bluuebunny/crossref_metadata_2025 huggingface dataset:
RADT-09. CHEMORADIOTHERAPY WITH TEMOZOLOMIDE VS. RADIOTHERAPY ALONE IN PATIENTS WITH IDH WILD-TYPE AND TERT PROMOTER MUTATION HISTOLOGICAL GRADE 2/3 GLIOMAS: A POSTHOC ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL
Authors: Wang Peng , Zhang Jing , Feng Jin , Chen Li , Ren Yin , Deng Kaiwen , Liu Fei , Qiu Xiaoguang , Liu Yanwei
Published: November 2024

PURPOSE

In 2016, we initiated a signal center prospective randomized trial to compare chemoradiotherapy (CRT) with temozolomide (TMZ) to radiotherapy (RT) alone in patients with IDH wild-type and TERT promoter mutation histological grade 2/3 gliomas. This study demonstrated patients who received CRT had a longer median OS than those who received RT alone and found no statistical difference in PFS between the two groups. Now, we recruited more patients in the CRT group to further explore whether there were differences in PFS between patients treated with CRT and RT. Besides, we explored the effect of MGMT promoter (MGMTp) methylation status on OS and PFS in patients receiving CRT therapy in the STUPP schedule.

METHODS

We expanded the scope by enrolling 21 participants in the CRT group and extending the follow-up period. OS and PFS were analyzed using the log-rank test, and high-risk factors were explored through Cox regression analysis.

RESULTS

Patients’ median follow-up is 21.9 months. CRT group has a longer median OS (25.3 vs 17.2 months; P = 0.029, HR = 0.443) and PFS (14.6 vs 8.3 months; P = 0.0008, HR = 0.387) than the RT group. Multivariate analysis identified CRT as a favorable prognostic variable for both OS (P = 0.003) and PFS (P = 0.002). The status of MGMTp methylation did not affect OS (P = 0.560, HR = 1.30) and PFS (P = 0.75, HR = 0.88) in patients with IDH-wt/TERTp-mut receiving TMZ chemotherapy. CRT with TMZ did not significantly increase grade 3 or higher toxicities.

CONCLUSIONS

The long-term results confirmed that the OS and PFS benefits of the RT plus TMZ regimen exceeded those of the RT alone group in patients with IDH-wt/TERTp-mut gliomas.
RADT-17. FRACTIONATED REIRRADIATION OF RECURRENT IDH WILDTYPE GLIOBLASTOMA: HIGHER REIRRADIAITON DOSE AND SAFETY
Authors: LeCompte Michael , Vuppala Neil , Reyes Juan , Page Brandi , Croog Victoria , Huang Ellen , Redmond Kristin , Kleinberg Lawrence
Published: November 2024

The optimal regimen, normal tissue tolerances, and appropriate indications for reirradiation for recurrent glioblastoma (GBM) are uncertain. We evaluate outcomes and toxicity after fractionated reirradiation. Patients with recurrent IDH wildtype GBM after prior standard radiotherapy during 2007-2022 were retrospectively reviewed. All patients initially received conventionally fractionated radiotherapy. Radiation necrosis (RN) was determined by imaging or pathology. Overall survival (OS) was estimated using Kaplan-Meier methodology. Univariate and multivariate Cox proportional hazard models for OS were constructed. Bivariable associations with RN were estimated using fisher exact tests. 99 patients (median age 56 yrs, median KPS 80) were treated with reirradiation (median followup 7.4 mo). Median time between initial and reirradiation was 20 months (range, 2 – 214 mo). Median received dose at reirradiation was 41.4 Gy (30.6 – 60 Gy) to a median planning target volume (PTV) of 183 cc (16 – 825 cc). Median cumulative maximum dose to the optics and brainstem were 54 Gy (4 – 103 Gy) and 76 Gy (5 – 146 Gy), respectively. Median OS was 9 mo (95% CI 6.2 – 10.6 mo). On univariate analysis, time between initial and reirradiation ≥24 mo (HR 0.58, CI 0.36 – 0.94) and reirradiation dose ≥41.4 Gy (HR 0.56, CI 0.35 – 0.88) were associated with longer OS. On multivariate analysis, interval between radiation sessions (HR 0.56, CI 0.34 – 0.91) and higher reirradiation dose (HR 0.55, CI 0.35 – 0.87) remained associated with OS. No cases of radiation injury to the optics or brainstem were reported. 10% of patients experienced RN. Reirradiation dose ≥41.4 Gy, reirradiation PTV ≥200 cc and interval between radiation sessions < 24 mo were not significantly associated with RN. These data support the safety and efficacy of fractionated reirradiation for recurrent GBM including for large tumors. This study suggests that higher reirradiation dose may be feasible, including for large treatment volumes.
RADT-34. RE-IRRADIATION REGIMENS FOR RECURRENT GLIOMA: SURVIVAL AND TOXICITY
Authors: de Jong Anouk , Cialdella Fia , van der Boog Arthur , Post Cathalijne , Dankbaar Jan-Willem , Hendrikse Jeroen , Kleynen Karin , Philippens Marielle , Smid Ernst , de Vos Filip , Robe Pierre , David Szabolcs , Snijders Tom , Verhoeff Joost
Published: November 2024

