Pub Date : 2024-01-29eCollection Date: 2024-04-01DOI: 10.1093/nop/npae007
Katrina Roberto, James R Perry
{"title":"A longer and/or better life for the oldest old with glioblastoma.","authors":"Katrina Roberto, James R Perry","doi":"10.1093/nop/npae007","DOIUrl":"10.1093/nop/npae007","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"11 2","pages":"113-114"},"PeriodicalIF":2.4,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela Sekely, Konstantine K Zakzanis, Donald Mabbott, Derek S Tsang, Paul Kongkham, Gelareh Zadeh, Kim Edelstein
Abstract Background This study investigates long-term changes in neurocognitive performance and psychological symptoms in meningioma survivors, and associations with radiation dose to circumscribed brain regions. Methods We undertook a retrospective study of meningioma survivors who underwent longitudinal clinical neurocognitive assessments. Change in neurocognitive performance or psychological symptoms was assessed using reliable change indices. Radiation dosimetry, if prescribed, was evaluated based on treatment-planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Mixed effects analyses were used to explore whether incidental radiation to brain regions outside the tumor influence neurocognitive and psychological outcomes. Results Most (range=41-93%) survivors demonstrated stable – albeit often below average - neurocognitive and psychological trajectories, although some also exhibited improvements (range=0-31%) or declines (range=0-36%) over time. Higher radiation dose to the parietal-occipital region (partial R2=0.462) and cerebellum (partial R2=0.276) was independently associated with slower visuomotor processing speed. Higher dose to the hippocampi was associated with increases in depression (partial R2=0.367) and trait anxiety (partial R2=0.236). Conclusions Meningioma survivors experience neurocognitive deficits and psychological symptoms many years after diagnosis, and a proportion of them decline over time. This study offers proof of concept that incidental radiation to brain regions beyond the tumor site may contribute to these sequelae. Future investigations should include radiation dosimetry when examining risk factors that contribute to quality of survivorship in this growing population.
{"title":"Long-Term Neurocognitive and Psychological Outcomes in Meningioma Survivors: Individual Changes Over Time and Radiation Dosimetry","authors":"Angela Sekely, Konstantine K Zakzanis, Donald Mabbott, Derek S Tsang, Paul Kongkham, Gelareh Zadeh, Kim Edelstein","doi":"10.1093/nop/npad072","DOIUrl":"https://doi.org/10.1093/nop/npad072","url":null,"abstract":"Abstract Background This study investigates long-term changes in neurocognitive performance and psychological symptoms in meningioma survivors, and associations with radiation dose to circumscribed brain regions. Methods We undertook a retrospective study of meningioma survivors who underwent longitudinal clinical neurocognitive assessments. Change in neurocognitive performance or psychological symptoms was assessed using reliable change indices. Radiation dosimetry, if prescribed, was evaluated based on treatment-planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Mixed effects analyses were used to explore whether incidental radiation to brain regions outside the tumor influence neurocognitive and psychological outcomes. Results Most (range=41-93%) survivors demonstrated stable – albeit often below average - neurocognitive and psychological trajectories, although some also exhibited improvements (range=0-31%) or declines (range=0-36%) over time. Higher radiation dose to the parietal-occipital region (partial R2=0.462) and cerebellum (partial R2=0.276) was independently associated with slower visuomotor processing speed. Higher dose to the hippocampi was associated with increases in depression (partial R2=0.367) and trait anxiety (partial R2=0.236). Conclusions Meningioma survivors experience neurocognitive deficits and psychological symptoms many years after diagnosis, and a proportion of them decline over time. This study offers proof of concept that incidental radiation to brain regions beyond the tumor site may contribute to these sequelae. Future investigations should include radiation dosimetry when examining risk factors that contribute to quality of survivorship in this growing population.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"14 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Egiroh Omene, Omar Abdel-Rahman, Eugene Batuyong, Samir Patel, Roland Coppens, Jacob Easaw, Kelvin Young
