bluuebunny/crossref_metadata_2025_split huggingface dataset:
CMET-02. ESTABLISHING THE SAFETY AND EFFICACY OF A NEW MULTI-AGENT INTRATHECAL TREATMENT PROTOCOL FOR PATIENTS WITH NEOPLASTIC MENINGITIS
Authors: Zammar Samer , Eby Richard , Zacharia Brad , Strowd Roy , Grossman Stuart , Aregawi Dawit , Michael Glantz 
Published: November 2019

Abstract

BACKGROUND
The prognosis for neoplastic meningitis (NM) remains dismal and single-agent (rather than multi-agent) chemotherapy remains the standard of care. Objective: To analyze survival of patients with NM receiving multi-agent vs. single-agent intrathecal chemotherapy and evaluate the safety of antitumor intrathecal biological agents.

METHODS
We compared a standardized multi-agent intrathecal treatment cohort to the corresponding patient level data acquired from 6 of the 7 randomized controlled trials (RCTs) conducted in patients with NM, all of which used single-agent intraventricular therapies. The toxicity of intrathecal biological agents was studied by analyzing the outcome data form patients with NM treated with at least 1 intrathecal biological drug.

RESULTS
283 patients receiving multi-agent therapy were compared to 290 patients from the RCTs. Patients and tumor characteristics did not differ between groups. All patients from the multi-agent patient group were included in an intent-to-treat model. For all solid tumors, median survival (multi-agent vs. single-agent treatment) was 211 vs. 97 days, hazard ratio (HR) 3.39, p< 0.001. For lymphoma, survival was 304 vs. 81 days, HR 2.10, p< 0.001. Stratified by tumor histology, median survival for breast cancer NM was 315 days [95% CI 248–449], for lung cancer 193 days [127- 200]; for melanoma 307 days [65–1492], and for primary brain tumors 253 days [187- 348]. No additional toxicity was seen in the multi-agent compared to the single-agent treatment groups. In 110 patients, grade III toxicity occurred in 5.3%, 3.1%, 0% and 0% of patients receiving rituximab, trastuzumab, panitumumab, and alpha interferon. No difference in survival was seen when comparing patients with and without treatment related toxicity in any histological groups.

CONCLUSION
Multi-agent intraventricular chemotherapy was associated with dramatically increased survival in patients with solid tumor and lymphomatous NM. Incorporating biologic agents as part of a multi-agent intrathecal treatment regimen is very safe.
CMET-12. EFFICACY OF UPFRONT IMMUNE CHECKPOINT INHIBITORS IN LUNG CANCER BRAIN METASTASIS
Authors: Barnett Addison , Lauko Adam , Li Hong , Ali Assad , Sagar Soumya , Chao Samuel , Pennell Nathan , Peereboom David , Stevens Glen , Angelov Lilyana , Yu Jennifer , Murphy Erin , Mohammadi Alireza , Suh John , Barnett Gene , Ahluwalia Manmeet 
Published: November 2019

Abstract

INTRO/OBJECTIVE
Immune checkpoint inhibitors (ICI) have improved outcomes in a subset of patients with lung cancer. However, data describing the efficacy of ICI in lung cancer brain metastasis (LCBM) is limited. We analyzed overall survival (OS) in patients with LCBM treated with upfront ICI, defined as having received ICI within 90-days of LCBM diagnosis, compared to non-ICI therapies.

METHODS
We reviewed 665 patients with LCBM diagnosed between 2000 and 2018 at a major tertiary care institution. Of those patients, 240 received ICI, 164 of which received ICI after 90-days and 76 received ICI within 90-days. Propensity score (PS) was calculated by logistic regression model including age, KPS, number of baseline brain lesions, and presence of extra-cranial metastasis (ECM) at time of LCBM diagnosis. OS from LCBM diagnosis between PS matched cohorts were compared using Kaplan-Meier, the Log-Rank test, and Cox proportional hazards models.

