bluuebunny/crossref_metadata_2025_split huggingface dataset:
CTNI-27. SYSTEMIC DELIVERY OF LOW ENERGY RADIOFREQUENCY ELECTROMAGNETIC FIELDS FOR THE TREATMENT OF PATIENTS WITH PRIMARY BRAIN TUMORS
Authors: Feher Olavo , Chaul Caroline , Xavier Camila Bragança , de Sousa Micelange Carvalho , Testagrossa Leonardo , de Medeiros Maria Fernanda Barbosa , Sampaio Luana Alencar Fernandes , Gansl Rene , Tuma Rogerio , Meireles Sibele , Zanesco Tatiana , Iemma Antonio , Costa Tiago , Wiedenmann Bertram , Tuszynski Jack , Costa Frederico Perego 
Published: November 2024

Abstract

BACKGROUND
Tumor Treating Fields plus maintenance temozolomide (mTMZ) showed a survival advantage in the first-line glioblastoma (GBM) treatment. The survival benefit remains limited in patients with unmethylated MGMT gene promoter. The AutEMsys device emits low-energy amplitude modulated systemic electromagnetic fields (EMF) at patient specific frequencies. It is an outpatient procedure that can be integrated with mTMZ.

METHODS
This study involved a prospective compassionate access program targeting adult GBM patients using an intrabuccal EMF exposure via AutEMsys in addition to chemoRT+mTMZ. The program explored the effects on survival and patients’ reported quality-of-life (QOL) by EORTC-QL-C30. Patients underwent a 90-minute session of EMF exposure therapy repeated every 2 weeks until progression, deterioration in QOL or death. All patients had pathological specimens for diagnosis, IDH mutation status through NGS techniques, and MGMT promoter region methylation status.

RESULTS
31 participants were enrolled, including 29 with GBM and 2 with diffuse midline glioma. 14 patients (45%) received EMF+chemoRT followed by EMF+mTMZ and 17 patients (55%) received EMF+mTMZ (post chemoRT). Survival time was measured from the start of mTMZ to the date of the last follow-up. The median overall survival (mOS) for all 31 patients was 26.0 months (95% CI: 14.4 – 37.2 months). Specifically for 21 patients with unmethylated MGMT, the mOS was 25.0 months (95% CI: 15.9 – 34.1 months). Similarly, for the 28 patients with IDH wildtype status, the mOS remained 26.0 months (95% CI: 9.6 – 42.4 months). The addition of AutEMsys with chemoRT+mTMZ demonstrated an improved role functioning in 79% of patients with 25% of these with &gt;10-point score.

CONCLUSION
The AutEMsys device has shown promising initial results when added to chemoRT+mTMZ treatment of GBM. These findings warrant further prospective investigation and validation in a multicenter clinical trial setting.
CTNI-28. IN VITRO GLIOMA STEMLIKE CELL-BASED SCREENING TO PREDICT DRUG SENSITIVITY IN RECURRENTGLIOBLASTOMA: A CLINICAL SERIES AND SYSTEMATIC LITERATURE REVIEW
Authors: Buccarelli Mariachiara , Offi Martina , Chiesa Silvia , Mazzarella Ciro , Falchetti Maria Laura , Ceccarelli Giovanni Maria , Bartoli Francesco Beghella , Silvia Silvia , Bonaventura Rina Di , Pepa Giuseppe Maria Della , Shetty Sohum Rajesh , Monaco Giuliano Di , Doglietto Francesco , Pallini Roberto , Olivi Alessandro , Lauretti Liverana , Ricci-Vitiani Lucia , D’Alessandris Quintino Giorgio 
Published: November 2024

Abstract

INTRODUCTION
There is no standard care for recurrent glioblastoma (GBM) after surgery and radiochemotherapy. Lomustine is commonly used in clinical trials, while regorafenib, a multikinase inhibitor, has shown a survival benefit in the randomized multicentric REGOMA trial, becoming the standard treatment in several countries, including Italy. However, due to nonnegligible toxicity, early identification of likely responders is crucial for personalized treatment. Various studies have explored putative molecular predictors of response with conflicting results. Glioma stem-like cells (GSCs), the most treatment-resistant subpopulation, are believed to drive GBM recurrence post-chemoradiotherapy. Thus, GSCs might provide valuable insights into the drug sensitivity of recurrent GBM.