Re-irradiation is a common treatment option for recurrent high-grade glioma (HGG), though the optimal dose-fractionation regimen remains unclear. This report presents single-center data from an ongoing multicenter, retrospective study in the Netherlands. We included adult HGG patients treated with re-irradiation. Dose-fractionation regimens were categorized in 3 groups: conventionally fractionated radiotherapy (CFRT, <3Gy/fraction), hypofractionated radiotherapy (HFRT, 3-5 Gy/fraction) and stereotactic radiotherapy (SRT, ≥5Gy/fraction). We compared baseline characteristics, overall survival, and toxicity including incidence of radionecrosis between groups to identify the optimal dose-fractionation regimen. Of 112 patients, 33 underwent CFRT, 60 HFRT and 19 SRT. 21 patients had a good prognostic Niyazi score, 70 intermediate and 6 poor, with more poor scores in the SRT group. SRT patients had smaller median GTVs compared to HFRT and CFRT (1.9, 20.5, 32.8 respectively, p=0.003). Radiation groups also differed in primary histology (less grade 4 in CFRT, p=0.009), but not in age and KPS. Overall survival (OS) was worse for HFRT (median OS 9 months (95%-CI 6.5-11.5)) compared to CFRT (12 months (8.9-15.2, p=0.039)) and SRT (12 months (9.2-14.8, p = 0.012)), but did not differ between CFRT and SRT (p=0.437). In Cox regression, Karnofsky performance score <80 (hazard ratio (HR): 1.874, p=0.006) and large GTV (HR: 1.011, p=0.003) were independently associated with poor survival, while the fractionation schedule was not. Multivariable logistic regression on toxicity analysis indicated an increased risk of radionecrosis in the CFRT and HFRT groups compared to the SRT group (OR 5.861, p=0.011), even after adjusting for GTV and age. In conclusion, re-irradiation schemes in HGG are univariably, but not independently, associated with overall survival; this relationship seems to be confounded by differences in GTV and possibly by KPS. Radionecrosis was more common in HFRT and CFRT than in SRT. Extension and/or validation of findings will be performed in a multicenter cohort.
CTIM-30. NT-I7, A LONG-ACTING INTERLEUKIN-7, PROMOTES ACTIVATION, CYTOTOXIC FUNCTION, AND SELECTIVE CLONOTYPE EXPANSION OF CD8+ T CELLS IN PATIENTS WITH HIGH GRADE GLIOMAS
Authors: Barozinsky Kaiden , Foltz Jennifer A , Butt Omar H , Zhou Alice Y , Singhal Kartik , Griffith Obi , Griffith Malachi , Etter Kelsey , Grote Cierra , Luo Jingqin , Nehring Leslie , Katumba Ruth , Ferrando-Martinez Sara , Stermer Kristina , Lee Byung Ha , Johanns Tanner , Huang Jiayi , DiPersio John , Chheda Milan , Fehniger Todd , Campian Jian L
Published: November 2024

Lymphopenia following chemoradiation for high grade gliomas (HGG) is common and is associated with decreased survival. NT-I7 (efineptakin alfa) is a long-acting analog of the lymphocyte pro-survival cytokine, interleukin-7. Our Phase I dose-escalation study of 19 patients with HGG demonstrated early elevations in CD4+ and CD8+ T cells in the first 4 weeks after administration of NT-I7. In this study, we explored the diversity and potential functionality of the NT-I7-expanded T cell population. A subset of 4 subjects with glioblastoma multiforme (GBM) treated at 720 µg/kg of NT-I7 during adjuvant temozolomide in our study (NCT03687957) underwent Cellular Indexing of Transcriptomes and Epitopes by Sequencing (CITE-seq) of peripheral blood. CITE-seq with TCR clonotype sequencing (10x Genomics 5’) permitted simultaneous tracking of the T cell phenotype at the protein level, individual T cell clones, and gene expression dynamics between 4 timepoints: pre-treatment, and post-treatment weeks 1, 2, and 13. Here, we report the results of differential expression analyses between timepoints and patient-specific differences in T cell clonotype expansions. Both CD4+ and CD8+ T cells in our study patients had increased expression of T cell activation markers LTB, CISH, and CD74. CD8+ T cell subsets demonstrated additional elevations in genes important in cytotoxic function (granzymes (GZMA, GZMB) and perforin (PRF1)), MHC Class II expression (HLA-DRA, HLA-DRB1), and AP-1 transcription factor subunits (JUND, JUN, JUNB, FOS, FOSB). After excluding known viral antigen clonotypes, 2 of 4 patients demonstrated TCR clonotype expansion. Notably, nearly all the expanded TCR clonotypes were found within CD8+ T cells, but not CD4+ T cells. NT-I7 promotes activation, cytotoxic function, and selective clonotype expansion of CD8+ T cells in patients with HGG. This, combined with its role in increased CD4+ T cell counts, suggests NT-I7 may be a powerful tool to restore immune function after treatment-associated lymphopenia in HGG.
CTNI-09. TYPE II RAF INHIBITOR TOVORAFENIB IN RELAPSED/REFRACTORY (R/R) PEDIATRIC LOW-GRADE GLIOMA (PLGG): RESULTS FROM PATIENTS ON A DRUG HOLIDAY (DH) IN THE PHASE 2 FIREFLY-1 TRIAL
Authors: Perreault Sébastien , Khuong-Quang Dong-Anh , Kilburn Lindsay B , Landi Daniel B , Leary Sarah E S , Bailey Simon , Larouche Valérie , Nysom Karsten , Driever Pablo Hernáiz , Baxter Patricia A , Witt Olaf , Oren Michal Yalon , Abdelbaki Mohamed S , Kline Cassie , Whipple Nicholas S , Ziegler David S , van der Lugt Jasper , Hassall Timothy E , Gerber Nicolas U , Segal Devorah , Hansford Jordan R , McCowage Geoffrey , Kang Hyoung Jin , Han Jung Woo , Hargrave Darren , Franson Andrea T , Toledano Helen , Jabado Nada , Gottardo Nicholas G , Chi Susan N , Oren Liat , Tan Enrica E K , Mueller Sabine , Hoke Molly E , Kim Yeonhee , Walter Ashley , Da Costa Daniel , Manley Peter , Waanders Angela J
Published: November 2024

BACKGROUND

Tovorafenib, a selective, CNS-penetrant, type II RAF inhibitor, received US FDA accelerated approval for r/r BRAF-altered pLGG. Results from the ongoing FIREFLY-1 (NCT04775485) phase 2 study (Kilburn LK, et al. Nat Med. 2023) in this population showed clinically meaningful tumor responses and a manageable safety profile.

METHODS

Patients in FIREFLY-1 treated for ≥26 cycles (~24 months) who entered a DH period were routinely assessed every 3 cycles; once-weekly tovorafenib 420 mg/m2 (not to exceed 600 mg) could be restarted if there was radiographic and/or clinical evidence of new disease progression.

