = .046) and neratinib (HR, 0.72; 95% CI, 0.50 to 1.02; one-sided P = .033) relative to the control arm but there was no PFS benefit with CC-115 (one-sided P = .523). None of the experimental therapies demonstrated a significant OS benefit (P > .05). CONCLUSION The INSIGhT design enabled efficient simultaneous testing of three experimental agents using a shared control arm and adaptive randomization. Two investigational arms had superior PFS compared with the control arm, but none demonstrated an OS benefit. The INSIGhT design may promote improved and more efficient therapeutic discovery in glioblastoma. New arms have been added to the trial.
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Affiliation(s)
- Rifaquat Rahman
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | - Eudocia Q Lee
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | | | - Mehdi Touat
- Brigham and Women's Hospital, Boston, MA
- Sorbonne Universite, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | | | | | | | - Mary R Welch
- Division of Neuro-Oncology, Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian, New York, NY
| | | | | | - Howard Colman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | | | | | - Ugonma N Chukwueke
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Rameen Beroukhim
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Lakshmi Nayak
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | - Tracy T Batchelor
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | - Wenya Linda Bi
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | | | - Daphne Haas-Kogan
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Shyam Tanguturi
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | - Ayal Aizer
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | - David A Reardon
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Brian M Alexander
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Keith L Ligon
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Patrick Y Wen
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
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2
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Nayak L, Standifer N, Dietrich J, Clarke JL, Dunn GP, Lim M, Cloughesy T, Gan HK, Flagg E, George E, Gaffey S, Hayden J, Holcroft C, Wen PY, Macri M, Park AJ, Ricciardi T, Ryan A, Schwarzenberger P, Venhaus R, de los Reyes M, Durham NM, Creasy T, Huang RY, Kaley T, Reardon DA. Circulating Immune Cell and Outcome Analysis from the Phase II Study of PD-L1 Blockade with Durvalumab for Newly Diagnosed and Recurrent Glioblastoma. Clin Cancer Res 2022; 28:2567-2578. [PMID: 35395080 PMCID: PMC9940445 DOI: 10.1158/1078-0432.ccr-21-4064] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/15/2022] [Accepted: 04/05/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE PD-L1 is upregulated in glioblastoma and supports immunosuppression. We evaluated PD-L1 blockade with durvalumab among glioblastoma cohorts and investigated potential biomarkers. PATIENTS AND METHODS MGMT unmethylated newly diagnosed patients received radiotherapy plus durvalumab (cohort A; n = 40). Bevacizumab-naïve, recurrent patients received durvalumab alone (cohort B; n = 31) or in combination with standard bevacizumab (cohort B2; n = 33) or low-dose bevacizumab (cohort B3; n = 33). Bevacizumab-refractory patients received durvalumab plus bevacizumab (cohort C; n = 22). Primary endpoints were: OS-12 (A), PFS-6 (B, B2, B3), and OS-6 (C). Exploratory biomarkers included: a systematic, quantitative, and phenotypic evaluation of circulating immune cells; tumor mutational burden (TMB); and tumor immune activation signature (IAS). RESULTS No cohort achieved the primary efficacy endpoint. Outcome was comparable among recurrent, bevacizumab-naïve cohorts. No unexpected toxicities were observed. A widespread reduction of effector immune cell subsets was noted among recurrent patients compared with newly diagnosed patients that was partially due to dexamethasone use. A trend of increased CD8+Ki67+ T cells at day 15 was noted among patients who achieved the primary endpoint and were not on dexamethasone. Neither TMB nor IAS predicted outcome. CONCLUSIONS Patients with recurrent glioblastoma have markedly lower baseline levels of multiple circulating immune cell subsets compared with newly diagnosed patients. An early increase in systemic Ki67+CD8+ cells may warrant further evaluation as a potential biomarker of therapeutic benefit among patients with glioblastoma undergoing checkpoint therapy. Dexamethasone decreased immune cell subsets. PD-L1 blockade and combination with standard or reduced dose bevacizumab was ineffective.
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Affiliation(s)
- Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nathan Standifer
- Integrated Bioanalysis, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, South San Francisco, CA
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Jennifer L. Clarke
- Departments of Neurology and Neurosurgery, University of California San Francisco, San Francisco, CA
| | - Gavin P. Dunn
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Hui K. Gan
- Department of Medical Oncology, Austin Health, Melbourne, AU
| | - Elizabeth Flagg
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA
| | - Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sarah Gaffey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Julia Hayden
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | | | | | - Melissa de los Reyes
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Nicholas M. Durham
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Todd Creasy
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Raymond Y. Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA
| | - Thomas Kaley
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - David A. Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Rahman R, Trippa L, Lee EQ, Arrillaga-Romany I, Touat M, Fell G, McCluskey C, Bruno J, Gaffey S, Drappatz J, Lassman A, Galanis E, Ahluwalia M, Colman H, Nabors LB, Hepel J, Elinzano H, Schiff D, Chukwueke U, Beroukhim R, Batchelor T, Nayak L, McFaline-Figueroa JR, Rinne M, Kaley T, Lu-Emerson C, Bi WL, Arnaout O, Haas-Kogan D, Tanguturi S, Cagney D, Aizer A, Welch M, Doherty L, Lavallee M, Fisher-Longden B, Dowling S, Pisano W, Lapinskas E, Meredith D, Chiocca EA, Reardon D, Ligon K, Alexander B, Wen P. CTNI-40. EVALUATING FEASIBILITY AND EFFICIENCY OF PHASE II ADAPTIVE PLATFORM TRIAL DESIGNS BASED ON THE INDIVIDUALIZED SCREENING TRIAL OF INNOVATIVE GLIOBLASTOMA THERAPY (INSIGhT) EXPERIENCE. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
The Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) is a phase II platform trial with Bayesian adaptive randomization and deep genomic profiling to more efficiently test experimental agents in newly diagnosed glioblastoma and to prioritize therapies for late-stage testing.
METHODS
In the ongoing INSIGhT trial, patients with newly diagnosed MGMT-unmethylated glioblastoma are randomized to the control arm or one of three experimental therapy arms (CC-115, abemaciclib, and neratinib). The control arm therapy is radiotherapy with concomitant and adjuvant temozolomide, and primary endpoint is overall survival. Randomization has been adapted based on Bayesian estimation of biomarker-specific probability of treatment impact on progression-free survival (PFS). All tumors undergo detailed molecular sequencing, and this is facilitated with the companion ALLELE protocol. To evaluate feasibility of this approach, we assessed the status of this ongoing trial.
RESULTS
Since INSIGhT was activated 4.3 years ago, it has expanded to include 12 sites across the United States. A total of 247 patients have been enrolled. Randomization probabilities have been repeatedly adjusted over time based upon early PFS results to alter the randomization ratio from standard 1:1:1:1 randomization. All three arms have completed accrual and efficacy estimates are available based upon comparison to the common control arm in context of relevant biomarkers. There are 87 patients alive and in follow-up, and there are ongoing plans to add additional arms to evaluate further treatments in the future.