MATERIALS AND METHODS
Between 2020 and 2022, nine patients enrolled in a prospective study to obtain GSC cultures from tumor tissue obtained at first surgery were treated with regorafenib upon tumor recurrence. Four patients underwent reoperation before starting regorafenib. GSC cultures were exposed to increasing regorafenib doses in vitro to determine sensitivity (IC50).

RESULTS
The median progression-free survival (PFS) was 3 months, consistent with REGOMA data. Only one patient achieved 6-month PFS (11.1%). GSCs from this patient were the only ones with an IC50 below the plasma range of regorafenib during treatment (IC50 4.6 μM, range 5.2-8.1 μM). Additionally, this patient had not undergone reoperation before starting regorafenib. Systematic literature review showed few but promising studies in which therapy personalization was based on in vitro drug screening.

CONCLUSIONS
Although preliminary, these findings suggest a potential paradigm shift in personalized treatment for recurrent GBM, utilizing a GSC-based approach rather than molecular profiling. Further evaluation of GSCs from recurrent tumor tissue is necessary to determine their utility.
CTNI-29. A PHASE 1B STUDY TO EVALUATE THE SAFETY, PHARMACOKINETICS, AND OBJECTIVE RESPONSE OF LP-184 ALONE AND IN COMBINATION WITH SPIRONOLACTONE IN IDH WILD TYPE GLIOBLASTOMA AT FIRST PROGRESSION
Authors: Schreck Karisa , Laterra John , Kulkarni Aditya , Bhatia Kishor , Ewesuedo Reginald , Chamberlain Marc 
Published: November 2024

Abstract
LP-184 is a fully synthetic small molecule alkylator of the acylfulvene therapeutics class that induces DNA double-strand breaks and improves survival in orthotopic GBM xenograft models. In preclinical studies, LP-184 is brain penetrant with a brain tumor/plasma concentration ratio of 0.2. DNA damage induced by acylfulvenes is repaired via transcription-coupled nucleotide excision repair (TC-NER) mediated by ERCC complexes. GBM with intrinsic or pharmacologically induced DNA Damage Repair deficiency (dDDR) may preferentially respond to LP-184, independent of MGMT status. LP-184 is currently under investigation in a first-in-human Phase 1a dose-escalation safety study (NCT05933265) in adult patients with advanced solid tumors including GBM, with no dose-limiting toxicities to date at dose level 6. Following determination of the Maximum Tolerated Dose and/or Recommended Phase 2 Dose from Phase 1a, the selected expansion dose will be assessed in a Phase 1b study to evaluate the safety, pharmacokinetics, and objective response of LP-184 alone and in combination with spironolactone in IDH wild type glioblastoma at first progression. Spironolactone is a brain penetrant FDA approved agent that proteolytically degrades the TC-NER component ERCC3, thereby creating dDDR. Two rGBM cohorts will be enrolled according to a Simon’s 2-stage optimal design: (i) LP-184 alone (days 1 and 8 in a 21-day cycle, as intravenous infusion over 30 minutes) and (ii) combination of LP-184 and spironolactone (200 mg orally daily in conjunction and before the LP-184 infusion). In the first stage, 10 response evaluable subjects will be enrolled. If 1 or more of the first 10 response evaluable subjects achieve an objective response, 19 further subjects may be accrued in the second stage. In each cohort, at least 5 subjects will undergo planned tumor resection and will be treated with LP-184 or the combination the day prior to surgery to evaluate PK/PD.
CTNI-52. EXPEDITED CHEMORADIATION AFTER LASER INTERSTITIAL THERMAL THERAPY (LITT) IS FEASIBLE AND SAFE IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA
Authors: Yu Jennifer , Meade Seth , Zhao Ran , Wei Wei , Dashora Himanshu , Prayson Richard , Grabowski Matthew , Stevens Glen , Murphy Erin , Suh John , Chao Samuel , Barnett Gene , Peereboom David , Ahluwalia Manmeet , Mohammadi Alireza 
Published: November 2024

Abstract

BACKGROUND
High-grade gliomas (HGG) are incurable primary brain tumors. Laser Interstitial Thermal Therapy (LITT) has emerged as an alternative to surgery for select patients. Hyperthermia can improve the efficacy of radiation and chemotherapy. Shortening the time between LITT and chemoradiation may maximize their biological and clinical benefits. This clinical trial evaluated the safety and feasibility of expediting chemoradiation after biopsy and LITT in patients with newly-diagnosed HGG.