RESULTS
Prior to PS matching, median survival between ICI and non-ICI cohorts was not significantly different (10.9 months for both, p=0.81), although more ICI patients had ECM (57.1% vs 40.9%, p=0.006). Following PS matching, the ICI (n=76) and non-ICI (n=76) cohorts had median age (62.4 vs 62.3 years), KPS (80 for both), lesion number (2 for both), and ECM (56.6% for both). Of matched patients, 94% received SRS, 52% received WBRT, and 29% underwent surgical resection. Compared to non-ICI, the ICI cohort had a 2-year OS hazard ratio=0.87 (95% CI=0.58–1.31, p=0.51). Median and 1-year survival were not significantly different between ICI and non-ICI cohorts (median: 10.9 vs 9.1 months; 1-yr: 43.0% vs 42.4%).

CONCLUSION
Patients with LCBM who received ICI within 90-days of their diagnosis did not have improvement in OS compared to patients who received non-ICI therapies. Evaluation of clinical factors that may affect the efficacy and durability of immunotherapy is ongoing and will be presented.
CMET-16. A PHASE II TRIAL OF BEVACIZUMAB IN PATIENTS WITH RECURRENT SOLID TUMOR BRAIN METASTASES WHO HAVE PROGRESSED FOLLOWING WHOLE BRAIN RADIATION THERAPY (WBRT): FINAL RESULTS
Authors: Kumthekar Priya , Dixit Karan , Grimm Sean , Lukas Rimas , Schwartz Margaret , Helenowski Irene , Sharp Laura , Nelson Valerie , Raizer Jeffrey 
Published: November 2019

Abstract

BACKGROUND
Brain metastases (BM) are the most common intracranial tumor with limited treatment options following the progression after WBRT.

METHODS
This open label phase 2 study for patients have progressed following WBRT enrolled participants who received bevacizumab 10 mg/kg intravenously every two weeks until CNS disease progression (one cycle=4 weeks). The primary endpoint was objective radiographic tumor response as defined by modified Response Assessment in Neuro-oncology (RANO) criteria. Secondary endpoints included safety, progression free survival (PFS), time to response, duration of response, overall survival (OS), and quality of life (QOL) as measured by FACT-G and FACT-Br.

RESULTS
A total of 27 patients were registered of which 24 were evaluable for ORR (3 came off study prior to first follow up MRI brain). Median age was 53 (range 27–73), median number of cycles was 5.5 (range 1–20) with a median follow up of 8.7 months (range 2.4–47.9mo). Of the 24 evaluable patients, 6 showed radiographic response (Partial response=6, stable disease=16, progressive disease=2, 81% (22/24) experienced clinical benefit). The 6 month PFS: 46% (95% CI: 25% - 67%) and median PFS was 5.3 months. Median OS was 9.5 months (95% confidence interval 6.3m – 15.0m). For the patients who completed sequential QOL assessments, there no decline in QOL seen secondary to treatment and there was a non statistically significant improvement seen in the FACT-Br questionnaire. Overall, treatment was well tolerated with 3 grade 3 adverse events seen: hypertension (n=3), headache (n=1) and thrombotic event (n=1).

CONCLUSION
For this pretreated BM population with historically poor clinical outcome and survival, we showed disease response with bevacizumab therapy, drug tolerability and improved survival as compared to historical controls. While larger studies are needed to confirm, bevacizumab therapy could be a viable option for solid tumor BM patients who experience progression following WBRT.
CMET-27. EVALUATION OF DYNAMIN 2 (DNM2) AS A THERAPEUTIC TARGET IN LEPTOMENINGEAL METASTATIC DISEASE
Authors: Chernikova Sophia , Polyak Dina , Deng Jiaojiao , Tsau Sheila , Casey Kerriann , Johnson Eli , Bhambhvani Hriday , Khoeur Lina , Stanley Geoff , Tran Kevin , Connolly Ian , Joyce Annie , Li Yingmei , von Eyben Rie , Nagpal Seema , Hayden Gephart Melanie 
Published: November 2019