Abstract Background Temozolomide (TMZ) is an oral, systemic chemotherapy used chiefly for treating high grade glioma. Due to the rising costs of systemic chemotherapy, many jurisdictions have replaced brand-name with generic formulations. The aim of this study was to determine whether or not there was difference in the incidence of grade 3 or 4 bone marrow toxicity and median overall survival in patients treated with brand-name vs generic TMZ in the province of Alberta, Canada. The province suspended use of generic TMZ based on preliminary data pointing to excess toxicity. Methods This multicenter, retrospective study included data from patients with newly diagnosed high grade glioma that received treatment with TMZ in Alberta. Multivariate logistic regression analysis was performed to determine association between grade 3 or 4 toxicity to generic vs. brand-name TMZ exposure, ECOG score and age. Kaplan-Meier survival estimates and log-rank testing were used to determine differences in overall survival between the brand-name and generic TMZ cohorts, as well as the cytopenic vs non-cytopenic patients. Furthermore, a screening analysis for grade 3 or 4 bone marrow toxicity was conducted on all de novo glioma patients treated with brand-name TMZ after Alberta preemptively stopped generic TMZ. Results Grade 3 or 4 neutropenia and thrombocytopenia were observed in 15% and 19% of patients treated with generic TMZ (n=156) as compared to 3% and 5% of patients (n=100) treated with brand-name TMZ treated patients; p= 0.003 and 0.001. A trend towards increased median overall survival in GBM patients treated with generic TMZ (13.7 months) versus brand-name (15.8 months, p = 0.178.) was also observed though meeting statistical significance. Based on these results, the province stopped the use of generic TMZ and reverted to the Merck TMZ. An initial review of all new glioma patients (n= 89) treated with Merck TMZ since the province stopped generic drug demonstrated 3.4% and 10.1% grade 3 or 4 neutropenia, and respectively. Conclusions The statistically significant difference in toxicity profile has prompted the province of Alberta to replace generic TMZ for brand-name TMZ in high grade glioma patients pending more detailed analysis. Our study provides evidence supporting the importance of conducting prospective studies on long-term safety for generic chemotherapies.
{"title":"Switch to generic formulation of temozolomide results in statistically significant increase in grade 3 and 4 bone marrow toxicity in glioma patients in the province of Alberta","authors":"Egiroh Omene, Omar Abdel-Rahman, Eugene Batuyong, Samir Patel, Roland Coppens, Jacob Easaw, Kelvin Young","doi":"10.1093/nop/npad065","DOIUrl":"https://doi.org/10.1093/nop/npad065","url":null,"abstract":"Abstract Background Temozolomide (TMZ) is an oral, systemic chemotherapy used chiefly for treating high grade glioma. Due to the rising costs of systemic chemotherapy, many jurisdictions have replaced brand-name with generic formulations. The aim of this study was to determine whether or not there was difference in the incidence of grade 3 or 4 bone marrow toxicity and median overall survival in patients treated with brand-name vs generic TMZ in the province of Alberta, Canada. The province suspended use of generic TMZ based on preliminary data pointing to excess toxicity. Methods This multicenter, retrospective study included data from patients with newly diagnosed high grade glioma that received treatment with TMZ in Alberta. Multivariate logistic regression analysis was performed to determine association between grade 3 or 4 toxicity to generic vs. brand-name TMZ exposure, ECOG score and age. Kaplan-Meier survival estimates and log-rank testing were used to determine differences in overall survival between the brand-name and generic TMZ cohorts, as well as the cytopenic vs non-cytopenic patients. Furthermore, a screening analysis for grade 3 or 4 bone marrow toxicity was conducted on all de novo glioma patients treated with brand-name TMZ after Alberta preemptively stopped generic TMZ. Results Grade 3 or 