METHODS
Patients with suspected HGG were enrolled. Those with pathologic confirmation of HGG and deemed appropriate candidates for LITT and chemoradiation were considered evaluable. Participants underwent 6 weeks of adjuvant chemoradiation within seven days of LITT. Endpoints were assessed until the completion of radiation, and included the occurrence of wound dehiscence; new, treatment-refractory seizures; cerebral edema; and completion of planned radiotherapy.

RESULTS
Fifteen patients with suspected HGG were enrolled and ten were considered evaluable. All ten patients were diagnosed with glioblastoma (GBM, IDHwt). Five patients were deemed unevaluable: four patients with other CNS tumors and one GBM patient who developed grade 4 postoperative edema. Of ten evaluable patients, the median age was 60.2 years (IQR: 51.0, 69.4), and median preoperative KPS was 90 (IQR: 90, 80). The median time between LITT and the initiation of chemoradiation was seven days. There were no occurrences of significant protocol-related adverse events.

CONCLUSIONS
Accelerated initiation of chemoradiation after biopsy and LITT is safe and feasible for patients with newly diagnosed HGG. A larger study is needed to assess potential synergy of hyperthermia and chemoradiation to improve survival.
CTNI-57. REAL-WORLD EVIDENCE OF THE FREQUENCY OF POST-SURGICAL INITIAL OBSERVATION IN PATIENTS WITH IDH-MUTANT GLIOMA
Authors: Nisnboym Ziv Michal , Bhagnani Tarun , Binder Gary , Chacar Christelle , Potluri Ravi , Werwath Timothy , Dewey Jonathan , Peters Katherine 
Published: November 2024

Abstract

BACKGROUND
After initial resection of IDH-mutant gliomas, initial observation is an option for low-risk patients, to postpone potential therapy-related toxicities without impacting survival. Since NCCN guidelines for risk stratification are considered controversial, we aimed to assess the frequency of initial observation in IDH-mutant gliomas using real-world evidence in the US.

METHODS
We evaluated Optum claims from 2016-2021 of patients age ≥12 with ICD-10 codes for incident glioma. Since ICD-10 does not distinguish IDH-mutant from IDH-wild type (GBM) gliomas, we excluded patients with factors indicative of GBM (age&gt;60/ hypofractionated RT/ carmustine wafer/ tumor-treating fields) to create a baseline cohort. We then evaluated the subgroup age &lt;40 (&lt;40 cohort), who have higher IDH-mutant incidence. To distinguish initial observation from surgical recovery, we assessed time from index surgery to first intervention. When 90% of first interventions had occurred those still without intervention were considered to undergo initial observation.

RESULTS
The baseline and &lt;40 cohorts comprised 5404 and 646 patients, respectively. In the baseline cohort, 56% had intervention by day 90 (most commonly concurrent chemoradiation); peak intervention rate was 60%. Initial observation rate was 44%. In the &lt;40 cohort, 47% had an intervention by day 90; peak intervention rate was 52%. Initial observation rate was 53%.

CONCLUSIONS
In both cohorts ≥90% of patients with likely IDH-mutant gliomas not initiating treatment within 3 months post-surgery continued in active observation. Initial observation rates were 44-53%, well above the levels we had expected based on NCCN guidelines. The cohorts likely include some GBM patients, for whom observation is unaccepted, and therefore these rates may understate actual initial observation rates for IDH-mutant glioma patients. These findings suggest that clinicians and patients have chosen initial observation over existing treatments, evincing a need for additional treatment options for this younger group of patients with considerably long life expectancy.
CTNI-59. TUMOUR VOLUMES PREDICT PROGNOSIS AND RESPONSE TO TREATMENT WITH DEPATUXIZUMAB MAFADOTIN
Authors: Gan Hui , Lau Eddie , Lee Sze Ting , Pillai Sruti , Gorlia Thierry , van den Bent Martin , Scott Andrew 
Published: November 2024

Abstract

BACKGROUND
Preclinical data demonstrates that tumor volumes predicted response to the anti-EGFR ADC Depatuxizumab mafadotin (Depatux-M) because of reduced drug delivery in large tumors. We investigated the impact of tumor volumes on outcomes with Depatux-M in the EORTC randomized phase 2 Intellance 2 study on recurrent glioblastoma (NeuroOncol 22(5):684).

