bluuebunny/crossref_metadata_2025_split huggingface dataset:
RADT-24. SYNTHETIC TREATMENT OF CENTRAL NERVOUS SYSTEM EWING/PRIMITIVE NEUROECTODERMAL TUMOR (EWING/PNET): A CASE REPORT
Authors: Yang yanying , Shan Changguo , Hong Weiping , Cai Linbo 
Published: November 2021

Abstract
Ewing/PNET is a rare tumor of the central nervous system. After the standard treatment, there’re still 86.7% of patients had recurrence and no standard treatment after recurrence. Here we report a case of Ewing/PNET with a good survival after synthetic treatment to provide evidence for future clinical strategies. A 23-year-old male underwent resection of the left frontal tumor on April 28, 2017, the pathological diagnosis was Ewing/PNET. He received whole brain radiotherapy 36Gy in 18 fractions, and tumor bed boost to 56Gy in 28 fractions, with 3 courses of Nedaplatin adjuvant chemotherapy. The tumor recured 23 months after the surgery. The patient underwent the second resection, followed by 4 courses of ADM+VCR+CTX/IE chemotherapy. However, 27 months after the first surgery, the tumor evaluation progressive resection of recurrent tumors in the anterior cranial base-ethmoid sinus. During the chemotherapy, MRI showed that tumor still increased. There was a mass in the root of the forehead and nose. After the third recurrence, the patient received re-radiotherapy (50Gy in 25 fractions) 29 months later after the first RT. The tumor was significantly reduced after radiotherapy. Physical examination showed that the sense of smell continued to weaken, the visual acuity was the same as before. 8 courses of VIT (Irinotecan, vincristine, temozolomide) were followed by second RT, tumor was assessed every 2 courses. 44 months after the first surgery, he suffered a third recurrence in spina cord. And then he received rescue RT (20Gy in 10 fractions) in the recurrent tumor. The tumor was reduced after local radiotherapy. He was undergoing follow-up till May 2021, And the OS is 49 months. In conclusion, the incidence of this disease is low, especially in adults. However, the prognosis is poor. Early detection, early operation, combined with radiotherapy and chemotherapy are promising to improve the efficacy of Ewing/PNET.
RADT-34. OLFACTORY PERCEPTION DURING PROTON RADIATION AND DIFFERENCES IN FREQUENCY OF OLFACTORY PERCEPTIONS BASED ON PROTON CRANIOSPINAL IRRADIATION TECHNIQUE FOR PEDIATRIC BRAIN TUMOR PATIENTS
Authors: Ioakeim-Ioannidou Myrsini , Erfani Parsa , Urell Tobias , Daartz Juliane , Berv julia , leahy Shannon , Fullerton Barbara , Bolton Rachel , Yock Torunn , Tarbell Nancy , Yeap Beow , MacDonald Shannon 
Published: November 2021

Abstract

BACKGROUND
Unusual olfactory perception has been reported during brain radiation treatments but is infrequent and does not typically interfere with the ability to deliver treatment or cause notable distress.

METHODS
We performed a retrospective review of 127 pediatric patients treated with proton radiation therapy (PRT) for primary brain tumors in a single institution between 2016-2021. Patients received PRT to the brain as part of craniospinal irradiation (CSI) followed by a boost to the brain. Proton CSI was delivered with 3D-CRT protons (n=53) or pencil beam scanning technique (PBS) (n=74). Within the PBS group, treatment delivery to the CSI utilized a single PA field (n=24) or two posterior oblique fields (n=50). We collected data on abnormal olfactory sensations, nausea/vomiting, and the use of medical intervention for those symptoms.

RESULTS
Our cohort included 80 males and 47 females. The median age of patients was 10 years old (range, 3 – 21). Seventy-one patients received concurrent chemotherapy. Prior to PRT, 31 patients were nauseous. During the radiation course, 104 patients developed worsening nausea while 63 patients reported episodes of emesis. Four patients vomited while receiving radiation. Seventeen patients reported olfactory perceptions during CSI. We found a higher rate of olfactory perception in patients treated with PBS (n=16, 22%) than 3D-CRT (n=1, 2%) (p=0.001) and, within the PBS group, patients treated with a single PA field (n=11, 46%) than two oblique fields (n=5, 10%) (p=0.002). Seventy-eight patients required intervention including addition of anti-emetic or anti-anxiety medication. Two patients required sedation due to the malodorous smell during CSI. We did not find any significant difference in nausea/vomiting based on treatment technique.