4 neutropenia and thrombocytopenia were observed in 15% and 19% of patients treated with generic TMZ (n=156) as compared to 3% and 5% of patients (n=100) treated with brand-name TMZ treated patients; p= 0.003 and 0.001. A trend towards increased median overall survival in GBM patients treated with generic TMZ (13.7 months) versus brand-name (15.8 months, p = 0.178.) was also observed though meeting statistical significance. Based on these results, the province stopped the use of generic TMZ and reverted to the Merck TMZ. An initial review of all new glioma patients (n= 89) treated with Merck TMZ since the province stopped generic drug demonstrated 3.4% and 10.1% grade 3 or 4 neutropenia, and respectively. Conclusions The statistically significant difference in toxicity profile has prompted the province of Alberta to replace generic TMZ for brand-name TMZ in high grade glioma patients pending more detailed analysis. Our study provides evidence supporting the importance of conducting prospective studies on long-term safety for generic chemotherapies.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"36 23","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136318174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dario Di Perri, David Hofstede, Dianne Hartgerink, Karin Terhaag, Ruud Houben, Alida A Postma, Ann Hoeben, Monique Anten, Linda Ackermans, Inge Compter, Daniëlle B P Eekers
Abstract Background Glioblastoma (GBM) is widely treated using large radiotherapy margins, resulting in substantial irradiation of the surrounding cerebral structures. In this context, the question arises whether these margins could be safely reduced. In 2018, clinical target volume (CTV) expansion was reduced in our institution from 20 to 15 mm around the gross target volume (GTV) (ie, the contrast-enhancing tumor/cavity). We sought to retrospectively analyze the impact of this reduction. Methods All adult patients with GBM treated between January 2015 and December 2020 with concurrent chemoradiation (60Gy/2Gy or 59.4Gy/1.8Gy) were analyzed. Patients treated using a 20 (CTV20, n = 57) or 15 mm (CTV15, n = 56) CTV margin were compared for target volumes, dose parameters to the surrounding organs, pattern of recurrence, and survival outcome. Results Mean GTV was similar in both groups (ie, CTV20: 39.7cm3; CTV15: 37.8cm3; P = .71). Mean CTV and PTV were reduced from 238.9cm3 to 176.7cm3 (P = .001) and from 292.6cm3 to 217.0cm3 (P < .001), for CTV20 and CTV15, respectively. As a result, average brain mean dose (Dmean) was reduced from 25.2Gy to 21.0Gy (P = .002). Significantly lower values were also observed for left hippocampus Dmean, brainstem D0.03cc, cochleas Dmean, and pituitary Dmean. Pattern of recurrence was similar, as well as patient outcome, ie, median progression-free survival was 8.0 and 7.0 months (P = .80), and median overall survival was 11.0 and 14.0 months (P = .61) for CTV20 and CTV15, respectively. Conclusions In GBM patients treated with chemoradiation, reducing the CTV margin from 20 to 15 mm appears to be safe and offers the potential for less treatment toxicity.
摘要背景胶质母细胞瘤(GBM)广泛使用大放射治疗边缘，导致周围大脑结构的大量照射。在这方面，问题是这些差额是否可以安全地减少。2018年，我院临床靶体积(CTV)的扩张范围从总靶体积(GTV)(即增强肿瘤/腔)周围的20毫米缩小到15毫米。我们试图回顾性分析这种减少的影响。方法分析2015年1月至2020年12月期间接受同步放化疗(60Gy/2Gy或59.4Gy/1.8Gy)治疗的所有成年GBM患者。采用20 (CTV20, n = 57)或15 mm (CTV15, n = 56) CTV切缘治疗的患者比较靶体积、对周围器官的剂量参数、复发模式和生存结果。结果两组平均GTV相似(CTV20: 39.7cm3;CTV15: 37.8立方厘米;P = .71)。平均CTV和PTV从238.9cm3降至176.7cm3 (P = 0.001)，从292.6cm3降至217.0cm3 (P <.001)，分别为CTV20和CTV15。结果脑平均剂量(Dmean)由25.2Gy降至21.0Gy (P = 0.002)。左海马Dmean、脑干D0.03cc、耳蜗Dmean、垂体Dmean均显著降低。复发模式和患者结局相似，即CTV20和CTV15的中位无进展生存期分别为8.0和7.0个月(P = 0.80)，中位总生存期分别为11.0和14.0个月(P = 0.61)。结论在接受放化疗的GBM患者中，将CTV边缘从20 mm减少到15 mm似乎是安全的，并且有可能减少治疗毒性。