CONCLUSION
The INSIGhT trial demonstrates that a multi-center Bayesian adaptive platform trial is a feasible and effective approach to help prioritize therapies and biomarkers for newly diagnosed GBM. The trial has maintained robust accrual, and the simultaneous testing of multiple agents, sharing a common control arm and adaptive randomization serve as features to increase trial efficiency relative to traditional clinical trial designs.
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Affiliation(s)
- Rifaquat Rahman
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Jan Drappatz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew Lassman
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Howard Colman
- University of Utah - Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - L Burt Nabors
- University of Alabama, Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | - Tracy Batchelor
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | | | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Wenya Linda Bi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Omar Arnaout
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Shyam Tanguturi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Daniel Cagney
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Ayal Aizer
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Mary Welch
- Columbia / New York Presbyterian, New York, USA
| | | | | | | | | | | | | | | | - E Antonio Chiocca
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA, Boston, MA, USA
| | | | - Keith Ligon
- Massachusetts General Hospital, Boston, ME, USA
| | - Brian Alexander
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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4
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Arrillaga-Romany I, Trippa L, Fell G, Lee EQ, Rahman R, Touat M, McCluskey C, Bruno J, Gaffey S, Drappatz J, Lassman A, Galanis E, Ahluwalia M, Colman H, Nabors LB, Hepel J, Elinzano H, Kaley T, Mellinghoff IK, Schiff D, Chukwueke U, Beroukhim R, Nayak L, McFaline-Figueroa JR, Batchelor T, Lu-Emerson C, Bi WL, Arnaout O, Peruzzi P, Haas-Kogan D, Tanguturi S, Cagney D, Aizer A, Welch M, Doherty L, Lavallee M, Fisher-Longden B, Dowling S, Geduldig J, Watkinson F, Santagata S, Meredith D, Chiocca EA, Reardon D, Ligon K, Alexander B, Wen P. CTNI-05. PRELIMINARY RESULTS OF THE NERATINIB ARM IN THE INDIVIDUALIZED SCREENING TRIAL OF INNOVATIVE GLIOBLASTOMA THERAPY (INSIGHT): A PHASE II PLATFORM TRIAL USING BAYESIAN ADAPTIVE RANDOMIZATION. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
EGFR is amplified in over 50% of glioblastoma and 20-30% have EGFRvIII mutations. Neratinib is a potent inhibitor of EGFR/HER2 approved for metastatic HER2+ breast cancer. To efficiently evaluate the potential impact of neratinib on overall survival (OS) in newly-diagnosed glioblastoma and to simultaneously develop information regarding potential genomic biomarker associations, neratinib was included as an arm on the Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) trial. INSIGhT is a phase II platform trial using response adaptive randomization and deep genomic profiling to more efficiently test experimental agents in MGMT unmethylated glioblastoma and accelerate identification of novel therapies for phase III testing. Initial randomization was equal between neratinib, control, and two other experimental arms but subsequent randomization was adapted based on efficacy as determined by progression-free survival (PFS). We report preliminary results for the neratinib arm.
METHODS
Patients with newly diagnosed MGMT-unmethylated glioblastoma were randomized to receive either radiotherapy with concomitant and adjuvant temozolomide or standard radiochemotherapy followed by adjuvant neratinib (240 mg daily). Treatment continued until progression or development of unacceptable toxicities. The primary endpoint was OS. Association between neratinib efficacy and EGFR amplification was also investigated.
RESULTS
There were 144 patients (70 control; 74 neratinib). Neratinib was reasonably well-tolerated with no new toxicity signals identified. PFS was compared (HR 0.84; p=0.38, logrank test – not significant) between the neratinib (median 6.05 months) and control (median 5.82 months) arms. For patients EGFR pathway activation the PFS HR was 0.53 (p-value=0.03 – significant, median PFS: neratinib, 6.21 months, control, 5.26 months). However, there was no significant improvement in OS in EGFR amplified/mutated patients (HR 1.05; p-value 0.87) between neratinib (median 14.2) compared to the control arm (median 14.6).
CONCLUSION
Neratinib prolonged PFS in the EGFR positive subpopulation but there was no overall PFS benefit, or any OS improvement.
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Affiliation(s)
| | | | | | | | - Rifaquat Rahman
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | | | | | | | - Jan Drappatz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew Lassman
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Howard Colman
- University of Utah - Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - L Burt Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | - Tracy Batchelor
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Mary Welch
- Columbia / New York Presbyterian, New York, NY, USA
| | | | | | | | | | | | | | | | | | - E Antonio Chiocca
- Harvey Cushing Neuro-oncology Laboratories, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Keith Ligon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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5
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Bi WL, Nayak L, Meredith DM, Driver J, Du Z, Hoffman S, Li Y, Lee EQ, Beroukhim R, Rinne M, McFaline-Figueroa R, Chukwueke U, McCluskey C, Gaffey S, Cherniack AD, Stefanik J, Doherty L, Taubert C, Cifrino M, LaFrankie D, Graillon T, Wen PY, Ligon KL, Al-Mefty O, Huang RY, Muzikansky A, Chiocca EA, Santagata S, Dunn IF, Reardon DA. Activity of PD-1 blockade with Nivolumab among patients with recurrent atypical/anaplastic meningioma: Phase II trial results. Neuro Oncol 2021; 24:101-113. [PMID: 34015129 DOI: 10.1093/neuonc/noab118] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Programmed death-1 ligand (PD-L1) contributes to tumor immunosuppression and is upregulated in aggressive meningiomas. We performed a phase II study of nivolumab, a programmed death-1 (PD-1) blocking antibody among patients with grade ≥2 meningioma that recurred after surgery and radiation therapy. METHODS Twenty-five patients received nivolumab (240 mg biweekly) until progression, voluntary withdrawal, unacceptable toxicity, or death. Tumor mutational burden (TMB) and quantification of tumor infiltrating lymphocytes (TIL) were evaluated as potential immunocorrelative biomarkers. Change in neurologic function was prospectively assessed using the Neurologic Assessment in Neuro-Oncology (NANO) scale. RESULTS Enrolled patients had multiple recurrences including ≥3 prior surgeries and ≥2 prior courses of radiation in 60% and 72%, respectively. Nivolumab was well tolerated with no unexpected AEs. PFS-6 was 42.4% (95% CI: 22.8, 60.7) and the median OS was 30.9 months (95% CI: 17.6, NA). One patient achieved radiographic response (ongoing at 4.5 years). TMB was > 10/Mb in 2 of 15 profiled tumors (13.3%). Baseline TIL density was low but increased post-treatment in 3 patients including both patients with elevated TMB. Most patients who achieved PFS-6 maintained neurologic function prior to progression as assessed by NANO. CONCLUSION Nivolumab was well tolerated but failed to improve PFS-6, although a subset of patients appeared to derive benefit. Low levels of TMB and TIL density were typically observed. NANO assessment of neurologic function contributed to outcome assessment. Future studies may consider rationally designed combinatorial regimens.