Abstract
Leptomeningeal metastasis (LM), a spread of cancer to the meninges and cerebrospinal fluid, carries extremely poor prognosis due to fast progression and no effective treatment. Given that LM mostly develops in specific types of cancer, notably melanoma, breast and lung cancer, it is likely that predisposition for LMD is shaped by specific genetic footprints and/or anti-cancer therapies. In this regard, it is interesting that among all breast cancers the triple-negative (i.e. estrogen and progesterone receptor-negative and HER2 overexpression-negative) breast cancer (TNBC) type develops a disproportionally high percentage of LM, accounting for the majority (~40%) of all breast cancer LM cases. TNBCs trace their origin to the genomic instability stemming from defects in DNA repair (notably homology-directed repair, HDR). We have recently shown that the efficiency of HDR depends on dynamin 2 (DNM2) best known for its role in endocytic protein trafficking. Higher DNM2 was associated with more efficient HDR and the resistance to DNA-crosslinking chemotherapy. Importantly, elevated DNM2 was associated with lower relapse-free survival and shorter times to relapse after chemotherapy only in TNBCs and not in other types of breast cancer. As DNM2 also fuels migration and invasion, the cells with high DNM2 are not only the most resistant to chemotherapy but also are the most mobile, and thus may represent the core population of LM. Here we test the inhibition of the DNM2-dependent endocytic trafficking as a potential therapeutic strategy to halt LM in TNBC. As a model of LM we use the human-in-mouse model of brain metastasis based on internal carotid injection of MDA-MB-231-BR3 cells, which we have shown to faithfully recapitulate human LM. We show that DNM2 knockdown delays metastatic spread to the brain and potentiates the effect of DNA-crosslinking chemotherapeutic cyclophosphamide, providing justification for further testing of DNM2 inhibitors for targeted therapy of LM.
CMET-29. DETECTING TUMOR MUTATIONS IN CEREBROSPINAL FLUID: LIQUID BIOPSY FOR THE DIAGNOSIS OF CENTRAL NERVOUS SYSTEM METASTASES
Authors: Shah Mauli , Zorofchian Soheil , Lan Chieh , Duose Dzifa , Hu Peter , Zhu Jay-Jiguang , Luthra Rajyalakshmi , Esquenazi Yoshua , Ballester Leomar Y 
Published: November 2019

Abstract
There is a critical need for better methodologies to diagnose and monitor patients with central nervous system (CNS) tumors. Recent advancements in the use of circulating tumor DNA (ctDNA) show that it is a promising tool for the evaluation of patients with primary or metastatic CNS tumors. Cerebrospinal fluid (CSF) is a more suitable sample type to evaluate metastatic CNS cancers than plasma. The current techniques for diagnosing metastatic CNS tumors include imaging (e.g., MRI), examination of tumor cells in CSF (CSF-cytology) and biopsies. However, MRI and CSF-cytology have poor specificity and sensitivity, respectively, and brain biopsies are invasive. The objective of this study is to optimize and validate a next generation sequencing (NGS) assay to detect ctDNA in the CSF of patients with metastatic CNS tumors. We have compared several methods to isolate ctDNA from CSF and identified the optimal method based on the quantity and quality of ctDNA obtained. CSF-ctDNA was extracted using QIAamp Circulating Nucleic Acid kit from CSF patient samples (CNS tumor= 10, Breast cancer=17, Lung cancer=8, Ovarian cancer=1, Melanoma=1, B-cell lymphoma=2, and Uterine cancer=1). We analyzed CSF-ctDNA mutations with the OncomineTM Pan-Cancer cell-free assay and found mutations in 19/40 (47.5%) CSF samples. The targeted panel detected 22 single nucleotide variations involving 11 genes and TP53 was the most commonly mutated gene. Copy number variations were detected in FGFR3, MYC, CCND1, CCND3, FGFR1, and CDK4 genes. We compared the sensitivity of the NGS assay to detect ctDNA with CSF-cytology and found that 7/22 (31.8%) CSF-cytology negative patients were positive for CSF-ctDNA. In conclusion, CSF-ctDNA targeted sequencing is more sensitive than CSF-cytology in the evaluation of patients with CNS metastasis. This approach will improve the diagnosis and management of primary and metastatic CNS tumors.
CMET-35. COMPETING RISKS ANALYSIS OF FACTORS INFLUENCING DEVELOPMENT OF LEPTOMENINGEAL METASTASIS IN BREAST CANCER PATIENTS RECEIVING STEREOTACTIC RADIOSURGERY FOR LIMITED BRAIN METASTASES
Authors: Zhang Michael , Lazar Ann , Chan Jason , Xu Chelsea , Anderson August , Villanueva-Meyer Javier , McDermott Mike , Melisko Michelle , Sneed Patricia , Morin Olivier , Braunstein Steve 
Published: November 2019