{"title":"Impact of CTV margin reduction in glioblastoma patients treated with concurrent chemoradiation","authors":"Dario Di Perri, David Hofstede, Dianne Hartgerink, Karin Terhaag, Ruud Houben, Alida A Postma, Ann Hoeben, Monique Anten, Linda Ackermans, Inge Compter, Daniëlle B P Eekers","doi":"10.1093/nop/npad071","DOIUrl":"https://doi.org/10.1093/nop/npad071","url":null,"abstract":"Abstract Background Glioblastoma (GBM) is widely treated using large radiotherapy margins, resulting in substantial irradiation of the surrounding cerebral structures. In this context, the question arises whether these margins could be safely reduced. In 2018, clinical target volume (CTV) expansion was reduced in our institution from 20 to 15 mm around the gross target volume (GTV) (ie, the contrast-enhancing tumor/cavity). We sought to retrospectively analyze the impact of this reduction. Methods All adult patients with GBM treated between January 2015 and December 2020 with concurrent chemoradiation (60Gy/2Gy or 59.4Gy/1.8Gy) were analyzed. Patients treated using a 20 (CTV20, n = 57) or 15 mm (CTV15, n = 56) CTV margin were compared for target volumes, dose parameters to the surrounding organs, pattern of recurrence, and survival outcome. Results Mean GTV was similar in both groups (ie, CTV20: 39.7cm3; CTV15: 37.8cm3; P = .71). Mean CTV and PTV were reduced from 238.9cm3 to 176.7cm3 (P = .001) and from 292.6cm3 to 217.0cm3 (P &lt; .001), for CTV20 and CTV15, respectively. As a result, average brain mean dose (Dmean) was reduced from 25.2Gy to 21.0Gy (P = .002). Significantly lower values were also observed for left hippocampus Dmean, brainstem D0.03cc, cochleas Dmean, and pituitary Dmean. Pattern of recurrence was similar, as well as patient outcome, ie, median progression-free survival was 8.0 and 7.0 months (P = .80), and median overall survival was 11.0 and 14.0 months (P = .61) for CTV20 and CTV15, respectively. Conclusions In GBM patients treated with chemoradiation, reducing the CTV margin from 20 to 15 mm appears to be safe and offers the potential for less treatment toxicity.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"132 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136234161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski
{"title":"Time to treat the climate and nature crisis as one indivisible global health emergency","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski","doi":"10.1093/nop/npad066","DOIUrl":"https://doi.org/10.1093/nop/npad066","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"48 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135217667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina Stadler, Dorothee Gramatzki, Emilie Le Rhun, Andreas F Hottinger, Thomas Hundsberger, Ulrich Roelcke, Heinz Läubli, Silvia Hofer, Katharina Seystahl, Hans-Georg Wirsching, Michael Weller, Patrick Roth
Abstract Background Incidence rates of glioblastoma in very old patients are rising. The standard of care for this cohort is only partially defined and survival remains poor. The aims of this study were to reveal current practice of tumor-specific therapy and supportive care, and to identify predictors for survival in this cohort. Methods Patients aged 80 years or older at the time of glioblastoma diagnosis were retrospectively identified in six clinical centers in Switzerland and France. Demographics, clinical parameters and survival outcomes were annotated from patient charts. Cox proportional hazards modeling was performed to identify parameters associated with survival. Results Of 107 patients, 45 were diagnosed by biopsy, 30 underwent subtotal resection and 25 had gross total resection. In 7 patients, the extent of resection was not specified. Post-operatively, 34 patients did not receive further tumor-specific treatment. Twelve patients received radiotherapy with concomitant temozolomide, but only 2 patients had maintenance temozolomide therapy. Fourteen patients received temozolomide alone, 35 patients radiotherapy alone, one patient received bevacizumab and one took part in a clinical trial. Median progression-free survival (PFS) was 3.3 months and median overall survival (OS) was 4.2 months. Among patients who received any postoperative treatment, median PFS was 3.9 months and median OS was 7.2 months. Karnofsky performance status (KPS) ≥ 70%, gross total resection and combination therapy were associated with better outcome. The median time spent hospitalized was 30 days, accounting for 23% of the median OS. End of life care was mostly provided by nursing homes (n = 20; 32%) and palliative care wards (n = 16; 26%). Conclusions In this cohort of very old patients diagnosed with glioblastoma, a large proportion was treated with best supportive care. Treatment beyond surgery and, in particular, combined modality treatment were associated with longer OS and may be considered for selected patients even at higher ages.