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Affiliation(s)
- Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - David M Meredith
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Driver
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ziming Du
- Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Samantha Hoffman
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yvonne Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Eudocia Quant Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rameen Beroukhim
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Mikael Rinne
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christine McCluskey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah Gaffey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrew D Cherniack
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer Stefanik
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lisa Doherty
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christina Taubert
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meghan Cifrino
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Deborah LaFrankie
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas Graillon
- Faculté de Médecine, Aix Marseille Université, Marseille, France
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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6
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Subbiah V, Groisberg R, Skefos C, Cleary JM, Subbiah IM, Palma J, Oster M, Young SW, Elvin JA, Sicklick JK, Gaffey S, Ward A, Alexander BM, Lee JJ, De P, Kato S, Kurzrock R. TCF-001 TRACK (Target Rare Cancer Knowledge): A national patient-centric precision oncology trial for rare cancers. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3143 Background: Many rare cancers are understudied, and affected patients often have few if any standard treatment options and limited access to clinical trials. Comprehensive genomic profiling (CGP) is a robust tool to efficiently identify the genomic alterations of cancer and can be applied to study rare tumors. The promise of this technology is to simultaneously enhance our understanding of diverse rare tumors and find matched therapies to benefit the individual patient in real-time. The COVID19 pandemic has challenged the “trial-centric” clinical trial infrastructure. Novel “patient-centric” trials are needed, especially for rare cancers. TRACK is a decentralized, patient advocacy-initiated trial that aims to establish whether patients with rare tumors and cancer of unknown primary can benefit from matched molecular therapy as dictated by their CGP results. Methods: This is a national open label, non-randomized, multi-center (includes community and academic centers) pragmatic study in rare tumors (<6 cases per 100,000 persons per year) and cancer of unknown primary. All participants will have tumor tissue and blood analyzed by CGP (FoundationOneCDx and FoundationOneLiquidCDx). A Virtual Molecular Tumor Board (VMTB) will convene to identify targeted treatment recommendations for participants with genomic alterations. Overall, 400 participants will be enrolled to achieve the goal of 100 patients matched to genomically informed treatment, utilizing remote consenting to ensure study access regardless of geographic location. The primary feasibility endpoint is the percent of participants who receive a molecularly matched treatment after recommendation from the VMTB. The primary efficacy endpoint is the progression-free survival (PFS) among participants who received the molecularly matched treatment. Secondary endpoints include the percent of participants with genomic alterations, overall response rate, response duration, overall survival, clinical benefit rate (SD > 6 months; PR; CR), and high-grade toxicities (as available) of matched targeted therapy. Exploratory endpoints include matching rates; understanding genomic correlates of response; concordance rates between CGP from tissue and blood, time-to-treatment failure, and the impact of the cancer treatment from the patient perspective (via ESAS-FS, a validated patient-reported outcomes (PRO) instrument). All eligible and enrolled patients, regardless of whether receiving matched treatment or not, will be followed for a minimum of one year in a uniform way such that the treatment efficacy and outcomes can be assessed in standard formats. The study is open with six patients enrolled at time of submission. Clinical trial information: NCT04504604.
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Affiliation(s)
- Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Jim Palma
- TargetCancer Foundation, Cambridge, MA
| | | | | | | | | | | | | | | | - J. Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pradip De
- Avera Cancer Institute, Sioux Falls, SD
| | - Shumei Kato
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | - Razelle Kurzrock
- University of California San Diego, Moores Cancer Center, La Jolla, CA
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7
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Nayak L, Molinaro AM, Peters K, Clarke JL, Jordan JT, de Groot J, Nghiemphu L, Kaley T, Colman H, McCluskey C, Gaffey S, Smith TR, Cote DJ, Severgnini M, Yearley JH, Zhao Q, Blumenschein WM, Duda DG, Muzikansky A, Jain RK, Wen PY, Reardon DA. Randomized Phase II and Biomarker Study of Pembrolizumab plus Bevacizumab versus Pembrolizumab Alone for Patients with Recurrent Glioblastoma. Clin Cancer Res 2020; 27:1048-1057. [PMID: 33199490 DOI: 10.1158/1078-0432.ccr-20-2500] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/31/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE VEGF is upregulated in glioblastoma and may contribute to immunosuppression. We performed a phase II study of pembrolizumab alone or with bevacizumab in recurrent glioblastoma. PATIENTS AND METHODS Eighty bevacizumab-naïve patients with recurrent glioblastoma were randomized to pembrolizumab with bevacizumab (cohort A, n = 50) or pembrolizumab monotherapy (cohort B, n = 30). The primary endpoint was 6-month progression-free survival (PFS-6). Assessed biomarkers included evaluation of tumor programmed death-ligand 1 expression, tumor-infiltrating lymphocyte density, immune activation gene expression signature, and plasma cytokines. The neurologic assessment in neuro-oncology (NANO) scale was used to prospectively assess neurologic function. RESULTS Pembrolizumab alone or with bevacizumab was well tolerated but of limited benefit. For cohort A, PFS-6 was 26.0% [95% confidence interval (CI), 16.3-41.5], median overall survival (OS) was 8.8 months (95% CI, 7.7-14.2), objective response rate (ORR) was 20%, and median duration of response was 48 weeks. For cohort B, PFS-6 was 6.7% (95% CI, 1.7-25.4), median OS was 10.3 months (95% CI, 8.5-12.5), and ORR was 0%. Tumor immune markers were not associated with OS, but worsened OS correlated with baseline dexamethasone use and increased posttherapy plasma VEGF (cohort A) and mutant IDH1, unmethylated MGMT, and increased baseline PlGF and sVEGFR1 levels (cohort B). The NANO scale contributed to overall outcome assessment. CONCLUSIONS Pembrolizumab was ineffective as monotherapy and with bevacizumab for recurrent glioblastoma. The infrequent radiographic responses to combinatorial therapy were durable. Tumor immune biomarkers did not predict outcome. Baseline dexamethasone use and tumor MGMT warrant further study as potential biomarkers in glioblastoma immunotherapy trials.
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Affiliation(s)
| | | | | | | | | | | | - Leia Nghiemphu
- University of California, Los Angeles, Los Angeles, California
| | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Howard Colman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Sarah Gaffey
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - David J Cote
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Qing Zhao
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - Dan G Duda
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Rakesh K Jain
- Massachusetts General Hospital, Boston, Massachusetts
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8
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Nayak L, Molinaro A, Peters K, Clarke J, Jordan J, de Groot J, Nghiemphu P, Kaley T, Colman H, McCluskey C, Gaffey S, Smith T, Cote D, Severgnini M, Yearley J, Zhao Q, Blumenschein W, Duda G, Muzikansky A, Jain R, Wen P, Reardon D. NCOG-44. NEUROLOGIC ASSESSMENT IN NEURO-ONCOLOGY (NANO) SCALE IN A PHASE II STUDY OF PEMBROLIZUMAB OR PEMBROLIZUMAB PLUS BEVACIZUMAB IN PATIENTS WITH RECURRENT GLIOBLASTOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
PURPOSE
The neurologic assessment in neuro-oncology (NANO) scale was developed as a standardized metric to objectively measure neurologic function in brain tumor patients to complement radiographic assessment in defining overall outcome. A multicenter, phase 2 study of pembrolizumab with or without bevacizumab in patients with recurrent glioblastoma incorporated the NANO scale as an exploratory endpoint.