CONCLUSIONS
PBS and PBS technique influence olfactory perceptions but not the occurrence of the rate of nausea/vomiting. Further studies should be performed to validate these findings and determine techniques to minimize unpleasant olfactory perceptions.
CTIM-23. EVIDENCE OF T CELL ACTIVATION AND INTRATUMORAL NIVOLUMAB-PRESENCE IN GLIOBLASTOMA PATIENTS TREATED WITH NIVOLUMAB AND BEVACIZUMAB
Authors: Skadborg Signe , Maarup Simone , Draghi Arianna , Borch Annie , Svane Inge Marie , Hasselbalch Benedikte , Poulsen Hans , Lassen Ulrik , Hadrup Sine 
Published: November 2021

Abstract
Glioblastoma (GBM) is an aggressive brain tumor with a dismal prognosis. Salvage neurosurgical resection is performed if possible and GBM patients are hereafter treated with Stupp’s regime as standard treatment in the primary setting. However, after relapse, treatment in the recurrent setting shows very limited effect. We are monitoring the immune system of patients participating in a phase II clinical trial, where patients with recurrent GBM receive Nivolumab and Bevacizumab, treatments blocking PD1 and VEGF, respectively. The clinical trial consists of two arms. Arm A includes patients where surgical removal of the tumor is possible, and arm B includes patients who are only able to receive medical treatment. Arm A has received Nivolumab 7 days prior to surgery. Single cells suspension was produced from the resected tumors and blood samples was collected from patients through the course of treatment, wherefrom PBMCs (peripheral blood mononuclear cells) were purified. All samples were immunophenotyped using multi-color flow cytometry, to identify and follow the distribution of various immune cell types, and determine their expression of activating and inhibitory molecules over the course of treatment, in the periphery and in the tumor. An activated subset of T cells was characterized by CD103 (tissue residence), CD39 (antigen exposure) and CD69 (cytotoxicity). Such T cell populations were significantly enriched in the tumor. Importantly, we could demonstrate the presence of Nivolumab in the tumor, using an anti-IgG4 antibody to detect Nivolumab binding to T cells. We observed IgG4 positive T cell in the tumor digest, suggesting T cells binding Nivolumab are present in the tumor. Additional data analysis will be performed prior to the conference. With this we hope to gain further knowledge of the immune system’s role in tumor clearance in the brain and the impact of immunotherapy hereupon.
CTIM-26. PHASE I/II STUDY OF THE COMBINATION OF PEMBROLIZUMAB (MK-3475) AND LASER INTERSTITIAL THERMAL THERAPY (LITT) IN RECURRENT GLIOBLASTOMA
Authors: Campian Jian , Butt Omar , Ghinaseddin Ashley , Rahman Maryam , Chheda Milan , Johanns Tanner , Ansstas George , Huang Jiayi , Liu Jingxia , Talcott Grayson , Katumba Ruth , Zhou Alice , Leidig William , Dunn Gavin , Kim Albert , Leuthardt Eric , Tran David 
Published: November 2021

Abstract

BACKGROUND
The blood brain barrier (BBB) remains a potential barrier to central nervous system (CNS) penetration of novel immunotherapies in recurrent glioblastoma (rGBM). Laser interstitial thermal therapy (LITT) was recently demonstrated to induce BBB disruption. When combined with anti-PD1 blockade, LITT may therefore potentiate host T-cell mediated cytotoxicity. This phase I/II study aims to evaluate the safety and efficacy of combining LITT and the PD-1 inhibitor pembrolizumab for rGBM.