{"title":"Glioblastoma in the oldest old: clinical characteristics, therapy and outcome in patients aged 80 years and older","authors":"Christina Stadler, Dorothee Gramatzki, Emilie Le Rhun, Andreas F Hottinger, Thomas Hundsberger, Ulrich Roelcke, Heinz Läubli, Silvia Hofer, Katharina Seystahl, Hans-Georg Wirsching, Michael Weller, Patrick Roth","doi":"10.1093/nop/npad070","DOIUrl":"https://doi.org/10.1093/nop/npad070","url":null,"abstract":"Abstract Background Incidence rates of glioblastoma in very old patients are rising. The standard of care for this cohort is only partially defined and survival remains poor. The aims of this study were to reveal current practice of tumor-specific therapy and supportive care, and to identify predictors for survival in this cohort. Methods Patients aged 80 years or older at the time of glioblastoma diagnosis were retrospectively identified in six clinical centers in Switzerland and France. Demographics, clinical parameters and survival outcomes were annotated from patient charts. Cox proportional hazards modeling was performed to identify parameters associated with survival. Results Of 107 patients, 45 were diagnosed by biopsy, 30 underwent subtotal resection and 25 had gross total resection. In 7 patients, the extent of resection was not specified. Post-operatively, 34 patients did not receive further tumor-specific treatment. Twelve patients received radiotherapy with concomitant temozolomide, but only 2 patients had maintenance temozolomide therapy. Fourteen patients received temozolomide alone, 35 patients radiotherapy alone, one patient received bevacizumab and one took part in a clinical trial. Median progression-free survival (PFS) was 3.3 months and median overall survival (OS) was 4.2 months. Among patients who received any postoperative treatment, median PFS was 3.9 months and median OS was 7.2 months. Karnofsky performance status (KPS) ≥ 70%, gross total resection and combination therapy were associated with better outcome. The median time spent hospitalized was 30 days, accounting for 23% of the median OS. End of life care was mostly provided by nursing homes (n = 20; 32%) and palliative care wards (n = 16; 26%). Conclusions In this cohort of very old patients diagnosed with glioblastoma, a large proportion was treated with best supportive care. Treatment beyond surgery and, in particular, combined modality treatment were associated with longer OS and may be considered for selected patients even at higher ages.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"33 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135567806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriela T Gomez, Brandon E Turner, Kristin J Redmond, Curtiland Deville, Subha Perni
Journal Article Corrected proof Neuro-oncology clinical trial locations and social vulnerability in the United States Get access Gabriela T Gomez, Gabriela T Gomez Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA https://orcid.org/0000-0002-1761-0070 Search for other works by this author on: Oxford Academic Google Scholar Brandon E Turner, Brandon E Turner Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, USA Search for other works by this author on: Oxford Academic Google Scholar Kristin J Redmond, Kristin J Redmond Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA Search for other works by this author on: Oxford Academic Google Scholar Curtiland Deville, Jr, Curtiland Deville, Jr Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA Search for other works by this author on: Oxford Academic Google Scholar Subha Perni Subha Perni Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Corresponding Author: Subha Perni, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Y2.5316, 1515 Holcombe Blvd, Houston TX, 77030, USA (SPerni@mdanderson.org) https://orcid.org/0000-0003-2851-4903 Search for other works by this author on: Oxford Academic Google Scholar Neuro-Oncology Practice, npad062, https://doi.org/10.1093/nop/npad062 Published: 20 October 2023 Article history Corrected and typeset: 20 October 2023 Published: 20 October 2023