RESULTS

As of the April 19, 2024 data cutoff, 26 patients (BRAF fusion: 22; BRAF V600E mutation: 4) (33.8%) of 77 patients in arm 1 (pLGG registrational) had completed 2 years of treatment and started a DH. No patients on a DH withdrew. Twenty-four patients (92.3%) remain on a DH, of which 22 were evaluable for response (duration range: 0.6-10.9 months); duration of response off-treatment ranged from 0.0-8.5 months. (Ranges exclude 2 non-evaluable patients treated beyond radiographic progression who remained on treatment in first 26 cycles due to ongoing clinical benefit; both remain on DH without clinical progression.) Two patients had tumor progression while on a DH and restarted treatment; 1 patient with a BRAF V600E mutation progressed (≥25% in tumor size) after 1 month (rebound growth per O’Hare P., et al. Neuro-Oncol. 2024: ≥25% increase [per RANO-LGG] w/in 6 months of stopping treatment) and has been on retreatment for 4 months; 1 patient with a BRAF fusion progressed after 9 months and has been on retreatment for 3 months. Treatment-related adverse events of any grade experienced by patients on retreatment were alopecia and rash (1 each). Independent radiographic analysis for response during retreatment is ongoing.

CONCLUSIONS

Tovorafenib provided durable tumor responses off-treatment in patients with r/r pLGG on a DH in FIREFLY-1.
CTNI-15. A PERIOPERATIVE STUDY OF SAFUSIDENIB IN PATIENTS WITH IDH1 MUTATED GLIOMA
Authors: Whittle James , Rosenthal Mark , Spiteri Montana , Tobler Robert , Topp Monique , Cain Sarah , Jones Jordan , Shaya Sammy , Valkovic Adam , Fatunla Oluwaseun , Dimou James , Roberts-Thomson Samuel , McArdle David , Lui Elaine , Nijagal Brunda , Mitchell Camilla , Grimmond Sean , Best Sarah , Freytag Saskia , Drummond Kate
Published: November 2024

BACKGROUND

IDH mutations cause aberrant accumulation of (R)-2-hydroxyglutarate (2-HG), an oncometabolite that promotes tumorigenesis through abnormal hypermethylation of histones and DNA as well as suppression of normal cellular differentiation. IDH inhibition significantly improves progression free survival in patients with IDH mutant WHO grade 2 glioma, however most patients progress, and there is a lack of understanding on mechanistic reasons for failure.

METHODS

We tested Safusidenib, an oral, blood brain barrier penetrant IDH1 R132X enzyme inhibitor in a single arm, open label perioperative study. Patients with IDH1 mutated glioma, treatment naïve to radiation or chemotherapy, received Safusidenib (250 mg BID) for four weeks following surgical biopsy and prior to definitive resection (Part A). After resection patients continued Safusidenib until toxicity or progression (Part B). Translational endpoints include paired whole genome transcriptome sequencing (WGTS), single nuclei RNA sequencing (snRNAseq), spatial transcriptomics and spatial metabolomics as well as longitudinal sampling of blood and CSF for circulating tumour DNA (ctDNA). Here we are reporting Part A of the study.

RESULTS

As of May/27/2024 10 patients (mean age 37, 40% female) have been enrolled: seven with astrocytoma, three with oligodendroglioma; six had prior surgical resection. Pharmacokinetic sampling showed a mean tumor concentration 2457 ng/mL (range 957.0 – 4810) with tumor:plasma ratio 0.33. Consistent with mechanism, tumor 2-HG reduced 86% from biopsy (mean 75.0μM, range 7.8-203) to surgery (10.3μM, range 2.3 – 30.8), as well as identification of novel biomarkers of response. Paired tumour snRNAseq reveals transcriptional shift with changing cell-to-cell communication, and increased immune infiltration post-treatment, validated by spatial transcriptomics. Additionally, we find reduced heterogeneity consistent with a more differentiated tumour state. Treatment was well tolerated with ongoing follow-up.

CONCLUSIONS

This innovative trial facilitates intra-patient comparisons and confirmation of the on-target effects of Safusidenib, enhancing understanding of the mechanisms of response and resistance. The approach serves as a proof of concept for advancing drug development in glioma through perioperative trials.
CTNI-20. ADDRESSING SKIN ADVERSE EVENTS (AES) DURING MIRDAMETINIB TREATMENT IN PATIENTS WITH NEUROFIBROMATOSIS TYPE 1-ASSOCIATED PLEXIFORM NEUROFIBROMAS (NF1-PN): GUIDANCE FROM A MULTIDISCIPLINARY GROUP OF EXPERTS ON THE MANAGEMENT OF MEK INHIBITOR-ASSOCIATED SKIN AES
Authors: Hirbe Angela , Anadkat Milan , Boull Christina , Moertel Christopher , Nickerson Molly , Weber Michael , Babovic-Vuksanovic Dusica , Gershon Timothy
Published: November 2024