METHODS
Neurologic examination was evaluated at baseline and MRI assessments using the NANO scale until patients came off study. Statistical descriptive data analysis was performed using R (version 3.4.3). Correlation analysis utilized Fisher’s exact test.
RESULTS
NANO compliance rate was 94% in 80 patients accrued on the study. Of the 80 patients, 7 were missing NANO at baseline visit and were excluded from analysis for NANO response criteria. Fifteen patients did not have end of treatment NANO evaluation. Of 73 patients, 35 (48%) had a normal neurologic examination at baseline by NANO. Strength and language accounted for the majority of changes in neurologic function over the course of study treatment. Eighteen patients (25%) had neurologic progression by NANO, of whom 2 did not have concurrent radiographic progression. Three patients (pembrolizumab plus bevacizumab cohort) had a neurologic response associated with stable disease on MRI. NANO assessment prior to initiation of cycle 3 correlated with RANO response (p=0.011), change in KPS (p=0.002) and dexamethasone requirement (p=0.007) while those with NANO progression at this assessment had worse overall survival (291 vs 324 days), but this trend did not achieve statistical significance (p=0.2).
CONCLUSIONS
Evaluation of neurologic function by NANO scale was feasible in a multicenter prospective study in patients with GBM with a high compliance rate. The NANO scale objectively tracked stable neurologic function in most patients throughout the trial period and was associated with a trend for survival.
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Affiliation(s)
| | - Annette Molinaro
- Department of Neurological Surgery, University of California (UCSF), San Francisco, San Francisco, CA, USA
| | | | - Jennifer Clarke
- Department of Neurological Surgery, University of California (UCSF), San Francisco, San Francisco, CA, USA
| | | | - John de Groot
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Timothy Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | - Rakesh Jain
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick Wen
- Dana Farber Cancer Institute, Boston, MA, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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9
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Rahman R, Trippa L, Fell G, Lee E, Arrillaga-Romany I, Touat M, McCluskey C, Brunno J, Gaffey S, Drappatz J, Lassman A, Galanis E, Ahluwalia M, Colman H, Nabors L, Hepel J, Elinzano H, Schiff D, Chukwueke U, Beroukhim R, Nayak L, Mcfaline-Figueroa J, Batchelor T, Rinne M, Kaley T, Lu-Emerson C, Bi WL, Arnaout O, Haas-Kogan D, Tanguturi S, Cagney D, Aizer AA, Welch M, Doherty L, Lavallee M, Fisher-Longden B, Dowling S, Geduldig J, Watkinson F, Santagata S, Meredith D, Chiocca EA, Reardon D, Ligon K, Alexander B, Wen P. CTNI-11. CC-115 IN NEWLY DIAGNOSED MGMT UNMETHYLATED GLIOBLASTOMA IN THE INDIVIDUALIZED SCREENING TRIAL OF INNOVATIVE GLIOBLASTOMA THERAPY (INSIGHT): A PHASE II RANDOMIZED BAYESIAN ADAPTIVE PLATFORM TRIAL. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
CC-115 is an oral, CNS-penetrant, selective inhibitor of mammalian target of rapamycin kinase (mTOR) and deoxyribonucleic acid-dependent protein kinase (DNA-PK). Both targets are important in glioblastoma; PI3K/Akt/mTOR signaling is hyperactive in most glioblastomas, and DNA-PK is integral to repair of radiotherapy-mediated DNA damage. To investigate CC-115 in newly diagnosed glioblastoma and explore potential genomic biomarker associations, CC-115 was evaluated in the Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) trial, an adaptive platform trial designed to efficiently test experimental agents.
METHODS
Adults with newly diagnosed MGMT-unmethylated glioblastoma, with genomic data available, are eligible for this ongoing trial. Patients are adaptively randomized to one of several experimental arms or the control arm: standard radiotherapy with concurrent and adjuvant temozolomide. The primary endpoint is overall survival (OS). Patients randomized to CC-115 (10mg po BID) received it concurrently with radiotherapy and as adjuvant monotherapy. As the first in-human use of CC-115 with radiation, a safety lead-in 3 + 3 design was used.
RESULTS
Twelve patients were randomized to CC-115; seven patients had possible treatment-related CTCAE grade > 3 toxicity, including four pre-specified dose-limiting toxicities: liver function abnormality (n=1), hyperlipidemia (n=1), lipase elevation (n=1) and cerebral edema (n=1). There was no significant difference in progression-free survival (PFS, median 4.2 months [CC-115] vs. 5.2 months, p=0.9) or OS (median 10.1 months [CC-115] vs. 14.5 months, p=0.9) compared to the 50 patients randomized to the control arm. Based on early PFS results, randomization probability to CC-115 decreased from 25% to < 10% at time of the trial arm closure.
CONCLUSION
Concurrent and adjuvant CC-115 was associated with toxicity and failed to improve PFS or OS. The INSIGhT trial design allowed for more efficient testing of CC-115, decreasing patients and resources allocated to a therapy that was discontinued due to concerns about toxicity and unfavorable risk-to-benefit ratio.
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Affiliation(s)
- Rifaquat Rahman
- Brigham and Women’s/Dana-Farber Cancer Center, Boston, MA, USA
| | | | | | - Eudocia Lee
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Mehdi Touat
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | - Andrew Lassman
- New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | - Louis Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | | | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | | | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daphne Haas-Kogan
- Dana-Farber Cancer Institute/Boston Children’s Hospital, Boston, MA, USA
| | | | | | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Mary Welch
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | | | | | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - David Meredith
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - E Antonio Chiocca
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
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10
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Wen P, Trippa L, Lee E, Fell G, Rahman R, Arrillaga-Romany I, Touat M, McCluskey C, Brunno J, Gaffey S, Drappatz J, Lassman A, Galanis E, Ahluwalia M, Colman H, Nabors L, Hepel J, Elinzano H, Schiff D, Chukwueke U, Beroukhim R, Nayak L, Mcfaline-Figueroa J, Batchelor T, Rinne M, Kaley T, Lu-Emerson C, Bi WL, Arnaout O, Peruzzi PP, Doherty L, Haas-Kogan D, Tanguturi S, Cagney D, Aizer AA, Welch M, Lavallee M, Fisher-Longden B, Dowling S, Geduldig J, Santagata S, Meredith D, Chiocca EA, Reardon D, Ligon K, Alexander B. CTNI-12. PRELIMINARY RESULTS OF THE ABEMACICLIB ARM IN THE INDIVIDUALIZED SCREENING TRIAL OF INNOVATIVE GLIOBLASTOMA THERAPY (INSIGHT): A PHASE II PLATFORM TRIAL USING BAYESIAN ADAPTIVE RANDOMIZATION. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
The cyclin D-CDK4/6-Rb pathway is activated in most glioblastomas. Abemaciclib is a potent CDK4/6 inhibitor with good brain penetration approved for ER/PR/HER2- breast cancer. In order to efficiently evaluate the potential impact of abemaciclib on overall survival (OS) in newly diagnosed glioblastoma and to simultaneously develop information regarding potential genomic biomarker associations, abemaciclib was included as an arm on the Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) trial. INSIGhT is a phase II platform trial using response adaptive randomization and deep genomic profiling to more efficiently test experimental agents in MGMT unmethylated glioblastoma and potentially accelerate identification of novel therapies for phase III testing. Initial randomization was equal between abemaciclib, control, and two other experimental arms but subsequent randomization was adapted based on efficacy as determined by progression-free survival (PFS). Ineffective arms were discontinued and new arms added by protocol amendment. We report preliminary results for the abemaciclib arm which has completed accrual.