Abstract
Leptomeningeal metastasis (LM) is a late stage manifestation of advanced breast cancer frequently managed with whole brain radiotherapy (WBRT) and/or intrathecal chemotherapy. A subset of breast cancer patients who undergo stereotactic radiosurgery (SRS) for limited brain metastases (BM) ultimately develop LM. We hypothesized that this subset of high-risk patients may be identified by patient, disease, and/or treatment parameters. Clinical records from 133 breast cancer patients from a single institution who underwent SRS for BM between February 2010 and March 2018 were retrospectively analyzed. Variables including histopathology, BM features, systemic disease burden, and prior treatments were analyzed. Cumulative incidence rates were estimated with death as a competing risk. Dichotomous variable cutoffs were based on the 75th percentile value. In our cohort, 27 (20.3%) patients ultimately developed LM. With a median follow up of 21.2 months after diagnosis of BM, the actuarial rate of LM at 24 months was 15.2% (95% CI, 8.7%-21.7%). Median OS after diagnosis of LM was 7.0 (95% CI, 3.1–15.4) months. There was significantly increased risk of LM with ≥9 vs < 9 BM at BM diagnosis (28.1% vs 10.8% [24-month actuarial risk], subdistribution HR 2.4, p=0.027), and ≥11 vs < 11 cumulative number of BM treated (25.7% vs 11.7% [24-month actuarial risk], subdistribution HR 2.7, p=0.01). Variables not significantly associated with the risk of LM included tumor receptor status (ER, PR, HER2, triple negative), graded prognostic assessment, KPS, extracranial metastases, total BM volume, prior WBRT, or prior surgical resection. Time intervals between SRS treatments immediately preceding LM diagnosis was not significantly different from other time intervals. In conclusion, patients with a larger number of brain metastases at BM diagnosis (≥9) or cumulatively treated (≥11) appear to be at higher risk of developing LM and may benefit from stronger consideration of WBRT, intrathecal chemotherapy, and/or brain-penetrating systemic therapy.
CMET-37. CLINICAL UTILITY OF ENCYCLOPEDIC TUMOR ANALYSIS TO TREAT PATIENTS WITH BRAIN METASTASIS IN REFRACTORY CANCERS
Authors: Crook Timothy , Patil Darshana , Akolkar Dadasaheb , Ranade Anantbhushan , Bhatt Amit , Datta Vineet , Bhatia Jatinder , Schuster Stefan , Patil Revati , Srinivasan Ajay , Kathuria Harjeet , Datar Rajan 
Published: November 2019