METHODS
260 patients were randomized to Depatux-M, Depatux-M with temozolomide, or control treatment (lomustine/temozolomide). Manual segmentation of enhancing tumor on baseline MRI scans was performed and compared with OS and PFS using SPSS Version 29.0: Kaplan-Meier survival analysis including log rank test and Cox regression analyses; categorical data were compared with Fishers’ exact test; correlation between 2D and 3D measurements with Pearson’s correlation.

RESULTS
MRI scans and data from 240/260 (92%) patients were available. Firstly, we confirmed that tumor volumes were a significant prognostic variable. Significant differences were seen in OS between the 0-20 vs 20-40 ml groups (321 vs 216 days, p&lt;0.001) and between the 20-40ml vs 40+ groups (216 vs 150 days, p&lt;0.001) with corresponding differences in PFS. Tumor volumes were also predictive of benefit from Depatux-M, with only patients with smaller tumors benefiting from Depatux-M. Patients in the 0-20 ml and 20-40 ml group group had superior OS when treated with Depatux-M compared to controls (356 vs 309 days, p=0.011 and 229 vs 178 days, p=0.028 respectively). Conversely, the 40 ml + group had no benefit (146 vs 152 days, p=0.875) as predicted. The benefit was maximal in the combination arm, with OS improvement in the 0-20 ml group (437 vs 309 days, p=0.007) and 20-40ml groups (225 vs 178 days, p=0.009). The impact of tumor volumes was confirmed in multi-variate analysis and superior to similar analysis with 2D RANO measurements.

CONCLUSIONS
Tumor volumes are an important prognostic variable in recurrent glioblastoma and modulate survival to large molecules like Depatux-M.
CTNI-61. PRELIMINARY RESULTS OF A PHASE I/II TRIAL OF SELINEXOR AND TEMOZOLOMIDE IN RECURRENT GLIOBLASTOMA
Authors: Chow Frances , Berens Michael , Palmer Joycelynne , Villalona-Calero Miguel , Ney Douglas , De La Fuente Macarena , Jaeckle Kurt , Kizilbash Sani H , Nasany Ruham Alshiekh , Hrachova Maya , Porter Alyx B , Piccioni David , Hoang Kimberly , Lipinski Lindsay , Strowd Roy , Giglio Pierre , Mantica Megan , Schiff David , Gore Steven , Portnow Jana 
Published: November 2024

Abstract

BACKGROUND
Selinexor (SEL) is a first-in-class XPO1 inhibitor with potent antitumor activity through the nuclear retention and reactivation of tumor suppressor proteins, reduced translation of oncogenes, and decreased expression of anti-apoptotic proteins. As a single agent, SEL has demonstrated brain penetration and clinically relevant responses in glioblastoma. We seek to enhance the effect and benefit of SEL by priming with temozolomide (TMZ).

METHODS
Through an NCI Project Team, we developed a multi-institutional phase I/II clinical trial which opened across the NCI Experimental Therapeutics Clinical Trial Network. Eligibility included histologically confirmed 1st recurrent MGMT promoter methylated glioblastoma. We evaluated safety, tolerability, and dose finding with an IQ 3 + 3 design of TMZ 150mg/m2 on days 1-5 of a 28-day cycle plus SEL on days 8 and 15.