METHODS
Patients with newly diagnosed MGMT-unmethylated glioblastoma were randomized to receive either radiotherapy with concomitant and adjuvant temozolomide at standard doses or standard radiochemotherapy followed by adjuvant abemaciclib (150–200 mg orally BID) without temozolomide. Treatment continued until progression or development of unacceptable toxicities. The primary endpoint was OS. Association between abemaciclib efficacy and cyclin D-CDK4/6-Rb pathway genomic alterations was also investigated.
RESULTS
There were 123 patients (50 control; 73 treated with abemaciclib). Abemaciclib was generally well-tolerated with no new toxicity signals identified. PFS was significantly longer (p=0.03, logrank test) with abemaciclib (median 6.31 months 95% CI [5.29, 8.18]) compared to the control arm (5.16 months 95% CI [4.37, 6.28]). 28/50 control and 36/73 abemaciclib patients remain alive.
CONCLUSION
Preliminary analysis suggests that abemaciclib increases PFS compared to control. Updated toxicity, PFS and survival data and potential genomic biomarker associations will be presented.
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Affiliation(s)
- Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Eudocia Lee
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Rifaquat Rahman
- Brigham and Women’s/Dana-Farber Cancer Center, Boston, MA, USA
| | | | | | | | | | | | | | - Andrew Lassman
- New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | - Louis Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | | | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | | | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Lisa Doherty
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Daphne Haas-Kogan
- Dana-Farber Cancer Institute/Boston Children’s Hospital, Boston, MA, USA
| | | | | | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Mary Welch
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - David Meredith
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - E Antonio Chiocca
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Keith Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
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11
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Lu MW, Walia G, Schulze K, Doral MY, Maund SL, Gaffey S, Cabili MN, Bourla AB, Green RJ, Santos EC, Herbst RS, Chiang AC, Schwartzberg LS. A multi-stakeholder platform to prospectively link longitudinal real-world clinico-genomic, imaging, and outcomes data for patients with metastatic lung cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2087 Background: Making personalized diagnostics and treatments a reality for every cancer patient necessitates comprehensively capturing the patient journey. Real-world data has shown promise for the future of clinical research and advancing precision medicine. However, certain limitations exist such as data quality management as well as bias and confounding factors associated with retrospective analyses. We present a multi-stakeholder platform to prospectively collect and link real-world clinico-genomic, imaging, and outcomes data to longitudinal blood genomic profiling for lung cancer. Methods: This study is enrolling approximately 1000 patients with metastatic non-small cell lung cancer or extensive-stage small cell lung cancer who will initiate standard-of-care systemic anti-neoplastic treatment, regardless of line of therapy, at 20 community oncology and academic practices within the Flatiron Health network. Relevant clinical data points from both structured and unstructured fields will be collected through the electronic health records via technology-enabled abstraction, eliminating the need for case report forms. Digital pathology and clinical images at standard-of-care visits will be collected. Blood samples for circulating tumor DNA (ctDNA) profiling using FoundationOne Liquid will be collected at three timepoints: enrollment, first tumor assessment, and end of treatment. Tumor tissue samples may be submitted at baseline for genomic profiling using FoundationOne CDx. Overall survival follow-up will occur until death, withdrawal of consent, loss to follow-up, or end of study. The objectives are to evaluate 1) the feasibility of building a scalable, prospective platform and 2) the associations between ctDNA and real-world clinical outcomes, including overall survival. Enrollment is ongoing. Clinical trial information: NCT04180176.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Eric C. Santos
- Cancer and Hem Ctrs of Western Michigan, Grand Rapids, MI
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12
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Lee EQ, Chukwueke UN, Hervey-Jumper SL, de Groot JF, Leone JP, Armstrong TS, Chang SM, Arons D, Oliver K, Verble K, Musella A, Willmarth N, Alexander BM, Bates A, Doherty L, Galanis E, Gaffey S, Halkin T, Friday BE, Fouladi M, Lin NU, Macdonald D, Mehta MP, Penas-Prado M, Vogelbaum MA, Sahebjam S, Sandak D, van den Bent M, Weller M, Reardon DA, Wen PY. Barriers to accrual and enrollment in brain tumor trials. Neuro Oncol 2019; 21:1100-1117. [PMID: 31175826 PMCID: PMC7594546 DOI: 10.1093/neuonc/noz104] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Many factors contribute to the poor survival of malignant brain tumor patients, some of which are not easily remedied. However, one contributor to the lack of progress that may be modifiable is poor clinical trial accrual. Surveys of brain tumor patients and neuro-oncology providers suggest that clinicians do a poor job of discussing clinical trials with patients and referring patients for clinical trials. Yet, data from the Cancer Action Network of the American Cancer Society suggest that most eligible oncology patients asked to enroll on a clinical trial will agree to do so. To this end, the Society for Neuro-Oncology (SNO) in collaboration with the Response Assessment in Neuro-Oncology (RANO) Working Group, patient advocacy groups, clinical trial cooperative groups, including the Adult Brain Tumor Consortium (ABTC), and other partners are working together with the intent to double clinical trial accrual over the next 5 years. Here we describe the factors contributing to poor clinical trial accrual in neuro-oncology and offer possible solutions.