期刊文章更正证明美国神经肿瘤学临床试验地点和社会脆弱性获取Gabriela T Gomez, Gabriela T Gomez流行病学系，约翰霍普金斯大学公共卫生学院，巴尔的摩，马里兰州，美国https://orcid.org/0000-0002-1761-0070牛津大学学术bbb学者布兰登·E·特纳，布兰登·E·特纳放射肿瘤科，布莱根妇女医院，波士顿，马萨诸塞州，美国，搜索作者的其他著作:牛津大学学术bb1学者克里斯汀·J·雷德蒙德，克里斯汀·J·雷德蒙德放射肿瘤学和分子辐射科学系，约翰霍普金斯大学，巴尔的摩，马里兰州，美国牛津大学学术谷歌学者Curtiland Deville, Jr, Curtiland Deville, Jr放射肿瘤学和分子放射科学系，约翰霍普金斯大学，巴尔的摩，马里兰州，美国搜索本文作者的其他著作:牛津大学学术谷歌学者Subha Perni Subha Perni放射肿瘤学部门，德克萨斯大学MD安德森癌症中心，休斯顿，德克萨斯州，美国通讯作者:Subha Perni，医学博士，放射肿瘤学部门，德克萨斯大学MD安德森癌症中心，Y2.5316, 1515 Holcombe Blvd, Houston TX, 77030, USA (SPerni@mdanderson.org) https://orcid.org/0000-0003-2851-4903搜索作者的其他作品:Oxford Academic谷歌Scholar neurooncology Practice, npad062, https://doi.org/10.1093/nop/npad062发表:2023年10月20日文章历史校正和排版:2023年10月20日发表:2023年10月20日
{"title":"Neuro-oncology clinical trial locations and social vulnerability in the United States","authors":"Gabriela T Gomez, Brandon E Turner, Kristin J Redmond, Curtiland Deville, Subha Perni","doi":"10.1093/nop/npad062","DOIUrl":"https://doi.org/10.1093/nop/npad062","url":null,"abstract":"Journal Article Corrected proof Neuro-oncology clinical trial locations and social vulnerability in the United States Get access Gabriela T Gomez, Gabriela T Gomez Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA https://orcid.org/0000-0002-1761-0070 Search for other works by this author on: Oxford Academic Google Scholar Brandon E Turner, Brandon E Turner Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, USA Search for other works by this author on: Oxford Academic Google Scholar Kristin J Redmond, Kristin J Redmond Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA Search for other works by this author on: Oxford Academic Google Scholar Curtiland Deville, Jr, Curtiland Deville, Jr Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA Search for other works by this author on: Oxford Academic Google Scholar Subha Perni Subha Perni Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Corresponding Author: Subha Perni, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Y2.5316, 1515 Holcombe Blvd, Houston TX, 77030, USA (SPerni@mdanderson.org) https://orcid.org/0000-0003-2851-4903 Search for other works by this author on: Oxford Academic Google Scholar Neuro-Oncology Practice, npad062, https://doi.org/10.1093/nop/npad062 Published: 20 October 2023 Article history Corrected and typeset: 20 October 2023 Published: 20 October 2023","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135567850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Margaret Shatara, Megan Blue, Joseph Stanek, Yin A Liu, Daniel M Prevedello, Pierre Giglio, Vinay K Puduvalli, Sharon L Gardner, Jeffrey C Allen, Kenneth K Wong, Marvin D Nelson, Floyd H Gilles, Roberta H Adams, Jasmine Pauly, Katrina O’Halloran, Ashley S Margol, Girish Dhall, Jonathan L Finlay
Abstract Background Patients with relapsed intracranial germinoma can achieve durable remission with standard chemotherapy regimens and/or re-irradiation; however, innovative therapies are required for patients with relapsed and/or refractory intracranial non-germinomatous germ cell tumors (NGGCTs) due to their poor prognosis. Improved outcomes have been reported using re-induction chemotherapy to achieve minimal residual disease, followed by marrow-ablative chemotherapy (HDCx) with autologous hematopoietic progenitor cell rescue (AuHPCR). We conducted a phase II trial evaluating the response and toxicity of a 3-drug combination developed for recurrent intracranial GCTs (iGCTs) consisting of gemcitabine, paclitaxel and oxaliplatin (GemPOx). Methods Nine patients with confirmed relapsed or refractory intracranial GCT were enrolled after signing informed consent, and received at least two cycles of GemPOx, of which all but one had relapsed or refractory NGGCTs. One patient with progressive disease