RESULTS
From October 2022 to March 2024, we enrolled 12 patients (n=11 evaluable) into phase I of the study. Patient characteristics included 82% male, median age 62 (range 50-77), 64% white. The median number of cycles administered was 6 (range 1-12). Two dose levels (SEL 60mg and SEL 80mg) were evaluated. No dose-limiting toxicities (DLTs) were observed. The most common treatment related adverse events were nausea (58%), decreased platelet count (50%), fatigue (50%), constipation (42%), vomiting (25%), decreased lymphocyte count (25%), and decreased neutrophil count (25%). Grade 3+ treatment related adverse events included nausea, grade 3 (n=1); decreased lymphocyte count, grades 3-4 (n=2); and anorexia, grade 3 (n=1). Phase I has completed enrollment and the recommended phase II dose will be SEL 80mg. Additional results will be presented.

CONCLUSION
Results suggest that a sequential dosing regimen of SEL+TMZ is feasible, well-tolerated, and may minimize the cumulative toxicity of SEL. The phase II randomized portion of this trial is enrolling nationwide and will investigate efficacy and candidate molecular signatures of vulnerability (NCI #10505, NCT05432804).
CTNI-65. DETERMINANTS OF LONG-TERM SURVIVAL IN PATIENTS WITH IDH-MUTANT GLIOMAS
Authors: Katzendobler Sophie , Weller Jonathan , Niedermeyer Sebastian , Blobner Jens , Trumm Christoph , Egensperger Rupert , Harter Patrick , von Baumgarten Louisa , Stoecklein Veit , Tonn Joerg-Christian , Weller Michael , Thon Niklas 
Published: November 2024

Abstract

BACKGROUND
Survival times of patients with IDH-mutant gliomas is variable and can extend to decades. Many studies only provide progression-free rather than overall survival times and prognostic factors remain ill-defined. Here we explored clinical disease characteristics of long-term survivors within a large cohort of patients with extended follow-up.

METHODS
This single-center, retrospective analysis included 114 patients with IDH-mutant glioma that either died due to tumor-related causes or survived at least 15 years after first diagnosis. Patient characteristics, outcomes, and prognostic factors were stratified by short- (&lt; 15 years) versus long-term (≥ 15 years) survival. Initial diagnosis was (re-)classified according to the WHO 2016 classification. Uni- and multivariate analyses were performed.

RESULTS
Overall, 66 patients (58%) were diagnosed with astrocytoma and 48 patients (42%) with oligodendroglioma. Median follow-up of the survivors was 16.6 years (range 15-28.9). 62 tumor-related deaths (54%) had been reported at database closure. Patients that died before reaching 15 years survival time had been diagnosed with astrocytoma in 41 (72%) and oligodendroglioma in 16 cases (28%). The long-term survivor cohort comprised 25 patients (44%) with astrocytoma and 32 patients (56%) with oligodendroglioma. Long-term survival was associated with grade 2 histology (p &lt; 0.01), smaller tumor volumes (p &lt; 0.01), and lack of contrast enhancement (p = 0.02). 41 long-term survivors (72%) were initially monitored by a wait-and-scan strategy as opposed to 16 patients (28%) in the cohort of short-term survival (p&lt;0.01). In patients with oligodendroglioma, a higher KPS was associated with longer survival (HR 0.25; 95% CI 0.02-0.67; p = 0.05). Tumor resection (HR 0.43; 95% CI 0.22-0.86; p = 0.02) and wait-and-scan strategies (HR 0.34; 95% CI 0.14-0.79; p = 0.01) were associated with longer survival in patients with astrocytoma.

CONCLUSION
Tumor resection followed by a wait-and-scan strategy may yield excellent survival times, especially in patients with IDH-mutant grade 2 astrocytoma. Age appears not be an important predictor for survival in patients with IDH-mutant gliomas.
CTNI-78. PNOC008: A PILOT TRIAL TESTING THE CLINICAL BENEFIT OF USING MOLECULAR PROFILING TO DETERMINE AN INDIVIDUALIZED TREATMENT PLAN IN CHILDREN AND YOUNG ADULTS WITH NEWLY DIAGNOSED HIGH-GRADE GLIOMA (EXCLUDING DIFFUSE INTRINSIC PONTINE GLIOMA)
Authors: Kilburn Lindsay , Franson Andrea , Cooney Tab , Kline Cassie , Stoller Schuyler , Reddy Alyssa , Banerjee Anu , Packer Roger , Bendel Anne , Skrypek Maggie , Minturn Jane , Abdelbaki Mohamed , Whipple Nicholas , Chan Priya , Crawford John , Crotty Erin , Waanders Angela , Elster Jennifer , Raabe Eric , George Elizabeth , Pinto Soniya , Supakul Nucharin , Kraya Adam , Prados Michael , Nazarian Javad , Solomon David , Long-Boyle Janel , Molinaro Annette , Waszak Sebastian , Mueller Sabine 
Published: November 2024