ReNeu (NCT03962543) is a trial of the investigational, oral, selective MEK1/2 inhibitor (MEKi) mirdametinib in adults (≥18 years) and children (2-17 years) with NF1-PN. Skin adverse events (AEs) were common in ReNeu, and some discontinuations were noted with low-grade AEs. A multidisciplinary team retrospectively reviewed skincare practices at one high-enrolling site (n=12) with no discontinuations due to skin AEs; these were incorporated into ReNeu trial recommendations and recently updated. The purpose was to prevent/manage skin AEs and maintain protocol treatment adherence. MEKi skin AEs vary by pubertal status, therefore recommendations also vary by pubertal status. All patients were counseled to adopt hygienic skincare practices, including bathing daily, and using mild cleansers and hypoallergenic skin moisturizers (cream or ointment-based emollient; minimum BID) to prevent dry skin. Prepubescent patients were advised to incorporate diluted bleach baths (3-4 times/week) when initiating mirdametinib or after rash development. Treatments recommended for mild-to-severe dermatitis were hydrocortisone cream (2.5% BID) on face/skinfold areas and triamcinolone ointment (0.1% BID) on trunk/extremities. Treatments for mild acneiform eruptions included topical clindamycin lotion (1.0% BID) until resolution, with optional hydrocortisone cream (2.5% BID). For moderate-to-severe acneiform eruptions, cephalexin (20 mg/kg/day divided BID, max 500 mg, ≤6 weeks), amoxicillin (25 mg/kg/day divided BID, max 875 mg, ≤6 weeks), or oral fluconazole (20 mg/kg/day, max 100 mg, 5 days then once weekly for 3 months) were suggested. Postpubescent patients were advised to initiate topical 1.0% clindamycin lotion and oral doxycycline or minocycline (50-mg daily, 3 months) with mirdametinib initiation. Patients with subsequent mild-to-severe acneiform eruptions were advised to apply hydrocortisone cream (2.5% BID) or triamcinolone ointment (0.1% BID). Referral to a dermatologist was suggested for all patients with uncontrolled dermatitis, worsening acneiform eruptions, or infection. Proactive skincare practices appeared effective at this site, but prospective validation is necessary before making clinical recommendations.
CTNI-30. A PHASE 2 DOUBLE-BLIND, RANDOMIZED, PROSPECTIVE, PLACEBO CONTROLLED STUDY OF NANO₂TM COMBINED WITH RADIATION AND TEMOZOLOMIDE IN PATIENTS WITH NEWLY-DIAGNOSED GLIOBLASTOMA: RESTORE
Authors: Badruddoja Michael A , Placencia Crystal , Unger Evan , Gellert Scott , Stea Baldassarre , Peters Katherine B , Kong Xiao-Tang , Aiken Robert , Goldin Caroline , Mahadevan Daruka , Goldlust Samuel A
Published: November 2024

INTRODUCTION

Glioblastoma (GBM) commonly has extensive hypoxic regions, possibly due to thrombosis from tumor-produced pro-coagulant factors. Radiation-induced cell death relies on oxygen free radicals and oxygen fixation of DNA-strand breaks. In the absence of oxygen tumor cells can repair the DNA strand breaks leading to treatment resistance. Hypoxic cells also exhibit chemoresistance due to decreased drug efficacy, limited drug diffusion, and poor delivery to distant cells. This study hypothesizes that increasing oxygen delivery to hypoxic GBM tissue using NanO₂ (2% w/v dodecafluoropentane emulsion) infusion will enhance the effectiveness of radiation therapy (RT) and chemotherapy (CT).

METHODS

Patients diagnosed with GBM per CNS5-WHO criteria receive standard chemoradiation: 30 fractions of focal RT with 60 Gy, delivered as 2 Gy fractions five days per week for six weeks with concurrent oral TMZ at 75 mg/m²/day for six weeks. Patients are randomized in a 1:2 ratio to receive either a placebo (0.9% Sodium Chloride) or NanO₂ infusion administered immediately prior to each RT dose. Patients continuously breathe oxygen during infusion and RT. Following six weeks of RT with temozolomide, patients have a four-week break before starting adjuvant temozolomide.

RESULTS

Ten patients have been enrolled in the RESTORE trial. Seven continue to be followed through maintenance treatment and long term follow up. There have been 23 non-hematologic adverse events described as CTCAE severity grade 3 and above. Grade 4, hematologic toxicity occurred in two patients, with one patient experiencing prolonged pancytopenia necessitating hematologic support and discontinuation of temozolomide. Two patients discontinued therapy due to early tumor progression.

CONCLUSION

This study is ongoing, assessing the safety and potential efficacy of NanO₂ in improving treatment outcomes for GBM by enhancing oxygen delivery to hypoxic tumor regions.
CTNI-32. A MULTICENTER PHASE 1 TRIAL OF TUCATINIB, TRASTUZUMAB, AND CAPECITABINE WITH STEREOTACTIC RADIOSURGERY IN PATIENTS WITH BRAIN METASTASES FROM HER2 POSITIVE BREAST CANCER (TUTOR)
Authors: Ahluwalia Manmeet , Ozair Ahmad , Bardhan Mainak , Bellur Shreyas , Starosciak Amy , Perche Dilanis , Khosla Atulya , Leon-Ariza Daniel , Rubens Muni , Odia Yazmin , Mehta Minesh , Kotecha Rupesh , McDermott Michael , Sandoval-Leon Ana , Mahtani Reshma , Peereboom David
Published: November 2024

BACKGROUND

Nearly 20-40% of HER2+ breast cancer patients develop brain metastases (BMs), where stereotactic radiosurgery (SRS) is standard-for-care for local control. Tucatinib, an oral HER2-selective TKI, is safe and efficacious in HER2+ breast cancer in combination with capecitabine and trastuzumab. Synergism between these 3 drugs (TCT) and radiation may enhance DNA damage. This phase 1 trial aims to evaluate TCT plus SRS for HER2+ breast cancer BMs (BCBM).

METHODS

TUTOR is a pre-registered (NCT05553522), single-arm, multicenter, ongoing, phase 1 trial that aims to determine the safety and efficacy of TCT+SRS in HER2+ BCBM patients. Patients with age 18-80 years, ECOG score 0-2, normal organ function, and ≤10 newly-diagnosed BMs are being enrolled at six US centers. Any number of prior systemic therapies are allowed, except tucatinib and capecitabine. Key exclusion criteria include leptomeningeal metastases, intra-tumoral or peri-tumoral hemorrhage, and BMs ≤5 mm of optic chiasm/nerve. Primary endpoint is maximum tolerated dose (MTD) of tucatinib, in this 3 + 3 de-escalation study starting at dose level (DL) 300 mg BID. DL-1 is 250 mg BID, and DL-2 is 200 mg BID. Secondary endpoints include efficacy as determined by response rate, intracranial progression-free survival (PFS), extracranial PFS, and overall survival. Neurocognitive outcomes are assessed using Hopkins Verbal Learning, Controlled Oral Word Association, Trail Making, and Grooved Pegboard Tests. Toxicities are assessed using CTCAE v5.0. Quality of life is assessed using Functional Assessment of Cancer Therapy with Brain Tumor module. Patients are administered tucatinib with SRS as per treating radiation oncologist, followed by tucatinib for two weeks, i.e. dose-limiting toxicity (DLT) period, followed by TCT until progression or intolerable toxicity. DLTs are defined by Grade 3 or 4 thrombocytopenia, grade 4 anemia, grade 4 neutropenia lasting >7 days, febrile neutropenia, and any non-hematologic toxicity of grade ≥3 (excluding alopecia). Cohort expansion at MTD to 40 patients is planned. Patient enrollment started in February 2023 and remains ongoing.
CTNI-37. INTERIM SAFETY ANALYSIS OF THE PHASE IB/II RANDOMIZED ANTI-GLUTAMATERGIC DRUG REPURPOSING TRIAL GLUGLIO IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (NCT05664464)
Authors: Wirsching Hans-Georg , Roth Patrick , Fischer Angela , Hundsberger Thomas , Migliorini Denis , Romagna Lorenz , Läubli Heinz , Seystahl Katharina , Imback Lukas , Hortobagyi Tibor , Held Leonhard , Bink Andrea , Weller Michael
Published: November 2024