Abstract
Brain metastasis in solid organ cancers is associated with adverse prognosis, which is further aggravated by limited systemic treatment options. Such patients are also often excluded from clinical trials since their poor prognosis is perceived to unfavorably impact trial outcomes and misrepresent efficacy data. We retrospectively evaluated the efficacy of treatment guided by Encyclopedic Tumor Analysis (ETA) in patients with advanced refractory malignancies and brain metastases to determine the impact on outcomes. Freshly biopsied tumor tissue (primary / lymph node / liver) and peripheral blood of patients were used for integrational multi-analyte investigations as part of ETA, which included gene mutations, gene expression, and in vitro chemosensitivity profiling of viable tumor cells. Based on ETA, patients received individualized therapy recommendations. All patients underwent a PET-CT scan as well as MRI scan prior to treatment start to determine extent of disease. All patients underwent follow-up PET-CT scans and brain MRI scans every 6–8 weeks. Of the ten patients with brain metastases, which were evaluated after receiving ETA-guided treatment, the median follow-up duration was 97 days (range 79 – 180 days) during which all ten patients remained progression-free. Median time to progression for these patients on the last (failed) line of treatment was 91 days (range 30 - 176 days). Five patients showed partial response and five patients showed stable disease while on ETA-guided treatment. During the follow-up period, all brain metastases were either stable (n=7) or had regressed (n=3), and none of the patients reported new brain lesions. Personalized ETA guided treatments imparted clinical benefit by halting disease progression in this cohort of high-risk patients who would have otherwise been considered for palliative regimens due to perceived unfavorable prognosis.
COMP-08. COMPREHENSIVE RNA ANALYSIS OF CEREBROSPINAL FLUID FROM LEPTOMENINGEAL METASTASES
Authors: Polyak Dina , Li Yingmei , Liu Boxiang , Connolly Ian , Khoeur Lina , Wasunga Kakusa Bina , Johnson Eli , Andersen Stephanie , Pan Wenying , Nagpal Seema , Montgomery Stephen B , Hayden Gephart Melanie 
Published: November 2019

Abstract
Leptomeningeal metastases (LM), a diffuse form of brain metastases is rare and fatal progression of non-small cell lung cancer (NSCLC). In LM, metastatic cancer cells spread and resign on the brain meninges, the cerebrospinal fluid (CSF), cranial and spinal nerves. Rapid disease progression and scarce tissue availability hinder the progress of scientific study of LM and its treatment. To overcome the critical lack of tissue and to determine the genetic profile of NSCLC LM, we have developed methods to extract tumor-associated cell-free RNA from CSF, and isolated and sequenced circulating single cells from CSF. Herein, we used high throughput qPCR to target lung and brain-associated genes and identified NSCLC LM metastases-related RNA. Brain-specific gene signature (GFAP, NRGN, SNCB, ZBTB18) was detected in all CSF sample (control and metastases), whereas lung-specific genes (MUC1, SFTPB, SFTPD, SLC34A2) were detected in CSF of brain metastases patients. Normal, healthy CSF lacks cellular component, but CSF of patients with LM metastases inhabited with very low amount of circulating tumor cells. Single cells from CSF of 4 patients with NSCLC LM metastases were captured with microfluidic chip. Cells (n = 197) were clustered by significantly differential expressed genes demonstrating two distinct populations of white blood and tumor cells. These data identified specific cfRNA and single cell transcriptome profiles compared to normal cells or patients without NSCLC LM metastases, and highlighted metastases-associated carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) as highly expressed in patients with NSCLC LM metastases. CEACAM6 mRNA was detected in CSF of 86% of patients with NSCLC LM but not in the CSF of control patients. In vitro inhibition of CEACAM6 protein lead to decreased invasion in NSCLC cells which was rescued by overexpression of the protein. We have developed sensitive and robust techniques to leverage human CSF to study NSCLC LM.
DDIS-03. DEVELOPMENT OF A NOVEL CLASS OF cGAS AGONISTS TO TRIGGER STING PATHWAY-DEPENDENT INNATE IMMUNE RESPONSES AGAINST GLIOBLASTOMA
Authors: Stegh Alexander 
Published: November 2019