Abstract

BACKGROUND
Despite multiple clinical trials in young patients with newly diagnosed high grade gliomas (HGG), survival remains poor. PNOC008 is a single-arm, multi-center pilot trial, investigating the feasibility, toxicity, and efficacy of a molecularly guided individualized treatment approach following radiotherapy.

METHODS
Patients aged ≤21 years with newly diagnosed, localized, hemispheric HGG (Stratum A) or non DIPG, diffuse midline glioma (DMG) (Stratum B) were eligible. Comprehensive molecular profiling (targeted gene panel, whole exome, and whole transcriptome sequencing) was performed on primary tumor tissue. The molecular data was reviewed by a dedicated tumor board that recommended an individualized treatment plan combining up to four FDA approved drugs. Patients were followed for toxicity and efficacy. Circulating tumor DNA (ctDNA), imaging, and quality of life (QOL) measures were collected at multiple timepoints.

RESULTS
Fifty-five HGG patients enrolled between 2018 and 2023 (median age 11 years [range 2-20], n=31 female, n=29 Stratum A), including H3K27-altered (n=17), H3/IDH-wildtype diffuse pediatric-type (n=16), and H3G34-mutant diffuse hemispheric glioma (n=12). In 44 patients that followed the recommended treatment, median overall survival (OS) from time of study enrollment was 26.5 months in Stratum A (lower 95% CI: 18.5) and 23.6 months in Stratum B (lower 95% CI: 16.8), and 30 months in H3G34-mutant patients (n=10, lower 95% CI:24.6) with median follow-up of 34.5 months for all patients (lower 95% CI: 32.2). The treatment recommendations most commonly included alkylator with targeted therapy combinations. The often novel drug combinations were generally well tolerated with grade 3 or 4 treatment-related adverse events being mostly hematologic. Central imaging, ctDNA, and QOL analyses are underway.

CONCLUSIONS
A personalized treatment approach using comprehensive transcriptomic and genomic analysis is feasible and well tolerated with encouraging survival data in children and young adults with HGG. Further analyses of molecular subgroups and correlatives are ongoing.
CTNI-80. 177LU-DOTATATE IN PATIENTS WITH RECURRENT MENINGIOMA
Authors: Nasrollahi Elham , Drappatz Jan 
Published: November 2024

Abstract

BACKGROUND
There are no effective medical therapies for patients with meningioma who progress after surgical and radiotherapeutic interventions. Somatostatin receptor type 2 (SSTR2) represents a promising treatment target in meningiomas. Here, we describe our experience with use of 177Lu-DOTATE in recurrent meningioma

PATIENTS AND METHODS
This is a retrospective study. All patients had progressive intracranial meningiomas and were heavily pre-treated. Patients underwent 68Ga-DOTATATE PET-MRI at baseline and received 177Lu-DOTATATE every eight weeks for up to four doses. We collected patient demographics, tumor grade, treatment history prior to starting 177Lu-DOTATATE, duration of treatment, toxicities, overall survival (OS) and progression-free survival (PFS). Descriptive statistics were used to summarize patient’s characteristics.

RESULTS
Seven patients (female = 2, male = 5) with progressive meningiomas (WHO 1 = 1, 2 = 1, 3 = 5) were enrolled. Median age was 56 (range 41-72) years. All patients previously underwent tumor resection and at least one course of radiation. Treatment with 177Lu-DOTATATE was well tolerated. Three patients achieved PFS-6. One patient with malignant meningioma remains progression free at 13 months. Three patients remain on active treatment. Best radiographic response was stable disease (SD) in six patients.

CONCLUSIONS
Treatment with 177Lu-DOTATATE was well tolerated and demonstrated encouraging efficacy. Updated survival data will be presented.