was found to have pathologically confirmed malignant transformation to pure embryonal rhabdomyosarcoma (without GCT elements), hence was ineligible and not included in the analysis. Patients who experienced sufficient responses proceeded to receive HDCx with AuHPCR. Treatment response was determined based on radiographic tumor assessments and tumor markers. Results Seven patients achieved sufficient response and proceeded with HDCx and AuHPCR, and five subsequently received additional radiotherapy. Two patients developed progressive disease while receiving GemPOx. Myelosuppression and transaminitis were the most common treatment-related adverse events. With a mean follow-up of 44 months, 4 patients (3 NGGCTs, 1 germinoma) are alive without evidence of disease. Conclusion GemPOx demonstrates efficacy in facilitating stem cell mobilization, thus facilitating the feasibility of both HDCx and radiotherapy.
{"title":"Final Report of the Phase II NEXT/CNS-GCT-4 Trial: GemPOx followed by Marrow-ablative Chemotherapy for Recurrent Intracranial Germ Cell Tumors","authors":"Margaret Shatara, Megan Blue, Joseph Stanek, Yin A Liu, Daniel M Prevedello, Pierre Giglio, Vinay K Puduvalli, Sharon L Gardner, Jeffrey C Allen, Kenneth K Wong, Marvin D Nelson, Floyd H Gilles, Roberta H Adams, Jasmine Pauly, Katrina O’Halloran, Ashley S Margol, Girish Dhall, Jonathan L Finlay","doi":"10.1093/nop/npad067","DOIUrl":"https://doi.org/10.1093/nop/npad067","url":null,"abstract":"Abstract Background Patients with relapsed intracranial germinoma can achieve durable remission with standard chemotherapy regimens and/or re-irradiation; however, innovative therapies are required for patients with relapsed and/or refractory intracranial non-germinomatous germ cell tumors (NGGCTs) due to their poor prognosis. Improved outcomes have been reported using re-induction chemotherapy to achieve minimal residual disease, followed by marrow-ablative chemotherapy (HDCx) with autologous hematopoietic progenitor cell rescue (AuHPCR). We conducted a phase II trial evaluating the response and toxicity of a 3-drug combination developed for recurrent intracranial GCTs (iGCTs) consisting of gemcitabine, paclitaxel and oxaliplatin (GemPOx). Methods Nine patients with confirmed relapsed or refractory intracranial GCT were enrolled after signing informed consent, and received at least two cycles of GemPOx, of which all but one had relapsed or refractory NGGCTs. One patient with progressive disease was found to have pathologically confirmed malignant transformation to pure embryonal rhabdomyosarcoma (without GCT elements), hence was ineligible and not included in the analysis. Patients who experienced sufficient responses proceeded to receive HDCx with AuHPCR. Treatment response was determined based on radiographic tumor assessments and tumor markers. Results Seven patients achieved sufficient response and proceeded with HDCx and AuHPCR, and five subsequently received additional radiotherapy. Two patients developed progressive disease while receiving GemPOx. Myelosuppression and transaminitis were the most common treatment-related adverse events. With a mean follow-up of 44 months, 4 patients (3 NGGCTs, 1 germinoma) are alive without evidence of disease. Conclusion GemPOx demonstrates efficacy in facilitating stem cell mobilization, thus facilitating the feasibility of both HDCx and radiotherapy.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135803929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine B Peters, Candice Alford, Amy Heltemes, Alicia Savelli, Daniel B Landi, Gloria Broadwater, Annick Desjardins, Margaret O Johnson, Justin T Low, Mustafa Khasraw, David M Ashley, Henry S Friedman, Mallika P Patel