METHODS
Phase I treated eligible bevacizumab-naïve high grade glioma patients with LITT and the anti-PD1 inhibitor pembrolizumab at 3 dose levels (100, 150, and 200 mg IV Q3W; 3 patients at each level), while phase II was restricted to rGBM patients only with the recommended phase II dose (RP2D) of pembrolizumab. Phase II was initially designed to randomize rGBM to either pembrolizumab or pembrolizumab+LITT but was later amended to receive only pembrolizumab+LITT after 16 patients were randomized (10 pembrolizumab+LITT arm, 6 pembrolizumab-alone arm). Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan Meier method, and adverse events (AE) documented.

RESULTS
Phase I enrolled 9 patients (7 rGBM and 2 anaplastic astrocytomas, 33% IDH-mut, 44% MGMTp-methylated) with no dose limiting toxicities (DLT), prompting selection of 200mg Q3W as the RP2D. Phase II interim analysis included 34 rGBM patients (9% IDH-mut, 50% MGMTp-methylated; 6 receiving pembrolizumab alone and 28 pembrolizumab+LITT) plus two Phase I rGBM patients who received RP2D. On per-protocol analysis, pembrolizumab+LITT cohort had improved PFS (median PFS 10.5 months vs 2.1 months) and OS (median OS 11.4 months vs 5.2 months) than pembrolizumab alone. A single treatment-related grade 3 AE was noted (respiratory infection). CONCLUSION: LITT may be safely combined with pembrolizumab for rGBM with promising clinical outcomes on interim analysis. Enrollment for Phase II, correlative studies, and continued AE documentation are ongoing.

Clinical Trial ID
NCT02311582.
CTNI-01. A PHASE 1-2 CLINICAL TRIAL OF EO1001 (APL-122), A NOVEL IRREVERSIBLE PAN-ERBB INHIBITOR WITH PROMISING BRAIN PENETRATION
Authors: Frentzas Sophia , Richardson Gary , Bacha Jeffrey , Kanekal Sarath , Sankar Neil , Shen Wang , Redkar Sanjeev , Lai Chinglin , Yu Peony , Nisbet Ian , Skoff Kathy , Wheeler Helen , Pedersen Harry , Zhong Wang Zhen , Brown Dennis 
Published: November 2021

Abstract
CNS metastases are a prominent driver of cancer morbidity and mortality, especially as targeted therapies have improved systemic outcomes. Mutations in the ErbB/HER kinase family are known oncodrivers in many cancers. Extensive crosstalk among ErbB/HER receptors suggests that inhibition of multiple family members may benefit treatment and limit drug resistance. There is a desperate need for new agents that are more tolerable and effective in treating CNS metastases. EO1001 (APL-122) is a first-in-class, oral, irreversible pan-ErbB inhibitor targeting ErbB1, ErbB2 and ErbB4 with promising CNS penetration in preclinical models. Preclinical data suggests a favorable pharmacokinetic and safety profile and activity against ErbB-driven cancers in patient-derived xenograft models. We report on a first-in-human Phase 1-2 clinical trial in progress. Adult participants with confirmed ErbB-positive cancer, including patients with CNS involvement, who have progressed after standard-of-care, with adequate bone marrow, renal and liver function are eligible. ESCALATION: One subject per dose cohort is enrolled in an accelerated dose-escalation design until drug-related toxicity (≥G2) is observed in the first cycle, after which dose escalation will revert to a 3 + 3 design to determine the maximum tolerated dose (MTD). Cycle 1: Patients receive a single oral dose of EO1001 on day 1; single-dose pharmacokinetics are measured. Beginning on day 8, EO1001 is administered once daily for 21 days; multi-dose pharmacokinetics are measured. Cycles 2-6: EO1001 is administered once daily in continuous 28-day cycles for up to 20 weeks. EXPANSION: EO1001 will be administered once daily to 20 patients at the MTD in continuous 28-day cycles for up to 6 cycles to determine a recommended Phase 2 dose (RP2D) for further study. Toxicity is assessed based on NCI CTCAEv5 and tumor response is assessed by RECIST 1.1. CNS exposure is evaluated in patients via CSF collection with confirmed CNS disease involvement.
CTNI-23. A FIRST-IN-HUMAN PHASE 0/1 CLINICAL TRIAL OF 5-AMINOLEVULINIC ACID SONODYNAMIC THERAPY IN RECURRENT GLIOBLASTOMA
Authors: Sanai Nader , Tien An-Chi , Tovmasyan Artak , Chang Yu-Wei , Margaryan Tigran , Hendrickson Kristin , Eschbacher Jennifer , Yoo Wonsuk , Harmon Jocelyn , Quarles Christopher , Alhilali Lea , Barani Igor , Mehta Shwetal , Mirzadeh Zaman 
Published: November 2021