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Affiliation(s)
- Eudocia Q Lee
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ugonma N Chukwueke
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Jose Pablo Leone
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan M Chang
- University of California San Francisco, San Francisco, California, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, Surrey, UK
| | - Kay Verble
- The Sontag Foundation and Brain Tumor Network, Ponte Vedre Beach, Florida, USA
| | - Al Musella
- The Musella Foundation for Brain Tumor Research and Information, Hewlett, New York, USA
| | | | | | - Amanda Bates
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Lisa Doherty
- National Brain Tumor Society, Newton, Massachusetts, USA
| | | | - Sarah Gaffey
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas Halkin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Maryam Fouladi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - David Sandak
- Accelerate Brain Cancer Cure (ABC2), Washington, DC, USA
| | | | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Patrick Y Wen
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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13
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Lee EQ, Muzikansky A, Duda DG, Gaffey S, Dietrich J, Nayak L, Chukwueke UN, Beroukhim R, Doherty L, Laub CK, LaFrankie D, Fontana B, Stefanik J, Ruland S, Caruso V, Bruno J, Ligon K, Reardon DA, Wen PY. Phase II trial of ponatinib in patients with bevacizumab-refractory glioblastoma. Cancer Med 2019; 8:5988-5994. [PMID: 31444999 PMCID: PMC6792497 DOI: 10.1002/cam4.2505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 01/22/2023] Open
Abstract
Background Responses to bevacizumab in glioblastoma (GBM) are not durable. Plasma levels of basic fibroblast growth factor (bFGF) increase at the time of tumor progression. By targeting vascular endothelial growth factor receptor (VEGFR), platelet‐derived growth factor receptor, Src, and FGF receptor pathways, ponatinib may potentially help to overcome some of the putative mechanisms of adaptive resistance. Methods We performed a phase II trial of ponatinib in patients with bevacizumab‐refractory GBM and variants. Adult patients with Karnofsky performance score (KPS) ≥60, measurable disease, and normal organ and marrow function received 45 mg ponatinib daily. No limit on the number of prior therapies but only one prior bevacizumab‐containing regimen was allowed. Primary endpoint was 3‐month progression‐free survival. Plasma biomarkers of angiogenesis and inflammation were evaluated before and after treatment. Results The study closed after the first stage. Fifteen patients enrolled: median age 61 [27‐74]; median KPS 80 [70‐90]; median number of prior relapses 2 [2‐4]. Three‐month progression‐free survival rate was 0, median overall survival was 98 days [95% CI 56, 257], and median PFS was 28 days [95% CI 27, 30]. No responses were seen. The most common grade ≥3 adverse events included fatigue (n = 3), hypertension (2), and lipase elevation (2). Ponatinib treatment significantly increased plasma VEGF, soluble (s)VEGFR1, sVEGFR2, sTIE2, interferon gamma (IFNγ), tumor necrosis factor alpha (TNF‐α), interleukin (IL)‐6, IL‐8, and IL‐10 and decreased sVEGFR2. Conclusions Ponatinib was associated with minimal activity in bevacizumab‐refractory GBM patients. Circulating biomarker data confirmed pharmacodynamic changes and suggested that resistance to ponatinib may be related to an increase in inflammatory cytokines.
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Affiliation(s)
- Eudocia Q Lee
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Alona Muzikansky
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Dan G Duda
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Gaffey
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Jorg Dietrich
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Lakshmi Nayak
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Ugonma N Chukwueke
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Rameen Beroukhim
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Lisa Doherty
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | | | - Debra LaFrankie
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Brittney Fontana
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Jennifer Stefanik
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Sandra Ruland
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Victoria Caruso
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Jennifer Bruno
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Keith Ligon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - David A Reardon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Patrick Y Wen
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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14
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Alexander BM, Trippa L, Gaffey S, Arrillaga-Romany IC, Lee EQ, Rinne ML, Ahluwalia MS, Colman H, Fell G, Galanis E, de Groot J, Drappatz J, Lassman AB, Meredith DM, Nabors LB, Santagata S, Schiff D, Welch MR, Ligon KL, Wen PY. Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT): A Bayesian Adaptive Platform Trial to Develop Precision Medicines for Patients With Glioblastoma. JCO Precis Oncol 2019; 3:1800071. [PMID: 32914038 PMCID: PMC7448806 DOI: 10.1200/po.18.00071] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Adequately prioritizing the numerous therapies and biomarkers available in late-stage testing for patients with glioblastoma (GBM) requires an efficient clinical testing platform. We developed and implemented INSIGhT (Individualized Screening Trial of Innovative Glioblastoma Therapy) as a novel adaptive platform trial (APT) to develop precision medicine approaches in GBM. METHODS INSIGhT compares experimental arms with a common control of standard concurrent temozolomide and radiation therapy followed by adjuvant temozolomide. The primary end point is overall survival. Patients with newly diagnosed unmethylated GBM who are IDH R132H mutation negative and with genomic data available for biomarker grouping are eligible. At the initiation of INSIGhT, three experimental arms (neratinib, abemaciclib, and CC-115), each with a proposed genomic biomarker, are tested simultaneously. Initial randomization is equal across arms. As the trial progresses, randomization probabilities adapt on the basis of accumulating results using Bayesian estimation of the biomarker-specific probability of treatment impact on progression-free survival. Treatment arms may drop because of low probability of treatment impact on overall survival, and new arms may be added. Detailed information on the statistical model and randomization algorithm is provided to stimulate discussion on trial design choices more generally and provide an example for other investigators developing APTs. CONCLUSION INSIGhT (NCT02977780) is an ongoing novel biomarker-based, Bayesian APT for patients with newly diagnosed unmethylated GBM. Our goal is to dramatically shorten trial execution timelines while increasing scientific power of results and biomarker discovery using adaptive randomization. We anticipate that trial execution efficiency will also be improved by using the APT format, which allows for the collaborative addition of new experimental arms while retaining the overall trial structure.
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Affiliation(s)
- Brian M Alexander
- Dana-Farber Cancer Institute, Boston, MA.,Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | - Mikael L Rinne
- Brigham and Women's Hospital, Boston, MA.,Novartis Institutes for Biomedical Research, Boston, MA
| | | | | | | | | | | | - Jan Drappatz
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - David M Meredith
- Dana-Farber Cancer Institute, Boston, MA.,Brigham and Women's Hospital, Boston, MA