Abstract Background Isocitrate dehydrogenase (IDH) is commonly mutated (mIDH) in gliomas, and this mutant enzyme produces the oncometabolite 2-hydroxyglutarate (2HG). 2HG promotes gliomagenesis and is implicated in epileptogenesis. Ivosidenib (IVO), a small molecule oral mIDH1 inhibitor, is FDA-approved for mIDH1 newly diagnosed and relapsed/refractory acute myeloid leukemia. Moreover, IVO has efficacy in clinical trials for recurrent mIDH1 gliomas. Given the lack of targeted treatments for gliomas, we initiated off-label IVO for mIDH glioma patients in October 2020. Methods Retrospectively, we sought to assess early outcomes in our patients and describe their experience on IVO from October 2020 through February 2022. Our objective was to report on the following variables of off-label use of IVO: radiographic response, seizure control, tolerability, and access to the medication. All patients initially received single-agent IVO dosed at 500 mg orally once daily. Results The cohort age range was 21–74 years. Tumor types included astrocytoma (n = 14) and oligodendroglioma (n = 16), with most being grade 2 (n = 21). The best radiographic response in nonenhancing disease (n = 22) was 12 stable diseases, 5 minor responses, 3 partial responses, and 2 progressive diseases. Seizure frequency was stable to improved for most patients (70%, n = 21). IVO was well-tolerated, with the most common toxicities being diarrhea, elevated creatine kinase, and QTc interval prolongation. Most patients (66.7%, n = 20) received drugs via the patient assistance program, with insurance initially covering a third of patients and with ongoing use, later covering 60%. Conclusions Targeted therapies like IVO are options for mIDH glioma patients and can provide positive oncologic and neurological outcomes.
{"title":"Use, Access, and Initial Outcomes of Off-Label Ivosidenib in Patients with IDH1 Mutant Glioma","authors":"Katherine B Peters, Candice Alford, Amy Heltemes, Alicia Savelli, Daniel B Landi, Gloria Broadwater, Annick Desjardins, Margaret O Johnson, Justin T Low, Mustafa Khasraw, David M Ashley, Henry S Friedman, Mallika P Patel","doi":"10.1093/nop/npad068","DOIUrl":"https://doi.org/10.1093/nop/npad068","url":null,"abstract":"Abstract Background Isocitrate dehydrogenase (IDH) is commonly mutated (mIDH) in gliomas, and this mutant enzyme produces the oncometabolite 2-hydroxyglutarate (2HG). 2HG promotes gliomagenesis and is implicated in epileptogenesis. Ivosidenib (IVO), a small molecule oral mIDH1 inhibitor, is FDA-approved for mIDH1 newly diagnosed and relapsed/refractory acute myeloid leukemia. Moreover, IVO has efficacy in clinical trials for recurrent mIDH1 gliomas. Given the lack of targeted treatments for gliomas, we initiated off-label IVO for mIDH glioma patients in October 2020. Methods Retrospectively, we sought to assess early outcomes in our patients and describe their experience on IVO from October 2020 through February 2022. Our objective was to report on the following variables of off-label use of IVO: radiographic response, seizure control, tolerability, and access to the medication. All patients initially received single-agent IVO dosed at 500 mg orally once daily. Results The cohort age range was 21–74 years. Tumor types included astrocytoma (n = 14) and oligodendroglioma (n = 16), with most being grade 2 (n = 21). The best radiographic response in nonenhancing disease (n = 22) was 12 stable diseases, 5 minor responses, 3 partial responses, and 2 progressive diseases. Seizure frequency was stable to improved for most patients (70%, n = 21). IVO was well-tolerated, with the most common toxicities being diarrhea, elevated creatine kinase, and QTc interval prolongation. Most patients (66.7%, n = 20) received drugs via the patient assistance program, with insurance initially covering a third of patients and with ongoing use, later covering 60%. Conclusions Targeted therapies like IVO are options for mIDH glioma patients and can provide positive oncologic and neurological outcomes.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135767397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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