Abstract
The Stimulator of Interferon Genes (STING) pathway represents a major innate immune sensing mechanism for tumor-derived DNA. Modified cyclic dinucleotides (CDNs) that mimic the endogenous STING ligand cGAMP are currently being explored in patients with solid tumors that amenable to intratumoral delivery. Inadequate bioavailability and insufficient lipophilicity are limiting factors for clinical CDN development, in particular when consideration is given to systemic administration approaches. We have shown that the formulation of oligonucleotides into Spherical Nucleic Acid (SNA) nanostructures, i.e., the presentation of oligonucleotides at high density on the surface of nanoparticle cores, lead to biochemical and biological properties that are radically different from those of linear oligonucleotides. First-generation SNAs conjugated with TLR9-agonsitic DNA oligonculeotides (NCT03086278; solid cancers) and intravenously administered, brain-penetrant siRNA-based SNAs (NCT03020017, recurrent GBM) have recently entered clinical trials. Here, we report the development of a STING-agonistic immunotherapy by targeting cGAS, the sensor of cytosolic dsDNA upstream of STING, with SNAs presenting dsDNA at high surface density. The strategy of using SNAs exploits the ability of cGAS to raise STING responses by delivering dsDNA and inducing the catalytic production of endogenous CDNs. SNA nanostructures carrying a 45bp IFN-simulating dsDNA oligonucleotide, the most commonly used and widely characterized cGAS activator, potently activated the cGAS-STING pathway, as evidenced by increased IRF responses, elevated protein marker expression indicative of the activated M1 macrophage state, and enhanced expression of pro-inflammatory cytokines in macrophage cultures in vitro, and in intracranial isogenic GBM explants in vivo. Our use of SNAs addresses the challenges of nucleic acid delivery to intracranial tumor sites, exploits the binding of closely-spaced, neighboring dsDNA molecules on the SNA surface to enhance the formation of a dimeric cGAS:DNA complex, and establishes cGAS-agonistic SNAs as a novel class of immune-stimulatory modalities for triggering innate immune responses against tumor.
DDIS-17. DEVELOPMENT OF BRAIN-PENETRANT EGFR INHIBITORS FOR CNS MALIGNANCIES
Authors: Tsang Jonathan , Urner Lorenz , Tse Christopher , Baufeld Lynn , Faull Kym , Clark Peter , Cloughesy Timothy , Jung Michael , Nathanson David 
Published: November 2019

Abstract
The epidermal growth factor receptor (EGFR) is altered in nearly 60% of glioblastoma (GBM) tumors, however, EGFR tyrosine kinase inhibitors (TKIs) have failed to improve outcomes for patients with GBM. This can be attributed to the inability of clinically available EGFR TKIs (e.g., erlotinib, gefitinib, lapatinib, afatinib, cetuximab) to effectively cross the blood-brain-barrier (BBB) and reach adequate pharmacological levels for a tumor response. Herein, we performed a structure-activity relationship (SAR) to obtain EGFR TKIs with both high brain penetrance and potency against EGFR-activated GBM cells. From over 80 novel compounds synthesized, our lead EGFR TKI—JCN068—exhibited exceptional BBB penetration (350% brain to plasma) while also having optimal ADME properties (60% oral bioavailability, ~5 hr half-life, >100 µg/mL solubility, etc). Moreover, JCN068 demonstrated picomolar potency against purified EGFR kinase, 1000-fold selectivity for EGFR relative to other kinases, and nanomolar activity against EGFR-altered, GBM patient-derived cells in culture. Importantly, JCN068 demonstrated superior efficacy—with negligible toxicity—compared to clinically available small molecule EGFR TKIs (erlotinib and lapatinib) against multiple EGFR-altered patient-derived orthotopic GBM xenografts. Due to these excellent drug-like properties, JCN068 is currently progressing towards clinical development for EGFR-activated GBM patients.