Abstract
5-Aminoleveulinic acid sonodynamic therapy (5-ALA SDT) is a drug-device strategy that exploits the metabolic liabilities of cancer. Following systemic administration of 5-ALA, aberrant tumor metabolism leads to accumulation of protoporphyrin-IX (PpIX). Activation of PpIX by non-invasive, non-ablative magnetic resonance-guided focused ultrasound (MRgFUS) induces reactive oxygen species and tumor cell death. This first-in-human Phase 0/1 study investigates the feasibility, safety, and biological effects of 5-ALA SDT in recurrent glioblastoma (GBM) patients. Six hours prior to SDT, adult patients with recurrent GBM are administered Sonala-001 (10mg/kg), an IV formulation of 5-ALA. In a Dose-Escalation Arm, 9-18 patients are assigned to one of three ascending acoustic energy doses of MRgFUS (200J/400J/800J, measured at transducer surface), followed by a four-day interval to planned tumor resection. In each patient, half the tumor volume, including Gadolinium-enhancing and nonenhancing tumor, is targeted with MRgFUS and the other half serves as an internal control. Using tumor pharmacodynamic endpoints, the Minimum Biological Dose (MBD) associated with 5-ALA SDT response is identified. In a subsequent Time-Escalation Arm, 12 patients are treated at the MBD and assigned to one of two time-intervals between SDT and resection. As of May 1, accrual to the 200J dose level (n=3) is complete without significant drug- or device-related adverse events. No cellular or radiographic changes to non-targeted tissue were detected. The median Cmax for 5-ALA and PpIX were 307 µM and 319 nM, respectively. The oxidative stress biomarkers 4-hydroxynonenal, glutathione, cysteine, and thiol were significantly elevated in treated tissue vs. control. Similarly, the apoptosis biomarker cleaved caspase-3 was increased in treated tumor vs. control (median, 48.6% vs. 29.6%, p=0.05). This first-in-human experience with a new therapeutic modality for recurrent glioblastoma patients demonstrates that 5-ALA SDT is safe at 200J. Sonodynamic therapy leads to targeted oxidative stress and tumor cell death in human glioblastoma tissue.
CTNI-49. PHASE 1 STUDY OF ST101, A FIRST-IN-CLASS PEPTIDE ANTAGONIST OF CCAAT/ENHANCER-BINDING PROTEIN ß, IN PATIENTS WITH ADVANCED SOLID TUMORS, WITH A PHASE 2 EXPANSION IN RECURRENT GLIOBLASTOMA MULTIFORME
Authors: Symeonides Stefan , Evans Jeff , Arkenau Hendrik-Tobias , McKean Meredith , Lakhani Nehal , Lim Emerson , Falchook Gerald , Rotolo Jim , Capiaux Gina , Michel Rob , Kaesshaefer Stephen , Bexon Alice 
Published: November 2021

Abstract

BACKGROUND
C/EBPβ is a transcription factor that is active during embryofetal development but held in an inactive state in most mature cells (Zahnow 2009). C/EBPβ is upregulated or overactivated in multiple cancers, where it inversely correlates with disease prognosis and survival due to activation of a gene signature that promotes tumor cell proliferation and survival. ST101 is a cell-penetrating peptide antagonist of C/EBPβ. ST101 exposure leads to selective tumor cell death in multiple human cancer cell lines, including GBM, without impacting normal cell viability. In vivo, ST101 displays rapid uptake into multiple organs, the ability to cross the blood-brain barrier, and a long plasma half-life due to its resistance to degradations. It has potent anti-tumor activity in multiple GBM models, as a single agent or in combination, which supported moving into clinical development.