The advent of cancer neuroscience has significantly advanced our understanding of brain tumor biology, yet the clinical implications remain largely unexplored. Glutamate, the most abundant excitatory neurotransmitter, presents a potential therapeutic target in brain tumors. Glioblastoma cells synthesize and secrete large amounts of glutamate, driving epilepsy, neuronal death, tumor growth, and invasion. Several brain-penetrating drugs, approved for other conditions, can inhibit glutamate synthesis, secretion, and signaling. These drugs include: (i) gabapentin, an anti-seizure medication that inhibits the glutamate synthesis enzyme branched-chain amino acid transaminase 1; (ii) sulfasalazine, an anti-inflammatory drug that blocks the cystine-glutamate exchanger system Xc, reducing glutamate secretion; and (iii) memantine, a cognitive enhancer that prevents glutamate-driven, calcium-induced neuronal death and tumor cell invasion by blocking N-methyl-D-aspartate type glutamate receptors. The multi-center, open-label, parallel-group, two-arm, 1:1 randomized phase Ib/II trial GLUGLIO is investigating the efficacy of a daily oral anti-glutamatergic triple combination of gabapentin, sulfasalazine, and memantine until tumor progression, in conjunction with standard chemoradiotherapy, compared to chemoradiotherapy alone. The primary endpoint is progression-free survival at 6 months (PFS-6). A sample size of 120 patients was determined to detect an increase in PFS-6 from 50% to 70%, with 80% power, using exploratory hypothesis testing at a one-sided significance level of 10%. Secondary endpoints include overall survival, seizure-free survival, response rate, quality of life for patients and caregivers, symptom burden, cognitive functioning, tumor glutamate levels (measured by magnetic resonance spectroscopy), and the use of anti-convulsants and steroids. Each drug is dosed up to the maximum approved amount. Results from the phase Ib part of the trial, including an interim safety analysis, will be presented at the conference.
CTNI-39. UPDATE ON GBM AGILE: A GLOBAL, PHASE 2/3 ADAPTIVE PLATFORM TRIAL TO EVALUATE MULTIPLE REGIMENS IN NEWLY DIAGNOSED AND RECURRENT GLIOBLASTOMA
Authors: Lassman Andrew , Alexander Brian , Berry Donald , Berry Nicholas , Buxton Meredith , Colman Howard , Gan Hui , de Groot John , de la Fuente Macarena , Drappatz Jan , Ducray Francois , Ellingson Benjamin , Gordon Gary , Hyddmark Emma , Johnson Adam , Khasraw Mustafa , Lee Eudocia , Lim Michael , McGlothlin Anna , Mellinghoff Ingo , Mikkelsen Tom , Nghiemphu Phioanh , Perry James , Powell Ashley , Sulman Erik , Tanner Krik , Untch Sarah , Weller Michael , Wen Patrick , Wick Antje , Yung Alfred , Cloughesy Timothy
Published: November 2024

BACKGROUND

GBM AGILE (Glioblastoma Adaptive, Global, Innovative Learning Environment) is a biomarker based, multi-arm, international, seamless Phase 2/3 platform trial designed to rapidly identify and confirm experimental therapies that improve overall survival for approval along with their associated biomarker signatures. GBM AGILE is a collaboration between academic investigators, patient organizations, and industry to support new drug applications for newly diagnosed (ND) and recurrent glioblastoma.

METHODS

The primary objective of GBM AGILE is to identify therapies that improve the overall survival in patients with ND or recurrent glioblastoma. Bayesian response adaptive randomization is used within subtypes of the disease to assign participants to investigational arms based on their performance. GBM AGILE operates under a Master Protocol allowing multiple drugs to be evaluated simultaneously and over time against a common control. New experimental therapies are added as information about promising new drugs is identified, while therapies are removed as they complete evaluation. Six investigational arms have been included to date. Along with an adaptive trial design, shared control arm and operational processes, GBM AGILE continues to incorporate new design and operational elements. One recent design element added to the Master Protocol for consideration for future arms is an extended evaluation period, of up to 11 months, for arms that reach maximum sample size in Stage 1 (Stage 1: learn most responsive signature) without having reached a decision for futility or graduation. Allowing data to mature and additional events to accumulate may increase the ability of the trial to detect efficacy, and if appropriate, for an arm to graduate to Stage 2 (Stage 2: confirm activity in graduating signature). Using improved and flexible processes, GBM AGILE continues to serve as a global trial that supports the efficient and rapid incorporation and evaluation of new experimental therapies for patients with glioblastoma. NCT number: NCT03970447.
CTNI-40. PSYCHOLOGICAL DOMAINS CORRELATE WITH ADHERENCE IN TTFIELDS TREATMENT OF GLIOBLASTOMA
Authors: Proescholdt Martin , Haj Amer , Schmidmeier Melissa , Muehlberger Andreas , Schmidt Nils-Ole
Published: November 2024

INTRODUCTION

Adherence is critical to the success of the treatment with Tumor Treating Fields (TTFields) for Glioblastoma Multiforme (GBM). Previously found factors influencing treatment adherence in general are social support, belief in the efficacy of treatment, communication with physicians, anxiety, and depression. We propose those five factors predict adherence to TTFields treatment since, to our knowledge, no systematic data exists for this treatment.