| | | | - Sandro Santagata
- Dana-Farber Cancer Institute, Boston, MA.,Brigham and Women's Hospital, Boston, MA
| | - David Schiff
- University of Virginia Health System, Charlottesville, VA
| | - Mary R Welch
- Columbia University Medical Center, New York, NY
| | - Keith L Ligon
- Dana-Farber Cancer Institute, Boston, MA.,Brigham and Women's Hospital, Boston, MA
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15
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Touat M, Dubuc A, Meredith D, Tsuji J, Mills C, Gaffey S, Geduldig J, Watkinson F, Pelton K, Malinowski S, Lennon N, Sorger P, Trippa L, Ramkissoon S, Reardon D, de Groot J, Galanis E, Welch M, Nabors LB, Arrillaga-Romany I, Chiocca EA, Santagata S, Schiff D, Ahluwalia M, Colman H, Drappatz J, Alexander B, Wen P, Ligon K. INNV-13. ALLELE: A CONSORTIUM FOR PROSPECTIVE GENOMICS AND FUNCTIONAL DIAGNOSTICS TO GUIDE PATIENT CARE AND TRIAL ANALYSIS IN NEWLY-DIAGNOSED GLIOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.587] [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: 11/12/2022] Open
Affiliation(s)
- Mehdi Touat
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Adrian Dubuc
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David Meredith
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Junko Tsuji
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Caitlin Mills
- Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA
| | | | - Jack Geduldig
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Fiona Watkinson
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kristine Pelton
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Seth Malinowski
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Niall Lennon
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Peter Sorger
- Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA
| | - Lorenzo Trippa
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | | | - John de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Mary Welch
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - L Burt Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - E Antonio Chiocca
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandro Santagata
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David Schiff
- University of Virginia, Charlottesville, VA, USA
| | | | - Howard Colman
- Department of Neurosurgery, Huntsman Cancer Institute and Clinical Neuroscience Center, University of Utah, Salt Lake City, Utah, Salt Lake City, UT, USA
| | | | - Brian Alexander
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Patrick Wen
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Keith Ligon
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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16
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Prins R, Mochizuki A, Orpilla J, Lee A, Davidson T, Gaffey S, Sanders C, Rytlewski J, Ellingson B, Li G, Yong W, Clarke J, Arrillaga-Romany I, Colman H, Reardon D, Kaley T, de Groot J, Liau L, Wen P, Cloughesy T. ATIM-12. NEOADJUVANT ANTI-PD-1 IMMUNOTHERAPY PROMOTES INTRATUMORAL AND SYSTEMIC IMMUNE RESPONSES IN RECURRENT GLIOBLASTOMA: AN IVY CONSORTIUM TRIAL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Robert Prins
- UCLA Depts. of Neurosurgery and Molecular and Medical Pharmacology, LA, CA, USA
| | | | | | - Alexander Lee
- UCLA Dept of Molecular and Medical Pharmacology, Los Angeles, CA, USA
| | - Tom Davidson
- David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | | | - Benjamin Ellingson
- University of California Los Angeles, Los Angeles, CA, USA, Los Angeles, CA, USA
| | - Gang Li
- David Geffen School of Medicine, Los Angeles, CA, USA
| | - William Yong
- UCLA Dept. of Pathology and Laboratory Medicine, Los Angeles, CA, USA
| | - Jennifer Clarke
- University of California at San Francisco, San Francisco, CA, USA
| | | | - Howard Colman
- Department of Neurosurgery, Huntsman Cancer Institute and Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | | | - Thomas Kaley
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - John de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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17
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Lee EQ, Duda DG, Muzikansky A, Gerstner ER, Kuhn JG, Reardon DA, Nayak L, Norden AD, Doherty L, LaFrankie D, Stefanik J, Vardam T, Smith KH, McCluskey C, Gaffey S, Batchelor TT, Jain RK, Wen PY. Phase I and Biomarker Study of Plerixafor and Bevacizumab in Recurrent High-Grade Glioma. Clin Cancer Res 2018; 24:4643-4649. [PMID: 29941486 DOI: 10.1158/1078-0432.ccr-18-1025] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/22/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Although antiangiogenic therapy for high-grade glioma (HGG) is promising, responses are not durable. Correlative clinical studies suggest that the SDF-1α/CXCR4 axis may mediate resistance to VEGFR inhibition. Preclinical data have demonstrated that plerixafor (a reversible CXCR4 inhibitor) could inhibit glioma progression after anti-VEGF pathway inhibition. We conducted a phase I study to determine the safety of plerixafor and bevacizumab in recurrent HGG.Patients and Methods: Part 1 enrolled 23 patients with a 3 × 3 dose escalation design to a maximum planned dose of plerixafor 320 μg/kg subcutaneously on days 1 to 21 and bevacizumab 10 mg/kg intravenously on days 1 and 15 of each 28-day cycle. Cerebrospinal fluid (CSF) and plasma samples were obtained for pharmacokinetic analyses. Plasma and cellular biomarkers were evaluated before and after treatment. Part 2 enrolled 3 patients and was a surgical study to determine plerixafor's penetration in tumor tissue.Results: In Part 1, no dose-limiting toxicities were seen at the maximum planned dose of plerixafor + bevacizumab. Treatment was well tolerated. After plerixafor 320 μg/kg treatment, the average CSF drug concentration was 26.8 ± 19.6 ng/mL. Plerixafor concentration in resected tumor tissue from patients pretreated with plerixafor was 10 to 12 μg/g. Circulating biomarker data indicated that plerixafor + bevacizumab induces rapid and persistent increases in plasma SDF-1α and placental growth factor. Progression-free survival correlated with pretreatment plasma soluble mesenchymal-epithelial transition receptor and sVEGFR1, and overall survival with the change during treatment in CD34+ progenitor/stem cells and CD8 T cells.Conclusions: Plerixafor + bevacizumab was well tolerated in HGG patients. Plerixafor distributed to both the CSF and brain tumor tissue, and treatment was associated with biomarker changes consistent with VEGF and CXCR4 inhibition. Clin Cancer Res; 24(19); 4643-9. ©2018 AACR.
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MESH Headings
- Adult
- Aged
- Benzylamines
- Bevacizumab/administration & dosage
- Bevacizumab/pharmacokinetics
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/cerebrospinal fluid
- Cyclams
- Dose-Response Relationship, Drug
- Drug Resistance, Neoplasm/genetics
- Female
- Gene Expression Regulation, Neoplastic
- Glioma/blood
- Glioma/cerebrospinal fluid
- Glioma/drug therapy
- Glioma/genetics
- Hepatocyte Growth Factor/blood
- Hepatocyte Growth Factor/cerebrospinal fluid
- Heterocyclic Compounds/administration & dosage
- Heterocyclic Compounds/pharmacokinetics
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/cerebrospinal fluid
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/genetics
- Neoplastic Cells, Circulating/metabolism
- Progression-Free Survival
- Proto-Oncogene Proteins c-met/blood
- Proto-Oncogene Proteins c-met/cerebrospinal fluid
- Receptors, CXCR4/antagonists & inhibitors
- Receptors, CXCR4/genetics
- Signal Transduction/drug effects
- Vascular Endothelial Growth Factor A/antagonists & inhibitors
- Vascular Endothelial Growth Factor A/genetics
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Affiliation(s)
- Eudocia Q Lee
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.