TRIAL DESIGN
This phase 1-2 study is enrolling patients ≥ 18 years of age with advanced, unresectable metastatic solid tumors refractory to or intolerant of other therapeutic options. We began recruitment in August 2020. The primary objective of phase 1 is to evaluate safety and tolerability of ST101. Secondary objectives include the recommendation of a dose and regimen of ST101 for further evaluation, pharmacokinetics, several pharmacodynamic measures, and preliminary efficacy. Patients receive intravenous ST101 once weekly in a standard 3 + 3 design. Enrollment is ongoing, and by 21 May 2021, 15 patients have been recruited in four dose-escalation cohorts up to 4 mg/kg; a 5th cohort (6 mg/kg) is ongoing. The recommended phase 2 dose will be used in a 15-30 patient GBM expansion cohort, with a Simon 2-stage design, which requires one response or two patients with PFS6 in the first cohort to continue the study. Up to 120 patients are planned in a total of four expansion cohorts, which should be enrolling by Q3 2021.
DDRE-13. PROSTAGLANDIN E RECEPTOR 3 (PTGER3) REGULATES RESISTANCE TO TUMOR TREATING FIELDS (TTFields) IN GLIOBLASTOMA CELLS
Authors: Chen Dongjiang , Le Son , Hutchinson Tarun , Tran David 
Published: November 2021

Abstract

INTRODUCTION
TTFields, a novel approved therapy for GBM, employ alternating intermediate-frequency electric fields to disrupt mitotic macromolecules leading to chromosome mis-segregation and apoptosis. The addition of TTFields significantly improves survival. However, most patients eventually develop resistance to TTFields through an unknown mechanism.

METHODS
Multiple human GBM cell lines were treated with TTFields continuously using Inovitro, an in vitro TTFields system, until cells with relative resistance to killing by TTFields emerged. Temporal gene expression profiles were analyzed using NETZEN, an innovative deep-learning and gene network-based ranking computational algorithm, to identify resistance pathways, followed by experimental validation.

RESULTS
PTGER3, a Gαi-protein-coupled cell surface receptor, is the top ranked master regulator in the predicted resistance program, which is upregulated in GBM cells within 24 hrs of exposure to TTFields and further reinforced as resistance sets in. Forced expression of PTGER3 in sensitive GBM cells confers relative resistance to TTFields, while PTGER3 depletion in resistant cells re-sensitizes them to TTFields. Most importantly, pharmacological inhibition of PTGER3 using either aspirin to reduce prostaglandin E production or PTGER3-specific inhibitors effectively prevent resistance from developing. Mechanistically, PTGER3 is rapidly translocated from the plasma membrane to the nucleus after TTFields exposure, where it interacts with ZNF488, a stemness transcription factor tightly linked to PTGER3 in our predicted network to initiate and maintain the resistance program. Indeed, TTFields resistance is associated with a transition to glioma stem cells (GSCs) as determined by increased neurosphere formation and orthotopic tumorigenesis in immunocompromised mice, and PTGER3 inhibition alone reverses the GSC transition leading to improved tumor control and survival.

CONCLUSIONS
PTGER3 is at the apex of a novel pathway that indispensably regulates TTFields resistance through a unique mechanism involving the physical nuclear translocation of this 7-transmembrane receptor. PTGER3 and its pathway are thus potential therapeutic targets to enhance therapeutic efficacy of TTFields.
DDRE-41. TREATMENT OF REFRACTORY PITUITARY NEOPLASMS WITH TEMOZOLOMIDE IN THREE PATIENTS
Authors: Duncan Kelsey , Arafah Baha , Rogers Lisa 
Published: November 2021

Abstract

BACKGROUND
There is relatively little information regarding the efficacy of temozolomide (TMZ) for pituitary adenomas; less than 100 cases treated with TMZ are reported, with a variable response rate of 50-75%, depending on response criteria.

METHODS
Retrospective review of patients with pituitary tumors treated with TMZ at University Hospitals Cleveland Medical Center.