METHODS

We conducted a longitudinal study and included 25 patients with newly diagnosed GBM who received treatment with TTFields. Participants were invited to take part in six structured interviews, each four weeks apart, during their treatment with TTFields, assessing the five factors expected to influence treatment adherence over time.

RESULTS

We found a significant impact of communication, anxiety, and depression on treatment adherence with TTFields. Furthermore, also the time point during treatment (days of treatment) was significantly related to adherence. Better physician communication and a higher level of anxiety were associated with higher adherence and higher depression with less adherence. A higher belief in efficacy showed a trend toward significantly improving treatment adherence. When results were separately compared for early, middle, and later 90-day treatment phases, factors seemed to be differentially influential, with belief in efficacy being significantly relevant in the first, efficacy, communication, and anxiety in the second, and depression in the third phase of treatment with TTFields.

CONCLUSIONS

Our findings not only confirm the predictive role of psychosocial factors in treatment adherence but also provide specific targets for psychological interventions. This suggests that by addressing these factors, healthcare providers can potentially increase treatment adherence among GBM patients. Moreover, our results indicate that these interventions may be most effective when tailored to the specific phase of treatment, offering a practical approach for healthcare providers.
CTNI-69. A FIRST-IN-HUMAN FEASIBILITY STUDY TO EVALUATE THE SAFETY OF SELECTIVE YTTRIUM-90 ENDOVASCULAR RADIOTHERAPY IN PATIENTS WITH RECURRENT GBM: INTERIM RESULTS FROM THE FRONTIER TRIAL
Authors: Mouli Samdeep , Ansari Sameer , Middlebrooks Erik , Boockvar John , Weinstein Jonathan , Serulle Yafell , Butowski Nicholas , Narsinh Kazim , Kennedy Paul , Eldridge Amanda , Basarabescu Franco , Elahi-Gedwillo Kianna , Salem Riad , Stupp Roger
Published: November 2024

BACKGROUND

Yttrium-90 (Y90) microsphere treatment is an FDA-approved endovascular radiotherapy for Hepatocellular Carcinoma; however, extra-hepatic experience is limited. The FRONTIER trial (NCT05303467) is a first-in-human study conducted under an IDE from the FDA evaluating the safety and feasibility of intra-arterial Y90 endovascular radiotherapy in patients with recurrent glioblastoma (rGBM).

METHODS

The primary endpoint is the incidence of treatment-related limiting toxicities through 30 days, in 12 patients with rGBM. Eight subjects (50% male) with non-dominant hemisphere rGBM have been enrolled to date, with 6 patients reported herein. The treatment region, encompassing the recurrent lesion, excluding eloquent regions, and defined using cerebral angiography-MRI fusion, was selectively targeted with 40±4Gy. Immediate post-treatment imaging included MRI to evaluate acute treatment-related effects and Y90-PET to evaluate the absorbed dose distribution. Neurological assessments were performed pre- and post-treatment. Analysis of post-contrast T1w enhancing tissue volume (T1wvol) inside and outside the treated region was performed longitudinally.

RESULTS

All patients tolerated the procedure well and were discharged the following day. No decrease in neurological function and no limiting toxicities were reported through 30 days. Post-treatment MRI revealed no device-related acute ischemia or hemorrhage. Mean absorbed dose to the treatment region was 42.1±2.4Gy, within 3% of the targeted value, suggesting technical feasibility. Mean tumor absorbed dose within the treatment region was 65.1±22.6Gy most likely due to increased tumor perfusion in the treatment region. A reduction in T1wvol at 2m was observed in 4/6 patients, with the remaining 2 patients showing increased T1wvol. Disease progression by T1wvol occurred more rapidly outside the treatment region than within. All patients received subsequent therapy, with 2 patients receiving surgery 82 and 120 days post Y90 treatment.

CONCLUSION

Interim results in this first-in-human feasibility study demonstrated technical feasibility and no limiting toxicities through 30 days. Enrollment is ongoing. These data warrant additional investigation.
DNAR-11. INHIBITION OF RAD52 ACTIVITY INDUCES DNA DAMAGE BY ACCUMULATING R-LOOPS IN DIFFUSE MIDLINE GLIOMA
Authors: Uchida Eita , Ishi Yukitomo , Watanabe Jun , Kaur Savneet , Mineji Kentaro , Abdala-Valencia Hiam , Singer Benjamin , Gadd Samantha , Hashizume Rintaro
Published: November 2024

Diffuse midline glioma (DMG) is one of the most devastating childhood cancers with a median survival of < 1year from diagnosis. There is a critical need for new therapeutics for improving treatment outcomes for DMG patients. We performed genome-wide CRISPR/Cas9 screening and identified RAD52 as a potential therapeutic target in DMG cells. RAD52 inhibition, using shRNA-mediated RAD52 depletion and treatment with RAD52 inhibitor, D-I03, suppressed DMG cell proliferation. Western blotting revealed that RAD52 inhibition increased DNA double-starand breaks (DSBs) marker γH2AX while it decreased repair markers BRCA1 and RAD51. Also, RAD52 inhibition causes a sustained level of phosphorylated RAD50 and γH2AX in irradiated DMG cells over 24 hours. Immunocytochemistry (ICC) of γH2AX and repair marker 53BP1 showed that RAD52 inhibition sustained DNA damage with high levels of γH2AX at 24 hours following radiation while the level of 53BPI was decreased, thereby inhibiting DNA DSB repair. DNA repair assay showed that RAD52 inhibition suppressed DNA DSB repair through a homologous recombination pathway. RNA sequencing showed that RAD52 inhibition downregulated genes associated with the DNA repair pathway. Importantly, RAD52 inhibition increased the radiosensitivity of DMG cells. To understand the mechanism of RAD52 inhibition on DNA damage, we performed dot plot assay and ICC of S9.6 which recognizes DNA-RNA hybrids (also known as R-loops) and found accumulation of R-loop formation in DMG cells treated with RAD52 inhibitor. In addition, RAD52 inhibition decreased the expression of RNA polymerase II. Finally, the combination therapy of RAD52 inhibitor and radiation inhibited tumor growth and increased survival of mice bearing DMG patient-derived xenografts, outperforming either monotherapy. Together, our results highlight that RAD52 inhibition induces DNA damage by accumulating R-loops, results in reducing DMG cell proliferation, while also increase DMG radiosensitivty, and providing a rationale for developing combination therapy with radiation for the treatment of DMG.
DNAR-14. MODULATING POPULATIONAL VARIANCE OF METHYL-GUANINE METHYL TRANSFERASE (MGMT) EXPRESSION THROUGH MICRORNA DEGRADATION: A NOVEL MECHANISM OF TEMOZOLOMIDE RESISTANCE
Authors: Singh Gatikrushna , Ramakrishnan Valya , Singh Shilpi , Xu Beibei , Akers Johnny , Jiang Tao , Wei Hua , Ying Mao , Chen Clark
Published: November 2024