- Harvard Medical School, Boston, Massachusetts
| | - Dan G Duda
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Elizabeth R Gerstner
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - David A Reardon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Lakshmi Nayak
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Andrew D Norden
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Lisa Doherty
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Debra LaFrankie
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Jennifer Stefanik
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Trupti Vardam
- Massachusetts General Hospital, Boston, Massachusetts
| | - Katrina H Smith
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | | | - Sarah Gaffey
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Tracy T Batchelor
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
| | - Rakesh K Jain
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
| | - Patrick Y Wen
- Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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18
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Nayak L, Hays J, Do K, Muzikansky A, Gaffey S, Lee E, Rinne M, Norden A, Beroukhim R, Puduvalli V, Wen P, Doyle LA, Chen H, Shapiro G, Reardon D. ACTR-93. A PHASE I STUDY OF MLN0128 (TAK-228) AND BEVACIZUMAB IN PATIENTS WITH ADVANCED SOLID TUMORS INCLUDING GLIOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Lee E, Muzikansky A, Gerstner E, Kuhn J, Reardon D, Nayak L, Norden A, Doherty L, Stefanik J, Armitage J, LaFrankie D, Ruland S, Vardam T, Stokes D, Smith K, McCluskey C, Gaffey S, Batchelor T, Jain R, Duda D, Wen P. ACTR-76. FINAL RESULTS FROM A PHASE I STUDY OF PLERIXAFOR AND BEVACIZUMAB IN RECURRENT HIGH-GRADE GLIOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Lee E, Muzikansky A, Gerstner E, Kuhn J, Reardon D, Nayak L, Norden A, Doherty L, Stefanik J, LaFrankie D, Pulverenti J, Vardam T, Stokes D, Smith K, McCluskey C, Gaffey S, Batchelor T, Duda D, Jain R, Wen P. ATNT-14PHASE I STUDY OF PLERIXAFOR AND BEVACIZUMAB IN RECURRENT HIGH-GRADE GLIOMA. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov205.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Nayak L, Hays J, Muzikansky A, Gaffey S, Do K, Hilton J, Lee E, Rinne M, Norden A, Beroukhim R, Puduvalli V, Wen P, Doyle LA, Chen H, Shapiro G, Reardon D. ATNT-18A PHASE I STUDY OF MLN0128 AND BEVACIZUMAB IN PATIENTS WITH RECURRENT GLIOBLASTOMA AND OTHER SOLID TUMORS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov205.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Lee E, Muzikansky A, Kesari S, Wong E, Fadul C, Reardon D, Norden A, Nayak L, Rinne M, Alexander B, Arvold N, Doherty L, LaFrankie D, Pulverenti J, Smith K, Gaffey S, Kenney A, Hammond S, Drappatz J, Wen P. SM-03 * A RANDOMIZED, PLACEBO-CONTROLLED PILOT TRIAL OF ARMODAFINIL FOR FATIGUE IN PATIENTS WITH GLIOMAS UNDERGOING RADIOTHERAPY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou277.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Lee E, Smith K, Muzikansky A, Gerstner E, Kuhn J, Reardon D, Nayak L, Norden A, Rifenburg J, Pulverenti J, Stokes D, Lam P, Martins T, Hempfling K, McCluskey C, Gaffey S, Batchelor T, Duda D, Jain R, Wen P. AT-37PHASE I STUDY OF PLERIXAFOR AND BEVACIZUMAB IN RECURRENT HIGH-GRADE GLIOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.37] [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)
- Eudocia Lee
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katrina Smith
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Elizabeth Gerstner
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - John Kuhn
- University of Texas, Austin, TX, USA
| | - David Reardon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lakshmi Nayak
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andrew Norden
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Deirdre Stokes
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Priscilla Lam
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Tiago Martins
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Kelly Hempfling
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Sarah Gaffey
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Tracy Batchelor
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Dan Duda
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Rakesh Jain
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Wen
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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24
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Lee E, Reardon D, Schiff D, Drappatz J, Muzikansky A, Grimm S, Norden A, Nayak L, Beroukhim R, Rinne M, Chi A, Batchelor T, Hempfling K, McCluskey C, Smith K, Gaffey S, Wrigley B, Ligon K, Raizer J, Wen P. AT-36PANOBINOSTAT IN COMBINATION WITH BEVACIZUMAB FOR RECURRENT GLIOBLASTOMA AND ANAPLASTIC GLIOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.36] [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)
- Eudocia Lee
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Reardon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Schiff
- University of Virginia, Charlottesville, VA, USA
| | | | | | - Sean Grimm
- Central Dupage Hospital, Warrenville, IL, USA
| | - Andrew Norden
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lakshmi Nayak
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rameen Beroukhim
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mikael Rinne
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andrew Chi
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Tracy Batchelor
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Kelly Hempfling
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | | | - Katrina Smith
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Sarah Gaffey
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Brendan Wrigley
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Keith Ligon
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey Raizer
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patrick Wen
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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25
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Ambady P, Holdhoff M, Ferrigno C, Grossman S, Anderson MD, Liu D, Conrad C, Penas-Prado M, Gilbert MR, Yung AWK, de Groot J, Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi JI, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M, Apok V, Mills S, Soh C, Karabatsou K, Arimappamagan A, Arya S, Majaid M, Somanna S, Santosh V, Schaff L, Armentano F, Harrison C, Lassman A, McKhann G, Iwamoto F, Armstrong T, Yuan Y, Liu D, Acquaye A, Vera-Bolanos E, Diefes K, Heathcock L, Cahill D, Gilbert M, Aldape K, Arrillaga-Romany I, Ruddy K, Greenberg S, Nayak L, Avgeropoulos N, Avgeropoulos G, Riggs G, Reilly C, Banerji N, Bruns P, Hoag M, Gilliland K, Trusheim J, Bekaert L, Borha A, Emery E, Busson A, Guillamo JS, Bell M, Harrison C, Armentano F, Lassman A, Connolly ES, Khandji A, Iwamoto F, Blakeley J, Ye X, Bergner A, Dombi E, Zalewski C, Follmer K, Halpin C, Fayad L, Jacobs M, Baldwin A, Langmead S, Whitcomb T, Jennings D, Widemann B, Plotkin S, Brandes AA, Mason W, Pichler J, Nowak AK, Gil M, Saran F, Revil C, Lutiger B, Carpentier AF, Milojkovic-Kerklaan B, Aftimos P, Altintas S, Jager A, Gladdines W, Lonnqvist F, Soetekouw P, van Linde M, Awada A, Schellens J, Brandsma D, Brenner A, Sun J, Floyd J, Hart C, Eng C, Fichtel L, Gruslova A, Lodi A, Tiziani S, Bridge CA, Baldock A, Kumthekar P, Dilfer P, Johnston SK, Jacobs J, Corwin D, Guyman L, Rockne R, Sonabend A, Cloney M, Canoll P, Swanson KR, Bromberg J, Schouten H, Schaafsma R, Baars J, Brandsma D, Lugtenburg P, van Montfort C, van den Bent M, Doorduijn J, Spalding A, LaRocca R, Haninger D, Saaraswat T, Coombs L, Rai S, Burton E, Burzynski G, Burzynski S, Janicki T, Marszalek A, Burzynski S, Janicki T, Burzynski G, Marszalek A, Cachia D, Smith T, Cardona AF, Mayor LC, Jimenez E, Hakim F, Yepes C, Bermudez S, Useche N, Asencio JL, Mejia JA, Vargas C, Otero JM, Carranza H, Ortiz LD, Cardona AF, Ortiz LD, Jimenez E, Hakim F, Yepes C, Useche N, Bermudez S, Asencio JL, Carranza H, Vargas C, Otero JM, Bartels C, Quintero A, Restrepo CE, Gomez S, Bernal-Vaca L, Lema M, Cardona AF, Ortiz LD, Useche N, Bermudez S, Jimenez E, Hakim F, Yepes C, Mejia JA, Bernal-Vaca L, Restrepo CE, Gomez S, Quintero A, Bartels C, Carranza H, Vargas C, Otero JM, Carlo M, Omuro A, Grommes C, Kris M, Nolan C, Pentsova E, Pietanza M, Kaley T, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, Artoni A, Carrabba G, Bertani G, Cogiamanian F, Ardolino G, Zarino B, Locatelli M, Caroli M, Rampini P, Chamberlain M, Raizer J, Soffetti R, Ruda R, Brandsma D, Boogerd W, Taillibert S, Le Rhun E, Jaeckle K, van den Bent M, Wen P, Chamberlain M, Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Hilton M, Kerloeguen Y, Guijarro A, Cloughsey T, Choi JH, Hong YK, Conrad C, Yung WKA, deGroot J, 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NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2013; 15:iii98-iii135. [PMCID: PMC3823897 DOI: 10.1093/neuonc/not182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
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