RESULTS
Three patients were identified. Patient age at the time of TMZ treatment was 20, 51, and 70 years. Two were female, one male. Histology was prolactinoma in two and Cushing’s disease in one. Each patient had undergone multiple surgeries and medical treatments with insufficient response or relapse. Two had received radiosurgery; it was withheld in a 20 year old male due to concerns of optic nerve radiation injury. A 5d q 28d regimen was used in each, beginning at 150mg/M2 daily for initial dose then increased to 200mg/M2 daily. Diplopia and headache improved in one patient, whose serum prolactin significantly declined (222.8 to 81.9 ng/ml). Headache resolved in another patient and prolactin remained stable. In the patient with Cushing’s disease, headaches improved and ACTH remained elevated but stable. The tumor remained stable on MRI in each patient. There were no adverse effects from TMZ used over 5 to 29 months.

CONCLUSIONS
Our clinical experience adds to the limited published information regarding the effectiveness of TMZ for pituitary adenomas. In our case series, clinical improvement was noted in each of 3 patients with pituitary adenomas that had failed or recurred after other therapies. Serum prolactin significantly declined in one patient. This data suggests a beneficial role for TMZ in treating pituitary adenomas.
DDRE-47. ASSESSMENT OF BRAIN PENETRANCE, BIODISTRIBUTION, AND EFFICACY OF PLATINUM (IV)-CONJUGATED FLUORINATED MACROCYCLIC CELL-PENETRATING PEPTIDES IN A MURINE GLIOBLASTOMA MODEL
Authors: Jimenez Macias Jorge , Lee Yen-Chun , Finkelberg Tomer , Zdioruk Mykola , Berger Gilles , Nowicki Michal , Cho Choi-Fong , Fedeles Bogdan , Loas Andrei , Pentelute Bradley , Lawler Sean 
Published: November 2021

Abstract

INTRODUCTION
Glioblastoma (GBM), an aggressive brain tumor with a poor prognosis, presents an average of 2% of patients surviving beyond 2 years after diagnosis. Therapies to effectively manage glioblastoma are hindered due to the presence of the blood-brain barrier (BBB). Previously, a cell-penetrating peptide, M13, was conjugated to a Pt(IV) cisplatin prodrug, via amide bond formation. The conjugated Pt(IV) releases active cisplatin upon intracellular reduction. Herein, we investigated the BBB-penetrance and biodistribution of M13 conjugated to Pt(IV), as well as its effectiveness against GBM in mouse models.

METHODS
M13 platinum-conjugate tumor cell killing capacity was assessed by luminescent cell viability assays in vitro. By using Inductively-Coupled Plasma Mass-Spectrometry for platinum detection, BBB penetration and bio-distribution studies were performed in a three-dimensional BBB spheroid in vitro model and in vivo in mouse brain, intracranial tumor, and peripheral organs. Dose-regime studies involved observations of symptomatology and weight variations after bi-weekly injections of platinum compounds at 2mg/kg and 5mg/kg.

RESULTS
The Pt(IV)-M13 conjugate possesses tumor cell killing effects similar to cisplatin when tested in GBM cell lines in vitro. Platinum increased by using Pt(IV)-M13 when compared to cisplatin in our in vitro BBB-spheroid model (20-fold, p-value=0.0033), in brain tissue (10-fold, p&lt; 0.0001) and GBM tumor-bearing mice models (7.5-fold, p&lt; 0.0001). Bio-distribution of platinum delivered by Pt(IV)-M13 in spleen, heart and blood was significantly different to cisplatin 5hrs. after intravenous injection (p&lt; 0.001). Bi-weekly dose regimes of Pt(IV)-M13 are tolerable in nude mice without toxicity at a similar concentration to reported tolerable cisplatin doses at 5 mg/kg. Finally, Pt(IV)-M13 significantly increased survival in a murine glioblastoma xenograft model compared with controls (median 24 days vs. 29 days, p-value=0.0071).

CONCLUSION
Overall, our data support the further development of BBB-crossing peptide-drug conjugates for GBM treatment.