O6 methyl-guanine methyltransferase (MGMT) restores alkylated DNA to its undamaged form in a stochiometric manner to prevent the cytotoxic effects of temozolomide (TMZ), a DNA alkylating agent used as a standard-of-care treatment for glioblastomas. We previously demonstrated that he microRNA, miR-181d, post-transcriptionally repressed MGMT expression. Here, we show that treatment of glioblastoma cells with TMZ induced a feed-forward cascade resulting in an ataxia telangiectasia and Rad3 (ATR) and polyribonucleotide nucleotidyl transferase 1 (PNPT1)-dependent degradation of miR-181d. Single-cell analyses revealed such miR-181d degradation induced an: 1) increased mean level of MGMT expression and 2) widened the variance in MGMT expression in the cell population. While the former is known to confer increased population fitness to temozolomide, the importance of the latter is unknown. By mixing cultures derived from isogenic glioblastoma subclones with distinct MGMT expression levels, we generated glioblastoma cell populations with comparable mean MGMT expression levels while differing in the populational variance in MGMT expression (classified as “wide” or “narrow”). Despite comparable mean levels of MGMT expression, the glioblastoma population with wide variance exhibited increased temozolomide resistance relative to the population with the narrow variance, in vitro and in vivo. Transfection of miR-181d into the wide-variance population narrows the variance of MGMT expression and restores TMZ sensitivity to levels comparable to that observed in miR-181d transfected narrow-variance populations. These findings suggest that TMZ-induced miR-181d degradation enhanced TMZ resistance through modulation of both the mean and variance of MGMT expression, mechanisms which may be extrapolated to microRNA biology in general.
DDEL-09. AS1411 APTAMER-CONJUGATED NANOSPHERES FOR TARGETING GLIOBLASTOMA THERAPY
Authors: Kim Chae-Yong , Song Yoon-Kyu , Seo Kyeongjin , Hwang Kihwan , Nam Kyung Mi
Published: November 2024

Postoperative chemotherapy remains essential for treating glioblastoma (GBM), with nanocarrier-based drug delivery emerging as the most efficient method. However, non-specific delivery across the blood-brain barrier (BBB) can limit drug accumulation in tumors and cause damage to nearby tissues. As cancer progresses, angiogenic processes lead to the formation of an irregular blood-tumor barrier (BTB), necessitating nanodrug platforms for precise targeting and efficient drug delivery to cancer cells. In this study, we aimed to demonstrate targeted cancer therapy by selectively identifying tumor cells overexpressing nucleolin (NCL) protein using Dox-loaded AS1411 aptamer-conjugated nanospheres. Drug nanocarriers were synthesized from small molecules with sizes ranging from 100 to 300 nm to facilitate drug delivery. Selective drug delivery and cellular uptake were demonstrated for NCL-positive GBM cells (U87 and U251) compared to NCL-negative normal human astrocyte (NHA) cells. Flow cytometric analysis using FAM dye-labeled AS1411 aptamer-conjugated nanospheres confirmed that drug delivery to GBM U87 and U251 cells was actively targeted by specific AS1411-NCL interactions. Confocal laser scanning microscopy and cytotoxicity analysis confirmed that inoculation of Dox-loaded AS1411 aptamer-conjugated nanospheres induced selective internalization in GBM U87 and U251 cells. Moreover, to evaluate cytotoxicity and anti-tumor effects after treatment with PBS, Apt-Nanospheres, Free Dox, and Dox-Apt-Nanospheres, the results were analyzed through cell counting kit (CCK-8) analysis, evaluation of differences in 3D tumor sphere radii, and an in vivo GBM xenograft tumor model. The AS1411 aptamer-conjugated nanosphere drug delivery system was developed for dual-target treatment of GBM. AS1411-mediated specific recognition and drug accumulation significantly enhanced binding to NCL-positive U87 and U251 cells and improved cytotoxicity efficiency compared to Free Dox. Additionally, this study demonstrated that the active targeting model using aptamer-mediated drug delivery was more effective in improving drug penetration and retention in tumor cells than non-specific enhanced permeability and retention (EPR)-mediated delivery and passive drug delivery.
DDEL-12. LOCAL DELIVERY OF CHEMOTHERAPIES VIA BIORESORBABLE IMPLANT IN MENINGIOMAS
Authors: Youngblood Mark , Hu Ziying , Nandoliya Khizar , Thirunavu Vineeth , Wang Wenxia , An Shejuan , McCord Matthew , Sears Thomas , Gomez Mateo , Tran Anh , Steffens Alicia , Walshon Jordain , McCortney Kathleen , Flowers Mariah , Magill Stephen , Rogers John , Horbinski Craig
Published: November 2024

Many meningiomas recur despite repeated surgical resections and radiation, and patients must undergo progressively morbid surgical procedures due to recurrent or progressive disease. However, unlike most gliomas, meningiomas do not diffusely infiltrate throughout the brain on a single-cell basis, but instead recur and invade locally. Thus, they may be particularly vulnerable to localized chemotherapy. To investigate this, we screened 13 patient-derived primary meningioma cell cultures and two commercially available meningioma cell lines using a library of 147 FDA-approved compounds. We identified drugs with elevated potency across all meningiomas, including bortezomib (mean IC50 = 7nM) and romidepsin (mean IC50 = 18nM), as well as drugs with selective potency against specific samples, such as docetaxel (IC50 range 6nM to >10uM). We reasoned that delivery of a multi-drug cocktail with independent anti-neoplastic mechanisms would provide the strongest therapeutic effect in meningiomas. As systemic treatment with combination agents resulted in severe toxicity in mice, we performed local injection of bortezomib / romidepsin / docetaxel (BRD) triple therapy over 24 days in flank xenografts of IOMM-LEE and CH157 meningiomas. Tumor growth was reduced by 71-88% relative to vehicle (p<0.01), and mice showed no systemic toxicity with local therapy. Notably, the addition of radiotherapy did not further enhance the effect of BRD. To optimize local delivery, we developed a polyanhydride bioresorbable wafer designed to fit in a meningioma resection cavity, analogous to carmustine wafers used in gliomas. Intracranial implantation of wafers caused no local toxicity or inflammation in mice. Docetaxel-loaded wafers prevented the growth of flank-injected IOMM-LEE cells relative to wafers without drug (0 mm3 vs. 230 mm3 at 3 weeks post-injection, N=5/group, p<0.01). Our results demonstrate that bioresorbable wafers containing a cocktail of potent chemotherapies may be an effective new strategy against locally aggressive meningiomas.
DDEL-19. DRUG-TUMOR RESIDENCE TIME DRIVES EFFICACY OF CONVECTION-ENHANCED DELIVERY IN H3 K27-ALTERED DIFFUSE MIDLINE GLIOMA
Authors: Rechberger Julian S , Anderson Jacob B , Ge Jizhi , Zhang Liang , Daniels David J
Published: November 2024

Advancements in understanding H3 K27-altered diffuse midline glioma (DMG) biology have not yet translated into effective therapies for these tumors likely due to delivery challenges across the blood-brain barrier (BBB) and variable tumor genetics. This study systematically probes convective-enhanced delivery (CED) as a means to administer small molecule drugs directly to DMG tumors, circumventing constraints imposed by the BBB. Our findings emphasize the necessity of strategic drug selection and pharmacokinetic analysis in refining CED approaches, advocating for precision medicine techniques specialized for DMG. We demonstrate that while most small molecule drugs are rapidly cleared from the brain following CED, their retention and effectiveness are substantially improved by co-administration of systemic efflux transporter (ET) inhibitors such as everolimus. The synergistic potential of combining everolimus with topotecan or ponatinib offers a novel therapeutic pathway, advocating for further investigation into this DMG management strategy.
DDDR-01. TUMOR ASSOCIATED MACROPHAGES VIS-À-VIS TMZ RESISTANCE IN PTEN-DEFICIENT GLIOMA
Authors: Ni Xiang-rong , Zhang Ji , Yu Yan-jiao , Wang Jing , Chen Fu-rong , hen Zhong-ping C
Published: November 2024

Drug resistance is one of the most important obstacles during chemotherapy. Currently temozolomide (TMZ) is still first line chemotherapy agent for gliomas, while drug resistance is one of the main reasons for chemotherapy failure. It has been reported that tumor-associated macrophages (TAMs) could be related to drug resistance, and thus we have investigated the association between TAMs and TMZ response in gliomas. Firstly, our study have found that PTEN-deficient glioma can specifically induce a large number of M2 phenotype TAMs, which can attenuate the TMZ-mediated the killing effect on glioma cells. Further search for the possible mechanism, we have found TAMs may secrete cytokine IL-6 in PTEN-deficient gliomas, which in turn mediate TMZ resistance. We also revealed that IL-6 highly secreted by TAMs can enhance the stemness of glioma cells through activation of the JAK-STAT3 signaling pathway in PTEN-deficient glioma cells. Secondly, have found valproic acid (VPA) can promote the transformation of TAMs from M2 to M1, reduce its IL-6 secretion, and in turn enhancing sensitivity of TMZ in PTEN-deficient gliomas. Our study revealed that TMZ resistance may modulated through soluble factors released by TAMs. Conventional anti-epilepsy drug- VPA may enhance TMZ sensitivity in PTEN-deficient gliomas, and worth to further clinical investigation. Keywords: PTEN-deficient gliomas; tumor-associated macrophages; valproic acid; temozolomide resistance
DDDR-02. NOVEL MDM4 INHIBITOR CEP-1347-BASED THERAPY FOR P53 WILD-TYPE MALIGNANT MENINGIOMA
Authors: Mitobe Yuta , Suzuki Shuhei , Nakagawa-Saito Yurika , Togashi Keita , Sugai Asuka , Sonoda Yukihiko , Kitanaka Chifumi , Okada Masashi
Published: November 2024

BACKGROUND

Although a significant proportion of meningiomas are clinically aggressive, there is currently no effective chemotherapy for them. An increasing number of studies have been conducted to develop targeted therapies, but none have focused on the p53 pathway as a potential target. In this study, we determined the in vitro and in vivo effects of CEP-1347, a novel small-molecule inhibitor of MDM4 with known safety in humans, on malignant meningioma cells, and also investigated the effects of CEP-1347 when combined with MDM2 inhibition.

METHODS

The effects of CEP-1347 and MDM4 knockdown on the p53 pathway in human meningioma cell lines with and without a p53 mutation were investigated using RT-PCR and Western blot analyses. The growth inhibitory effects of CEP-1347 were investigated in vitro and in a mouse xenograft model of meningioma. We also investigated the effects of CEP-1347 in combination with genetic or pharmacological inhibition of MDM2 in vitro. [Results] CEP-1347 at clinically relevant concentrations inhibited MDM4 expression, activated the p53 pathway in malignant meningioma cells with wild-type p53, and inhibited growth preferentially in cells expressing wild-type p53, which was mostly mimicked by MDM4 knockdown. CEP-1347 effectively inhibited the growth of malignant meningioma xenografts at a dose substantially lower than the maximum dose that could be safely administered to humans. The small-molecule MDM2 inhibitor RG7112 effectively cooperated with CEP-1347 to reduce MDM4 expression, activate the p53 pathway, and inhibit cell growth. [Conclusion] Our findings suggest that targeting the p53 pathway with CEP-1347 is a novel and viable approach to treating aggressive meningiomas, with even greater efficacy when combined with MDM2 inhibitors.